The Budget is a country’s most important policy document. It indicates what the Government considers priorities and what it will spend money on.
If one participated in the consultations leading up to the Budget presentation, one will be looking closely to see whether or not the ideas/suggestions offered at these consultations were taken on board. The devil is in the details. Therefore the Estimates of Revenue and Expenditure will be most significant.
The Budget is a means by which the Government “walks its talk”. It is therefore necessary to follow the money…..what the Government said it would do and what it is actually doing and how via the spending as set out in the Estimates.
Strategic Focus Areas re Budget 2023
Budget Presentation 2023 advises:
Foundational: Year 1, i.e. 2023, is about “laying a foundation for sustainable progress”.
Six Strategic Focus Areas: The six strategic focus areas of Budget 2023 and the next two years going forward are:- Health and Wellness; Education and Training; Agriculture and the Marine Industry; Physical and Digital Infrastructure; Culture and the Creative Sector; and Energy Transition and the Environment.
Consultations/Party Manifesto/NSDP 2035: These strategic focus areas are:-
the result of wide consultations; consistent with the “overarching pillars of the Party’s Manifesto” : supports “our national vision for our nation as set out in our National Sustainable Development Plan, 2020 to 2035”.
Prioritising Health and Wellness
Prioritising Health and Wellness is one of the components of Pillar 1, Empowerment of Citizens, articulated in the Party Manifesto and NSDP 2020-2035. Budget 2023 notes;-
“Transforming our health care system is the single most important priority for this Administration.
Our ultimate goal is to transform Grenada into the health capital of the Eastern Caribbean. This means the highest quality in health care facilities and services with access for all, underpinned by a culture of healthy lifestyles.”
Comment: Non-Communicable Diseases
Non-communicable diseases are the leading cause of death and disability in Grenada. These are diseases that are linked to diet and lifestyle and, for the most part, are preventable or can be arrested by attention to/changes re diet and lifestyle, particularly physical exercise. Among these diseases are:-
Diabetes (a.k.a. sugar) and its various complications and consequences including renal/kidney failure (and the need for dialysis services); amputations, blindness;
high blood pressure/hypertension and its complications and consequences including strokes, heart attacks and other cardio-vascular problems; renal/kidney failure;
obesity and its complications, which include predisposition to diseases such as diabetes and its complications; high blood pressure and its complications;
Are we the people aware of the costs of non-communicable diseases:-
the costs of treatment to the Government of Grenada (and ultimately to the taxpayer);
Costs to the individual and the household – loss of income as a result of sick days and inability to work; loss of limb and the impact on ability to work; the costs of prosthetic limbs; the psychological impact;
The loss of productivity to the individual, household and country?
Preventative/Primary Health Care
Health is wealth. It is also the basis of productivity (physical and mental which is required of we the people, child or adult). Prevention is better and also CHEAPER than cure. Thus in the achievement of health and wellness, the objective and focus should be preventative.
The function of the primary health care system is preventative and thus the bulwark of Grenada’s health care system should be the primary health care system. An efficient primary health care system will also take the pressure off the hospital facilities.
The following are the foundational deliverables proposed by Budget 2023 for prioritizing health and wellness:- Strengthening Human Resource Capacity; Upgrading Health Facilities; Embracing Technology (digitisation of the health records); Promoting Mental Wellness; and National Health Insurance.
Strengthening Human Resource Capacity
The measures identified include:-
regularizing nursing staff and the training of more nursing staff;
increased compensation via a monthly $500 honorarium over the next 12 months as the Government works towards a long term solution; XCD 4.2. mn. has been allocated for this purpose.
Honorarium: It is well known that the salary scale of our nursing professionals needs to be upgraded and an increase is well deserved. However, what is the significance of an honorarium and how was the amount of $500 across the board worked out? Why is it an honorarium and not an allowance?
Bastion of Community Primary Health Care: It is also useful to remember that well-trained nurses are the bastion of our health care system, particularly the community primary health care system.
Training/Accreditation Nurses: The Ministry of Health, via its nursing school, was responsible for the training of nurses. This responsibility was passed to the Ministry of Education via TAMCC, and sometime during the tenure of the past administration, it seems to have shifted to the St. George’s University.
Nursing Programme/Curriculum: Is the programme/curriculum offered at the SGU in sync with the requirements of the regional body responsible for accrediting nurses? For whom is SGU training nurses, for Grenada or for the US market?
Doctor-Nurse Relationship: Under this system, what is the doctor-nurse relationship? What is the status of the nurse vis-à-vis the doctor and does it affect the functions and operations of the nurse staff on ward?
Upgrading Health Facilities
Teaching Hospital: Budget 2023 has identified the construction of a new, modern public hospital with teaching facilities as the centre piece to the development of the Education, Health, and the Wellness Sector. The amount of $5.0 million has been budgeted for Phase 1 next year. It has been identified as one of the transformational capital projects to be funded by CBI receipts from the National Transformation Fund.
Strengthening Primary Health Care Access and Delivery: Health facilities across the Tri-Island State will be upgraded and systems introduced, including primary health care teams, to strengthen primary health care access and delivery.
Given the focus on health and wellness, is a teaching hospital, at this particular time, a priority for the health and wellness of Grenadian citizens?
Community Facilities/Teaching Hospital: Should the priority be investment in the community facilities – including equipment and staffing – for adequate and upgraded community facilities/services which focus on primary care?
