MINISTRY OF HEALTH & SOCIAL DEVELOPMENT
Presentation by the
MINISTER OF HEALTH & SOCIAL DEVELOPMENT
Commonwealth of The Bahamas
4th June 2008
Mr. Speaker, one of the most vital ingredients to achieving prosperity and success as a nation is full and fair access to quality affordable healthcare. To this end, the Government of The Bahamas has allotted the second largest percentage of the national budget the public healthcare system including the Public Hospitals Authority.
It therefore gives me great pleasure, to contribute to the National Budget Debate as the Minister of Health and Social Development. This contribution will focus mainly on the Department of Public Health, The Department of Environmental Health Services and The Public Hospitals Authority. My colleague, the Honourable Loretta Butler -Turner, Minister of State for Social Development will contribute on behalf of these areas.
Mr. Speaker, I am pleased that my ministry has made significant progress in addressing the government’s trust agenda for the Health and well being of our nation. The notable achievements which I shall highlight have been made possible through the continued cooperation and commitment of competent and hard working employees who consistently deliver quality services to the residents in every community on New Providence and the Family Islands.
Indeed, we owe a tremendous debt of gratitude to the public officers of the government health sector. As we set the stage to move forward for another year, I am inspired by their passion, dedication and commitment to public service and I daresay, I am even more confident today, that, by continuing to work together, we will be able to execute our mandate to enhance the quality of, and access to health care for all.
Mr. Speaker, my Ministry will be able to move forward because the Government of The Bahamas proposes a total sum of $137,022,052 for recurrent and capital expenditure for the Ministry of Health and Social development to be allocated as follows: $23,102,079 to the Ministry Headquarters; $39,167,977 to the Department of Department of Social Services; $1,196,737 to the Willie Mae Pratt Centre for Girls, $1,264,453 to the Simpson Penn Centre for Boys; $29,583,366 to the Department of Public Health and $42,707,440 to the Department of Environmental Health Services. Overall this represents an increase of $12,865,484 over the 2007/2008 allocation for the Ministry.
In addition, funding of $174,140,170 is proposed for recurrent expenditure and $2,000,000 for capital expenditure, making a total of $176,140,170 in proposed allocations to the Public Hospitals Authority including the Corporate Office, Princess Margaret Hospital, Sandilands Rehabilitation Centre and Grand Bahama Health Services. The Authority will retain designated projected revenues of some $8,000,000 to offset its expenditure in 2008/2009. Allocations in Personnel Emoluments and Other Charges for the PHA represent an increase of $9,775,964.
Mr. Speaker, as I mentioned before, The Honourable Loretta Butler-Turner, Minister of State for Social Development will speak to all matters relating to the Department of Social Services, the Willie Mae Pratt Centre for Girls and the Simpson Penn Centre for Boys. The remainder of my communication will be dedicated to health sector.
I am very pleased to report that targeted improvements have been realized in many areas of the government health sector.
Wellness in The Nation (WIN) Programme
Mr. Speaker, when I assumed office, last year, my ministry immediately accelerated action towards the reduction of the prevalence of chronic non-communicable diseases which threatens to undermine the health status of our population, and our capacity for achieving and sustaining desired levels of economic growth and national development. To demonstrate its ongoing concern about chronic non communicable diseases, a “Wellness in the Nation” (WIN) programme has been initiated under the leadership of the Chief Medical Officer.
This programme incorporates the Healthy Lifestyle Initiative and articulates with the Health Education and Promotion and Nutrition Units to ensure greater coordination of efforts, prevent duplication and maximize utilization of limited resources. The physician coordinator of the National Chronic Non-Communicable Diseases Programme also has delegated responsibility as the National Health and Wellness Programme Director. My ministry has leased physical facilities for the Secretariat of the National Health and Wellness Programme and the Health Education and Nutrition units.
Mr. Speaker, secondly, improving of access to quality primary health services is critical to prevention and control of chronic-non communicable diseases.
The Ministry of Health and Social Development in conjunction with the Department of Public Health, is leading the way in shifting the emphasis of health care from secondary and tertiary care to that of Primary care. Primary care involves the promotion of health, the prevention of illnesses and the maintaining of good health without having to go to hospital to do so. The restructuring of primary health care services involves, Clinic Autonomy, Client empowerment and, Community involvement.
In regards to clinic autonomy, the plan is for all polyclinics to be managed by Executive Management Committees (EMCs). Each committee will consist of an administrator who will be responsible for the operations of the facilities and support staff, a nursing leader who has responsibility for nursing and nursing support staff and a medical team leader who has responsibility for medical staff. The EMC will have responsibility for the day to day operations and decision making in the clinic, eliminating some of the red tape and reducing the length of time needed for the implementation of changes. It is hoped that eventually each clinic will have its own line item budget.
Flamingo Gardens Clinic was used to pilot this style of management as well as initiate the development of community involvement. A community health fair was held to inform the residents within the Flamingo Gardens clinic catchment areas. At this fair the community was informed of the impending changes. The clients’ needs were assessed in relation to the services that were being offered. It was noted that a number of children were being brought to the clinic in the evenings, so the staff implemented an evening child health clinic, where parents who work during the day, can bring their children to receive the necessary care without the parent missing work or the child missing school.
The Flamingo Gardens Clinic EMC has established a Local Health Advisory Committee. Persons on the committee come from within the community and speak for the community on health matters and health issues that concern them. They also have a voice in what services should be provided to assist community residents in maintaining optimal health. The Flamingo Gardens Clinic staff members are actively engaging their clients in developing relationships with them.
The Clinics have started triaging patients; clients come in and are seen by a nurse or a doctor who assesses the extent of their illnesses. Once this assessment has been done, the patient may be allowed to register to see the doctor, or given an appointment to return at another time. It may also mean that the patient is given an appointment to return to a specialty clinic and see specialists, such as a Family Medicine Physician. It is hoped that telephone triage will be soon implemented, where the client calls the clinic and is advised by a nurse or a doctor, a decision is made jointly whether it is necessary to come to the clinic.
