The New Today

Commentary

Vote 50 – Ministry of Health, Wellness & Religious Affairs

Developments re the Health Sector
The following are developments, state and non-state, worthy of note and with particular relevance to Grenada’s health sector:-

Cabinet Reshuffle
It is interesting that shortly after the Budget Debate, there was a Cabinet Reshuffle. Particularly significant were the changes in respect of the Ministry of Health, Wellness and Religious Affairs:- • Hon. Johnathan La Crette, Minister for Health, Wellnss and Religious Affairs was reassigned to the Ministry of Youth and Sport.

  • Hon. Phillip Telesford is now the Minister with responsibility for Health.
  • Hon. Delma Thomas is now the Minister with responsibility for Mental Health, Wellness and Religious Affairs with special responsibility for the Mt Gay Psychiatric Hospital.

Sorry State of the Hospital
Most recently, the New Today, edition of March 9, 2024 front page story was “The Sorry State of the Hospital”which featured information shared by a senior nurse about “the terrible healthcare system including below par performance of doctors at the island’s premier health institution” and called upon Minister Telesford “to move quickly to address the situation and to rearrange the operations of the hospital including making some critical changes in the management structure”.

Access to Medical Supplies at the Hospital/Increased Prices of Medication
Since the beginning of 2023, there have been numerous complaints about lack of medical supplies at the hospital and the fact that family of patients have to go out and purchase most of the supplies and medication required. One also notes that basic medication has become very expensive, prices having doubled for some medication.

Agreement with AYFA Foundation1
On March 5th, 2024, the Hon. Telesford on behalf of the Government of Grenada signed an agreement with AFYA Foundation, a USA registered charitable organisation that sources unused medical supplies and then donates them to Third World or developing nations for use at health facilities such hospital, clinics and health centres.

This agreement is spearheaded by the Grenada Diaspora Advisory Committee. On February 22nd, the first container of supplies arrived in Grenada, estimated at fair market value of US100,000 – with wound care supplies, supplies for primary paediatric labs, surgical and urgent care; trigonometry trays, orthopaedic braces and other supplies.

AFYA creates access to critical medical supplies where there is none. E.g. sutures, bandages, assorted surgical instruments and other. . AYFA obtains these supplies from American hospitals which are required by federal regulations to discard them after a certain time period if they go unused.

Transforming Grenada’s Primary Health Care Services
According to Hon. Telesford, “the initiative with the foundation is to transform the primary health care services in the island as it will ensure that medical supplies are constantly available at primary health care facilities.

This initiative is geared towards assisting in transforming primary healthcare which will indeed pull people back to the community healthcare facilities.”

Care -Transition Clinic Nursing Programme2
According to its Facebook page, this private institution provides, “……. SKILLED nursing care for patients who require additional support following a hospital discharge.. or patients who require specialize care”.

It is now offering a number of training programmes. Among the programmes being offered in 2024 are the following:-

  • Clinical Medical Assistant Training Programme: Costs $5,500
  • Hemodialysis Technician Training Diploma: Duration 1 yr.; Costs $20,000
  • General Ultrasound Training Programme, Associate Degree: Duration 2yrs.; Costs $25,000 • General Nursing Programme, Associate Degree NCLEX-GN; Duration 3yrs,(full time): Costs $40,000
  • X-Ray Technician Training Programme Associate Degree; duration 2 yrs.; Costs $25,000 A Phelbotomy Technician Training Programme was offered in November 2023; Course fee $2,500.

According to its facebook, its programmes offer the following:-

  • Internationally accredited certificate
  • Expert instructors and hands-on training
  • Comprehensive curriculum
  • Access to exclusive job portal
  • Opportunities in the USA, UK, Canada and more

Budget Statement 2024
In his Budget Statement 2024, the Hon. Minister of Finance reiterated his government’s commitment to making Grenada the health care capital of the Eastern Caribbean. Indeed he declared, the transformation of our healthcare system will be a legacy of this Administration, recognising that it is a key pillar of a modern advanced society.

