[Reprinted: Jamaica Observer, 10-4-2020]
Health care opportunities for Jamaica in the post-COVID-19 world
Last week, the authors looked at cardiovascular care and radiology services as specific health care opportunities that can be harnessed by developing centres of excellence and consolidation of fragmented care systems that are usually inefficient and sub-optimal. They strongly believed that Jamaica, as a small island state is best served by consolidation of resources to gain economies of scale, improve access and quality while making the cost of health care services more affordable for all Jamaicans.
Consolidation will naturally lead to centres of excellence in critical service lines as more experts work within a health care ecosystem that allows for better infrastructure and cross-pollination of ideas. This is far preferable to a siloed and fragmented system of care with limited cooperation within specialties, resulting in multiple undercapitalised and poorly resourced facilities offering limited access to consumers. We continue our series this week by highlighting key opportunities in acute stroke care, mental health and elder care services.
Acute Stroke Care Centre of Excellence
Stroke is a leading cause of premature death and disability in Jamaica and the economic costs related to lost income, social disruption, treatment, and post-stroke care are substantial. According to the National Strategy and Action Plan for the Prevention and Control of Non-Communicable Diseases in Jamaica (2013-2018) published by the Ministry of Health, about 25,000 strokes occur annually in Jamaica with a prevalence of 4.5 per cent in those individuals aged 55-74 years. These are usually individuals in their most productive years of life.
According to World Health Organization (WHO), in 2018, stroke deaths in Jamaica reached 2,479 or 13.62 per cent of total deaths with an age adjusted death rate of 65.41 per 100,000 of the population. Despite this high disease burden, there is currently no centre of excellence for acute stroke treatment in Jamaica.
Over the last several years, significant advances have been made in diagnosis and treatment of acute strokes. Advances in treatment options have also resulted in favourable outcomes when appropriate treatment is administered in a timely manner. Many patients in whom diagnosis of stroke is made in a timely manner, early initiation of appropriate treatment can lead to full restoration of functions with no or minimal residual deficits.
To effectively diagnose and treat acute stroke, an appropriate infrastructure is necessary with a multi-disciplinary team working together to achieve optimal result. We recognise that acute stroke care is an unmet need and a potential area of health care investment that needs to be addressed. The founding team that brought the Heart Institute of the Caribbean (HIC) and the HIC Heart Hospital to address similar deficits in acute heart attack care is currently reviewing this opportunity and working to create an Acute Stroke Care Institute in Jamaica that would serve as a centre of excellence for stroke care. If we receive the necessary support, we believe that we can solve this problem in the near term.
Mental health services
Crime and violence pose significant threats to the health of the population and are major impediments to economic growth and quality of life in Jamaica. The International Monetary Fund (IMF) recently cited crime as the number one impediment to economic growth in Jamaica.
Jamaica’s homicide rate was 47 per 100,000 in 2018; this rate is three times higher than the average for Latin America and the Caribbean. Forbes Magazine listed Jamaica as the third most dangerous place for women travellers in 2017. In 2018, Business Insider ranked Jamaica 10th among the 20 most dangerous places in the world.
Crime and violence should be seen and designated as public health threats that are partly related to unaddressed mental health issues. There is a breakdown in the social contract between citizens and the community and this has driven aberrant behaviours that in the extreme, manifest in the form of violence and crime. There are incessant reports of various forms of domestic and other senseless acts of violence in response to perceived minor infractions.
According to the 2006 Report of the Caribbean Commission on Health and Development (CCHD), an analysis of direct and indirect costs associated with two major mental illnesses (depression and schizophrenia) in Jamaica, revealed the astronomical amount of about US$600 million for just one year. This finding is quite revealing and should encourage a critical need for primary prevention and early treatment of these disorders. Addressing mental health issues in the population is a necessary health care intervention and an opportunity to enhance economic growth and productivity. Surprisingly, we do not have robust mental health care services or designated centres of excellence for mental health care in Jamaica. Appropriately addressing mental and emotional health issues will mitigate aberrant behaviours that result from untreated mental or psychological health issues. We see this as a necessary and viable opportunity for investment attention in the post-COVID-19 era especially with the expected shocks from severe economic fall out and job losses from the pandemic that would invariably lead to increased demand for mental and psychological health services.
Elder Care Services
Jamaica’s population is aging. Currently, about 11 per cent of the population is 60 years and older. By 2050, more than 25 per cent of Jamaica’s population is expected to be 60 years or older. This is a population with specific needs, which are currently largely unmet. There is need for services in all areas of the economy that are designed to cater for the well-being of the older and elderly population. These services extend beyond traditional health care services and include financial inclusion, psychological support, chronic disease management, home health and assisted living services.
The old and traditional approach to meeting the health care needs of the elderly has focused on establishment of nursing homes. While there are several nursing homes in Jamaica, it must be emphasised that most elderly individuals do not need nursing home care. Other options for elderly care include home care with visiting aides, assisted living facilities, and group homes. These are investment opportunities for the private sector or as part of a PPP initiative. There is also need for specific legal framework to protect the elderly from physical, psychological, and financial abuses.
As we celebrate Senior Citizens Week (September 27 to October 3) under the theme, ‘Advancing the Health and Well-being of Older Persons amid COVID-19’, it is time to reflect on the opportunities to bring value to the care and wellbeing of older individuals. Under the leadership of Jean Lowrie Chin, the Caribbean Community of Retired Persons (CCRP) and Dorothy Finlayson of the National Council for Senior Citizens (NCSC), significant strides have been made in bringing the issues of the elderly to public attention. More needs to be done. CCRP has recently called for the introduction of an elder care and protection framework to ensure that the nation’s seniors are legally protected from abuse. We endorse that call.
Other potential opportunities for investment in Clinical Centres of Excellence in Jamaica include paediatric services and critical care services.
The series continues next week highlighting opportunities in renal care, oncology services and women’s health, that if properly harnessed, will improve access and quality of health care for Jamaicans while driving economic development and job creation.
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