THOUSANDS MORE ACCESSING PUBLIC SECTOR HEALTH CARE

By: LATOYA PENNANT

Minister of Health, Hon. Rudyard Spencer (left), emphasises a point during a Media Briefing held at Jamaica House in June, after the first two cases of Influenza A H1N1 were confirmed in Jamaica. Providing technical support were Chief Medical Officer in the Ministry, Dr. Sheila Campbell-Forrester (centre) and Director of Emergency, Disaster Management and Special Services in the Ministry, Dr. Marion Bullock Ducasse.

One of the major successes of the Ministry of Health in 2009 is the dramatic increase in the number of persons, particularly the poor, who are using the public health facilities, following the implementation of the Abolition of User Fees policy in 2008.  Jamaicans have also saved  a lot of money  as a  result of the policy.

Health Minister, Hon. Rudyard Spencer, told JIS News  that this initiative has saved Jamaicans $2.2 billion, with thousands now seeking health care through public health institutions.  

“This policy has increased the disposable income of Jamaicans and has removed a major impediment to access to health care for poor people," the Minister pointed out.

"The Government will not renege on its responsibility to the people of Jamaica from whom it has received a mandate to implement this policy. In the face of the worst economic recession in 70 years, it would be unthinkable and unjust to impose user fees on the poor and vulnerable. Now is the time to advance pro-poor and pro-health public policies to protect the incomes of the poor and safeguard their lives," Mr. Spencer added.

Data from the Ministry showed an 11.7 per cent increase in patient utilisation of the Accident and Emergency Departments at public hospitals, moving from 809,925 to 904,726 patients. Visits to the Accident and Emergency Department of the Kingston Public Hospital increased from 59,302 to 72,997 persons, or just over 23 per cent year. Conversely, there has been an 11.1 per cent decline in usage at the University Hospital of the West Indies, where user fees were retained.

Recorded visits to health centres have increased from  1.48 million to more than 1.8 million, representing a 17.4 per cent  increase.   

The abolition of user fees has also provided an opportunity for HIV infected persons to have greater access to services and drugs. 

Dialysis Treatment 

In June 2009, the Nephrology programme of the public health sector was boosted with the addition of 17 haemo-dialysis machines, valued at US$386,000. These were commissioned into service at the Kingston Public Hospital (KPH) and replaced the 15 units that were previously in use. The equipment acquired, which include two portable machines and a reprocessing system, have boosted the capabilities of the Renal Dialysis Unit, which provides medical treatment for persons affected by kidney disease.

The units were provided through the combined efforts of the Kidney Support Foundation, the National Health Fund (NHF), the South East Regional Health Authority (SERHA) and the Culture, Health, Arts, Sports and Education (CHASE) Fund. A total of US$30,000 has been earmarked for maintenance of the machines over a three-year period.  The Katie Hoo Clinic in Spanish Town, which offers dialysis treatment and services, also came into full operation this year.

“Nobody should have to travel more than 30-35 minutes to access dialysis services; and so we are going to every one of our health facilities to ensure that they offer dialysis treatment. Today, more Jamaicans are getting dialysis three times a week and they are in comfortable surroundings," the Minister said.

An on-going training programme has also been implemented by the Ministry to train nurses to use the machines.

Primary Health Care

Achievement of the health related Millennium Development Goals (MDGs) and Vision 2030 for Jamaica, will depend on the nation’s ability to transform the health sector. The renewal of primary health care remains a key area of the Ministry’s transformative agenda. 

Based on the recommendations from a Pan American Health Organisation (PAHO) supported consultancy that was undertaken last year to determine the strategic and action plans for the renewal of Primary Health Care. the Ministry has set about defining what the scope of services ought to be. They have also identified the need to improve the health information system throughout the health sector and optimise the use of human resources working in primary health care.

In keeping with the administration’s thrust to renew primary health care, rehabilitation work has started on some health centres, by way of some J$300 million in funding secured from the NHF. The Ministry is currently at varying stages of tendering, contracting and undertaking pre-construction works for centres  at Islington, Retreat, Gayle, Denham Town, Dallas, Darlow, Halse Hall, Milk River, Porus and Bethel Town.

