The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Government yesterday raised fears it is “throwing good money after bad” with National Health Insurance (NHI), given its two-and-a-half year failure to act on confidential recommendations for strengthening the existing public health system.

A report by the National Health Systems Strengthening Committee, which has never been widely-circulated or published, lists numerous issues that “must be addressed” prior to implementing universal health coverage (UHC) in the Bahamas.

The document, dated September 2014 and which has been obtained by Tribune Business, warns that the Bahamas’ existing healthcare model is one that has been shown to be “financially unsustainable”.

This, the committee explains, is because the Bahamian system is focused on treating illnesses and disease, rather than on education and the promotion of healthy living and eating.

“The Bahamas, like its global counterparts, continues to grapple with health system performance,” the report admitted bluntly.

“Many of our existing challenges relate to deficits in the governance of system, services delivery and resource allocation (human and otherwise) that must be addressed to implement UHC in the Bahamas.”

Critiquing the existing Bahamian healthcare system, it added: “The current health care organisational model is characterised as being centralised, predominantly curative and disease-centred.

“However, the medical literature suggests that such systems are inefficient, offer relatively small gains, are spread unevenly across the population, and are financially unsustainable. In countries where the health system is orientated towards health promotion rather than a disease-based approach, governments have been more successful in creating health-promoting environments.”

The report added that these problems were compounded in the public health sector because services were “fragmented”, with responsibility for their management split between the Public Hospitals Authority (PHA) and the Department of Public Health.

“This fragmentation contributes to a less effective health system performance, and limits access to services (long waiting list, delayed referrals),” the National Health Systems Strengthening Committee wrote.

It added that this was responsible for “poor health system performance” and treatment outcomes on “key clinical indicators”, such as infant and mother mortality.

Other problems stemming from this “fragmentation”, the report said, were issues with patient care co-ordination and continuity, resulting in low patient satisfaction, “duplication of services” and the “inefficient use of available resources”.

The latter led to an “inequitable distribution of health centres that does not improve access to care”, with existing health system weaknesses also causing an “unnecessary increase in production (healthcare) cost”.

The National Health Systems Strengthening Committee urged the Government to “firstly address the fragmentation of services and disease-based approach to healthcare” prior to the implementation of UHC, and any mechanism to finance, which is NHI.

Its report called for Bahamian healthcare’s governance structure to be completely reformed, and overseen by a Bahamas Public Health Authority, through which the Ministry of Health will be responsible for standards, policies and regulation.

Underneath it will be the Public Health Authority, an amalgamation of the PHA and the Department of Public Health. And, finally, there will be four regional health authorities, each responsible for the northern, central, southeastern and southern Bahamas, respectively.

Doctors spoken to by Tribune Business yesterday, some of whom have seen the National Health Systems Strengthening Committee report, said none of its recommendations had been acted upon or embraced by the Government as it works feverishly to implement NHI in some form prior to the May 2017 general election.

One physician, when asked whether any of the committee’s recommendations had been implemented, said bluntly: “None. The Government has not stepped up to the plate and done what they said they were going to do in strengthening healthcare services.”

Speaking on condition of anonymity, they added: “They’re [the Government] just making it a farce for the public to make them believe they’ve actually done something.”

The source added that Princesss Margaret Hospital was “operating at the same capacity it was previously”, and added: “The ICU (intensive care unit) surgical suites are operating at minimum levels because of staffing and equipment issues.”

They said there was a 12-18 hour waiting time in accident and emergency (A&E), while patients were enduring a one-three day wait to get a bed in a ward, requiring them to stay in A&E “on a trolley”.

“Currently, in terms of surgeries, there’s a major backlog because of non-functioning operating theatres when their A/C goes down,” the source said.

“They have so many patients that require emergency surgery that many people with non-elective surgeries are being postponed.....

“They [the Government] use this term health system strengthening as a loose term, but are not focused on what it actually takes to deliver primary healthcare and catastrophic healthcare.”

Dr Duane Sands, who has never seen the September 2014 document, said it sounded like “a realist report” that would never see widespread publication because it did not fit the Government’s NHI narrative.

“None of these themes are surprising,” he said of the report’s contents, when they were detailed for him by Tribune Business.

“They basically speak to the systemic challenges that lead to less than ideal outcomes in healthcare, and it speaks to the fact that if we’re going to get any major bang for the buck from any additional, incremental investment in healthcare, we have to get consensus on what will improve the health system now, instead of throwing good money after bad.

“If you double down on that now with more expenditure, why do you think you will get a better outcome?”

Dr Sands, who is the FNM’s Elizabeth candidate, said the pronouncement by Herbert Brown, the PHA’s managing director, that the Government is set to invest $200 million in healthcare infrastructure improvements over a two-year period was “raising a lot of eyebrows”.

Arguing that little to no evidence of such investment had been seen yet, Dr Sands said the National Health Systems Strengthening Committee report laid out what Bahamas “ought to be doing”, and showed that “throwing more money at it ain’t going to fix it”.

“I think what you have in the report is information that the technocrats know, and which has not been widely circulated, because it flies in the face of programmes the Government has already agreed to roll out,” he told Tribune Business.

“I am sure there are other reports, studies, recommendations out there that have been suppressed because they suggested the Government’s timeline was far too ambitious and going to result in chaos.”