Clinic doctors are now doing home visits and visiting the elderly, patients who are confined and psychiatric patients in the communities at least once a month. We would like to encourage the public to visit their area clinics. This lends itself to continuity of care, building relationship with clinic staff and if home visits are required, the area clinic staff can easily access clients’ homes.
Research has shown that when patients take charge of their health, the outcomes are better, there are less hospital admissions and debilitating illnesses are decreased because of early interventions. In other words, when clients are managed from a preventative aspect, potential illnesses are detected in timely manner, and if they do become ill, the outcomes are not as devastating as if an illness is caught in its secondary or tertiary stage.
It is the aim of the Primary Health Care services that clients not only come to the clinic to seek help for acute illnesses, but come to the clinic to maintain their health, take part in health promotion activities such as exercise programmes, patient education seminars, workshops and training such as first responders and basic life support.
A new thrust is the integration of family medicine into the poly Clinics. Physicians trained in family medicine will be available on scheduled days in the clinics to see clients referred to them.
Because diabetes and hypertension are two major illnesses that impact the well being of the population, the family medicine physicians will use their expertise to assist in treating clients who are experiencing difficulties in managing these diseases.
It is the intent of the Ministry of Health and Social Development and the Department of Public Health to implement along with the existing clinic services, women’s health, men’s health clinic, asthma clinic, mental health clinics and paediatric specialty clinics.
Another major goal of my Ministry is the decentralization of the HIVAIDS programme. Stigmatization of persons with HIV/AIDS continues. It is expected with this initiative, that anyone with HIV/AIDS may not have to go to a special clinic to seek treatment, but can receive treatment at any of the poly clinics whenever they so desire.
Training of staff within the Ministry of Health/Department of Public Health is critical to ensuring that quality health care is continuous, staff are being trained in areas such as emergency nursing, allied health specialties, and obtaining graduate degrees in Public Health and other areas. For example, during the 2007/ 2008 budget year, 24 health care providers received training in foot care management. This training will assist in early detection of foot disorders and appropriate treatment to reduce the number of disabilities due to amputation of limbs. I am also pleased to announce that for the first time two of our nurses received certification as diabetic educators from the University of The West Indies. These training initiatives will further strengthen our ability to reduce the incidence and prevalence of diabetes in this country.
Physicians coming into the department are being rotated through the Primary Health Care Training Centre, where they are oriented to the protocols and procedures use in Public Health. Further, continuing medical education is being provided to all physicians so that they are able to remain up to date with changing medical trends and treatment modalities. This is extended to Physicians from the Family Islands.
As the year progresses, further restructuring of the Primary Health Care services in the polyclinics will continue. It is intended that all polyclinics will follow the model at the Flamingo Gardens Clinic.
Mr. Speaker, one of the greatest challenges to the success of this initiative is the need for additional physicians. Several creative strategies have been embraced to address this issue. For example there are six doctors on loan to the Department of Public Health from the Princess Margaret Hospital. Transfer to the DPH is in progress with respect to two of the six. There are ten other PMH doctors who have been deployed with DPH since the latter part of 2007. With the concurrence of the PHA, recommendation for the transfer of these physicians is with the Department of Public Service and the necessary funds have been provided in the 2007/2008 budget. These physicians are a large part of the reason of the success achieved at the Flamingo Gardens Clinic. Funding will be needed to hire additional doctors accommodate expansion of the new primary health care delivery model to Elizabeth Estates, Flemming Street and other community health clinics, as planned.
Mr. Speaker, I take this opportunity to publicly thank the Executive Management Committee of the Public Hospitals Authority and specifically the Princess Margaret Hospital for cooperating with the Department of Public Health in facilitating the redeployment of physicians from that institution to the Department of Public Health. This strengthening of cooperation and developing espirit de corp between the Hospitals Authority and the Department of Public Health to advance the health and well being of the population is indeed another achievement of which we are proud.
Access to required drug therapy is the third important component for successful prevention and control of chronic non-communicable diseases.
In this regard, efforts are well underway, to establish the National Drug Fund, as mandated by the government’s Trust Agenda for Health Fund. This Plan will become fully operational within the upcoming budget year. When implemented, it will ensure access to drug therapy for selected chronic non-communicable diseases based on the needs of the patients as prescribed by a physician.
National Population Health Programmes
Mr. Speaker, at the national level we have continued to give focused attention to priority national population health programmes aimed at preventing and controlling the prevalence of communicable and non-communicable diseases within the population. In this regard there are a number of notable achievements.
Notwithstanding our focus on the prevention and control of chronic non-communicable diseases, much attention has been given to the prevention and control of communicable diseases. More specifically and of particular note is strengthening of national capacity within the surveillance unit, PMH laboratory and community clinics in New Providence and the Family Islands to address challenges associated with tuberculosis and malaria.
Malaria is not endemic to The Bahamas however, sporadic cases do occur from time to time, usually imported. In recent times, the island of Great Exuma has experienced sporadic cases with some local transmission all linked to imported cases occurring in the migrant population which frequently present themselves on that island.
Following the Exuma Malaria Outbreak in June of 2006, enhanced surveillance activities continued with the goal of preventing transmission of malaria in Great Exuma. A significant addition to the process was the ability to perform on-site rapid malaria screening utilizing the Optimal test kits.
With the assistance of PAHO, training in Rapid Malaria testing was received in December 2006, by 16 medical staff in New Providence, 17 in Exuma and 10 in Abaco. This training allowed staff in Exuma, in August of 2007 to test suspected cases and obtain results in a matter of minutes as opposed to waiting days for results from the laboratory in New Providence. Because of this quick testing, treatment and contact tracing could begin immediately thus removing the (positive) human reservoir and preventing new cases.
Because of the staff was properly trained, the cluster of 2 cases in 2007 was treated in Exuma and no hospitalization was required, compared to the 19 cases in 2006 when 12 persons were hospitalized.