Health Information System

An important need highlighted during the PAHO supported consultancy was that of improving the health information system throughout the health sector and optimising the use of human resources working in primary health care.

The Ministry has taken on the recommendation and already, sections of the country’s health sector have started to benefit from a US$1.5 million health information system initiative, funded by the Republic of Korea.

This support will see the implementation of a patient management information application for Jamaica’s public sector facilities. The system will also provide an information management facility at the Ministry to receive, generate, process and issue data, including patient and utilisation information that is generated at health facilities. A national health information website will also be established to improve communication with the public and stakeholders’ access to health information.

A pilot project of a Patient Management information application commenced at the Kingston Public Hospital (KPH) in August and will start at the Victoria Jubilee Hospital in Kingston soon.  

A Local Area Network (LAN) will be implemented at the KPH and the Victoria Jubilee Hospital, software and hardware installed and support maintenance provided for two years. Personnel from the Ministry will be trained in South Korea to enable the Ministry to manage, operate and maintain the system after the Korean support has ended.

Human Resources in Health Project

The Ministry, in collaboration with the University of the West Indies, Dalhousie University in Canada and the Pan American Health Organisation/World Health Organization (PAHO/WHO), has undertaken an in-depth human resource needs-based study of the Jamaican public health sector.

The report of the study submitted so far reveals general shortages across the health workforce, particularly in some professions and in some regions of the country. In addition to this, a severe shortage of dentists in the public health sector and a significant shortage of rehabilitation specialists in speech and occupational therapy have been identified.

Following this collaborative effort, the Minister recently announced that Jamaica has been selected as a Centre of Excellence for Health Workforce Planning. The Centre, he noted, will be funded by PAHO and the International Affairs Directorate, Health Canada Biennial Work Plan. Jamaica’s Centre of Excellence is a place where country leaders, institutions, researchers, and policy makers from the sectors of health, education, finance, and labour will come together with the common goal of providing quality health care to all people through a well-trained, well-placed, motivated workforce. 

Training

The need for highly trained health workers to fill severe shortages in the health sector, has seen the Ministry taking steps to train persons  in a number of vital areas.

In light of the shortage of pharmacists and the difficulty to attract staff from the private sector, the Ministry commenced training of Pharmacy Technicians who will assist pharmacists in day-to-day activities. Two cohorts comprising 30 persons have already been trained and the third cohort is close to completing their training.

The number of Dialysis Technicians entering the health sector is also expected to increase, with the opening of a training school at the Lionel Town Hospital in Clarendon.

The Ministry is now in the process of renovating a building that will house the training facility. The programme, which is a collaborative effort of the Ministry of Health, the University of Technology (UTech) and the National Health Fund (NHF), was officially launched by Minister Spencer on September 23. 

Workshops for Health Professionals

The Ministry also staged a number of workshops to heighten the awareness of health professionals about the needs of persons with disabilities. The content of the training included, among other things, a comprehensive list of non-governmental and Government organisations that provide support services for persons with disabilities.

HIV/AIDS Treatment, Care and Support

With the increasing spread of the worldwide HIV/AIDS pandemic, the Ministry of Health is reporting positive news that Jamaica has been making significant strides in HIV/AIDS treatment, care and support.   The HIV prevalence rate in Jamaica has remained fairly stable and approximately 80 per cent of persons living with HIV are on anti-retroviral drugs.  

More than 90 per cent of HIV positive infants are said to be receiving anti-retroviral drugs and over 85 per cent of HIV infected mothers are receiving highly active anti-retroviral therapy.   HIV infected persons now have greater access to services and drugs through the abolition of user fees policy. 

Additionally, the new National HIV/STI campaign was launched on December 1, under the theme, ‘Yes I Can...Support Someone Living With HIV/AIDS’. This theme not only speaks to increasing Universal Access to drugs, but it also aims to achieve marked behavioural/attitudinal change among Jamaicans with regard to their approach to persons living with HIV/AIDS.  

Government of Jamaica Health Card

In August, the Ministry unveiled and launched the Government of Jamaica Health Card. This will enable Jamaicans to more easily access drugs on the Vital, Essential and Necessary (VEN) list, free of cost.  Registration for the new health card began in September and is so far on target.   Use of the card will come into full effect in February 2010. The card will be used to fill prescriptions obtained from public health institutions, at all public sector pharmacies and selected private sector pharmacies.

