KENWYN NICHOLLS
UNHAPPINESS with the performance of the TT health sector, simmering as it has been for some time now with grievances that vacillate from lost charts to extended wait times, to unavailability of critical drugs, to yet inexplicable neonatal intensive care unit (NICU) deaths, you name it, boiled over on April 19 last when the editor of a daily newspaper penned a column: "An unhealthy health sector." Eight days later, May 8, a featured columnist chimed in with: "Healthcare in crisis."
The aim of this article is to explore the issues that have led to this unfortunate juncture and, hopefully, by doing so point the way forward to a successful turnaround.
Disillusionment with the performance of the health sector is not a recent phenomenon. Such negativity is greater than five decades old but a call for definitive action to address the situation did not materialise until 1988 when the government approached the Inter-American Development Bank (IDB) for support in strengthening primary care infrastructure, and to make functional the Eric Williams Medical Sciences Complex (EWMSC), which had been in virtual mothballs since its commissioning in 1986.
The bank did not disfavour the specific request but reached an understanding with the government that such support would take place within the context of a probe of the sector, widely viewed then to be underperforming, ie, not meeting the health demands of the population.
Grant money was awarded by the IDB in 1991, and following an international tendering process, consultants from the UK – Health and Life Science Partnership (HLSP) – contracted to conduct the necessary studies and make recommendations. My role, via a separate IDB contract (1991-1995), was to assist the selection of the consulting firm, oversee the work of the individual consultants, and relay the final report to the minister. The consultants were on the ground for 18 months and tabled their final report – 20 documents – in May 1994.
The detailed findings and recommendations of the HLSP team of consultants exceed the bounds of this article. Suffice it to say that the major finding of the consultant group was that, like most other developed and developing countries of that era, the TT population was living longer with an associated increased prevalence of preventable chronic conditions that were lifestyle related and socially determined: welcome to 21st century health and socio-economic challenges.
An associated major finding was that the health system in place, constructed as it was on acute hospital-centric care – to meet the 20th century health challenges posed by infectious disease – was antithetical to the primary care and public health approach that was required to address 21st century health and social challenges; reform was needed. The Health Sector Reform Plan (HSRP) recommended by the consultants held great promise as the vehicle for the needed reform.
In 1995 the IDB approved an overall loan package of US$192 million (of which US$34 million was counterpart funds provided b