Recognising the excellent work by The Bahamas in controlling the 2006 Malaria Outbreak, two persons were invited to give input at a Regional Meeting on Malaria in Panama in November 2007.
Heightened entomological activities are also continuing on the island inclusive of testing of natural water sources on a daily basis having increased from routine weekly checks. Treatment of these water sources is ongoing and in recent weeks, there has been a revision to the mechanism of delivery of the treatment – from plates to liquid form – in an attempt to intensify larviciding process. Ongoing adulticiding is carried out through fogging which has now increased from once daily to twice daily at dawn and dusk in identified high risk areas. Other areas on the island continue to receive once daily treatments.
In 2007 only two cases of malaria were identified associated with the island of Great Exuma. Since January 2008, there have been a total of seven (7) cases of malaria associated with the island. Five cases were diagnosed locally and two diagnosed in persons upon return to their country of residence who reported recent travel to the island of Great Exuma. Continued vigilance by health care providers in Exuma and rapid response by public health authorities, both locally and nationally, along with the assistance of regional partners such as PAHO and CAREC have been essential for the containment and control of malaria on this island. With the continuing arrival of large numbers of persons from areas where malaria is endemic, particularly to the island of Great Exuma, the risk of introduced malaria persists.
Mr. Speaker, I now turn to the surveillance of tuberculosis. Related to same, the following actions have been taken over the last year:
A draft of the TB Surveillance Manual protocol is now completed.
Staff members from the islands of New Providence, Abaco, Eleuthera, Andros and Exuma and Grand Bahama have been trained.
TB Education for the public has increased in reference to Tuberculosis in The Bahamas.
Mantoux training has been conducted in several poly clinics and routine testing moved to poly clinics to facilitate public demand.
Laboratory testing technology has been recently upgraded. With the advent of the new machine the department now has the ability to reduce the time for identification and sensitivity testing.
The procedure for identification of MTB is now genetic. The Versatrek 240 is fully automated in the culturing of specimens for TB. It also has the ability to perform sensitivity testing on multiple specimens. The instrument does a real time analysis, monitoring each specimen within in 24 hours. It also has the ability to interface into the lab information system enabling information to be downloaded into the patients file.
As a result of the unrelenting efforts of the Surveillance and HIV/AIDS personnel and the reduction in real time from weeks to days for the verification of diagnosis, TB cases have been reduced from 63 in 2006 to 49 in 2007.
Infant and Maternal Indicators
Since achieving a low of 12.7 per 1000 live births in 2001, The Bahamas saw a steady increase in the IMR to a high of 19.6 in 2005. In 2006 there was a small decline to 18.1 and although there was a further decline in 2007, the infant mortality rate remains unacceptably high at 17.6 per 1000 live births.
In an ongoing effort to reduce the infant mortality rate my ministry has strengthened/accelerated its public health promotion and education programmes with a focus on the importance of early and ongoing antenatal care and family planning. Various media was utilized including radio, television, promotional signs, community groups and church organizations. Recognizing the importance of skilled medical personnel, training sessions relative to reproductive and child health were conducted in New Providence, Abaco and Andros to enhance provider knowledge and skills.
These efforts are also intended to positively impact the maternal mortality ratio. Maternal deaths are especially tragic and have a significant impact on families and communities. There were 4 maternal deaths in both 2006 and 2007. The 4 deaths are in keeping with the average number of maternal deaths for the period 1997-2007.
Expanded Programme on Immunization
Mr. Speaker in 2007, I assured the Bahamian public that my Ministry will implement measures to prevent shortage of vaccines. I am pleased to report that during the 2007/2008 fiscal year except for a shortage of Yellow Fever vaccine due to the crisis in Central America, the Ministry of Health was able to maintain a constant supply of vaccines for other vaccine preventable diseases and was therefore able to achieve a 95% coverage of immunization to infants and children under the age of 1 year. Not only were vaccines available, but the long awaited centralized vaccine storage unit is now operational, which allows for better monitoring and distribution of vaccines.
Improved access to Diagnostic Services in the Primary Care Setting
Mr. Speaker, it is quite clear that the strengthening of primary health care services is essential to the prevention of not only hospital admissions but the prevention of secondary complications such as strokes and heart disease. Therefore, I am also pleased to report that additional ECG machines were purchased for clinics in New Providence and the Family Islands to improve screening for heart diseases. Further, in the next few weeks training will be conducted for Family Island health care providers in the use of these machines thus expanding the scope of screening and management of clients at the primary health care level.
Strategies to Address the Shortage of Allied Health Professionals
Mr. Speaker, one of the greatest deficiencies of the Public Health Sector is the shortage of pharmacists, laboratory technologists, physiotherapists and other allied health professionals. To address this situation my ministry has undertaken two important initiatives.
Firstly, in partnership with the Public Hospitals Authority we established the National Allied Health Cadet Programme from which Thirty seven tenth grade students are now benefiting. These students have been introduced to the various allied health professions mainly through lectures as well as weekly visits to observe relevant professionals at the Princess Margaret Hospital and other public and private health facilities throughout New Providence. Another twenty eight students have been identified from incoming tenth graders to join the current cadre of cadets.
Mr. Speaker, my Ministry is poised to realize another historic first in the health sector. Over the past twelve months we have been working diligently with the College of The Bahamas and the University of Technology in Jamaica, to offer a Bachelor of Pharmacy Degree at home. I am pleased to report that a full cohort of students has been identified for the first class commencing in the fall semester 2008. Students will study for two years at the College of The Bahamas and the final two years will be spent at the University of Technology in Jamaica. I am advised that the signing of the agreement between COB and UTEC in relation to this programme will occur before the end of this budget year. Again, this is a classic example as to what could be achieved through multisectoral cooperation.
