When Politics met the Jamaican Health Care System

This is my final article for the month of October, thank you for reading and I will see you in December!

Once again the Jamaican government proves to us that our country does not have industries but sectors. Having sectors are fine but certain areas that impact the public directly ought to feature constant updates, diversification and sustainable capital. The sector I speak of is Health. For years there have been multiple audits, published and unpublished, criticism and outcries from all areas of society regarding the debilitating and archaic infrastructure as well matters relating to training and sanitation in our Regional Hospitals and clinics. The recent scandals of dead babies from infections at major hospitals has only added fuel to the fire. Scarier still is that after doing a little research you realise that no amount of money or haphazard hiring is going to change much because the Jamaican health sector needs a complete refresh.

Money Management

With most equipment and materials that are being used in hospitals imported and the fact that the Jamaican dollar is in free fall, there will always be less money provided by the annual National Budget than what The Ministry of Health (MOH) needs to be great. However, my concern relates to the mismanagement of funds that I am reading about. In an article published by The Gleaner the columnist, a medical officer based at the South East Regional Health Authority, stated that, “It has long been suspected that funding for [hospital] projects may be available. However, slow turnaround in implementation has resulted in the stalling of projects and funding being redirected in some cases.” This slow turn around or stalling occurs because of inefficient promotions and lacklustre communication within the system as well the issue of who dictates expenditure.

Former president of the Jamaica Medical Doctors’ Association (JMDA), Dr. Alfred Dawes, loves to blame the plodding sector on a highly politicised bureaucracy. At the Private Sector Organization of Jamaica (PSOJ) President’s Forum in November 2015, Dawes said:

I acknowledge that we cannot separate politics from healthcare in Jamaica. We all know that there are appointments to public office and promotions based on political affiliations rather than merit. This has led to a governance issue in the MOH where decision makers and those who implement policies are not necessarily the best at what they do. Nor do they put the interest of the country above that of their party.

Additionally, in the latest published Clinical Audit Report of hospitals and major health centres done in 2015 The Jamaica Observer sighted that there was lack of evidence of consistent general staff meetings,- which is needed to promote teamwork- also that many employees were found to be unfamiliar with The Client Complaint mechanism which ensures that there is a fair process for handling complaints that may arise from the work and that orientation for new and transfer employers was not formalized. There is obviously a problem with communication here.

Greater Decentralisation

The way the system works now is that from the local clinical level upward, chief technical staff and chief medical officers report to a hospital’s CEO. Each hospital does not have a board to deal with issues internally so the CEO reports to the board on one of the four semi-autonomous Regional Health Authorities (RHA) on the island. Each RHA then reports directly to the Ministry of Health. With information passing through so many hands do you see how important problems at local hospitals could become shortchanged when they get to the head? In my mind I imagine it to be a bad game of Chinese Telephone.

To make matter worse the chief medical officer at each hospital, instead of reporting directly to the Minister of Health unloads issues of public health to the chief accounting officer or permanent secretary. These are the people who handle money, they do not handle people or as The Gleaner columnist puts it, “…technical or clinical decisions are ultimately decided on by administrators who may or may not have technical knowledge or competence in health.”

As stated before, this has been going on for years. So, I begin to wonder why there aren’t widespread strikes and callouts when I came accross the Official Secrets Act.  The Official Secrets Act of 1911 prohibits public servants from revealing certain information which would affect areas such as national security (in other words any information you learn is a secret) and even though  in 2011 then Prime Minister  Bruce Golding aimed to disband the act saying that, “This [act] has no place if next year we’re going to be celebrating 50 years of independence…” Surprise, surprise, it still stands today. And don’t say, oh but there is The Whistleblower Act (a bill is aimed at protecting workers who blow the cover on wrongdoing in organisations) because victimisation of informers in this country is rife, so let us not even discuss that.

Everyone knows that the happiest most productive countries often have a moderate to excellent health system- it is common sense- so I ask, why can’t we shed this barbaric alignment between state and health? Why is effective communication so hard to do and how many more years is this going to go on for?

Vision 2030 is fast approaching and I can’t say that I have seen any significant improvements in the health sector for the longest time, somebody tell me I’m wrong. In all honesty the whole thing just blows my mind. 

[cover art by: KwangHo Shin]