KENWYN NICHOLLS
THE MAIN task of any healthcare system is to provide healthcare services demanded by the population. That the TT health system was “underperforming” in this regard goes as far back as 1988. Although not appreciated then, TT’s health system, as was the case in most developing and developed countries, was already in a struggle to meet 21st century challenges: a longer living population afflicted by largely preventable conditions that are lifestyle-related and socially determined.
The system in place at the time (which, unfortunately, still exists today) was appropriately geared towards acute hospital-centric care, a response to the 20th century challenges posed by infectious disease.
An IDB-funded study performed by foreign-based consultants in 1993-94 revealed the underperformance was, in fact, a mismatch between public healthcare services demanded by the population and what was and had been supplied by successive governmental bodies over the years.
A final report from the contracted consultants (comprising 27 documents) was tabled in 1994. The documents included a national health services plan (NHSP), as the guiding document for the reforms, that detailed how and when changes recommended in the other 26 documents were to be instituted. The health sector reform programme (HSRP) came into being.
In 1996, the IDB approved US$192 million in loan financing (including US$32 million of counterpart funds provided by the government) to rationalise the existing services based on the framework developed by the consultants; the Ministry of Health was the executing agency.
Central to the proposed radical reform of the system was the passage of the Decentralisation Act of 1994 to achieve a patient-driven, bottom-up system that would bring customers (patients) closer to the services: regional health authorities (RHAs) were created. To ensure cohesion in service delivery, the ministry would itself undergo reorganisation to assist policy development, planning, regulating, financing, and monitoring and evaluation of the RHAs.
In respect of service delivery, the HSRP placed emphasis on prevention and health promotion at the primary level with a particular focus on primary-level management of chronic diseases. Why the HSRP did not achieve this latter objective is irrelevant to the intent of this article. Interested parties will find that post-mortems on the fate of TT’s HSRP abound in the relevant literature.
In 2007 the Gafoor Report, the product of a commission of enquiry (CoE) on the TT health services, found a multitude of inefficient services and processes – lab, X-rays, pharmaceuticals, etc – and recommendations were made to correct those deficiencies. In 2015, the incoming government appointed a committee to look into the state of the public health services. The Welch Report was laid in Parliament in 2017 but was not debated.
Fast-forward to November 19, 2023. At a meeting convened by the Joint Select Committee for Social Services and Public Administration, patients and nursing staff offered