Addressing Challenges
He identified the following as measures taken by his government to address a number of the challenges faced by the health care system:-

  • Strengthening Human Resource Capacity: Human resources was described as chief among the challenges facing the sector. “Proactive steps” to tackle the challenge included:- o the hiring of additional doctors, nurses, and other health professionals;
  • providing an honorarium of $6,000 for 12 months to motivate nurses, while working to address the more longer-term challenges of staff regularisation and training. The honorarium is extended for a further period over 2024.
  • honorarium of $1,000 per month for doctors for the same period. A sum of $4.2 million has been allocated for this purpose.
  • Upgrading Healthcare Facilities: There were major upgrades to health facilities to support primary health care, including at the Hillsborough Smart Health Centre, Victoria Medical Station, the Princess Royal and Alice Hospitals, and the Westerhall and Good Hope Medical Stations.

This will continue in 2024 to include Sauteurs Health Centre, Grand Bras Medical Station, the Mt. Rich Medical Station, the New Hampshire Medical Station, and repairs to the Operating Theatre.

Building New Medical and Teaching Hospital:
Described as a key pillar of the health transformation agenda is the construction of a health complex, the first phase of which is a modern state of the art medical hospital with teaching facilities through leveraging public private partnerships.

In 2023 , 83.9 acres of land at the at the Calivigny Estate was secured at a cost of $36 million as the site for this initiative. It is expected to be completed in 36 months.

  • Allocation 2024: $7.5 million is allocated for the preparatory works, including architectural and engineering designs. The Government intends to secure the services of professional advisory, project management, and backstopping support as well as technical assistance from our regional and international partners.

In this regard, a request has already been made to the World Bank for technical assistance.

  • Advancing National Health Insurance (NHI): The establishment of a National Health Insurance system is another pivotal pillar in our comprehensive transformational agenda for healthcare in our Tri-Island State. A National Health Insurance Programme will support Government’s philosophy to provide universal access to healthcare services, ensuring that all our citizens, including the less fortunate, can receive high quality medical attention without financial barriers.

Implement Phase I of a National Health Insurance:
The Go Live Date for the inauguration of the National Health Insurance is 24 months, that is by November 2025. Work has in fact started and will be guided by stakeholder consultations and key milestones.

A sum of $3.5 million has been budgeted for the restart of the National Health Insurance Project.

Promoting Mental Wellness:
A Health Sector Strengthening Project, with funding support from the Caribbean Development Bank has started. The strategic aim of this project is to address mental illness and substance abuse in the post pandemic era. An allocation of $2.0 million has been made for this project in 2024.

Vote 50 : Ministry of Health, Wellness and Religious Affairs – 63 vacant positions

According to Table 133, Accountable Officers, there are three Permanent Secretaries in the Ministry of Health, Wellness and Religious Affairs:-

  • Permanent Secretary with responsibility for General Health & Health Administration
  • Permanent Secretary with responsibility for Strategic and Operational Management of the General and Subsidiary Hospitals, Mt. Gay Psychiatric Hospital & the Richmond Home, and the Community Health Services
  • Permanent Secretary with responsibility for Wellness and Religious Affairs:

0082544, Wellness Programme:
It is interesting to note that there were no approved estimates or expenditure for a wellness programme in 2023. In 2024, there is an allocation of $250,000 to be financed by local revenue.

0082548, Implementation of the Religious Affairs Portfolio:
There was an approved estimate of $500,000 but there was no expenditure. The 2024 Approved Estimate is $250,000 to be financed by a grant.

Projects, General Administration:

Construction Of New Medical and Teaching Hospital – Phase 1:

The 2024 Budget Statement advised that $7.5 million was allocated for the preparatory works, including architectural and engineering designs. The 2024 Budget Estimates conflicts with this information.

The 2023 Approved Estimate was $5,000,000 but the 2023 Actual Provisional Expenditure was nil. There is no 2024 Approved Allocation.