Nursing continues to play an integral role in the advancement of health care in Ministry of Health & Social Development. Therefore, recruitment, training and retention of nurses therefore, are among the priorities of my Ministry. In this regard we are currently supporting more than 148 student nurses at the College of The Bahamas. Indeed, the Office of the Director of Nursing in partnership with The College of The Bahamas is making significant progress in meeting the need for registered nurses. In addition, to basic nurse training, funding has been utilized for post basic training in psychiatric nursing at the College of The Bahamas, and Emergency Care Nursing in Jamaica. Eight from the government health sector are also being trained as preceptors. Preceptors have oversight for the practical aspects of nursing education programmes at the basic and post basic levels. This is critical to ensuring that the unprecedented numbers of nursing interns receive highest quality of professional instruction and practical skill training.
Integrated Public Health Information System
Mr. Speaker, implementation of the integrated public health information system has continued. Over the last twelve months IPHIS which provides capacity for automated medical records has been installed in Fox Hill and Gambier. Last week installation was completed in all of the main health centres on the island of Eleuthera including Harbour Island and Spanish Wells, The relevant computers are in place and doctors, nurses and relevant clerical staff members have been trained to enter the data. This is a significant. What it means is that physicians in New Providence clinics are now able to access the medical records of patients referred from Eleuthera electronically. IPHIS allows Family Island physicians to review the results of interventions of the physician in New Providence.
Our ultimate objective, Mr. Speaker, is to establish one medical record for each patient within the primary health setting irrespective of whether they reside in New Providence or a Family Island. This should serve to prevent overuse of medication and improve the overall quality of follow-up medical care for patients.
Implementation of E-Health
The telemedicine pilot project is an e-health initiative of special interest in the Ministry of Health at this time is. In December 2007, the government recognizing the impact on health outcomes which the attainment of a truly integrated e-health network would afford commissioned a pilot telemedicine project.
Telemedicine equipment was installed in the Accident and Emergency Department at the Princess Margaret Hospital and in a Primary Health Care Clinic in Marsh Harbor Abaco. Utilizing fiber optics, this electronic connection presently facilitates real time consultations between primary level medical personnel with emergency care specialists 24 hours per day as required. Additionally, this state of the art technology is used to facilitate scheduled specialists consultations for paediatrics as well as dermatology cases.
Most recently, the educational components of e-health have been instituted into the pilot project with the provision of nutrition education sessions for the staff and community in Abaco. The project is scheduled for a 12 month pilot, and is presently at the mid-point with significant benefits realized to date. These include increased quality of care among patients requiring emergency medication attention, improved collaboration between district medical officers in the pilot area and consultants in A&E, improved pre-hospital management of patients prior to evacuation and real time management of patients reducing the need for very costly emergency evacuation.
As brought to light in the Commonwealth Health Ministers Meeting which I recently attended, in Geneva, Switzerland, the benefits of e-health are undeniable. Given the challenges faced in health care system today with limited resources and increasing prevalence’s and incidences of disease, close attention must be given to review and analysis of e-health initiatives already in place in developed and developing countries so as to benefit from lessons learned and continue to move forward with the integrated e-health network. Indeed e-health is evolving as an important delivery model for the future.
The Public Hospitals Authority
The Public Hospitals Authority can also boast of a number of major achievements including:
Relocation of the corporate office to a new site including a state of the art training facility
Princess Margaret Hospital:
Completion of project plan for the redevelopment and improvement of accident and emergency services
Completion of renovations and refurbishment of the Bahai building to house the new comprehensive cancer care centre, a furnished medical library and classrooms for the University of the West Indies School of Clinical Medicine and Research
Grand Bahama Health Services
GBHS benefited from improved facilities for the business office, pharmacy, physical therapy unit, human resources, training, accounts and payroll units.
Sandilands Rehabilitation Centre
The laundry department was upgraded and electrical upgrades were completed to the southern section of the compound.
Overall Direction and National Priorities for 2008/2009
Mr. Speaker, Much has been accomplished in twelve short months. However much remains to be done. In this regard, moving forward, the top priorities for my ministry have not changed. They are as follows:
Promotion of Healthy Lifestyles and Prevention and Control of Communicable Diseases has been selected as the number one priority for my Ministry.
Improving the health status indicators related to infant and maternal morbidity and mortality
Strengthening of Primary Health Care Services
Establishment of the National Drug Fund
Advancement of E-Health to enhance the scope and quality of health services accessible to the population in New Providence and the Family Islands.
A clean, green and pristine environment
Meeting the expectations of our internal and external customers, that is our staff and our patients.
Strengthening of the regulatory framework
Development of a National stand alone Blood Centre
Implementing Strategies to reduce the shortage of allied health personnel
Enhancing capacity to obtain value for money through effective strategic planning monitoring and evaluation
Mr. Speaker, focus on these priorities should positively contribute to our number one priority, the reduction in the prevalence of chronic non communicable diseases such as high blood pressure, diabetes, cancers, and indeed infant and maternal morbidity and mortality associated with these diseases.
Utilization of allocations 2008/2009
Mr. Speaker, in regard these priorities allocations budgetary will seek to address the following initiatives over the next twelve months:
Ministry of Health Headquarters
Under head 60 we have requested funding in new appointments to strengthen the office of the Chief Medical Officer. Also, funding is provided for an additional medical consultant to strengthen the health planning unit.
As my ministry focuses on evidence based decision making, the need for personnel to facilitate research becomes necessary. Funding is provided to employ two research officers to support the work of senior technical officers and the research agenda within the health services planning and HIV/AIDS units.
In addition under the Human Resources Division of my ministry, we propose to institute an employee assistance programme. Funding is provided to secure the services of a coordinator of this programme. One of the concerns repeatedly expressed by all categories of employees is the absence of a professional employee assistance programme within the Ministry. This programme will serve employees within all the departments and units of the ministry.
My Ministry is also seeking allocations of $274,871 to secure the lease of the building identified to house the national blood centre.
