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Oct 20, 2013 APNU Column, Features / Columnists
The People’s Progressive Party Civic (PPPC)-administered primary health care system is failing women, children and the aged. This failure has been most evident in hinterland and rural areas.
The primary health care system is meant to promote equity and social justice. All Guyanese – whether they live on the coastland or in the hinterland, in town or village or whether they are poor or rich – should have access to good health care.
Primary health care should be seen as an initiative to make health services more accessible. It should be seen as an investment in human development that avoids more expensive medical treatment at the secondary and tertiary stages.
The PPPC administration, however, seems unable to solve the problems facing health administration. It is now freely admitted that Guyana’s targets to achieve the United Nations’ Millennium Development Goals – MDGs – Four and Five, which concern the reduction of both maternal and infant mortality rates, are unlikely to be met by 2015. A plethora of problems plague the national primary health care system.
Administrative incapacity is the severest systemic impediment to the delivery of health care. The Minister of Health lamented, “We are somewhat alarmed at the level of Cabinet about the maternal mortality deaths…” The Cabinet Secretary added cynically, “I think we will have to prepare ourselves to obtain a report from this expert group [on a recent maternal death] in an ‘untimely’ way. We won’t get it tomorrow or next week… That is where our dissatisfaction lies.”
The PPPC’s clumsy treatment of nurses and its retarded attitude to their training is the second source of serious problems. Officials of the Guyana Nurses’ Association and Georgetown Hospital expressed alarm at the high failure rate – about 85 per cent – of a recent batch of nurses from the Georgetown School of Nursing, Charles Roza Nursing School and the New Amsterdam Nursing School. The huge size of the classes of student nurses and staff shortages have contributed to the failures.
The functioning of regional hospitals and community health centres has also weakened the national primary health care system. The Ministry of Health has had to react to what it calls “preventable difficulties” affecting nurses at the Linden Hospital Complex in the Upper Demerara-Berbice Region (No. 10) who went to the National Assembly in April to demand their gratuity payments.
Problems also arose at the West Demerara Regional Hospital in the Essequibo Islands-West Demerara Region (No. 3) where nurses and staff members threatened to strike in order to call attention to the non-payment of allowances and to the security lapses at the hospital. The Parika Health Centre has to be closed every time the rain falls because the building floods. The Skeldon Health Centre was abandoned a few months after it was commissioned. And so the story goes.
Health care delivery is erratic. The Minister of Health publicly lamented the “general dissatisfaction among Berbicians about health services being provided” in the East Berbice-Corentyne Region (No.6).
He threatened that health care officials would be made to ‘face the music’ more often and to account to the public for their actions.
Ministry of Health bureaucrats seem to have no notion of cost, distance and difficulty of transportation and communication in the hinterland. Staff at Imbaimadai Health Centre in the Cuyuni-Mazaruni Region (No.7), for example, was simply instructed to send seriously ill patients to Kamarang – a long journey usually by costly, privately-owned boats. There have been unnecessary deaths from snake bites and malaria owing to a lack of medication. St. Cuthbert’s Mission Health Centre turns away older patients owing to the lack of drugs. A child died last month as a result of a diarrhoea outbreak at Masakenari Village in the Rupununi Region (No.9).
The Ministry seems to be incapable of preventing, or responding promptly, to the prevalence of preventable diseases.
Data indicate that there were 144 deaths over a 12 year-period from 2001 to 2012 owing to Acute Gastroenteritis-Acute Diarrhoeal Diseases. 61 per cent of all deaths were children – five years or younger. Every year brings more deaths, most recently in the Barima-Waini Region (No.1).
The high cost of medical evacuation has been a consequence of dysfunctional community health centres. The Ministry of Health spent more than $25M in 2011 to facilitate the medical evacuation of emergency cases from hinterland areas because patients cannot receive care at the regional hospitals.
The absence of a national ambulance service and a corps of emergency medical technicians is the source of yet another problem.
The entire country has only about 25 ambulances. There are no dedicated air, road and river ambulances to deliver patients comfortably, cheaply and quickly to regional hospitals for treatment.
The Ministry of Health has been confounded continuously by the costly challenge of wanton waste and disposal of expired drugs. The Auditor General’s report revealed that $49.498M worth of expired drugs was dumped by the Georgetown Public Hospital Corporation alone last year.
The PPPC administration’s thrust to achieve universal health coverage through the primary health care system has not been a success. Its failure to prevent maternal deaths, to protect vulnerable children from deadly gastro-intestinal and other preventable diseases and to provide adequate care for the aged has lowered the quality of life for many Guyanese who depend on the flawed system.
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