SECTORAL PRESENTATION SECTORAL PRESENTATION WEDNESDAY JULY 15, 2009 WEDNESDAY JULY 15, 2009 HON. RUDYARD SPENCE HON. RUDYA RD SPENCER, OD, MP. R, OD, MP. MINISTER OF HEALTH NISTER OF HEALTH TRANSFORMING HEALTH FOR NATIONAL DEVELOPMENT ___________________________________________ Acknowledgements Mr. Speaker: I am honoured to once again stand in this Honourable House to report on the performance of the health sector over the last financial year and to share with the people of Jamaica some of the priority areas for this current financial year.
First of all, I would like to thank my Constituents who gave me the mandate to represent them in this Parliament. I thank them for their patience over the last year and a half as I try to balance the most challenging portfolio Ministry with my duties as Member of Parliament. I thank the Prime Minister for the confidence that he continues to repose in me in assigning me this portfolio and for the support that he continues to give to the health agenda. I thank Senator Aundre Franklin, Parliamentary Secretary in the Ministry on whose consistent support I rely to manage this challenging and complex portfolio. Mr. Speaker: I must recognize the tremendous work of the staff in the public health sector. I thank the Permanent Secretary for her leadership of the public health sector through the most challenging decade in global health. Dr. Allen Young was appointed as Permanent Secretary in 2001 and has therefore been at the helm of the ship for the development and implementation of some of the most far-reaching policy interventions. I speak of the National Health Fund, the abolition of user fees for minors and the wholesale abolition of user fees last year. She was also the chief architect of the Jamaica Drugs for the Elderly Programme which was introduced in 1997 which has been an outstanding success. Dr. Allen Young will proceed on pre-retirement leave effective September 1, 2009. On behalf of the health sector in Jamaica and this Honourable House, I wish her well and thank her on behalf of the people of Jamaica for her decades of service to the health sector in both the public and private sector. Mr. Speaker, I thank the Chief Medical Officer, Dr. Sheila Campbell Forrester and the thousands of health workers who continue to go beyond the call of duty for the people of this country. I recognize the work of the management and staff in all of our agencies and departments. 2
Our development partners continue to provide outstanding support to advance the health agenda of the country. I would like to mention: The Pan- American Health Organisation/World Health Organisation; The United Nations and its organs The United States Agency for International Development (USAID) The Caribbean Epidemiology Centre (CAREC) Various local and overseas based educational institutions The Caribbean Community (CARICOM) Individual governments such as the Governments of Cuba, Mexico, Spain and the Republic of Korea Volunteer Missions, including members of the Jamaican Diaspora I would also like to mention the many organizations in Jamaica in the private and non- governmental sectors that continue to work toward the achievement of the health agenda. Introduction Mr. Speaker: Last year when I made my maiden presentation in the Sectoral Debate, I indicated to this Honourable House that I was doing so “at a time of great challenge and change in the global and local arenas”. That was true then, but nothing could have prepared us for what was to follow. Following on the fuel and food crises of last year, the world found itself in the grip of a recession that is the worst since the 1930s and the Influenza A H1N1 pandemic. I believe that these global threats are unprecedented and threaten to undermine the social fabric of countries and pose the most serious challenge to human security in the world. Mr. Speaker: 3
There should be no doubt in this Parliament about the strategic value of health to the transformation of the Jamaican society and the critical role that it must play in reconstructing the social landscape of our country. My presentation will be located within the context of the transformative agenda for health which will require the unrelenting commitment of this Parliament and a re-engagement of the people of Jamaica through a re-invigorated programme of health promotion. Grave Global Developments Mr. Speaker: The Jamaican people need to be aware of the gravity of the global situation which is likely to impact negatively on health spending, health service delivery, health seeking behaviour and health outcomes. The working poor are expected to reach 1.4 billion according to the Global Employment Trend. Fifty million (50 million) people are projected to be added to the unemployment line and some 200 million people will be pushed into poverty. In addition, 40 million more people will suffer from malnutrition. The Economic Commission on Latin America and the Caribbean (ECLAC) projects growth of 1.9% for the Region after six years of consecutive growth averaging nearly 5%. Foreign Direct Investment to the Region is estimated to decline 35-45% this year. A Transformative Agenda Mr. Speaker: 4
The cumulative effects of the global recession, the influenza pandemic and the impacts of climate change require the development of the most farsighted and coherent health strategy and a convincing, rational and fully developed vision of any government in the postmodern era in Jamaica. We have decided to use the vehicle of transformation to reconstruct the bedrock foundation of Jamaica’s health sector, that is, the primary health care approach. This is the single most profound strategy that will simultaneously address those fundamental issues of equity, quality, access and community ownership, health promotion and social participation in health. The transformative agenda transcends a purely clinical response to the health needs of the Jamaican people and addresses the social determinants of health in the nation. The achievement of the Millennium Development Goals (MDGs) and Vision 2030 for Jamaica will depend on our ability to transform the health sector. A critical plank of the transformation is the abolition of user fees, which, as we indicated to the Jamaican people we would use as the impetus to re-position the health sector. The other planks of the transformation agenda are: Renewal of primary health care; and the, Restructuring of the Ministry of Health and the RHAs Abolition of User Fees Mr. Speaker: This Honourable House will recall that this Government took the bold decision to abolish user fees at public health facilities on April 1, 2008 led to many criticisms. Today, I wish to bring to the attention of the Parliament of Jamaica irrefutable evidence in support of that policy intervention. Studies have shown that even where best practice conditions for implementation do not exist, as is the case of developing countries, patient utilisation increases especially among the poor. 5
This has been the situation in South Africa, Zambia, Uganda, Burundi, Madagascar, Zimbabwe and Jamaica both in respect of the free health care policy for children in 2007 and the subsequent wholesale removal of user fees last year. Furthermore, there is compelling evidence of a link between user fees and poverty. A study carried out in eleven low to middle income countries in Asia has shown that 78 million people were pushed below the international poverty line because of out of pocket payments. Separate studies conducted in Burundi, Ethiopia and Kenya have shown that user fees have reduced people’s asset base leading to what is being called the “medical poverty trap phenomenon”. Mr. Speaker, I am proud to announce that since the abolition of user fees policy last year, this Government has saved the Jamaican people $ 2.214 billion dollars . In terms of patient utilization, the first year of abolition saw patient utilization increasing from 809,925 to 904,726 or 11.7% at Accident and Emergency Departments at public hospitals. Visits to the Accident and Emergency Department of KPH increased from 59,302 to 72,997 or just over 23% in the abolition year compared to the previous year. This compares to an 11.1% decline at the University Hospital of the West Indies where user fees were retained. Total admissions from Accident and Emergency increased from 166,684 to 173,703 in the abolition year, a 4.2% increase. Preliminary figures show health centre visits moved from over 1.48 million to more than 1.8 million representing a 17.4% increase in the abolition year. Pharmacy recorded the highest jump in utilization moving from 145,395 in 2007/08 when compared to 209,728 or an increase of over 44% in the first year of abolition. Mr. Speaker: 6
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