The Tribune

Dear Editor,

Thank you for allowing me to occupy this space for what I believe is a defining moment in the evolution of healthcare in The Bahamas.

There are pivotal moments in the life of a nation - moments that test our values, challenge our resolve and shape the future for generations to come. One such moment was July 10, 1973, upon becoming an independent nation. The creation of the National Insurance Board (NIB) was another. Today, the future of National Health Insurance (NHI) stands among them.

Implementing an NHI programme has been a 40-year journey. Its initial push to cover only the cost of catastrophic services met with great resistance. Wisely, the government policies adopted the World Health Organisation’s (WHO) clarion call of ‘Primary Healthcare for All’, which is a “whole-of-society approach to health that aims at ensuring the highest possible level of well-being and their equitable distribution”. Primary healthcare seeks “as early as possible along the continuum from health promotion and disease prevention to treatment, rehabilitation and palliative care, and as close as feasible to people’s everyday environment." The NHI launched the primary healthcare programme in April 2017. 

Having served as practicing physician in the Government’s health services for more than 40 years, and having had the privilege of serving as both chairman and deputy chairman of the National Health Insurance Authority (NHIA), I have seen first-hand both the promise and the pressures of healthcare reform in this country. I have seen also the cost and the tragedy of getting it wrong.

For decades, Bahamians have called for a healthcare system that is more accessible, more accountable and more responsive. Over the past nine years, NHI has worked to answer that call by expanding access to quality primary care, strengthening standards, modernising healthcare delivery and improving access to care for more than 160,000 registered beneficiaries across the archipelago. We emerge as a leader in healthcare reform in the region. 

That progress matters. It deserves to be part of the national conversation, especially now.

Much of the recent public discussion around NHI has centred on provider payments. Some of that discussion has raised legitimate questions. Some of it has reflected real frustration. But too much of it has also told only part of the story.

That matters because when public confidence in our healthcare system is shaped by incomplete information, it is not the NHIA that bears the greatest risk. It is the Bahamian people who depend on NHI every day.

Let me be clear: NHIA is experiencing financial pressures. We acknowledge that reality. It is an issue of timely payment, not a lack of payment. We own it. NHI will not default on its payments. We are working to address it, and to advocate for sustainable solutions. But acknowledging a challenge should never be mistaken for admitting failure, and nor should operational pressures be used to create the impression that NHI is collapsing or that beneficiaries should question whether care remains available to them.

That conclusion is simply not supported by the facts.

The programme remains operational. Beneficiaries continue to receive care. Providers continue to deliver services. The Authority continues to work to strengthen the programme while addressing the financial and operational issues before it.

It is also important to say plainly that the current conversation cannot be reduced to payment delays alone. National Health Insurance (NHI) exists within a broader healthcare system that has long struggled with inefficiency, inconsistent accountability, underutilised resources and the growing burden of chronic disease. Injecting more money into the system without confronting those underlying issues will not solve the challenges. 

Accountability for healthcare outcomes cannot rest solely with NHIA. Appointment availability is largely determined by providers. Utilisation patterns are influenced by providers. Referral pathways depend on provider participation. Quality standards are delivered by providers. If we are serious about improving healthcare in The Bahamas, then the conversation must be honest about the shared responsibility required to do so.

That honesty also extends to the role NHI has played in supporting the provider community.

Over the years, the programme has helped strengthen primary care as a viable area of practice, supported the growth of medical practices, introduced new standards and systems, and created opportunities for providers to modernise and expand. Many physicians have embraced that work with professionalism and commitment. They deserve recognition and appreciation.

But partnership must be a two-way street.

The question before us cannot be only what NHI owes providers. It must also be what all of us - institutions, physicians and policymakers alike - owe the Bahamian people.

More than 160,000 beneficiaries rely on this programme.

They deserve quality.

They deserve accessibility.

Most importantly, they deserve healthcare that prioritises them.

Public confidence in healthcare is a public health issue. When statements made in the public domain leave patients uncertain about whether they can continue receiving care, we have moved beyond debate and into something more damaging. That is why correcting the public record matters.

This is not about silencing criticism. Scrutiny, accountability and honest discussion are essential to the future of healthcare in this country. But those discussions must reflect the full picture. They must acknowledge both the challenges and the progress. They must recognise that National Health Insurance (NHI) was never intended to be defined by a single news cycle or a single operational pressure point. It was created to improve healthcare access, advance quality care and equity for all Bahamians. That mission remains unchanged. 

As long as the Bahamian flag flies, the aspiration of universal health coverage must endure. National Health Insurance belongs to the people of this country. Its future should not be shaped by fear, half-truths or narrow self-interest, but by a shared commitment to better healthcare for every Bahamian.

Yours sincerely,

Dr Robin Roberts

Deputy Chairman

National Health Insurance Authority