National Health Insurance Project:
According to the 2024 Budget Statement, the sum of $3.5 million has been budgeted for the restart of the National Health Insurance Project. The following is noted over the period 2021 to present:

2024 Budget Estimates: According to the 2024 Estimates, the 2023 Approved Estimate was $1,200,000 and 2023 Actual Provisional Expenditure was nil. There was no 2024 Approved Estimate.

2023 Budget Estimates:
2022 Actual Provisional Expenditure of $1,467,677 compared with 2022 Approved Estimates of $1,000,000. 2023 Approved Estimates of $1,200,000

2022 Budget Estimates:
It is useful to note that the 2021 actual provisional expenditure of $1,739,119 compared of the 2021 Approved Allocation of $500,000; 2022 Approved Estimates $1,000,000.

COVID- 19 Health Sector Strengthening Project (Mental Wellness):
This project was referenced in the 2024 Budget Statement. While there was a 2023 Approved Estimate of $750.000, there was no expenditure. There is 2024 Approved Estimate of $2,000,000 financed by loan.

OECS/PPS Support Programmes
Is this a special programme or part of the OECS Pharmaceutical Procurement Service (PPS)?

2024 Estimates: The 2023 Approved Estimate was $12,500 while the actual expenditure was nil. The 2024 Approved Estimate is $12,500 and the source of financing is a grant.

2023 Estimates: 2022 Approved Estimates $12, 500; 2022 Actual Provisional, $2,268; 2023 Approved Estimates $12,500.

2022 Estimates: 0082531, OECS/PPS Support Programmes: 2021 Approved Estimates, $50,000; 2021 Actual Provisional nil; 2022 Approved Estimates $12, 500; ▪ Note: OECS Pharmaceutical Procurement Service (PPS):

The Pharmaceutical Procurement Service (PPS) is the official institution within the OECS that procures medicines and allied health equipment on behalf of Member States.

The PPS works closely with the Pharmaceutical Industry, Ministries of Health in each Member State and associated clinical and public health policy specialists to select medicines based on Member State requirements at any given time.

The PPS operates a restricted international tender through the OECS E-Tendering System in which suppliers are pre-qualified. Pre-qualification is necessary to assess the quality standards, technical competence, and financial viability of competing suppliers.

It is active in the monitoring of the delivery of pharmaceuticals and supplier performance to ensure OECS quality standards are met.

Electronic Health Information System
2024 Estimates:
The 2023 Actual Provisional Expenditure $1,236,572 was compared with the 2023 Approved Estimate $1,000,000. The 2024 Approved Estimate is $1,000,000.

2023 Estimates: The 2022 Actual Provisional was $927,429 compared with the 2022 Approved Estimates of $1,000,000.

Strengthening of Health Sector Transition Project:
What is the health sector transitioning to? What are the deliverables of this project? The 2023 Actual Provisional expenditure was $2,880,518 compared with the 2023 Approved Estimates of $4,200,000. The 2024 Approved Estimates are $4,200,000.

3.1.1. 2023: Key Priorities/Strategies/Achievements Re General Hospital • Standardized and Accreditation of Clinical and Diagnostic Procedures: – Neonatal Protocols Established

  • Strengthened staff competencies through specialised and in-service training activities: Monthly Continuing Medical Education Training Programme started; CME (10) sessions completed
  • Improved patient care and service delivery options: Enhanced competencies in wound care to minimize risks for amputation: Risk Management Plan for Nursing Developed
  • Health Financing – Standardised Procurement Procedures and Inventory Management to optimise use of financial resources: Revenue collection enhanced with introduction of 24 Hours cash collection services: Pay.gov implemented for online payment of fees
  • Leadership and Governance – Develop Standard Operating Procedures to improve service delivery and monitoring of hospital operations: Standard Operating Procedures’ Developed for Housekeeping; In-service Training Performance Management Training conducted (30);
  • Refurbishment of the hospital infrastructure to enhance safety and service delivery: Second Phase Occupied for service delivery

