Jamaicans who are familiar with long waits for attention in public hospitals, protracted periods waiting for doctors to become available, and sleeping on chairs because there are no beds available are already quite familiar with the challenges facing the health sector in the country.
Of particular focus has been the extent to which infrastructure is keeping pace with population expansion in Kingston, St Andrew and St Catherine, the island’s main urban centres.
In these three parishes, health challenges are worse because of continued population growth. A background on the shortcomings is presented by the Ministry and Health and Wellness itself in its 10-year Strategic Development Plan for the health sector, now in its fourth year of implementation.
Among the challenges faced by the system it is outlined that health worker density is poorly aligned with hospital admissions and the number of health centre visits.
The report also highlights low hospital bed rates relative to population, with hospital wards functioning largely at excess capacity, and medical equipment in hospitals being poorly maintained as there are insufficient funds for maintenance.
The report also cites mortality rate in hospitals; noting that general death rates appear to be increasing, suggesting a decline in the quality of care, while maternal mortality rates appear to have increased since 1990.
The strategic plan also notes “fragmentation in the broader health system: There is no integrated care system, which is increasingly important given the growing proportion of the population with chronic diseases”.
In a July 2020 address Minister of Health and Wellness Christopher Tufton said non-communicable diseases (NCDs) continue to be problematic, with some 70 per cent of Jamaicans suffering from an NCD, including diabetes, hypertension and cancer, in addition to mental illness.
In speaking with the Business Observer for this review, the minister said that the Government of Jamaica was pressing ahead to upgrade hospitals in the ‘catchment area’, noting that challenges were not only population increase but continued high levels of illness from NCDs and trauma due to violence.
He said the Government has been undertaking major infrastructure upgrades to hospitals across the island, including Spanish Town Hospital in St Catherine; May Pen Hospital in Clarendon; Bustamante Hospital for Children and the University Hospital of the West Indies (UHWI) in St Andrew.
Dr Tufton noted that some communities in St Catherine made more use of May Pen Hospital, which is being upgraded, even though it is over the parish line.
He noted that the Government is also moving to retrofit health facilities across the island, including service centres in Kingston, St Andrew and St Catherine. The Government is to spend approximately $3.5 billion on the expansion of Spanish Town Hospital, upgrading it to a Type A facility.
Hospitals in Jamaica are either Type A, B or C. As a Type B facility, Spanish Town Hospital was limited in terms of specialist services it provides. The upgrading will, therefore, enable the facility to better serve the wide range of cases from St Catherine and neighbouring parishes.
Type A facilities provide comprehensive secondary and tertiary health-care services and are the final referral points for public and private hospitals. Plans are in train for upgrading Kingston Public Hospital (KPH), while a new tower is being planned for UHWI and is more advanced in implementation.
Dr Tufton, in comment on capacity challenges, told the Business Observer, “It is true that population has expanded over time putting more pressure on infrastructure and personnel.” However, he noted the upgrade of centres such as UHWI will mitigate some of the challenges being experienced.
He said, “The new tower which is now in its design phases will convert the hospital into a larger and more modern facility,” adding that it is a $20-million to $30-million investment.
The health minister said that the focus on UHWI is due to its position as a tertiary level institution dealing with not just services, but training also.
Meanwhile, Spanish Town Hospital is at the closing stage of a major expansion. Dr Tufton noted that this hospital has also benefited under a European Union funding facility dealing with mother and childcare.
Bustamante Hospital for Children in St Andrew, meanwhile, he pointed out, has been upgraded to include a new cardiac unit, and there are design plans in place to expand ward space and bed space. This project is being done in conjunction with the private sector and the Government of Jamaica. There are also discussions taking place around the upgrade of Kingston Public Hospital, but these are “very preliminary”, the minister stated.
At the same time and in tandem, four health centres are being upgraded with an emphasis on preventative health care. The Government has received two loans from the Inter-American Development Bank (IDB) to support the Health Systems Strengthening for the Prevention & Care Management of Non-Communicable Diseases Programme.
As noted in related documents, the programme’s objective is to improve the health of Jamaica’s population by strengthening comprehensive policies for the prevention of non-communicable (chronic) diseases (NCDs) risk factors and improved access to an improved primary and secondary health-care network in prioritised areas with an emphasis on chronic disease management.
The centres are all in St Catherine – one in Portmore, one in St Jago, and one in Old Harbour to deal with expansion. Kitson Town has been completed.
The Government has also opened a new pharmacy at Linstead Hospital and built a new health centre in Watermount, both in St Catherine. A new centre was also constructed in Stony Hill which is now operational.
The Government has additionally signed a US$8.5-million contract with telecoms provider Flow for equipment and computers to digitise and make medical services in all centres more efficient, Dr Tufton said, noting, “Doctors can send information without physically walking. We have also added additional personnel, including more posts for nurses, more health aides, and more mental health [care workers]. We have about 1,500 community health aides across the country.”
It gas also commissioned a new cancer treatment centre at the St Joseph’s Hospital in St Andrew, plus an additional ward, which, although now being used for COVID-19 treatment, will ultimately be converted to more bed space.
The health minister admitted that one area of challenge was medical equipment. “We need to now do more on equipment for diagnostics.” To manage this challenge, the Government has put in place an outsourcing programme by which private entities are paid for diagnostics. A total of $900 million was spent on the programme in 2020. The programme was again renewed for $1 billion in 2021.
For this programme there is no co-payment. Patients are referred through the public health system and their tests carried out without charge to them.
Tufton, in conclusion, boasted, “We don’t have many complaints anymore of people spending extended time in hospitals because they can’t do tests. Now that they have on-demand testing they do not have to wait. That’s a good outcome. We have improved the transaction time. We have also introduced a compassionate care programme. Less time spent in hospital means more throughput.”
He noted that, in the long run, the region will also benefit from the capacity buildout to deal with the treatment of the novel coronavirus disease.
“There is a field hospital in Spanish Town and one at the UHWI which add more bed space. In the future the expanded hospitals will add more beds and better working conditions.”
He said he felt that efforts have been commendable to keep up with the demand of more people suffering from premature illnesses, NCDs, violence, and trauma.
Regarding infrastructure plans which are only in the concept stage, the health minister stated, “The truth is that we have more infrastructure development and plans for more to come, but it is a certainty because the money is already in place.”
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