We cannot build our way out of Jamaica’s health-care challenges. Expanding services and capacity does not have to mean more block and cement. What it does require is innovation, efficient use of resources, and a fundamental restructuring of care delivery so that quality and sustainability go hand in hand.

Jamaica’s health-care system is at a critical crossroads. For decades shortcomings in our public hospitals — from bed shortages and prolonged emergency waits to chronic staffing challenges — have been evident. These issues were again thrust into the spotlight following the recent nurses’ protest after Hurricane Melissa and the national debate over whether specialist nurses can be encouraged to return home.

These challenges are not unique to Jamaica. Many countries with publicly funded health-care systems face similar pressures. However, this does not lessen the real suffering experienced by our people when care is delayed, inadequate, or simply unavailable.

I speak from experience. I trained as a nurse at the University of Technology, Jamaica; worked at Cornwall Regional Hospital as a registered nurse; and later served as a nursing educator at the University of Technology, Jamaica. I subsequently migrated to the United Kingdom, where I have worked across acute care wards, virtual wards, health-care leadership, and as an associate lecturer at Anglia Ruskin University. I also hold a master’s degree in health-care management.

I have seen Jamaica’s public health system from multiple perspectives: as a front-line care provider facing resource constraints, as an educator supporting students in under-resourced facilities, and as a patient who has experienced both exemplary care and deeply disappointing encounters. I also lost my mother within the system. While her death may have been inevitable, the care she received could have and should have been safer and more humane.

The reality is stark. Jamaica simply does not have the resources to build and staff hospitals at the scale required to meet growing demand through traditional expansion alone. Cornwall Regional Hospital, built in 1974 with 400 beds to serve approximately half a million people, now operates with around 300 beds, despite the population of the county of Cornwall exceeding 600,000. Montego Bay’s population alone has nearly doubled since the hospital opened. Yet hospital capacity has not kept pace with population growth, the rising burden of chronic diseases, pandemics, or increasing health-care expectations.

So what is the way forward?

Rethinking Care Delivery

Innovation in how we deliver care must be a priority, not merely how many beds we build. Two evidence-based approaches deserve serious consideration: virtual wards and expanded community care. Virtual wards allow patients who require hospital-level monitoring, but are clinically stable, to be safely managed at home. Patients are monitored remotely by multidisciplinary teams using digital tools, regular check-ins, and clear escalation pathways if their condition deteriorates. This model reduces pressure on hospital beds, improves patient flow, lowers the risk of hospital-acquired infections, and supports recovery in a familiar environment.

For example, a stable stroke patient who remains hospitalised solely for blood pressure monitoring could instead be discharged with a digital device. Daily readings are reviewed remotely, medications adjusted as needed, and rapid intervention arranged if deterioration occurs, often without the patient having to pass through a crowded emergency department. The hospital bed is then freed for someone in more acute need. Evidence suggests that patients often recover more quickly at home and take greater ownership of their health when supported by structured remote care.

Community care must also be revitalised. Many rural health centres close as early as 4:00 pm and remain underutilised in the afternoons. Why should an 88-year-old have to arrive before dawn to queue for hours to see a doctor who arrives at approximately 9:00 am and can only see one patient at a time? Introducing slotted appointment systems and extending operating hours could dramatically improve access and dignity of care.

Health centres could absorb much of the routine care currently managed by hospitals. Expanded roles for trained health aides ranging from wound care and medication support to home visits would allow patients to receive care within their communities, reducing preventable hospital admissions and unnecessary inpatient stays.

This is not about replacing hospitals; it is about managing demand more intelligently. Many patients remain hospitalised simply because they lack adequate support at home. Structured community support systems such as meal delivery (as seen post-Melissa), daily welfare checks, or locally provided personal care could enable safe discharge while preserving valuable hospital resources.

Realistic Solutions, Strategic Leadership

Jamaica may never be able to afford every health-care resource we desire, but we do have the capacity to modernise how care is delivered. Successive governments have attempted to improve the health system, often with limited success, by relying on familiar strategies rather than embracing transformative redesign.

While encouraging nurses to return home is a worthy goal, competing with developed countries on salary and working conditions remains a significant challenge. A more sustainable strategy would focus on retaining the nurses we currently have and investing meaningfully in their professional development. This includes better preparing nursing students to meet the diverse and evolving demands of modern health care.

It is also counterproductive to appeal to nurses overseas while many locally trained nurses have been unemployed for over a year. Furthermore, many highly skilled Jamaican nurses abroad may not wish to return as bedside clinicians but could still make invaluable contributions remotely through system redesign, specialist training, mentorship, and leadership development.

Modern health care demands modern solutions. It is time for Jamaica to rethink how we care for our people and to do so with courage, strategy, and compassion.

Danielle Huie is a registered nurse and an associate lecturer at Anglia Ruskin University in the United Kingdom. Send comments to the Jamaica Observer or huiedanielle@gmail.com

Danielle Huie