Trinidad and Tobago Registered Nurses President Idi Stuart.
Health stakeholders have expressed their general satisfaction with this year’s budget allocation of $5.695 billion, a slight decrease from last year’s $6.02 billion. However, some voiced concerns about the way the funds would be used, and called for better management and more details on the topics raised.
In Monday’s budget presentation, Finance Minister Colm Imbert announced the commencement of construction and completion of the Port of Spain General Hospital’s Central Bock, Sangre Grande Hospital, Pt Fortin Hospital, Arima Hospital, and the Couva Medical and Multi-Training Facility.
He also said that from January 1, 2019, Health Centres at Grand Riviere, Blanchisseuse, and Cedros would remain open for 24 hours a day, seven days a week to help community members who have to traverse long distances to visit public health facilities in an emergency.
President of the TT Registered Nurses Association (TTRNA), Idi Stuart, said the Ministry received a standard allocation of about ten per cent of the budget, which was acceptable by world standards.
Unfortunately he said for over 20 years the ministry had not been upholding its Annual Service Agreement with the RHAs. He explained that the ministry was supposed to provide funding and policy direction to the RHAs who would then focus on service delivery in line with those policies. He said the RHAs were supposed to be monitored and given financial support according to what they achieved, including better salaries and equipment.
He said because the past four or five health ministers made no mention of holding RHAs accountable for the management of funds or health goals, a lot of money was wasted. “In our view, the public health sector is not producing $5 billion worth of health care. We are not giving value for money to the public. We are spending it, yes, but we have seen a lot of wastage and bad management.”
Stuart said the organisation also wanted more details on several topics. These included particulars on the rebuilding of the PoS Hospital Central Block, as well as the composition of the board and the financial arrangements at the Couva Facility.
He said he hoped the Ministry would be approving financing for the Regional Health Authorities to hire more nursing personnel since there was a shortage of over 1,000 nurses. He said with the four new hospitals, the public heath sector would be even more short staffed. “Hopefully the Minister of Health would give much more details when doing his presentation.”
Stuart also had concerns about the security at health centres, especially if they remained opened at night. He said, over the past few years, such health facilities had become dangerous. “A number of nurses would have been physically and sexually assaulted in our nation’s institutions over the years, particularly in 2018. And with you opening these health centres in these remote districts where it may be difficult to get help, that is a worrying concern for the association.”
He added that the Ministry, as usual, did not consult with the unions and other stakeholders and hoped some discussion would take place to reassure nurses before the end of the year. “We are all for increasing services to the public but it cannot be at the risk of our staff.”
Asked what he thought of the budget, former Health Minister, Fuad Khan, said there was nothing new in it except the Sangre Grande Hospital and the PoS Central Block.
However he said the country did not need more hospitals because they were duplicating services and increasing cost. Instead, he said specialist centres were needed for ophthalmology (eye), otolaryngology (ear, nose and throat), orthopaedics (muscles and bones), cardiology (heart), and other branches of medicine.
He said while Mayaro needed a hospital, Sangre Grande needed a specialist centre or diagnostic clinic to work in conjunction with the existing Arima Hospital. He also believed that, because there would be a fee for service at the Couva facility, those who paid would get better service than those who could not.
Khan also criticised the opening of remote health centres for 24 hours a day, seven days a week. He said while he was Minister of Health he instituted the service in Blanchisseuse. He said it sounded like a good idea but no one came during the week and it cost too much to have nurses, doctors, pharmacists, and drivers sitting around doing very little between 6 pm and 6 am. He said residents did not need 24-hour service on weekdays because they could attend other health facilities. Instead he said the area needed a good ambulance service, a nurse practitioner, and 24-hour service on weekends only. He said the catchment in those areas was not very big so the staff may only see one person a day during the week. However he believed health centres in Carenage, Blanchisseuse, Maracas, Toco, Grand Riviere, in south Trinidad, and other areas people frequented on a weekends should open for 24 hours from Friday to Monday. In addition he said he would have liked it if the National Insurance System were addressed. “If you notice that has gone to the wayside. More hospitals mean more staff, more auxiliary services, more drugs. More everything else. NIS is the only thing that is going to allow any Ministry of Health to work with all those hospitals because the costs would increase and you have to have money to pay for it.”