Health sector restructuring
September 14, 1999
The planned shake up of the health sector unveiled earlier this month by Dr Leslie Ramsammy, Director of the Health Sector Reform Unit (HSRU) is nothing short of revolutionary and many questions arise.
Under the reform, the Ministry of Health will no longer be responsible for the delivery of services but will focus on developing policies, lead research initiatives and monitor and evaluate the effectiveness of efforts in the sector. Four regional health authorities (RHAs) in Berbice, Demerara, Essequibo (coast) and the Hinterland are envisaged and they will be responsible for planning, management co-ordination and the delivery of services. The RHAs will be managed by a Board of Directors which will name a Chief Executive Officer and there will also be a management executive for day-to-day operations.
In this scheme of things, the Georgetown Hospital will be run by its own board apparently outside of the Demerara RHA. A board will also be established to run a National Materials Management Agency (NMMA) which will handle the procurement and distribution of supplies including drugs and equipment.
One of the other notable goals of the revamping is the "financial sustainability" of the health sector, no doubt a reference to the thorny issue of cost recovery.
Ultimately, the synthesis of the various reforms should result in the full array of primary health care services being available to users, improved quality and efficiency in delivery, lower administrative costs and special emphasis at the community level on preventive health care.
These are the goals but will the methods outlined by the HSRU work? This is what the government and Dr Ramsammy must be sure of before the enterprise moves forward.
For many years, the ministry of health has been besieged by a range of problems such as substandard or non-existent service, mismatching of supplies with the needs of specific institutions, poor staffing and unaccountability.
Decentralisation of the health system could certainly help in theory but in practical terms the situation may be quite different. The establishment of four RHAs will most likely create more bureaucratic layers and the number of managers needed for these will rise steeply. With the grave shortage of skills would the health system not be spreading itself too thinly on the ground? Administrative costs to the state will probably rise because of the separate networks that will have to be created. How will a RHA - let's say stationed at Lethem - cater to the health needs of communities furthest from its reach more efficiently than the present Health Ministry?
Will the NMMA be equipped with the necessary wherewithal to allow it to match to perfection the distinct needs of each RHA in a timely fashion and won't that agency be another repository of sticky red tape?
For the RHAs to work there will have to be close co-ordination with the regional and local governments. With the widely held view that these tiers of government underperform and the possibility of changes through constitutional reform isn't it premature to hitch the RHAs to a system that isn't working?
What exactly will cost recovery mean to these various regional arms and their users? How will equitable distribution of health personnel be assured?
The planned rejigging of the health sector is an audacious move that breaks the mould of recycled ideas and the government should be congratulated for this. However, many questions have to be satisfactorily answered before the government can feel reasonably comfortable pursuing it. There has not been nearly enough public discussion of these proposals and specific information from the government on its implications. We hope that in the coming weeks there is more of this and considered analysis of the changes that have already been made in the context of the reform.
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