Suggestions for Health Sector Reform in Trinidad and Tobago
Health reform relates to changes in health management, health planning and health research that focus on local health issues aimed at improving health management, health planning and health care. They will be combined to create an effective health model that can improve the physical, medical and psychological safety of the patient. Health reform should be guided by empirical evidence, best practices and evidence-based practices. A variety of health statistics; such as mortality, labour force needs, technology principles and patient satisfaction; should be analysed and used to strengthen health systems.
In Trinidad and Tobago, the current health system is highly centralized. The Ministry of Health oversees five regional health authorities. These are the Northwest, Northwest, East, South West and Tobago regions. The south-west, north-west and north-central are the largest regions; each of them meets the medical needs of more than three hundred thousand people.
The main reform should be the specialization of the Ministry of Health on fewer functions to improve the efficiency of health care. For example, it can focus on data collection and analysis. It should be staffed by experienced health researchers to analyse epidemiological changes and trends in morbidity and mortality. In addition, the Ministry of Health should have the right to instruct regional authorities to make systemic and resource changes based on collected and analysed statistics. Regional authorities should be empowered to provide health statistics to the Ministry of Health on a quarterly basis. The Ministry of Health should control the regional authorities as a whole. It should compile annual reports based on self-monitoring and evaluation of systems, indicators and problems in each region. Annual financial statements and audits should be submitted to the Ministry of Health, and factors explaining the deviations should be taken into account. Recommendations should be made to improve and prosecute white-collar crimes.
An important reform that needs to be undertaken is to give regional health authorities absolute autonomy in providing health care. They should be able to generate their own resources by charging for their services. This will eliminate the need to rely on the Government or the treasury for funding. Any regional health authority should be able to invest in the stock market or take other income-generating measures that it deems appropriate. The money should be spent in accordance with the health needs of the serviced population. Regional authorities should be responsible for primary, secondary and tertiary health care. They should also be monitored in private hospitals and health facilities in their geographical region. Private enterprises must be subject to price controls to avoid excessive costs, and must be required to pay at least ten per cent of their annual profits to the regional government.
In addition, regional authorities should have the right to ensure that all health facilities and health care providers comply with national accreditation standards. The Ministry of Health should be responsible for developing national accreditation standards for all aspects of health facilities. This should include hospitals, pharmacies and private practices. Conventional and alternative medicines must also meet accreditation standards. All health facilities must meet accreditation standards comparable to those of more developed countries such as Canada and the United States.
It is felt that the boundaries of each regional government are being revised, so that they have almost equal population. The South-Western region is now responsible for just over half a million people. Therefore, given its limited resources, it cannot be expected to function optimally. Since the best health facilities are located in urban centres, this task should be approached wisely. To make this reform possible, regional authorities must establish joint public and private partnerships to establish health centres in rural areas and other less accessible to large hospitals and health centres.
To make the health care system effective, a centralized system of electronic medical records must be developed and implemented. This would provide access to care for patients in all regions. Thus, it will be easy to access the medical records of any medical facility owned and administered by the regional authorities. The Ministry of Health must play a leading role in this effort. Patient records in private hospitals should be available to the regional authorities, as they may be transferred to a public hospital if they cannot be provided with the care they need. Sometimes, for financial reasons, for example, because of exorbitant costs, patients are transferred to a public hospital.
Employment policies should allow the free movement of skills and competencies between regions. In some cases, highly specialized surgeons and health workers should be available to patients from other regions. In other words, one region can pay another for the required services of skilled personnel or physical resources.
Regional authorities can cooperate in health planning. They can jointly develop their strategic, business and budget plans. They can then tailor their plans to the needs of their employees. The main advantages of central planning are greater transparency, accountability and interoperability. Interplaning can reduce competition between regions and ensure the efficient use of intimidating agents. In fact, the Ministry of Health can compare operational efficiency and best practices between regions and provide opportunities to improve operational or institutional efficiency.
The health care system needs to be reformed so that it can offer patients high quality. Patients should be properly trained to benefit from a competent, well-organized and professionally managed health care system. Finally, all stakeholders must be involved in reform; government, private practitioners and citizens. A bottom-up and top-down model should be adopted to ensure universal compliance with health care reform, which can contribute to the economic and social development of the country’s human capital.