Minister of Health, Hon. Rudyard Spencer (third right), listens keenly as Sister in charge of the Renal Dialysis Unit at the Kingston Public Hospital (KPH), Ms. Christine Russel-Harris , explains the specifications of a haemodialysis machine, as they are being utilised by patients, during a tour of the Unit. Occasion was the handing over of 17 haemodialysis machines to the Unit at the hospital, located in downtown Kingston, on Wednesday, June 10. Chairman of the Southeast Regional Health Authority, Mr. Littleton Shirley, also listens attentively to Nurse Russel-Harris.

"We promised the nation that we would revise the VEN list. We completed the revision and the new list has an additional 142 items to bring the full List to 738. We have included more drugs for conditions such as cancer, cardiovascular diseases and diabetes. We have begun to sensitise our doctors on the new additions. We therefore expect to see an improvement in the availability of drugs," the Minister told JIS News.

Twenty-two new pharmacies signed contracts with the NHF to provide NHF card benefits, bringing the total number of NHF card providers to 422.

The Minister  has also disclosed that efforts are far advanced in sourcing cheaper pharmaceuticals for the public health system. The Ministry is expected to save approximately $300 million  through this venture.

Increased Access to NHF Benefits

The Ministry has also recorded a significant increase in the number of persons accessing benefits under the NHF in 2009.  During the period October 1, 2008 to October 31, 2009, the NHF paid out approximately $1.95 billion for just over  two million claims received from individual benefit cardholders, representing a $43 million increase over the previous year. The two million claims represent a 17 per cent increase over the previous year, with senior citizens registered under the Jamaica Drug for the Elderly Programme (JADEP) accounting for 761,000 of the submissions received, a five per cent increase over 2007/08.   This achievement was in large part attributed to the partnership of the NHF with the private pharmaceutical providers.

The NHF card beneficiaries received on average, a 56 per cent subsidy from more than 1.88 million prescriptions filled.

The Ministry has also reported success in the number of persons now enrolled for the NHF cards. Enrolment with the NHF at the end of March 2009 reached a total 404,615 persons for the NHF card for all ages and  the JADEP Card. The number of persons enrolled for the NHF card reached 208,488, while for JADEP the enrolment now stands at 196,127. This is a 16 per cent increase, compared to the end of March 2008, when there were 350,304 persons enrolled.

Influenza A H1N1 Virus

On April 26, 2009, Jamaica was alerted by the World Health Organization (WHO) to a Public Health Emergency of international concern, under the International Health Regulations (2005). The Influenza A H1N1 virus, formerly Swine Flu, had by this time claimed the lives of a number of individuals in Mexico and the United States and had become a matter of urgent concern.

The Ministry took swift action and on the instructions of the Minister, activated its National Emergency Operations Centre a day later, on April 27. A multi-sectoral approach was taken and the National Disaster Preparedness Committee met to apprise all the relevant stakeholders of their role in this global situation.

The Ministry heightened surveillance for unusual outbreaks of influenza-like illnesses and severe pneumonia and began preparing the health sector to ensure early detection and treatment and control of the virus. They also strengthened surveillance and monitoring activities at all ports of entry. Health alert cards were issued to arriving passengers at both air and seaports and screening areas established for tests to be conducted on persons who displayed visible symptoms of the flu.  

The Ministry also launched an aggressive Public Awareness Campaign, dispatching daily releases imploring persons to practise the relevant preventive measures, in order to prevent the introduction or spread of the virus. 

After successfully staving off the virus for more than a month, Jamaica confirmed and reported its first imported case of the virus on May 29, 2009. Based on the Ministry’s surveillance, Jamaica started experiencing local transmission of the virus on June 22. The country has benefitted from a number of donations of anti-viral medication.

“The Ministry of Health's surveillance is robust and is providing us with up-to-date information on early detection of cases. We continue to follow international guidelines in the testing and treatment of persons with flu-like symptoms. I wish to assure the people of Jamaica that the Ministry of Health is managing the situation and will keep the public informed in a timely manner,” the Minister told Parliament on June 23.

“The H1N1 virus is a public health threat of national concern. We are not taking this matter lightly. We have a team of competent public health specialists and managers who have a fine reputation nationally and internationally for successfully managing public health risks. The country and our people are in good hands. We urge our people to pay attention to the advice of the public health team to co-operate with us, as we seek to minimise and control the spread and reduce the impact on the activities of our people and on sectors,” he added.

Jamaica undertook six main strategies in dealing with the pandemic: Heightened surveillance at health facilities and ports (including informal ports); Early detection, diagnosis and treatment; Infection control in health facilities; Intersectoral collaboration with key entities; Public Awareness, Information and Education; and International Co-operation with regional and international health institutions.

Jamaica/Cuba Eyecare Project

In 2009, the Government reaped remarkable success in phase two of the Jamaica/Cuba Eyecare Project.   Screening activities were expanded to reach 12,000 Jamaicans across the island. Additionally, pterygium and cataract were this year added to the list of eye conditions treated under the programme.

The Government has also made significant strides in its plans to have the programme relocated to Jamaica. On Friday, December 18, Minister Spencer handed over three newly refurbished residences at the facility, which will accommodate Cubans who will now conduct eye surgeries locally. Refurbished at a cost of approximately $6 million, the fully furnished residences will house 22 persons.

The eye care professionals will be working from the new Opthalmology Centre at the St. Joseph's Hospital, Deanery Road, Kingston. This facility is expected to open in January 2010. Under the arrangements, patients who undergo surgery at  St.Joseph's will be sent to the National Chest Hospital to recover.

One of the hospital's wards was also renovated and fitted with 22 beds plus accessories to accommodate the pre-evaluation process and post-operative patient care. It has also been outfitted with offices and access to laboratory facilities.

This follows an agreement that was signed in July between Hon. Rudyard Spencer and outgoing Cuban Ambassador, Gisela Garcia Rivera, to establish the eye care centre at St Joseph's Hospital to provide ophthalmology services for the English speaking Caribbean.

Before, screening was conducted by a Cuban ophthalmologist, who then referred those selected for treatment to the Ministry of Health in Kingston, to be processed and scheduled for surgery in Cuba. Persons were then sent to Cuba for surgeries every 21 days.

Family Planning

The Ministry of Health, through the National Family Planning Board, in 2009 reported modest gains in family planning and reproductive health in the 2008 reproductive health survey published by the NFPB.  Jamaica’s fertility rate is currently at 2.4 per cent, a decline from 2.5 per cent from the last survey in 2002.

The report also drew attention to the sexual practices and behaviours of the nation’s youth, citing a 2.6 per cent decline in reported sexual experience in the 15 to 24 age group.  Abstinence among that same cohort increased from 17.9 per cent in 2002 to 25 per cent in the 2008 survey, with abstinence among young women increasing from 31 per cent to 33.6 per cent in 2008.

Safe Motherhood Programme

In July 2009, the Ministry of Health launched a Safe Motherhood Programme, which aims to, among other things, reduce maternal mortality in Jamaica by 25 per cent.  This programme forms part of the Ministry’s efforts to improve its performance in the attainment of the Millennium Development Goals (MDGs).  The theme of the programme is: ‘Healthy Mother. Healthy Baby. Healthy Family’.

Healthy Lifestyle Programme

The Ministry’s Healthy Lifestyle Programme remains robust, with numerous outreach activities held across the island. In 2009, the Ministry engaged the leaders of faith-based organisations to join their efforts in improving lifestyle practices of Jamaicans.

Over 70 religious leaders attended the workshop at the Jamaica Pegasus Hotel in Kingston, in August, staged as part of the Ministry of Health’s efforts to strengthen the national response to prevent and control chronic diseases, and promote healthy lifestyles.

International Meetings

Jamaica hosted two important meetings in June 2009. The first was a Special Council for Human and Social Development of Ministers of Health and Education in the Caribbean Region, held under the theme: ‘Winds of change: Education and Health Collaborating to Advance Human and Social Development’.

The Latin America and Caribbean Regional Ministerial Meeting, held in support of the 2009 Annual Ministerial Review of the United Nations Economic and Social Council (ECOSOC), was also hosted by Jamaica.