Substantial amounts are included to support bonded students who are accepted into the bachelor of pharmacy degree at the College of The Bahamas in affiliation with UTEC, Jamaica. These students will be bonded to the Bahamas Government similarly to student nurses and teachers who are the recipients of government grants.
Due to unprecedented increase in nursing students and interns an increased allocation of $391,540 is provided in the relevant item.
During this fiscal year, we plan to provide scholarships for forty-five (45) new nursing students at The College of The Bahamas. Included in the scholarship is, payment of full tuition and a stipend of four hundred and seventy-five dollars each month for students undertaking a minimum of twelve credits per semester.
Additionally, we will provide scholarships for another twenty (20) students, who were previously sponsored, but discontinued studies for varying reasons. This number, Mr. Speaker is in addition to the one hundred and seventeen students, which we are currently supporting at The College of The Bahamas.
Provisions have also been made during this fiscal year, ladies and gentlemen to provide sponsorship for seventy- two nurses during the Internship period. They will be paid ten thousand, two hundred dollars per annum during this period.
This number, I am advised, is the largest number of internship students we have had in the institutions, at one time, since the nursing Programme was transferred into The College of The Bahamas.
Mr. Speaker, a My Ministry has contracted a local consultant to coordinate the Community Health Nursing Diploma Programme which is scheduled to begin in August of 2008 at the College of The Bahamas. Funding is included in this budget to facilitate the participation of at least 17 nurses. At the end of their training, these nurses would have acquired the skills necessary for effective health promotion and disease prevention within a public health setting.
My Ministry has already begun the process of strengthening Nursing Regulations. A new Nurses and Midwives Act will be tabled in Parliament in short order.
Department of Public Health
The Department of Public Health is the agency within the Ministry of Health and Social Development with responsibility for the delivery of primary and public health services.
These services are provided through a network of 98 health care facilities strategically located for accessibility to services throughout the Country.
These services of which I speak include services such as Maternal and Child Health, Parenting and Breastfeeding, Family Planning and Reproductive Health Services for males and females, School and Adolescent Health Programs, Immunization for infants, children and adults, communicable and non-communicable diseases. Nutrition Services, Oral Health, Port Health; Services for sexually abused and neglected children; Workers Health and Safety, Prison Health and the Public Health Information System.
Mr. Speaker, in this budget year 2008 / 2009 the reduction of the maternal and infant mortality rates will continue as a priority for my Ministry. One of the key initiatives for this year will be the development and implementation of a pre – pregnancy education and counselling for all women in the child bearing age, especially those women already diagnosed with high risk conditions. Increased targeted intervention will be geared toward men as significant stakeholders in the improvement of the family health. Quarterly community education and forums will be conducted to further empower and improve the knowledge and skills of individuals, families and the general public with regards to maternal and child health as well as family health.
Additional obstetricians /gynaecologists will be deployed within the community clinics to improve the management of prenatal care.
Expansion of preventive child health services will also be implemented to provide for nutritional counselling for overweight infants and children. Health promotions and education will be sustained to increase the number of women exclusively breast feeding to reduce the number of infants suffering from respiratory diseases and gastroenteritis.
My Ministry will also establish a National Registry to identify “at risk” infants and children with special needs and develop appropriate services to address specific health issues.
Mr. Speaker, plans are being developed to address the restructuring of the National School Health Services to allow for greater participation of parents in the physical assessment treatment, and counselling of their children
I am convinced that early and sustained interventions are the best approach in reducing chronic non communicable diseases. Our data continues to reveal a high incidence and prevalence of obesity and chronic diseases among school children. My Ministry will strengthen collaboration with key stake holders in the Ministry of Education and other relevant agencies to assist in the reduction of these and other psychosocial problems affecting our student’s ability to learn and participate in educational activities.
Adolescent Health -Of importance Mr. Speaker, is the establishment of a multi -sectoral Technical Advisory Committee to provide a comprehensive approach to the development of appropriate preventive and curative adolescent health care services. Activities which began in the 2007 / 2008 to equip students, with knowledge and skills to make healthy choices will continue for young people in New Providence and the Family Islands. In fact, in the coming week, the team from Adolescent Health and School Health Services will travel to South Andros to conduct a summer camp for at least 40 students. Heightened and sustained child abuse prevention strategies will be implemented to reduce sexual abuse and child neglect in New Providence and the Family Islands.
Mr. Speaker, as stated earlier the ability of my Ministry to respond rapidly to disease threats and outbreaks will continue to be one of the highest priority of my Ministry. .Attention will be given to the education of the general public and “at risk” communities of factors contributing to the spread of communicable diseases and the role of the public in reducing the transmission of vector, water borne and other infectious diseases such as tuberculosis, chickenpox, conjunctivitis and gastroenteritis.
Continued collaboration will continue with Emory University, Atlanta Georgia to provide training for health care providers in communicable diseases investigation to strengthen the national capacity and response to disease threats in Eleuthera, Exuma, Abaco and New Providence. Plans are underway to provide training for one officer in contact tracing investigation at the University of the West Indies, so as to increase the number of visits to individuals and their contacts, exposed to sexually transmitted infections and other infectious diseases.
Food Handlers- Mr. Speaker, The Ministry of Health has secured improved facilities for the training of food handlers. My Ministry is pleased that through the provision of this training program, significant reduction (50%) of reported food borne illness has been achieved. By the end of this budget year trained resident food handlers will be available on all Family Islands.
Mr. Speaker, Nutrition and Health Education Programmes are two National Services that under gird all preventive and curative management and treatment plans. In fact, poor nutrition impacts the sustainability of wellness and recovery of illness. Studies have also shown that poor nutrition also contributes to high incidences of maternal and infant morbidity and mortality rates. During this budget year efforts will be made to promote the National Nutrition Guidelines, increase employee nutrition wellness programs as well as training and education of clients and healthcare providers in the nutrition management of obesity and other chronic diseases.
