On the 8th February 2017 the executive of TTRNA met with the Minister of Health to discuss a number of issues that are affecting the delivery of healthcare in Trinidad and Tobago. Present at the meeting were:
Mr.Terrence Deyalsingh Honourable Minister of Health
Dr.Parasam Chief Medical Officer
Ms. Barbie Roopchand Legal advisor in the Ministry of Health
Mr. Asif Ali Health Sector Advisor
Mr. Richard Madray Permanent Secretary in the Ministry of Health
Dr. Antoine Principal Medical Officer
Representing TTRNA were:
Mr.Idi Stuart President TTRNA
Mr.Corey Dillon Secretary TTRNA
Mr.Christopher Toussaint Chairperson Eastern Branch
Ms.Bettyann Murray-John Chairperson Southern Branch
Ms.Avril Dolly Vice Representative Tobago Branch
Ms. Letitia Cox Chairperson Northern Branch/Social Marketing Officer TTRNA
The meeting was cordial and well received by both parties. The discussions were healthy though passionate at times it never descended into an argument. No decisions were taken at this meeting as it was an introductory one where the issues were brought to the forefront and potential solutions were ventilated. It is expected that subsequent meetings would lead to action being taken to remedy shortfalls in the system. The matters discussed are outlined below:-
1. Acts and Legislation to be amended.
We delved into the fact that many of the legislation that governs health are outdated and limit the effective and efficient delivery of health care services in the 21st century. These pieces of legislation are:- The Nursing Personal Act (in particular the Nurse Intern), Private Hospitals Act, Mental Health Act and Health Accreditation Bill.
2. The Chief Nursing Officer (CNO)
This is an issue of great concern to the Trinidad and Tobago Registered Nurses Association (TTRNA) as there is no person at the policy making level to advise the Minister on matters pertinent to nursing. We reiterated that nurses are the single largest group of workers in the health sector and it is paramount that the untenable situation of no CNO for over 2 years be remedied. Applications have been received for a position designed to replace the CNO (National Nursing Advisor) and we should soon see someone in this position that is infinitely important to the nursing fraternity.
3. Specialist Training in Nursing
The issue of specialist training in nursing is of great concern. In all of our specialist area less than 50% who work in these areas have the training necessary to function competently in the area. The minister advised us that all training has been moved to the Ministry of Education and the line minister is Dr. Lovell Francis. The Minister of Health did say that he will facilitate us in acquiring a meeting with Dr. Francis to discuss a way forward for specialist training.
4. The Ambulance Service
We explained to the minister the dire straits this service is in at present. The ambulance service is inadequate in every possible way, added to that the personnel on the ambulance are not adequately trained. There is inadequate insurance coverage (risk insurance) for staff and patient on board. The service itself breaks a number of laws. An official in the ministry of health tried to defend the service but it was clear that she was not well informed as to the realities faced by Health Personnel who access this service.
It was realized from the discussions that rectifying the ambulance system in the RHA’s require immediate attention, as such a meeting was set up for the TTRNA to meet with Dr. Roshan Adams, Ms Barbie Roopchand and representatives of the 4 RHA’s in Trinidad to discuss the way forward and avert a possible disruption in service.
5. Community Nursing Issue
The issues relating to community nursing are unique and require their own remedial action.
Top of the list in community nursing is the number of District Health Visitors. At present in Trinidad and Tobago we have approximately 40% vacancy in this most vital community health professional. What is more disturbing though is the fact that over 60% of the persons currently employed are beyond 60 years of age and or made 33 1/3 years in the service.
Tax exemption for travelling officers in the RHA, most notably the District Health Visitor (DHV) and the Mental Health Officer (MHO). These are the 2 categories of staff primarily responsible for visiting clients who have problems in the community from a general and psychiatric standpoint respectively.
We highlighted the fact that many forms used in community nursing are outdated and carry information no longer valid and indicate on them services that are no longer available. Again further discussions between TTRNA and the Ministry are required on this issue.
6. Staff shortages
Nursing shortages is a global problem and we in Trinidad and Tobago are not exempted. We in Trinidad and Tobago are in a unique position owing to the fact that we have nurses who have successfully completed their training but they are at home awaiting employment.
We stated to the minister in no uncertain terms that if these things are not rectified in the short term we will be facing an exacerbated staff shortage problem than currently exists.
7. Advocacy and Succession Planning
Succession planning within the current system is absent. New head nurses and supervisors have to learn the job of management on the job. This creates discrepancies in the way each manage leading to role confusion within the management which trickles down to the subordinates. We are advocating for the creation of a Diploma in Health Administration. This should be the minimum entry requirement for nursing management positions. This is also to be discussed with Dr. Lovell Francis.
We thanked the minister for meeting with us and we look forward for continued dialogue on the way forward.
