By NEIL HARTNELL
Tribune Business Editor
The Minister of Health yesterday pledged to "maximise value for the Bahamian public" after revealing the former administration's planned $11 million investment in new Cat Island clinics would benefit just six patients per day.
Dr Duane Sands told Tribune Business that the "soundness" of such a multi-million dollar outlay was called into question by healthcare usage rates in the Family Islands.
"We have entered into tens of millions of commitments under the premise these new clinics would modernise the infrastructure for NHI," he said. "The question is whether or not they are predicated on sound principles.
"It is challenging when you look at the buildings proposed for Cat Island. We are spending so much money in Cat Island. Based on the utilisation studies for the last three years, if we were to build those clinics in Cat Island, on average they would see six patients per day."
Dr Sands had criticised the Cat Island clinics contracts during his 2017-2018 Budget presentation, but his revelation of the likely patient usage rates explains why he - and the Minnis administration - fear the investment will not provide taxpayers with value for money at a time of fiscal crisis.
The Christie government had awarded three clinic construction contracts pre-election that were valued at $2.349 million for Old Bight; $2.1 million for Orange Creek Clinic; and $6.6 million for Smith's Bay.
But Dr Sands argued that, beyond the construction contract's worth, the Government would also have to staff and equip all three clinics, plus pay for the likes of janitorial and security services, to serve a patient population numbering in the single digits daily.
"The average number of patients seen in the Family Islands, the number of visits to healthcare facilities, is around three visits per patient per year," the Minister of Health told Tribune Business.
While acknowledging that this frequency was slightly higher for Cat Island residents, Dr Sands added: "When you look at the projected utilisation of those clinics over the next five to 10 years, each of those clinics, costing $10 million, will see less than 10 patients per day."
Based on the 1,200-strong Cat Island population cited by Dr Sands in his Budget debate, and the three annual patient clinic visits average, the three proposed clinics would see a combined 3,600 patients annually.
This translates into a total 9.86 patients per day visiting the three government clinics on Cat Island, a figure in line with the estimates provided by the Minister.
"Underlying the premise of those buildings is NHI readiness," Dr Sands told Tribune Business. "As we look at the decisions made in the name of NHI, the commitments entered into in the name of NHI, the new NHI Authority is going to have to look a number of things.
"Ultimately, a sense of prudence and equanimity ought to apply so we end up maximising value for the Bahamian public."
Dr Sands's comments illustrate the difficulties in delivering a universal health coverage (UHC) system that matches equity with efficiency, and value for money, in an archipelagic nation with numerous sparsely populated islands.
His Budget debate address also noted that the Christie administration issued clinic construction contracts worth $1.6 million for Rum Cay, an island with a 70-strong population, and $300,000 for San Salvador.
"I have directed the National Health Insurance administration to revisit some of the decisions that have been made," the Minister said at the time. "We are going to review these contracts and if we can cancel some, we will cancel some, but we are going to set this right for the Bahamian people."
His remarks sparked an immediate riposte from Opposition leader Philip Davis, MP for Cat Island, Rum Cay and San Salvador, who said Bahamians in the Family Islands should enjoy the same rights and facilities as those living on New Providence.
"What amazes me is that this posturing, this flippant referral to these islands, comes from the Government that committed to the 'Back-To-The-Island' campaign which is anticipated to become the largest migration of Bahamians back to the Family Islands," Mr Davis responded.
"Why did they move in the first place? What incentive is there for them to return when something as basic as the construction of facilities to provide essential services becomes the subject of debate?"