The budget fails public health

Apr 06, 2014 APNU Column, Features / Columnists

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The Budget 2014 entitled “A Better Guyana for all Guyanese” prepared and presented to the National Assembly by the Minister of Finance, Dr. Ashni Singh, has fallen short and failed to address the socioeconomic status of the healthcare providers and by extension the general welfare of the citizenry.
The Budget has been touted as the largest and has shown an unprecedented growth and a GDP expanding 5.2%. However, despite the boast by the Government of surpluses and savings, the masses and working poor remain in a state of dispossession and the jobless poor continue in bewilderment and hopelessness.  The Budget raises several concerns.
The extension of the wards of the Obstetrics and Gynaecology Department of the Georgetown Public Hospital Corporation (GPHC), to accommodate high-risk mothers before and after delivery without having the adequate nursing staff is unwise. It is recommended that there continues to be capacity-building and that the technical capabilities of healthcare workers be strengthened at all levels through training and re-training with the major emphasis being placed on strengthening supervisory skills.
There is a race by the Government to achieve the elusive Millennium Development Goals 4 and 5, which address specifically the reduction of neonate, infant and maternal mortality.  To address these health indicators, efforts are being made for the construction and outfitting of the proposed maternity waiting homes in Lethem and Bartica. Although a good gesture, such programs should be decentralized and the newly-trained doctors should be encouraged and deployed to work in these remote areas so as to manage the patients efficiently and monitor them accurately. This would significantly reduce the incidence of patients, arriving at the GPHC at a late stage of their illnesses. They should spearhead procedures such as Mammograms, Pap Smears and Visual Inspection with Acetic Acid (VIA) among others.
Primary health care is being downplayed while the proposed Specialty hospital is being promoted. Guyana boasts five levels of health care service – Level 1- the Health Post; Level 2 –the Health Centre; Level 3 – the District Hospital; Level 4 -the Regional Hospital and Level 5 – Georgetown Public Hospital Corporation – a tertiary level referral and a teaching institution with specialists.
It would be wise to develop the already and existing tertiary level institution – the GPHC – which will result in less cost to/for the taxpayers.  The Georgetown Hospital, in collaboration with the University of Guyana and the Universities overseas have begun to train specialists in several disciplines to work in rural and remote parts of Guyana.
There has been a renewal of primary healthcare focus in the lead-up to having healthy people and healthy communities. In fact, this approach has been touted to strengthen society’s ability to reduce inequities and as an essential condition for meeting commitments, including the United Nations Millennium Declaration. The latter addresses the social determinants of health and the achievement of the highest attainable level of health by everyone.
The recommendation is that primary care service be complemented by different levels of specialized care, whether it is ambulatory or inpatient, but the focus should be at this time on improving the primary care system.
There should be the endorsement of the Integrated Prevention and Control of Non Communicable Disease Strategic Plan 2013-2020 that promotes wellness centres and primary care services to promote greater integration of services to meet the needs of remote communities including environmental surveillance.
More attention should be paid to Primary Health care which would have wider scope and greater impact in promoting health and human development rather than the deliberate orchestration to put in place mechanisms to foster the distribution of patronage to those who are perceived to be loyal or satisfy certain prescribed conditions.
The recognition of early childhood and teenage molestation, the growing incidence of domestic violence, suicidal behaviours and domestic violence – all these socials ills are of major concern to the Guyanese populace. There should be a structured guidance programme in schools and health clubs to address the issues such as the dangers of early sex and its sexually transmitted diseases and the dissemination of information on health as to what the children and youths need to know in life.
It is also recommended that proper data be collected to capture the factors and etiologies that have attributed to this social problem. For example, data on the percentage of persons who are frustrated and jobless; the percentage of persons who are engaged in substance abuse; the age ranges of such persons who commit suicide must be provided, so that a matrix can be developed to look at the host, environment and agent to address the cause and thus provide prevention strategies at a primary, secondary or tertiary level.
Over $ 2.5 billion has been allocated to the sanitation system established for the management and disposal of municipal solid waste and sewage. However, no plan has been posited or evidence of consultations being made among NGOs, the residents, the business sector or the city council as to the way forward for an integrated solid waste management plan.
There must be a comprehensive plan for waste prevention, waste disposal and combustion or controlled burning and recycling and composting.
Budget 2014 has comprehensively failed public health.

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