Key Priorities/Strategies 2024 Budget

The following are key priorities/strategies in respect of 2024 Budget:-_

  • Strengthen Operations: Training, Certification and Capacity Building to strengthen operations
  • Quality Control: Quality Control through development of Standard Operating Procedures • Informed Decision Making: Data collection and analysis for informed decision making
  • Customer Service: Customer Service Framework and Redress Mechanisms • Leadership and Governance – Strengthening Health Financing and Legislative and Policy Framework for hospital operations

Query/Observations:

  • What information and insights into the operations of the General Hospital do the priorities the 2023 Budget and 2024 convey?
  • What is responsible for this apparent lack of standardised and accredited procedures at the General Hospital?
  • Can one come to any conclusions about the “state” of the General Hospital based on the information about its key priorities re 2023 and 2024?

Community Health Services, Programme 0087000

  • Programme Objective: To increase access to improved quality preventative and curative community health services.
  • No Expenditure 2023: According to the Budget Estimates, there were allocations but there was no expenditure in respect of the following projects under the Community Health Services:-

0087525 – Reconstruct Gouyave Health Centre (Phase 1):

2024 Approved Estimates is $700,000; This project seeks to correct the defects of the newly constructed Gouyave Health Centre and restore the former building (that was temporarily used to for the health Centre during the construction of the new building) to its original condition.

  • 0088537 – Nat’l Non-communicable Disease Control Programme
  • 0089503 – Nat. School Based Health Programme:
  • 0088534 – Health Centres/Medical Station Refurbishment:

The 2023 Actual Provisional was $3,333 compared with 2023 Approved Estimates, $100,000. The 2024 Estimates is $150,000 to be financed by local revenue.

Key Priorities/Strategies/Achievements 2023 Budget

Health Services Delivery

Health services delivery was a key priority and the following were key achievements:

  • Enhancing Competencies for Blood Pressure Testing:

Completed Phase one of the HEARTS Programme including enhancing competencies for Blood Pressure testing and procurement of equipment;

  • Health Promotion Division:

Strengthened competencies of Health Promotion and key stakeholders in risk communication to support the re-organization for the Health Promotion Division;

  • CNCD Clinics: Re-establishment of CNDC Clinics resulting new diagnosis in CNCD (150 F/89 M) in key demographic age 45 to 64.

Health Financing

  • Trained staff (10) including Pharmacist and other key stakeholders in Supply Chain Management to strengthen the management of the Pharmaceutical supply chain to minimize the risk related to stock outs

Key Priorities/Strategies 2024 Budget

  • Chronic Non Communicable Disease: Reduce Burden of CNCD through introduction of the WHO HEARTS Initiative
  • Primary Health Care Services: Strengthen the Delivery and monitoring and evaluation of PHC Services including key intervention related to (DHIS2/, Diabetes and Hypertensive meds, MCH, Source reduction for vector and foodborne borne diseases, increased services for dentistry)
  • Health Promotion and Prevention Activities: Strengthen Community Engagement through strategic Health Promotion and Prevention Activities and partnership with District Wellness Councils and CBOs
  • Vulnerable and Underserved Communities:

Improve Access to PHC services with focus on vulnerable and underserved populations (adolescents, differently abled

Queries/Observations

  • No Expenditure/No Delivery: What was responsible for this failure to expend and, that would also mean, not deliver any services under those projects? i.e. the Non Communicable Diseases Control Programme and National School Based Health Programmes?
  • Enhancing Competencies for Blood Pressure Testing:

What does this mean? What does it suggest? Is it not reasonable to assume that blood pressure testing is a most BASIC competency that is expected of professional health care personnel at all levels in state health care facilities

Keeping an Eye
It is hoped that this presentation was of some assistance in acquainting the interested reader with Vote 50 of Budget Estimates 2024, the Ministry of Health, Wellness and Religious Affairs.

It is the first of those which take a more in depth look at various Vote Allocations.

Sandra Ferguson