Tufton suggests health services review

Sunday, May 17, 2015

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Former Cabinet Minister Dr Christopher Tufton believes that the public health system, including the controversial no-user-fee policy, needs to undergo a comprehensive review in order that the authorities can make informed decisions on the allocation of resources.

"That seems to be necessary -- a comprehensive evaluation of how health services are structured and how the services are provided -- before you determine how and where to allocate the resources, and even with the admission that there is a limitation based on what is allocated," Tufton told the Jamaica Observer in a recent interview.

Tufton was responding to the issues raised by members of the Jamaica Medical Doctors' Association (JMDA) and their President Dr Alfred Dawes about the state of public hospitals.

The JMDA had painted a picture of a public health system that is on the brink of collapse with hospitals lacking equipment vital for surgeries and doctors working in sub-standard conditions that pose serious risk to patients and themselves.

"We have flies in the operating theatre. We have to reuse single-use instruments that aren't disposed of but [are] washed and placed in antibacterial solution and used on another patient," a member of the JMDA who works at May Pen Hospital in Clarendon told the Sunday Observer earlier this month.

Another doctor said they often practise what they term 'socialist medicine' as leftovers from an individual's surgery are used on someone else.

"We have a mesh that is used to fix hernias. We ask patients to buy them as the hospital always runs out. When we don't use all of the sterile mesh in the surgery for the patient who bought it, we soak it in disinfectant and use the leftover on a patient who couldn't afford to buy their own," he said.

The doctors' claims were corroborated by the JMDA president during a news conference.

Tufton, in responding to the revelations, pointed to a 2013 study of the no-user-fee policy conducted by the Caribbean Policy Research Institute (CaPRI) of which he is the co-executive director.

"What is very clear is that the health sector is facing severe challenges and they are manifesting themselves both in terms of patient care and the practitioners' dissatisfaction, and it appears from all the information, reaffirmed by the survey, that it is getting worse," Tufton told the Sunday Observer.

"I don't think one can point to any firm factor. What is important however, is that there are resource constraints -- that is blatantly obvious," he added.

"The international benchmark for allocation of health care is normally 10 per cent or so. In this case, even with the increase that we have seen in the last budget, it's about five per cent. So, as a percentage of overall allocation to the provision of public health services, you're looking at half the global sort of benchmark standard. And the lack of resources is clearly reflected, and, to some extent, has been also amplified with the policy changes taken over time, including user fees," Tufton argued.

The no-user-feel policy was implemented by the Jamaica Labour Party when it formed the Government between 2007 and 2011.

But it has remained controversial as opponents say it is to be blamed for the strain on the public health system.

The CaPRI study had concluded that while Jamaicans were in favour of the policy, health workers are worried about its sustainability, based on the unintended outcomes of the system.

CaPRI, a policy think tank based at the University of the West Indies, had suggested that "If the policy is to be maintained it must be twinned with a package of reforms that address longer term health systems issues, in particular adequate financial resources, health worker availability and performance, and drug supply chain management."

This, CaPRI said, was essential if the poorest patients are to really benefit.

Tufton told the Sunday Observer that what was now needed was an examination of how the country was going to cope with the existing system, both from the resource allocation standpoint and the other structural issues within the health sector.

"On the user fee issue, clearly there is a general concern about access and the need to ensure access," he said and suggested a rethink of the policy.

According to Tufton, a model that could emerge from such a review could involve one that engages people who have insurance or some sort of national insurance policy that allows financial support for access, but in a more structured and organised way where there is a contribution of some kind from the citizenry.

"I think that has to be part of the review, and again, the study shows that even in cases where patients had some difficulty paying for access, there is an admission or an acceptance that those who can afford to pay should pay," he said.

Asked to comment on Dr Dawes' statement about poor management of resources affecting the health services system, Tufton said: "It is a function of the pressure that the system has had to bear, given the demand on the system. But it is also a function of how the system is streamlined to ensure that those who need particular care can access that care in other forms of health institutions, and the extent to which that streamlining takes place is also an issue."

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