THE Ministry of Finance and the Public Service and the Ministry of Health and Wellness (MOHW) have been seeking ways to fund improved health care in Jamaica, but challenges exist at this time.

In its current MOHW 10-year Strategic Development Plan for the health sector, these challenges are said to include health worker density, which is poorly aligned with hospital admissions and the number of health centre visits.

The report also highlights low hospital bed rates relative to population, with hospitals wards functioning largely at excess capacity, and medical equipment in hospitals, which are poorly maintained due to insufficient funds.

The report additionally cites mortality rate in hospitals, noting that general death rates appear to be increasing, suggesting a decline in the quality of care, while maternal mortality rates appear to have increased since 1990.

The strategic plan also notes “fragmentation in the broader health system: There is no integrated care system, which is increasingly important given the growing proportion of the population with chronic diseases.”

Global standards

Statsgate, a source of data and survey results, shared at ceoworld.biz provides a 2021 assessment of the best and worst health-care systems in the world, listing 89 countries.

Jamaica does not appear on the list and would appear to supercede Venezuela, which tops the list of the countries with the worst health-care systems for 2021 with a score of 33.42 on the Health Care Index.

In Statsgate rankings, South Korea has the best health-care system in the world. Taiwan placed second and Japan fifth. European countries occupy six of the top 10 spots with Denmark in third place, Austria (fourth), France (seventh), Spain (eighth), Belgium (ninth), and the United Kingdom in 10th place.

The Health Care Index is described as statistical analysis of the overall quality of the health-care system, including health-care infrastructure; health-care professionals (doctors, nursing staff, and other health workers) competencies; cost (USD pa per capita); quality medicine availability; and government readiness.

The report also considers the environment, access to clean water, sanitation, and government readiness to impose penalties on risks, such as tobacco use and obesity. The ranking looks at 89 countries around the world on five different health variables.

Of the 89 countries surveyed, South Korea’s health-care came in first place on the list, scoring 78.72 out of 100 on the Health Care Index.

The case of Jamaica

The island’s health system has been critically analysed by the Pan American Health Organization (PAHO) in a report entitled Health System and Services Profile of Jamaica, completed by its Organisation and Management of Health Systems and Services Programme Division.

PAHO describes the system as a physician-led model with a heavy reliance on nursing personnel and as an MOHW public-sector governed system supplemented by a loosely regulated private sector.

Drugs and other health-care supplies and equipment are largely imported. PAHO comments, “The lack of financial resources, trained technical personnel, parts and equipment for repairs, and management are the leading problems. This area is receiving more attention under a planned sector reform programme.”

PAHO states in its report, “The ratio of general practitioners to specialists has not changed significantly over the decade. The Ministry of Health human resource division focuses on the manpower needs of the public sector, not the entire health system.

“Most professions, with the exception of physicians, are in chronic shortage. Relatively low pay, poor working conditions and the lack of advancement opportunities lead many health professionals to leave the public service, their profession, and in many cases, migrate to developed countries. In addition to salaries, physicians and other personnel are entitled to an assortment of allowances, subsidies, and other benefits.”

The Pan American health authority states that physicians are better paid by a relatively wide margin than other health professions and notes that, to relieve the impact of staff shortages, contractual arrangements have been made with the governments of a number of countries to provide personnel, including physicians, nurses, and pharmacists. These countries include Cuba, Nigeria, and Ghana.

Non-functional equipment

PAHO indicates, “Traditionally, the management of equipment and technology has been an area of weakness within the MOH.

It was also reported that a significant percentage of equipment is not functional. PAHO said, “No readily available data exists on the type, number, or percentage of medical equipment that is defective or out of order. Less than 0.5 per cent of the operating budget is allocated to conservation and maintenance of plant and equipment.”

PAHO noted that, “The vast majority of the maintenance staff has only practical experience and lacks formal training. High-technology units and/or equipment are allocated to a few regional or specialty hospitals.”

Minister of Health and Wellness Christopher Tufton, in a presentation to Parliament on the health sector on May 4, 2022 stated, “In a developing country context, focus on human development and health care is a fundamental determining factor of our productivity and competitiveness as a nation.”

He added, “Too often, successive governments have ignored this fact. Over time, we have seen the manifestations of this in lost man hours and low productivity, due to premature sickness, not to mention the pain and suffering experienced by Jamaicans who may have access to health services, but due to a lack of infrastructure or personnel, the quality of service is compromised.”