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posted 17 Sept 2015, 08:38 by Gerry Kangalee   [ updated 17 Sept 2015, 08:57 ]
Minister of Health Terrence Deyalsingh

Honourable Terrence Deyalsingh
Minister of Health
Ministry of Health
63 Park Street
Port of Spain

On behalf of the membership of the National Health Workers Union (NHWU) and, by extension, on behalf of health workers throughout the country, we extend congratulations to you on your recent appointment as Minister of Health.

Health workers throughout the Regional Health Authorities look forward with great interest and concern to your government’s policy and operational approach to the public health system which has been aptly described by those who operate within it as dysfunctional.

On 2015/05/05, the NHWU wrote to the former Prime Minister, informing her about the horrendous situation existing within the public health system and recommending mechanisms which may be applied to begin to ameliorate the situation in the short term. Needless to say there was no consequent action on our letter.

In the estimation of the NHWU the dual track system of senior medical personnel operating in both the public and private health care systems must be abolished. The External Patients Programme (EPP) benefits a clique of medical doctors in the public health system that actually operates a private hospital sector funded by the state.

This situation has become so scandalously corrupt that medical capitalists have transformed public health institutions into gathering stations for those in need of medical procedures. Public health institutions are now holding bays and clearing houses for the routing of patients into the private health system and the state pays - another disgusting incident of the looting of public funds by politically connected persons.

In your party’s manifesto you promised to institute the much-touted national health insurance system by 2018. Your manifesto describes it thus: “an appropriate health insurance system, financed by the Government in partnership with the private sector, all members of the public will be able to access high quality health care at any health facility, whether public or private, regardless of their personal financial circumstances” This sounds uncomfortably like the justification put forward by the former, unlamented Minister of Health for the corrupt external patients programme. Rest assured, Mr. Minister, that health workers will keep a keen eye on your government’s approach to this National Health Insurance system.

Other corrupt practices are associated with the External Patients Programme. Sixteen private dialysis centres are being supplied with patients and being paid for by the State. It would be interesting to uncover what were the criteria used in selecting these centres and how much it actually costs the citizens of our country. Worse still: two dialysis centres are scheduled to be built at Mount Hope and San Fernando in collaboration with Comprehensive Nephrology Services Ltd and Biomedical Medical Technology Ltd. Five days before the General Election, the sod was turned for the one at Mount Hope.

David Jaikissoon
The two companies over time have registered the same addresses and have a common director in David Jaikissoon. The terms of the public-private partnership have not been revealed; neither have the track records of the two firms, which seem to exist only on paper. The NHWU strongly recommends that the relationship between the two companies and the former Minister of Health be carefully scrutinised as should the relationship between the companies and Fresenius Medical Care Deutschland GmbH.

The public Health system suffers from tremendous shortages of staff in most areas, particularly medical areas. Mechanisms must be put in place to fill the thousands of vacancies in the public health care system. According to official statistics, in the North Central Regional Health Authority there are, at least, six hundred and fifty vacancies to be filled, and in the South West Regional Health Authority (SWRHA) there are three thousand four hundred and thirteen (3413) vacancies, nine hundred and ninety-two (992) of them being nursing vacancies.

According to the World Health Organisation, the nurse to patient ratio should be one nurse to six patients. At San Fernando General Hospital the nurse to patient ratio is most times closer to one nurse to twenty two patients and this has been made worse since the advent of the Teaching Hospital. This is unsafe and puts both nurse and patient at risk.

In a statement issued on 2014-12-31 by nursing personnel at the San Fernando General Hospital and the Teaching Hospital it is stated that the staff shortages “result in long hours, excessive overtime, tired workers, denial of legitimate leave etc. and this must negatively impact the quality of health care to the population.” The statement goes on to say: “Overwork, frustration and a total lack of respect by those in authority for our efforts coupled with a lack of appreciation for all of us who work overtime and extra duty for minimal compensation in order to keep the hospital running is what we tolerate every day.”

Dr. Victor Wheeler
Dr. Victor Wheeler, in moving a motion at the fifteenth sitting of the fifth session of the tenth parliament on Tuesday January 20th 2015, calling for a comprehensive review of the regional health authority system, stated: 
"There is also a shortage of midwives; shortage of foetal monitors;”...The system clearly is not efficient. But in spite of all of these problems, I should state that there are many committed personnel in the health sector. There are many committed doctors, nurses and midwives who will still perform above and beyond the call of duty, and they are given little recognition for this…”

The shortage of medical personnel is bad enough, but there are also shortages of laboratory techs, phlebotomists, radiographers, pharmacists, dietetic and nutrition personnel, health, safety and environment personnel, medical social workers and many other specialisations.

