[Reprinted: Jamaica Observer, 8-30-2020]
Previously in Part 1, the authors explored the historicity of inequity in health care access in Jamaica resulting in poorer segments of the society often lacking access to optimal health care services. We believe that we have a unique opportunity to find creative solutions that will take advantage of the capacity within the entire health care ecosystem to provide a more equitable health care system for all Jamaicans.
The COVID-19 pandemic has reshaped the way the world operates and has given us a unique opportunity to reimagine our health care system, but we must draw from the lessons learnt, be willing to improve and be bold and imaginative to change the way we do things for the benefit of the larger society.
What lessons have we learnt?
(1) Need to develop high-quality health care in Jamaica
The lockdown necessitated by the novel coronavirus pandemic with severe limitations to foreign travels exposed the illogical thinking underpinning the desire by some to depend solely on overseas facilities for their health care needs. While it is an individual’s prerogative to seek health care wherever he chooses; self-preservation is a basic human instinct and that instinct would suggest that individuals should be vested in developing adequate health care systems and facilities locally.
The logic that it is okay to depend on an overseas territory exclusively for routine medical care has been torpedoed by the COVID-19 pandemic which resulted in the shutting down of borders. The lesson is that when we fail to develop or support the growth of appropriate health care delivery systems and facilities at home, we unwittingly imperil ourselves.
In the mid-1990s, one of us served on the Faculty of Telemedicine at the University of California (UCLA). The Division of Telemedicine at UCLA was the first of its kind to be established in any US medical institution. It was considered groundbreaking and we did seminal work establishing the role of telemedicine in the delivery of cardiovascular care.
Subsequently, we parlayed that understanding about 20 years ago to the establishment of Echo Doctors of America, one of the earliest companies in the USA, based on telemedicine. We learnt early that telemedicine is an excellent tool for delivery of care across geographic boundaries and that this technology was actually most cost effective for the low resourced nations of the world where access to care is often limited and the relative cost of care is often higher because of limited access to capital, infrastructural deficits, maintenance gaps and severe human capital deficits in specialised areas of medicine.
Unfortunately, the innovation of telemedicine has seen very slow and limited adoption in low resourced settings like Jamaica places that would benefit the most. Telehealth can be effectively used for patient triage and screening, pre and post-operational care, and remote patient monitoring.
Jamaica now has a unique opportunity to plan for long-term telehealth and virtual delivery of health care services. Inconsistent access to reliable broadband Internet services and the lack of Internet-enabled devices, especially among patients in lower income brackets and rural settings, remain formidable obstacles that must be overcome to make telehealth possible for the majority. We remain available to assist the nation at no direct cost in leveraging this innovation to expand access to care for the majority and optimising the utilisation of limited human capacity in health care.
(3) Supply chain and logistics need for national stockpiles of critical supplies exists
The supply chains around the world have been severely disrupted by the COVID-19 pandemic, with severe limitations in trans-shipment of goods and services. At one stage during the pandemic, personal protective equipment designated for many poorer countries were either stopped or impounded by the richer countries of the world.
Countries like Jamaica that depended almost exclusively on the importation of those products were left scurrying to find supplies for the country. We now know that we have an opportunity to manufacture some of those products at home to avoid being put in a similar situation of disadvantage in the future.
There is an opportunity for countries within the Caribbean region to increase regional cooperation and expand the serviceable market for companies engaged in the manufacture of critical medical supplies. We also had severe disruptions in the supply of life-saving equipment and medications for our citizens from overseas suppliers. We were deficient in the projected ventilator needs for the country based on estimates from the impact in New York and Italy.
Unless a solution is found, the lack of a predictable supply chain for essential materials will continue to hobble health care facilities and impede the delivery of quality care for Jamaican patients. While it is neither feasible nor practical for Jamaica to manufacture most medications at home, what is doable is a private-public sector initiative to develop a centralised larger purchasing power to engineer a global purchasing agreement with the major suppliers.
A global purchasing agreement will drive down the unit cost of essential products and make it feasible to keep national stockpiles of life-saving medications and equipment that can be activated in times of national emergencies, as we witnessed in the early stages of the COVID-19 pandemic. This requires a more robust and cooperative relationship between the public and private sector health care ecosystems and a recognition by bureaucrats of their responsibility and obligation to support health care development across the board and not just in the public system.
(4) Human capital needs
Jamaica remains under-resourced at all levels in health care. Most nurses trained in Jamaica end up leaving the island because of the perception of better career opportunities in the USA and other countries. Many doctors also leave the island.
Despite the voluntary departures for greener pastures, we now have a situation in which there is limited capacity to absorb those who wish to stay. It was recently reported that about 100 doctors waiting for appointment with the Government could not be absorbed. In a statement credited to the Minister of Health (for which he later apologised), the doctors were advised to seek employment in other Caricom territories or in the private sector. It would have been acceptable advice if Jamaica were already saturated with doctors for the population. However, there are multiple reports that junior doctors in the public sector are overworked because there is a deficit in staffing to match the demand.
The private sector would be a viable option but for that to be an option, the sector would need further development, support, and resilience to be able to create those employment opportunities. There is need to continue to grow both the public and private health care systems, to create the infrastructure and capacity that would attract Jamaican health care providers abroad to return home and to discourage those in Jamaica from leaving. A more robust system will also improve the career trajectory for health care providers locally and lead to better retention of those who leave the Island in search of better career options overseas.
In our subsequent articles, we will further explore these issues and review additional opportunities for health care reimagination in Jamaica post-COVID-19.
About the authors: Dr Ernest Madu, MD, FACC, and Paul Edwards, MD, FACC are Consultant Cardiologists at the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital.