Health reform refers to the changes in health administration, health planning and, health research that places significant emphasis on local health challenges aimed at improving health administration, health planning and healthcare. They will combine to produce an efficient model of healthcare delivery capable of increasing patient physical, medical and psychological safety. Health reform should be driven by empirical data, best practice and evidence based practice. A variety of health statistics; such as mortality, manpower needs, technology functioning and patient satisfaction; should be analyzed and employed in strengthening health systems.
In Trinidad and Tobago the current system of healthcare is highly centralized. The Ministry of Health maintains operational oversight of five regional health authorities. These are the North West Regional, North Central Regional, Eastern Regional, South West Regional and Tobago Regional. South West, North West and North Central are the largest regions; each catering for the healthcare needs of more than three hundred thousand people.
A significant reform should be the specialization of the Ministry of Health in fewer functions aimed to improve healthcare efficiency. For example, it can concentrate on data compilation and analysis. It should be staffed with expert health researchers tasked with analyzing changes in epidemiology, and trends in morbidity and mortality. Furthermore, the Ministry of Health should have the power to instruct regional authorities to make systemic and resource changes based on the statistics collected and analyzed. Regional bodies should be mandated to provide health based statistics to the Ministry of Health quarterly. The Ministry of Health must maintain general oversight of regional authorities. It should produce annual reports based on self- monitoring and evaluation of the systems, performances and challenges in each region. Financial statements and audits should be submitted annually to the Ministry of Health and factors accounting for variance should be justified. Recommendations should be made for improvements and incidences of white-collar crime prosecuted.
One major reform that should be implemented is granting absolute autonomy to regional health authorities for the delivery of healthcare. They should be able to generate their own funds by charging fees for their services. This would eliminate dependency on the state or Ministry of Finance for funding. Each regional health authority should be able to invest in the stock market or undertake other income generating measures it deems feasible. Its funds should be spent in accordance with the health needs of the population it serves. Regional authorities should be responsible for primary, secondary and tertiary healthcare. In addition, they should be given oversight of private hospitals and health facilities in their geographic regions. Private facilities should be subject to price controls to avoid exorbitant charges and should be required to pay at least ten percent of their annual profit to the regional authority.
In addition, regional authorities should have the power to ensure that all health institutions and providers adhere to national accreditation standards. The Ministry of Health should be charged with responsibility for developing national accreditation standards in all aspects of the operations of health institutions. These should include hospitals, pharmacies, private practice. Also conventional and alternative medicines should be subject to accreditation standards. Everything and every health based institution should be subject to accreditation standards comparable with those of more developed countries such as Canada and the United States.
It is palpable that the boundaries of each regional authority be redefined so that they are of almost equal population size. At this time South West Regional is responsible for slightly over one half million people. Therefore given its limited resources, it cannot be expected to perform with greatest efficiency. Given the fact that the better health facilities are situated in urban centers, this would be a challenge that must be overcome judiciously. To accommodate this reform, regional authorities should induce joint public and private partnerships in the provision of healthcare centers in rural and other districts less accessible to major hospitals and health centers.
To make the health system efficient, a centralized electronic health record system should be developed and implemented. This would ensure that patients could access care in any region. Thus it would make it easy to access health records from any healthcare facility owned and administered within any regional authority. It is expected that the Ministry of Health should take a leading role in this enterprise. Records of patients in private hospitals should be accessible to regional authorities given that they may be moved to a public hospital if the care they require cannot be attained there. Sometimes for financial reasons such as exorbitant cost, patients may be moved to a public hospital.
Employment policies should enable the free movement of skills and expertise across regions. In some instances, highly specialized surgeons and caregivers should be made available to patients in other regions on a needs basis. In other words, one region can pay another for the services of its skilled human or physical resources demanded.
Regional bodies can collaborate in health planning. They can develop their strategic, business and budget plans cooperatively. Afterwards they can tweak their plans to fit their population needs. The main advantages of centralized planning will be greater transparency, accountability and inter-operational functionality. Inter-planning can reduce competition between regions and ensure that scare resources are used efficiently. In effect, the Ministry of Health can compare operational effectiveness and best practice across all regions and provide opportunities to strength operational or institutional efficiency.
The health system should be reformed so that it is able to provide high quality care for patients. Patients should be well-educated to take advantage of a competent, highly organized and skillfully administered healthcare system. Finally reform must involve all stakeholders; government, private practitioners and citizenry. A convergent bottom up and top down model should be adopted so that there is universal buy-in to health reform capable of contributing to economic and social development of the country’s human capital.
This article contains suggestions for health sector reform in the small island nation state of Trinidad and Tobago. If these and other reforms are adopted, the nation’s overall health will be improved. Its citizens would benefit from a well administered system.