Finally Mr. Speaker, there is an urgent need for timely, quality and relevant data. The Public Health Information Program has long passed its scheduled implementation date by some two years. Funding in this budget will support the further implementation of IPHIS in New Providence and the Family Islands
The Public Hospitals Authority
Mr. Speaker, the PHA continues to carry out its mandate to manage the resources, staff and services of our Nation’s public hospitals (Princess Margaret, Rand Memorial and Sandilands Rehabilitation Centre) together with the community health clinics in Grand Bahama as well as the Bahamas National Drug Agency, Materials Management Directorate and National Emergency Medical Services. As of April 2008, the staff complement of the PHA stood at 3,684. Inpatient services are provided by a combined 985 beds across the three facilities, with discharges totalling in excess of 21,000 annually. Visits to the general acute outpatient facilities stood at 202,292 for last fiscal year 2006/07, while the outpatient psychiatric and geriatric areas typically register over 24,000 encounters each year. The community-based services in Grand Bahama have continued to attract more clients with the expansion of the scope of services to include geriatrics clinic and the community health unit.
The PHA has embarked upon a series of initiatives that will result in improvements in the areas of Governance & Strategic Leadership, Quality Assurance & Management Efficiency, Human Resources Management, Communications, Technology Expansion & Fortification and Infrastructure & Capital Development. Progress in all of these areas will result in the establishment of a “Culture of Excellence” throughout the network of the Public Hospitals Authority institutions and agencies where best care and best experience are the aims that all employees of the PHA aspire to follow.
As a means of reinforcing this “Culture of Excellence” and as a key to success in establishing the good Governance of the PHA, the Board of Directors and the senior leadership of the Public Hospitals Authority have introduced six categories of performance measures – six pillars if you will – that will guide the monitoring of performance and accountability of the PHA. These pillars are Clinical Quality & Patient Safety, Service, People, Prudent Fiscal Stewardship, Growth and Community Relations. Benchmarks will be established within the scope of each of these pillars which will be used to monitor progress in achieving the goals of the Public Hospitals Authority. With these mechanisms in place this Government and the Board of Directors of the PHA will, at the end of the day, be able to give a clear and accurate accounting for the achievements and progress of the Public Hospitals Authority to the people of the Bahamas.
Colleagues as you are aware that in addition to the approved 2007/2008 budget, the PHA has been extended a $15,000,000 Government guaranteed commercial bank loan to finance a number of critical capital development priorities.
Bank Loan Projects
These priority projects include the following:
1. Renovation and expansion of the Operating Theatre at the Rand Memorial Hospital at an estimated cost of about $700,000 to (a) correct the critical deficiencies in the existing theatre and (b) facilitate the construction of an additional Operating Room to decrease patient waiting time for elective surgeries and improve facilities for ophthalmic and orthopedic surgeries; thereby reducing the need for Grand Bahama patients to travel to Nassau or elsewhere for surgeries. This project is expected to go to tender shortly and construction is expected to begin by the end of November 2008.
2. Renovation and expansion of the Geriatric Hospital at Sandilands Rehabilitation Centre at an estimated cost of about $800,000. This work will allow for new bathroom facilities, isolation rooms, patient lockers and staff & patient lounges where patients can visit with relatives and friends.
3. A number of critical initiatives at Princess Margaret Hospital (totalling some 6 million dollars) include an electrical upgrade of the Ambulatory Block, digitization of the Radiology Department, and expansion of Operating Theatres.
4. A package of system-wide information systems developments totalling some $6.7 million for Materials Management; Pharmacy Services Management; Laboratory Services Management; Patient Information System upgrade and completion of infrastructure in the Data Centre, will also be achieved during this fiscal period. This package of IT developments is discussed later on.
Governance & Strategic Leadership Enhancement
In July 2007, the Government appointed a new Board of Directors for the Public Hospitals Authority for a two-year term. The primary area of focus of the new Board is enhanced governance for improved effectiveness, efficiency, transparency and accountability; with a view to transitioning our hospitals to become high performing institutions delivering quality care to all Bahamians and unleashing the talents of the nursing, physician and other employees of the PHA.
In this regard, a series of initiatives were undertaken over the last four months, involving: a) two structured visioning and strategic planning sessions and follow-up activities facilitated by The Governance Institute out of the USA; and b) two special leadership development seminars with the American College of Healthcare Executives, one on the topic “Understanding and Influencing Physician Relations” and the other on “Managing Healthcare Facility Design and Construction Programmes.”
Also noteworthy is fact that July 2007 also saw the election and appointment of a new Medical Chief of Staff, Chiefs of and Directors of Services at the Princess Margaret Hospital. This is the first time that this election process has been undertaken in keeping with the Medical Bye-Laws enacted in December 2004. The underlying objective in establishing this process is to place emphasis on elevating the role and effectiveness of physician leaders in the management and delivery of services.
Quality Assurance & Management Efficiency
A & E Services Improvement
Utilization of the emergency room at PMH continues to be high with approximately 50,905 visits occurring during the year ending June 30th 2007; which represents an increase of 7% over the last two fiscal years. Therefore, in July 2007, the government allocated a budget of one hundred thousand dollars ($100,000) to begin phased upgrading of the emergency room services. The project is planned as a three year improvement programme at an estimated total cost of $834,790.
The Project Plan provides for (among other things):
The implementation of a Fast Track System for non-urgent illnesses thereby decreasing waiting times;
Improving the efficiency of the patient flow system in the AED through the appointment of Patient Care Coordinators and the implementation of policies and procedures designed to minimize bottlenecks thereby improving patient safety and minimizing overcrowding and congestion;
Prioritizing customer satisfaction by the further development of the Patient Advocate Program and Communication systems that are designed to facilitate communication between staff and patients and their families thereby enhancing the hospital’s reputation as a leading resource for urgent care; and
Benchmarking, standardizing and implementation of a data collection system to track patient waiting times and utilization patterns to enhance planning and evidence-based decisions for the continued development of the AED
Tied to the comprehensive AED redevelopment project is a component to redesign and renovate the existing physical space to accommodate the triage and fast tracking system. In this regard, architectural plans have been drawn for the redesign of the existing space and have gone out to tender. It is anticipated that renovation work will be completed early in the new fiscal year.