Poly Clinic, Gouyave: A community health facility, financed by the European Union 11th EDF programme, was opened in Gouyave just before the June 23rd elections. Is this polyclinic adequately equipped and staffed? What additional services can it offer?
Carriacou and Petite Martinique: What about the people of Carriacou and Petite Martinique? How does a teaching hospital serve their health and wellness priorities?
Arrangements re Management and Operations of the Teaching Hospital: What arrangements are envisaged re the management and operations of this public, training hospital? Will arrangements be with the St. George’s University?
St. George’s University: It is interesting to note that at a Press Conference of February 17th this year, jointly hosted by then Prime Minister Keith Mitchell and Chancellor Charles Modica, the Chancellor announced that there would be greater involvement in the provision of health care services to Grenada. SGU’s faculty would be providing services to the general hospital and its students would also be rotating in the health centres throughout the island. So the question therefore arises as to whether the measures announced in the Budget 2023 presentation meet the health and wellness priorities of the people or of the SGU which uses its facilities.
Teaching is the business of the SGU: SGU has been here since 1976 and has enjoyed magnanimous and sweeping tax concessions for the entire period to present. A significant piece of real estate has been built on the prime property in the South and has been traded by the principals and owners. Note that in February, the St. George’s University Limited (Amendment) Order 2022 was passed to provide for a USD 30 mn grant (?) payment, and future payments to the Government of Grenada for changes in the ownership and control of the St. George’s University. Many of we the people are still trying to understand this transaction/grant(?). What it does indicate, however, is that SGU is more than capable of building its own teaching hospital with the usual generous support of the Government of Grenada.
Dr. Winston W. Thomas Block? There appears to have been significant investments over the last three years or so in the General Hospital, including the Accident and Emergency Block – (15 years late! I seem to recall that it was supposed to be open in time for World Cup 2007) – to be the named after the People’s Doctor, Dr. Winston Thomas (may he rest in peace and may the quality of service of that facility be worthy of his name) as was announced by the Hon. Member of Parliament for St. George’s on more than one occasion.
Would it be more prudent to improve the services at the existing hospitals and in the community facilities than to invest in another hospital at this time?
2.2.3. Embracing Technology/Digitisation of Health Records
Digitisation of health records will be part of the modernization of the health system.
Negotiations are at an advanced stage to transition entire rooms filled with files of patient data to the digitalised world.
The expenditure for this Project will not impact the 2023 Budget.
The expenditure for this Project will not impact the 2023 Budget. What does this mean? Has digitisation already been paid for?
Was PAHO and/or SGU ever involved in digitization of medical records ometimes during the tenure of the NDC, 2008 – 2013, or beyond? If yes, did it ever get off the ground? What is the status of this initiative?
Former Consul-General Warren Newfield: Was the former Consul-General/Kawana Bay developer involved in targeting investors and service providers for aspects of Grenada’s health care systems?
Appletree of Canada: Was there a group out of Canada, Appletree, dealing with health care in Grenada, installing putting (primary health care)systems and processes?
Canadian Health Systems Inc.: Was a company called Canadian Health Systems Inc. involved in setting up Electronic Medical Records for Grenada?
Promoting Mental Wellness:
Budget 2023 advised that mental wellness is a priority. “The pandemic negatively affected the mental health of many, and heightened the risk for people already suffering from mental illness and substance use disorders”. Financed by the Caribbean Development Bank, the COVID-19 Health Sector Strengthening Project, described as a “major integrated project”, is aimed at addressing the mental well-being of citizens, especially young people, who are struggling with substance abuse and psycho-social challenges. It envisages:-
Carlton House Rehabilitation: An allocation of $0.5 million for the Carlton House Project in 2023; works will begin on this rehabilitation facility.
Healthy Lifestyles: Adoption of integrated approach to healthcare and healthy lifestyles to sustainably improve the wellbeing of the nation;
Synergies with Other Sectors: the development of synergies between health, education, agriculture, and other key sectors.
Carlton House: The rehabilitation of Carlton House is long overdue. One recalls that the Grenada Co-operative Bank has raised and pledged significant funds to this initiative. When completed, this facility should take significant pressure off the mental hospital.
Increased Demand for Psychological Services: However, what happens in the meantime as the need for psycho-social services has increased with the challenges/stress of the pandemic? These services should be available at the community level, integrated into the primary health care system.
Healthy Life Styles/Synergies with other Sectors: Is there a relationship between mental health and diet? Between mental health and recreational spaces such as playing fields, green spaces, beaches, our forests? Between mental health and housing? Between mental health and noise? Between mental health and safety/security? Between mental health and road rage? Between mental health and the economy?
National Health Insurance
The plan is to introduce National Health Insurance to support health care financing by the beginning of 2025. There is an allocation of $1.9 million to re-engage the JIPA Network and move speedily towards implementation. The JIPA Network was first engaged in November 2019.
UNDP Funding: Did Grenada receive US$653,916 from the United Nations Development Program to establish the secretariat of the NHI and to undertake initial preparatory work? What was accomplished with that expenditure?
Transparency/Access to Information: To date, developments in respect of the National Health Insurance initiative have been rather opaque. During the tenure of the last administration, the tendency has been to “send the fool further on” when one sought to access information about studies/recommendations etc. One anticipates that the administration will be more forthcoming and accountable in respect of this National Health Insurance initiative.
The foregoing observations and queries in respect of the Prioritising Health and Wellness component form part of an attempt to go beyond the surface of the budget pronouncements – what is intended and how it would be achieved? Budget 2023 observations will continue in Part 3.