• Diabetes, hypertension consume 18% of healthcare spend
• Public clinics in ‘extraordinary requirement for improvement’
• Cancer death probability to rise as patient costs hit $23,000
By NEIL HARTNELL
Tribune Business Editor
Just two diseases consume more than one out of every six dollars in the Government’s annual health budget, it was revealed yesterday, with its public clinics facing an “extraordinary requirement for improvement”.
Documents associated with the $60m Inter-American Development Bank (IDB) financing to upgrade Bahamian primary healthcare disclose that the treatment of diabetes and hypertension alone is costing Bahamian taxpayers close to $35m per annum, or almost 18 percent of public health spending, as the Government ramps up efforts to combat chronic non-communicable diseases (NCDs).
Detailing the rising costs, and consequences, associated with an increasingly unhealthy Bahamian population, one IDB paper warned bluntly: “NCDs are highly prevalent. One of every ten adults has diabetes, and four of every ten adults have hypertension.
“There is an NCD-related gender health gap since more women are obese (women 54.8 percent, men 31.8 percent), have hypertension (women 77.5 percent, men 66.2 percent) and have malignant tumors (women 66.2 percent, men 47.9 percent). The most common cancers are prostate, breast, colorectal and cervical cancer .
“Additionally, NCDs are the leading causes of ambulatory and hospital care, and cause 63 percent of disability-adjusted life years. Moreover, the top five leading causes of death per 100,000 inhabitants are ischemic heart disease (52.5), cerebrovascular disease (39.8), prostate cancer (31.9), breast cancer (28.8) and diabetes (27.1). The estimates indicate that between 2000-2030, the probability of premature death from cancer per year will increase from 7.9 percent to 9.23 percent.”
The Government, aided by IDB funding and technical support, is aiming to catch these illnesses and treat them earlier by overhauling primary healthcare infrastructure and improving the efficiency of services offered to patients. And, in doing so, it is seeking to generate greater value for money for Bahamian taxpayers while also lowering healthcare costs.
“Appropriate preventive and curative care in primary care facilities and hospital settings can reduce health costs, and up to 25 percent of the mortality rates, for NCDs,” the IDB paper added. “For example, more than 70 percent of breast cancer patients are diagnosed with late-stage cancer, which in turn reduces treatment effectiveness and life expectancy.
“NCDs have a significant impact on health expenditures. The total direct cost of diabetes and hypertension is $34.8m per year, representing 17.6 percent of public health expenditures. The cost of cancer treatment is also high. It can reach up to $23,059 per case in The Bahamas.”
Primary healthcare providers and facilities, the IDB paper added, need to be better prepared “to deliver preventive and curative care” for Bahamians and residents with NCDs so that the number of patients seeking emergency/hospital care is lowered, thereby reducing healthcare costs.
However, the Government has admitted that primary healthcare capacity and infrastructure throughout The Bahamas - and especially in the Family Islands - is in “dire condition” and in need of significant transformation. This was acknowledged by Colin Higgs, the Ministry of Health and Wellness permanent secretary, in an April 20, 2022, letter to the IDB.
Confirming that the ministry “has had to adapt its activities to align with the new mandate of government” following the September 16, 2021, general election, Mr Higgs told IDB officials that the funding required for the clinic upgrades needed to be increased from the original $20m to $26m as the Davis administration wanted to double the number of either new-build or renovated locations from nine to 18.
With some $5m in European Union (EU) grant financing taking the total clinic investment to around $31m, Mr Higgs wrote: “The Ministry of Health and Wellness was mandated to do more with the funds allocated given the dire condition of health infrastructure and the extraordinary requirement for improvement.
“The facilities selected for air conditioning system retrofit were in no condition for that activity. Works identified as critical to the function of the health system are now proposed.” The former Minnis administration had sought to initially improve primary healthcare infrastructure across seven Family Islands.
However, Mr Higgs wrote: “The Ministry of Health later prioritised the construction of five new clinics and renovation of 12. Each facility to be built would factor in resiliency to disaster and climate change risks, sustainability and energy efficient design to comply with the EDGE certification, and sound design to care for and contain the spread of transmissible diseases, such as COVID-19, and handle other infectious disease outbreaks that might occur.”
The new clinics will be built in Fresh Creek and Mangrove Cay, Andros; Smith’s Bay, Cat Island; Staniel Cay, Exuma; Long Cay; and Rock Sound and Palmetto Point, Eleuthera. The primary healthcare clinics set for upgrade and renovation are based at Matthew Town, Inagua; Marsh Harbour and Fox Town, Abaco; Mastic Point, Andros; Simms and Deadman’s, Long Island; Alice Town, Bimini; and Fox Hill Clinic in New Providence.
An IDB cost-benefit analysis of the healthcare upgrades projected that they will produce a net return of some $37.141m, with a collective $249.863min benefits outweighing $212.722m in costs associated with the project over its lifespan.
Pointing out that the Bahamian public healthcare system is fragmented, and producing an uneven quality of healthcare, the IDB added: “The main objective is to improve the population’s health status by strengthening The Bahamas health system to meet the priority health needs.....
“The Ministry of Health and Wellness is modernising its health information system to reduce the public healthcare sector’s fragmentation and bridge the gaps in their asymmetric development. The National Health Insurance Authority has a primary healthcare electronic health record system that serves 43,000 people and enables them to access their health information through a digital patient portal.
“By contrast, the Ministry of Health and Wellness is about to begin a transition from a paper-based to a digital-based health information system. Currently, data management in the Ministry of Health and Wellness’ healthcare facilities is predominantly paper-based with manual data entry and reporting.”
The project aims to “introduce the electronic health record and digital technology in 85 clinics, which represent 100 percent of existing primary care clinics of the Department of Public Health”. Care for NCD patients will be modernised through the introduction of a “community-centred model of care” along with mechanisms to improve the quality of patient treatments.
“Primary care interventions to improve NCDs care are the most efficient way to reduce hospital admissions and premature mortality,” the IDB report reiterated.