Pre-Hospital Emergency Care
As you may be aware, some three (3) years ago the Public Hospitals Authority had been delegated responsibility for the management and development of Emergency Medical Service (EMS) throughout the Family Islands. At that time, the decision was taken to expand emergency services in Abaco beyond a voluntary service to a functional EMS base. During the first quarter of 2008, that base relocated service from the Marsh Harbour clinic to the Legacy Building in Marsh Harbour in order to provide additional space and improve the level of service to the people in Abaco.
In New Providence, the public is also benefiting from the recent training of paramedics working as a part of the NEMS team. This means that there is a larger pool of persons able to perform specific treatment / stabilizing procedures assigned on each EMS team, thereby improving the level of care received by patients prior to their arrival at the hospital.
In keeping with PHA’s mandate for achieving management efficiency, a “Cost Containment Seminar” was held in September 2007 with approximately 150 executives and managers from throughout the PHA as participants. This seminar provided the organization with a package of important strategies for reducing the continual increases in expenditures, particularly in high cost areas such as Drugs and Medical Supplies, Overtime, Utilities and Contracts for Medical Services. The fine-tuning and implementation of these approaches are receiving attention so as to improve our capacity to analyze and explain the causes of these increases with a view to reducing the problem of escalating costs.
There are active initiatives underway to strengthen the Supplies Management processes throughout the PHA. These include the reorganization of the systems for the management of drugs, medical/surgical and other supplies across the public sector. They will result in changes in reporting structures, business processes, upgraded standards and policies for Supplies Purchasing, Distribution and Inventory Management. The most recent initiative in this regard was a “Morning Lecture” series held in April 2008 to review with all stakeholders the procurement processes with specific reference to Tendering.
These improvements in policies and work flows are also an important step in preparing the organization for the new Information Systems which are being implemented this year to support the full span of Supplies Management processes.
Ultimately, the objective is to improve efficiency by better managing the procurement and distribution processes and reducing pilferage and product wastage.
Another achievement in the area of management efficiency was registered in November 2007 when the Bahamas National Drug Agency (BNDA) issued its tender for Pharmaceutical supplies for the public healthcare sector, using for the first time, the electronic medium. The use of this technology has streamlined the tendering process, making it more efficient. The next step in this regard will be the development of a software programme to facilitate all activities of the tendering, analysis and selection processes with integration into both the Materials Management Information System and Pharmacy Management Information System; which will come on stream in November of this year.
Concentrated work began in July 2007 to develop a comprehensive Health Pandemic preparedness plan for the PHA and its institutions. This work is two-thirds completed and is scheduled to be completed this year for the three hospitals. The completion of this plan is important as it will enable us to recognize and manage an influenza pandemic; assist in reducing transmission of the pandemic virus strain; to decrease cases, hospitalizations and deaths; to maintain essential services and to reduce the economic and social impact of a pandemic. Additionally, this plan can easily be used for broader contingency plans encompassing other disasters caused by the emergence of new, highly transmissible and/or severe communicable diseases.
Human Resources Management & Development
The development of two new organizational policies for human resources management was completed this year, addressing Conditions of Employment and Salary & Benefits.
In an effort to foster continued good relations between the PHA and its staff, an official PHA Employee Handbook was designed and circulated to acquaint staff with the organization and provide information about working conditions, benefits and policies that affect employment.
The Public Hospitals Authority is implementing a Labour Management System, known as “AcuStaf”, to support the processes of staff scheduling and time and attendance among shift workers and to provide data integration and automation to reduce labour costs, and monitor productivity goals. It will serve as a tool of accountability for the leadership team while ensuring adequate hours of care for patient safety and enhanced employee satisfaction. During the latter half of this fiscal year, the “AcuStaf” System is being piloted throughout the facilities of the PHA. This six-month period will afford the opportunity to identify and correct any remaining operational problems in the system. It is anticipated that the “AcuStaf” system will “Go Live” in July 2008. It must be reiterated at this crucial juncture in the project that this system is not a punitive tool to control select categories of staff; rather it is a practical tool to facilitate better management and improve the processes of scheduling and staffing at the unit level, support management in reviewing overtime costs while promoting accountability and efficiency.
Our hospitals boast a very dynamic and vibrant Continuing Education programme for employees. With respect to Nursing Services, the institutions have been actively training nursing staff with a view to improving the overall quality of patient care. In December 2007, twenty-one (21) Registered Nurses (12 at SRC, 4 at PMH, 1 at Rand, 4 at DPH) completed a nine month Psychiatric Nursing programme.Additionally, ten nurses recently participated in a 10-week online Perinatal Intensive Care programme, receiving the technical knowledge necessary to effectively complement the care delivered by neonatal physicians. The programme also includes five weeks of field site work in Toronto, Canada. These nurses are expected to successfully complete the entire programme in May. The aim of the programme is to improve new born outcomes at Princess Margaret Hospital. Additionally, two (2) nurses are undertaking a Midwifery Course and a management degree at the University of the West Indies in Jamaica respectively. Ongoing sessions in areas such as Intensive Care (an introduction), Basic Life Support, Advanced Cardiac Life Support, Neonatal Resuscitation and Medication Distribution are conducted for all levels of staff at the institutions.
