Kali­fa Clyne

The many prob­lems in the health sec­tor are in­her­ent­ly hu­man re­source is­sues, says Health Min­is­ter Fuad Khan. He said they are too nu­mer­ous to list ful­ly. Khan in­her­it­ed a prob­lem­at­ic health­care sys­tem from his for­mer col­league Therese Bap­tiste-Cor­nelis af­ter a Cab­i­net reshuf­fle in June 2011.

Even be­fore Bap­tiste-Cor­nelis held the post, com­plaints about the state of the health sec­tor were nu­mer­ous. In 2007, af­ter re­ceiv­ing the re­port of a Com­mis­sion of En­quiry in­to the Op­er­a­tion and De­liv­ery of Pub­lic Health­care Ser­vices in Trinidad and To­ba­go, then Prime Min­is­ter Patrick Man­ning pro­posed to send a copy to the Di­rec­tor of Pub­lic Pros­e­cu­tions (DPP).

The com­mis­sion said it had found ev­i­dence of cor­rup­tion or oth­er malfea­sance in the pub­lic health sys­tem. Khan out­lined mea­sures in­tend­ed to im­prove de­liv­ery of ser­vices in the health sec­tor, list­ing spe­cial­i­ty ser­vices, lab ser­vices and the num­ber of beds to ac­com­mo­date pa­tients as the main is­sue he has had to treat with as min­is­ter.

There have been in­ter­mit­tent com­plaints over the years that pa­tients at sev­er­al hos­pi­tals, most­ly the San Fer­nan­do Gen­er­al Hos­pi­tal, had to sleep in cor­ri­dors and on floors be­cause no beds were avail­able. Since then, Khan said, the out­pa­tient clin­ic of the San Fer­nan­do Gen­er­al Hos­pi­tal has been moved to the Chancery Lane Med­ical Com­plex and progress had been made in terms of avail­abil­i­ty of beds.

"So far we have been able to have a quick­er move­ment of pa­tient dis­charge where un­less there is a very high num­ber of ad­mis­sions the bed prob­lem seems to have abat­ed." Beds are not the on­ly prob­lem in pub­lic health­care. Khan said de­vel­op­ment of spe­cial­i­ty pro­grammes such as car­di­ol­o­gy, neu­ro­surgery, read­ing of X-ray re­ports and the need for rapid move­ment in the read­ing of ra­di­ol­o­gy in­ves­ti­ga­tions were ad­di­tion­al prob­lem­at­ic ar­eas in the de­liv­ery of health­care.

"It is most­ly hu­man re­source is­sues. "We are in the process of putting a sys­tem in place so that peo­ple would be able to get car­diac ser­vices such as an­giograms from pub­lic health­care in­sti­tu­tions," he said. Khan said car­di­ol­o­gy ser­vices have al­ways been lack­ing in the pub­lic health sec­tor but the min­istry is work­ing on pro­grammes to deal with that is­sue.

The min­is­ter ad­mit­ted that T&T has long-term prob­lems with staffing pub­lic med­ical in­sti­tu­tions. "The re­mu­ner­a­tion pack­ages giv­en to doc­tors and spe­cialised nurs­es does not au­gur well for them to en­ter in­to the pub­lic ser­vice." He said this was the rea­son he felt re­gion­al health au­thor­i­ties should de­ter­mine the salaries of their staff rather than re­ly­ing on the Chief Per­son­nel Of­fi­cer (CPO).

"The RHA acts al­lows the au­thor­i­ty to do ne­go­ti­a­tions with their staff ex­cept for salaries and al­lowances in ex­cess of $150,000 per year which must be ap­proved by the min­is­ter." Khan said be­cause salaries are not com­pet­i­tive it is dif­fi­cult to get nurs­es and doc­tors to stay in the pub­lic sec­tor.

"Right now we have space in the ICU and no nurs­es. I need to pay them more be­cause the CPO did not give them what they asked for, al­though they gave the To­ba­go peo­ple more, and I find that strange." The min­is­ter hopes that if doc­tors and nurs­es are giv­en bet­ter renu­mer­a­tion, "renu­mer­a­tion that is in line with pri­vate hos­pi­tals," they would be able to re­tain them in the pub­lic sec­tor.

That alone won't fill all the va­cant po­si­tions in the sec­tor though. The min­istry is work­ing with the Min­istry of Ter­tiary Ed­u­ca­tion to de­vel­op a pro­gramme to train more nurs­es. "I have sent a note to Cab­i­net to start back train­ing nurs­es at dif­fer­ent lev­els," said Khan.

The need for nurs­es will be­come even more ap­par­ent once the chil­dren's hos­pi­tal to be built in Cou­va is com­plet­ed and when re­fur­bish­ment of sev­er­al in­sti­tutes, in­clud­ing the San­gre Grande Hos­pi­tal, the Ari­ma Hos­pi­tal and the Women's Hos­pi­tal at the Er­ic Williams' Med­ical Sci­ences Com­plex (EWM­SC) are com­plete.

Khan said these are all works in progress. He said the Uni­ver­si­ty of the West In­dies (UWI) asked for more places to train clin­i­cal doc­tors. At present doc­tors are trained at UWI, St Au­gus­tine; the San Fer­nan­do Gen­er­al Hos­pi­tal and the EWM­SC. He said he is work­ing with the re­gion­al health au­thor­i­ties so that every hos­pi­tal could be­come a teach­ing hos­pi­tal.

"I am al­so hop­ing to get health cen­tres to open 24 hours in or­der to bet­ter serve the pub­lic and fo­cus on cus­tomer ser­vice at every hos­pi­tal." Khan said one of his big­ger fail­ures was deal­ing with the den­tal pro­grammes in the coun­try. There is no den­tal de­part­ment at the Port-of-Spain Gen­er­al Hos­pi­tal.

The EWM­SC has a back­log for den­tal surgery and den­tal ser­vices at most health cen­tres are not prop­er­ly avail­able. "We are try­ing to pro­duce a pro­gramme to in­crease den­tal care in the coun­try but it doesn't seem to be work­ing," Khan said. "It is some­thing I will have to look at again."