Hospitals are being built, when according to Dr. Wheeler; “we have a shortage of specialists, shortage of nurses, shortage of midwives, shortage of lab managers, shortage of staff.” The Couva Children’s Hospital is a case in point. The former Minister of Health claimed it needs 2, 500 workers. Where are these workers going to come from? Are the other medical facilities to be cannibalised to staff it when they are already woefully short of staff?

There is no medical logic that can be discerned in constructing these mega facilities without first guaranteeing their staffing needs. Of course, it is logical to commission mega projects where hundreds of millions of public funds are being spent if the objective is not to provide services but to generate wealth and capital accumulation for politically connected persons through the siphoning of public funds into private purses.

Of course, there is a major problem in the RHAs with procurement systems, serious deficits in terms of equipment, staff, medication, utensils and everyday products, maintenance of tools and equipment, theft of valuable tools and equipment.

There is another insidious form of corruption that is sapping the morale of thousands of workers in the RHAs and has a direct bearing on the backward master and servant syndrome that pervades industrial relations in the RHAs. It relates to the ridiculous job appointment system in the RHAs which has as its base what are called cabinet approved positions and board approved positions.

In a nutshell, cabinet approved positions are so-called permanent appointments and board approved positions are short term contract provisions, These short term contracts may be (in the case of Aides to Nurses) month to month contracts; for other categories there are six month contracts, one year contracts and two year contracts.

The system is so chaotic that some categories of permanent staff that are offered promotions are told that they have to resign their positions and go on short term contracts to accept the promotion. This horrendous contract system affects both workers with professional qualifications and those without. Short term contract workers obviously suffer anxiety over their job security, are at a disadvantage when it comes to accessing mortgage and other loans and credit facilities. They cannot properly plan the future of their families or make significant investments.

The horrendous contract system must be done away with in the RHAs. How can workers who are not comfortable when it comes to their quality of life be expected to provide quality health care for the members of the public? This horrendous short term contract system must be abolished as a matter of priority.

Dr. Wheeler also stated: “Because many of the workers in the Regional Health Authority system were on contract, the environment for victimization flourished… and also said: “the manner in which permanent appointment was given to health care personnel did not demonstrate any logic or basis by which some people were given permanent employment, and others were not.”

This assessment of Dr. Wheeler dovetails with a statement issued by the National Workers Union on June 6th 2014 which stated: “Management of the RHA’s is based on political allegiance and not on providing a first class health service to the citizens. The industrial relations are abysmal and lead to low morale and frustration on the part of employees who are not connected to the party in power...”

In such an environment nepotism reigns unchecked; unqualified personnel are put in positions of responsibility which they cannot handle, promotions are denied to deserving workers because they are not management’s favourites, victimisation flourishes and the provision of health care deteriorates with each passing day.

orts have been made to the NHWU that during the last nine days before elections mass interviews were being conducted and employment contracts 
were being prepared at lightning speed at the South West Regional Health Authority. The Human Resources Department was virtually shut down during the period (see memo attached).

The reports also suggest that there may have been the destruction of application records and interview results. The NHWU requests that an investigation be done to ascertain the veracity of these reports. There have been long-standing accusations by workers that SWRHA engages in nepotism in their hiring practices. SWRHA’s Chief Operations Officer, Mr. Randolph Badall may be able to throw some light on the reports.

In conclusion, the NHWU reiterates its position that if the public health system is to survive and working people and the poor are to enjoy a decent, civilised standard of living and health care is not to become the preserve of the rich:

 The dual track system of senior medical personnel operating in both the public and private health care systems must be abolished.

 The horrendous contract system must be done away with, so that our workers may enjoy job security, without which they cannot properly plan the future of their families.

 Mechanisms must be put in place to fill the thousands of vacancies in the public health care system.

 Nepotism in hiring practices must be stamped out.

If these simple measures are put in place, we would have made a good start in reforming the public health care system, a reformation that is sorely needed.

In the service of the working class

Dave Smith
General Secretary