With respect to Continuing Medical Education (CME), a new education initiative is being implemented, to prepare non-traditional medical school graduates to take the Caribbean Council of Medical Councils (CAMC) registration examinations. The program is being conducted at the Rand Memorial Hospital in collaboration with The Bahamas Campus of the University of the West Indies, School of medicine and Clinical Studies. The intent of this programme is to augment, identify and improve the medical training of the graduates while preparing them to sit an examination that will determine their eligibility for an internship at our facilities. This six (6) month course commenced on 5th May, 2008. At Princess Margaret Hospital the CME programme continues to be strong. So far this fiscal year, physicians have participated in lectures on a range of areas and topics including Clinico-Pathology conferences, Ethics forum, Management of Type II Diabetes, Drug Therapy challenges, Multi-Sliced CT-Scan benefits and limitations and Echocardiology. The stress on the importance of research to policy formulation and improvement of patient care is now being re-emphasized. Particular research forums with local and international collaboration are ongoing.
Workshops relative to the redevelopment of Accident & Emergency were conducted by the Training Department for the Patient Care Coordinators and included a Customer Service Initiative. That department also arranged training for the Oncology Department.
Additionally, the PHA provided training and retraining for medical records coders, facilitated by the Pan American Health Organization. This course which was conducted in October and November 2007, in New Providence and Grand Bahama had a total of 39 and 17 participants, respectively. Successful completion of this basic course by participants and new coders has increased the pool of persons capable of coding hospital morbidity and mortality encounters.
Health Careers Marketing
On October 16th, 2007 the Public Hospitals Authority collaborated with the Ministry of Health and Ministry of Education as it opened its Health Careers Fair which exposed 3000 students from primary (sixth grade) and secondary schools to professional opportunities in healthcare. Special emphasis was placed on allied health professions reflecting the present and future human resource needs within our public health system.
Technology Expansion and Fortification
It is important to note that significant advancements have been made over the last six months in building the infrastructural hub for modernized information and communications technology within the Public Hospitals Authority and, by extension, the wider healthcare delivery systems of the public sector.
A new state-of-the-art Health Services Data Centre will soon be officially commissioned, together with the new PHA Corporate Offices Complex. The construction and equipping of this Data Centre has placed the PHA in a vastly improved state of readiness for all the many technological developments that The Bahamas will be implementing in health over the remainder of this year and beyond.
Materials Management Information System
As a result of escalating costs of medical and surgical supplies, the Authority embarked on an investigation, in July 2005, to purchase an automated Inventory Management System. The work entailed in acquiring a new Materials Management Information System prepared the Materials Management Directorate to embrace new principles of supply chain management, thereby reducing wastage and ensuring the availability of critical supplies.
The successful launch of this new Materials Management Information System will result in greater efficiency, tracking, procurement, inventory and contract management and distribution of all supplies from a central site.
Pharmacy Management Information System
Following a lengthy planning and implementation process, the Authority will launch its new Pharmacy Management Information System to improve the efficiency of processing inpatient and outpatient prescriptions as well as improving access to appropriate management information.
By the end of June 2008, the project team of the Pharmacy Management Information System would have completed several levels of training and developed policies for the use of the new system. All of this work must be completed in preparation for the two-month piloting of the system at the Rand Memorial Hospital in Grand Bahama that will coincide with the September 2008 project launch. It is anticipated that the roll-out process to the other institutions will occur at the Princess Margaret Hospital in November 2008 and Sandilands Rehabilitation Centre in January 2009.
The team also re-worked the workflows for BNDA’s use of the system. This will have the desired result of fostering synergy between BNDA and our facilities, real time processing and procurement while removing the seams of the process and ensuring a true perpetual inventory.
Laboratory Information System
The Government of The Bahamas has mandated that all residents of the country should have universal access to health care and essential social services. As a result, the Laboratory Information System project was initiated; its purpose to provide clinicians in hospitals and in clinics the ability to request laboratory tests and receive laboratory data in a timely manner, thus improving patient diagnosis and care; and reduction in hospital patient days.
The PHA, as it perceives the vision and health care benefit to the Bahamian public, undertook a Request for Proposal process and following an exhaustive evaluation (inclusive of site visits to Ohio and Alabama) selected the MYSIS laboratory information system provided by Sunquest Information Systems, Inc. Funding for this cross-cutting project will be obtained as a part of the bank loan facility being advanced to the PHA through the Ministry of Finance.
Within the first quarter of the 2008/09 fiscal year, the Authority will seek to implement the new system in the hospitals in the first instance before rolling it out to the rest of the community clinics. Grand Bahama has been chosen as the best site for piloting the program as it comprises the Grand Bahama Health Services which is made up of the Rand Memorial Hospital and several Public Health clinics all operating under one administration. This provides an ideal test site as it represents a microcosm of the intended application in the country.
Cancer Registry System
A similar process was undertaken during the current fiscal period for the acquisition of a new integrated Hospital-based Cancer Registry System for use by the Cancer Program at the Princess Margaret Hospital. Specifically, the PHA entered into a contractual agreement with IMPAC Medical Systems Inc. for the provision of the METRIQ Cancer Registry System. Implementation of this new system is scheduled to commence in May 2008 with the system fully launched in July 2008.
The new cancer registry software will collect cancer data according to requirements of the Commission on Cancer and the American College of Surgeons, the approval body for the Hospital Cancer Programs in the United States and Canada. This will in turn facilitate the provision of comprehensive care by making information available to all appropriate healthcare providers; enable follow-up, including social work and outcomes while automating linkages with other existing and proposed information systems such as pharmacy, pathology, and hospital patient information.
With respect to national development, the new hospital cancer registry system has the capability to be integrated with a National Cancer Registry, as may be required in the future.
Patient Information System
At the core of any health information system is the need to capture demographic data on each patient that utilizes our hospital system. As the PHA has endeavoured to improve our services through substantial investment in information technology, it has become apparent that a “cleanup” of our patient information system is critical to the true success of the aforementioned systems.
In this regard, two major sub-projects were initiated to manage the analysis, electronic and physical clean-up of patient’s duplicate medical records at each of the three hospitals within the PHA, followed by merging of the three separate databases (Libraries) resulting in the creation of one organization-wide patient database within the Keane Patient Information System.
Additionally, a Public Health Information system (IPHIS) designed to capture clinical patient encounters at c