The recent protest by medical interns about working conditions at the Accident and Emergency (A&E) unit at the University Hospital of the West Indies (UHWI) is a case of protest for accountability, not resource limitation as suggested by the placard-bearing physicians.

This came barely a day after nurses in the very same A&E withdrew their services over similar concerns. Two sets of front-line workers pointing to the same ward in as many days tell us the problem is systemic, not isolated. I empathise with their concerns, but not necessarily more interns, but better roster scheduling and support for interns, and facilities for staff welfare, for those who work long hours at the hospital.

These are all valid demands, but where does accountability feature in this situation? Is this a financial resource issue, genuinely lack of people (interns) issue, or a systematic failure within the organisation to cohesively function for the best patient outcome?

Interns must relate to senior house officers, residents, and consultants. The system only works if there is synergy.

The result of a preliminary investigation suggests theirs isn’t in this case. Beds on wards unoccupied while A&E is overcrowded with patients to be admitted. Why? This is a reasonable question. What about the functionality called bed management? Isn’t there a person responsible for this? Why would 50 empty beds be identified while the protest is in session? Who is responsible? Who is accountable?

And why are interns, even in cases where numbers are limited, overworked? What about their supervisors — senior house officers, residents and consultants — all outnumbering interns and with a greater responsibility to ensure they work hard and gain experience to become good doctors. They must, at the same time, be guided based on a close working relationship, and being allowed to rest when they must to recharge for another round.

And why are staff lounges and overnight facilities broken or don’t have a microwave, a lounge chair, and a refrigerator to ensure working conditions support long hours? These are all responsible questions to ask.

If the Jamaica Medical Doctor’s Association (JMDA) is demanding that these be addressed, it means someone is falling down on the job. Who is the accountable officer?

Let me state upfront that, as minister, I have the ultimate responsibility as part of the Government of the day to ensure public health works through policies and programmes and adequate resource allocation. The system is not perfect, but it has come a long way, from just over $60 billion allocated in 2016 to over $140 billion this fiscal year. More doctors and nurses, higher salaries, and more hospital and health centre buildout, with more to come. More medication available through the National Health Fund (NHF) and more diagnostics with more to come. But even with improvements over this time, there are too many instances of the system failing both staff and patients. It is no longer about financial resources, rather human resources. It’s about leadership and management at the institutional levels.

TIME FOR A MINDSET CHANGE

The UHWI is unfortunately not the only culprit; it’s a system-wide challenge requiring greater levels of accountability from those who have been given the job to lead departments and health institutions. We must do better with what we are allocated to justify the investments that the Government has made. We must stop giving excuses for non-performance. We must stop identifying money as the sole basis of non-performance. There is a need for a mindset change in public health. The time is now.

That is why, last Friday, all ministry directors, regional directors, board chairmen, and institutional managers signed the ministry’s Accountability Framework Memorandum of Understanding. In doing so they committed to accountability, transparency, responsible stewardship, and service excellence across public health institutions. The signing was not intended as a public display; it carries real consequences, including sanctions for failing to meet the high standards expected by taxpayers, who deserve to be properly cared for.

Staff welfare, including facilities for having a warm meal, the timely filling of vacant positions so there can be no excuse of staff shortage, improved customer service, and staff reporting to work at the set times, are among the issues being looked at. A doctor cannot be paid to work an eight-hour shift and turns up three hours late yet leave at the set time. All this does is having patients at clinics and hospitals waiting much longer than expected, then the sector is blamed. It just cannot continue like this any longer. The decisions we make and the actions we take affect the lives of millions of Jamaicans. Every patient entering a health facility, every mother seeking care for a child, every senior citizen collecting medication, and every health-care worker serving on the front line expect a system that is governed effectively and managed responsibly.

The public expects us to deliver quality health care. Equally, Jamaicans expect us to manage public resources with integrity and accountability. The efficient operation of the health sector depends on all directors, board chairs and regional directors, medical staff, and all those on the front line.

Issues like those of working conditions raised by medical interns at UHWI, and subsequent statement by the JMDA calling for solidarity with the medical interns, should never reach a stage where the hospital’s operations are affected.

On Wednesday, I issued the following directives to directors of all four regional health authorities and the UHWI:

(Photo: Joseph Wellington)

• A physical audit of all intern accommodation facilities across every institution is to be completed within 72 hours. Findings are to be reported directly to my office and Chief Medical Officer Dr Jacquiline Bisasor-McKenzie.

• Any facility identified with structural, sanitary, or safety deficiencies, including those affected by sewage issues or inadequate sleeping arrangements, is to receive immediate interim remediation. Interns must not be housed in substandard conditions a single day longer than necessary.

• A review duty rosters to ensure that interns do not exceed assigned duties to mitigate the risk of post-call fatigue-related road incidents.

• HR directors are to submit, within five working days, a quantified assessment of the intern staffing gap by department and facility to inform accelerated deployment under the 2026 Medical Internship Programme.

• Employee Assistance Programme (EAP) coordinators at each institution are to proactively reach out to intern cohorts to offer mental health and well-being support.

At the same time, I have invited the JMDA to participate in a joint monitoring committee to track remediation progress on a fortnightly basis. We will report publicly on the outcomes of facility inspections, remediation actions taken, and staffing measures implemented.

Where will next generation of doctors come from?

The shortage of interns is not simply a problem of deployment. It begins further up the chain, at the point of training. A few years ago, The University of the West Indies was turning out, on average, more than 250 medical graduates a year. This year, 2026, that figure has fallen to around 100. Even the JMDA, in raising the alarm over intern shortages, pointed to roughly 90 candidates passing the most recent sitting, some of whom will return to their home countries to serve. What should concern us even more is that more than 60 candidates did not sit the final examinations at all, though they had reached the stage where they were eligible to do so. Once we account for the graduates who come from other Caribbean territories and return home, the pool of new interns available for placement in Jamaica narrows further still. So, even as we move to place some 232 interns across the public system this year, the real concern is the shrinking number being trained behind them.

So the questions must be asked and answered: Why has the output of our premier medical faculty fallen so steeply in barely five years? Are fewer young people entering medicine because of affordability? Why are so many failing or not sitting their final examinations? Is this a matter of teaching quality, of student support, or of preparation? And what is the Faculty of Medicine doing to respond to a population and a region crying out for more doctors, not fewer?

Accountability cannot stop at the hospital gate. It must extend to every institution the health system depends on, including those entrusted with training the very professionals we are counting on to serve.

I will also be seeking a meeting with trade unions which represent health-care workers to seek their support, not only in ensuring that issues affecting their members are addressed, but crucially that they are on board to ensure staff report to work as required and carry out their duties with diligence.

The accountability framework we are implementing is not punitive; it is corrective, developmental, and transformational. Its purpose is to strengthen institutions, improve performance, and build confidence in the governance of the sector. The framework rests on three critical pillars — governance and oversight; financial and procurement accountability; and capacity building and performance management.

Performance management must become part of our culture. It must move beyond compliance exercises and become a tool for continuous improvement, professional development, and organisational excellence. The journey will require commitment and collaboration.

This is a disciplined agenda with clear timelines, assigned responsibilities, measurable targets, and real consequences. Over the next 12 to 18 months the Ministry of Health and Wellness will report openly on progress and will ensure that public resources entrusted to the sector are managed with integrity, efficiency, and respect for the law. Together, we will build a stronger, more responsive, and more accountable health system for every Jamaican.

Dr Chris Tufton is Jamaica’s minister of health and wellness. Send comments to the Jamaica Observer or cctufton@gmail.com.