[Reprinted: Jamaica Observer, 11-8-2020]
What can the Government do to unlock potentials in health sector?
Over the past several weeks, we have explored key elements of health care delivery and fundamental frictions that impede access and quality of health care delivery in Jamaica.
We have also proposed granular solutions and note with comfort that some of these solutions are being implemented by those in authority. We have also identified some unique opportunities that would be ideal for private sector investments or public-private sector partnerships. Among those is a stroke centre for Jamaica for which we have reached advanced stages in our plan to bring to life, just like we did with heart care at the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital.
We believe that with an enabling environment, support and cooperation from the Ministry of Health and Wellness, the health care landscape will be greatly improved for the benefit of all our citizens. This week, we will explore other issues that are non-traditional but critical for the health and well-being of our nation. The current pandemic has brought some of these issues to the fore and has forced us to confront them. It will suit us to do so.
(1) Establish national stockpile for essential medical needs
The US Strategic National Stockpile (SNS) was formed in 2003 and is the United States’ national repository of antibiotics, chemical antidotes, vaccines, antitoxins, and critical medical supplies.
Currently, the SNS has an estimated US$ 7–8 billion worth of emergency supplies stored in secret warehouses located strategically around the USA. National stockpiles had existed in the USA from the 1950s, largely for military personnel, but were abandoned in the mid-1970s. However, in April 1998, then US President Bill Clinton read the Richard Preston novel, The Cobra Event, a fictionalised account of a mad scientist spreading a virus throughout New York City. He was so impressed, that he tasked his staff to seek solutions for a national response to bioterrorism and similar events. Ultimately, the Strategic National Stockpile was conceived and funded.
The SNS holds a variety of items that would be helpful to the general population in the event of a widespread disease outbreak and this has proved invaluable in the fight against the COVID-19 pandemic, despite policy lapses.
With the impoundment of critical goods and supplies by the US and other more developed nations at the peak of the pandemic, it would be unwise for Jamaica not to establish a national stockpile of essential medical supplies. We encourage this.
(2) Human capital development and retention in health care and related disciplines
Migration of health workers from Jamaica to other more developed countries has been and continues to be prevalent. The reported reasons for health care worker migration are many, systemic and longstanding and can largely be anchored on the perceived differences in earnings, professional growth, job satisfaction, living and working conditions between Jamaica and ‘destination’ countries.
While this problem has lingered over the years, we have not found any evidence of structured formal tracking of health worker migration from Jamaica either by the Government, regulatory or professional bodies in Jamaica. According to a 2016 study by Gail Tomblin Murphy et al, published in BMC Human Resources for Health, an estimated 50 per cent of all physicians trained in Jamaica since 1991 have emigrated, while about 67 per cent of nurses ever trained in Jamaica have also emigrated.
The popular migration destinations were USA, Canada, and UK. Nearly 2,000 Caribbean nurses had migrated to these destinations between 2002 and 2006. The World Bank estimated that in 2009, the number of Caricom-trained nurses practicing abroad outnumbered those practising within the Caricom region by a ratio of three to one.
We cannot afford to continue the current trend of training and exporting our best and brightest in health care and allied professionals to Europe, America, and Canada. This amounts to subsidisation of the more affluent countries because of our failure to fix fundamental frictions that lead to such migrations.
It is time to purposefully evaluate our internal systems and find mechanisms to correct the deficits and retain our trained personnel. This begins by encouraging and supporting robust investment in the health care ecosystem to develop the proper infrastructure that will improve the ability of health care professionals to deliver quality care to patients, achieve professional satisfaction and financial independence. This will eliminate the need to migrate in search of “greener pastures”.
(3) Digitisation of medical records and hospital information
According to national surveys, the use of electronic medical records (EMRs) in the USA ranged from 17 per cent in physicians’ office-based practices in 2003 to 29 per cent in hospital outpatient departments and 31 per cent in hospital emergency departments in 2002. Recognising the importance of electronic medical records in the care of patients and reduction of medical errors, President Barack Obama mandated transition to EMR by medical practices and the US Government offered financial incentives for practices to adopt EMR.
By 2017, about 86 per cent of US medical practices and nearly 100 per cent of US hospitals had made the transition to EMRs. The Heart Institute of the Caribbean (HIC) has used EMR since 2006. While the Jamaican Government may not be able to offer direct financial incentives to practices, there should be a national mandate to make the transition to EMRs a priority, starting with the hospitals and practices under the direct control of the Government. This will create a remarkable opportunity for young software engineers and developers in Jamaica to create agile electronic medical records and hospital information management systems that would improve the quality of health care in Jamaica, reduce documentation errors while securing patient’s data. This approach serves to improve quality of care while developing another economic layer of the health care ecosystem by enabling software engineers and developers.
(4) Access to capital for health care innovations
Access to capital for health care innovations remains a formidable challenge to improving health care delivery in Jamaica. Most of our local financial institutions have limited understanding of what modern health care is or should be. Most of our financial institutions are ignorant of the business aspect of health care and fail to understand the connection between health care and economic development.
It is not surprising that most funding for health care advances in Jamaica come from sources outside of Jamaica, even though Jamaican financial entities will more readily finance non-health care related ventures. Unfortunately, this lack of knowledge costs Jamaica substantially as those finance charges that could have been paid to local institutions are paid to overseas financiers. We believe that health care financing either on the supply or demand side, represents a growth area for Jamaica and an opportunity for existing or new financial services companies to tap into.
We encourage stakeholders to imagine with us what is possible with a combined national will.
About the authors: Dr Ernest Madu, MD, FACC, and Dr Paul Edwards, MD, FACC are Consultant Cardiologists at Heart Institute of the Caribbean (HIC) and HIC Heart Hospital, Kingston, Jamaica