It has become increasingly evident that Jamaica’s health system is failing to provide the services it was designed to. The removal of user fees resulted in increased access to an already burdened system and some will argue that the no-user-fee policy is the proverbial straw.

In my last letter, published April 4, 2016, I outlined four strategies Health Minister Christopher Tufton should consider to increase the training of competent registered nurses (RNs), one of which was to expand and improve the island’s existing acute care facilities while plans are laid to construct new ones.

The outcome of this strategy is twofold. First, nursing and other health care students will have access to more suitable practice sites. Second, patients would enjoy the health benefits of being cared for in well-equipped and well-staffed facilities.

It would be foolish of me to think that fixing our nation’s hospitals is the remedy for our ailing health system. I contend that the solution to our health system issues is the primary (preventative) health care given in agencies such as health centres.

The focus on improving primary health care yielded great success in post-Independence Singapore. Jamaica is in a similarly unfortunate situation in which the health sector is being overshadowed by other priorities such as ensuring economic stability. Nonetheless, the nation’s health system cannot be ignored as a healthy workforce is an important precursor for economic growth.

Singapore wisely made public health and primary health care its initial focus and is now reaping the social and economic benefits of this decision. It would be prudent of Jamaica’s newly installed Government to do the same.

Primary health care focuses on the prevention of illness and complications from chronic illness. I am encouraging Minister Tufton to strengthen Jamaica’s primary health care system as a means to reduce hospitalisation thereby relieving the burden on secondary care (provided in hospitals).

Improving public health requires a multi-ministerial approach. It means that we can no longer allow our citizens to build what they want where they want. It means that agencies responsible for garbage collection and disposal should put strategies in place to ensure that waste is collected regularly and disposed of responsibly. It means that our citizens are provided with a reliable supply of potable water for domestic purposes. It also means that each citizen is made aware of and held accountable for the individual role they play in maintaining public health.

Improving primary health care is a much simpler task to undertake. First, the physical state of health centres needs to be improved, urgently! It is impossible to provide safe health care in a mould- or termite-infested examination or treatment room. The deplorable state of some of the country’s health centres was featured recently in press.

Second, advance practice registered nurses or nurse practitioners (NPs) need the support of a legislative framework which will enable them to practice within their full scope, the opposite of what exists today. NPs receive advanced education and training at the master’s and doctoral levels, which enables them to provide a full range of health services. NPs can perform comprehensive health examinations; order, perform and interpret diagnostic tests, such as blood and urine tests; diagnose and treat acute and chronic conditions such as diabetes and high blood pressure; prescribe medications and other treatments; provide supportive services such as education and counselling.

Although Jamaica trains NPs, the country’s laws limits the extent to which they can practice, thereby limiting how they can contribute to the improvement in our country’s health. Nurse led-clinics are not new to Jamaica, in fact, they are highly successful. Antenatal clinics provide an excellent example of a nurse-led clinic.

I propose the introduction of nurse practitioner-led clinics where patients who are following the normal clinical pathway can be monitored and treated by these highly skilled advanced practice nurses. This move will enable physicians to focus their skills and expertise on managing patients with more complex health issues. For this to become a reality NPs need legislations in place to support them to practice to their full scope. It means that they need prescriptive rights!

Jamaica’s health care system requires an injection of a significant amount of resources and political will for it to perform effectively and efficiently. The process of detangling the web caused by years of neglect and mismanagement will be an admittedly painstaking one. But where the solutions are clear, I urge Minister Tufton act on them.

It is clear that for Jamaica’s health care system to improve public health and primary health care need to be strengthened. Advanced practice nurses such as nurse practitioners will play an integral role in improving of Jamaica’s health system.