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daswainy · 8 years ago

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Guyanacare – The Importance of Quality Health Care in Guyana

What is something that you can't afford to have, you can't afford to be without, and you hope to never use? …health insurance. (Kahler, 2007) As with most important things health is something we often don’t think about until there is an absence of it. The World Health Organisation (WHO) crafted the perfect definition for health being: “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” (WHO, 1948) Therefore, health care refers to the efforts made to maintain or restore physical, mental, or emotional well-being especially by trained and licensed professionals. (Merriam-Webster, n.d.) Quality health care is important to Guyana because not only is it “central to human happiness and well-being but it also makes an important contribution to economic progress and development, as healthy populations live longer, are more productive, and save more” (Health and Development, WHO)

Proper health care is not possible without a good health system. The WHO describes a good health system as one which “delivers quality services to all people, when and where they need them”. For a good health system to exist, it must have the following:

1. a robust financing mechanism;

2. a well-trained and adequately paid workforce;

3. reliable information on which to base decisions and policies;

4. well-maintained facilities and logistics to deliver quality medicines and technologies. (Health Systems, WHO)

Does Guyana’s health system have all these elements to make it good? We may all have our own feelings and opinions about this but let’s look at the international data. The United Nations Human Development Programme Report 2015 uses the Human Development Index (HDI) to assess the “three basic dimensions of human development” one of which is a long and healthy life. Guyana’s life expectancy at birth is 66.4 years compared to 71.1 and 70.0 years in Suriname and Belize respectively which are countries from our region which are closest to us in HDI Rank and population size. This means only compared to the two countries most similar to us, our life expectancy is about 4 years shorter. On a global scale, the people of Norway are expected to live about 15 years longer than the people of Guyana which shows how important quality health care is…would you not wish for 15 years more of life?

The key to recognising the importance of quality health care is to understand how our health system is organised. According to the Guyana WHO Cooperation Strategy 2010-2015:

Guyana's health care system is highly decentralised; with the Ministry of Local Government and Regional Development undertaking responsibility for managing, financing and providing health services at the regional level through the Regional Democratic Councils (RDC) and the Regional Health Authorities (RHA). The RDCs and RHAs receive technical and professional guidance from the Ministry of Health (MOH). The private sector functions independently but is guided by the health facilities Licensing Regulation which mandates standards of care and practices (WHO, 2013)

Now that we understand the framework in which health care is provided to us in Guyana, we can examine each of the elements that make-up a good health system and attempt to determine if they exist here and how they contribute to the importance of competent healthcare.

Nothing good comes cheap. To have proper healthcare, money needs to be spent – “a robust financing mechanism.” Under our health system, public health services are mainly financed by the government with contributions from an active donor community (WHO, 2015). The National Budgets over the years have steadily increased the percentage of the finances given to the health sector rising from 9.4% in 2010 to 12.5% in 2017. (Jordan, 2016). In addition, the WHO Official Development Assistance (ODA) for Health to Guyana recorded US$63.25 million dollars given in donations for the 2009-2010 period alone. This money has been put to good use with the establishment of the Caribbean Heart Institute(CHI) in 2007 and the Cardiac Catheterization Laboratory in 2016. The value of quality health care is vividly displayed in this instance. The CHI is now able to offer services to Guyanese who may not have been able to afford them overseas, resulting in many lives being saved. Although some progress has been made challenges to health care still remain especially in hinterland regions and “in the recruitment and retention of human resources” (WHO, 2015)

This brings us to our second pillar of the health system – “a well-trained and adequately paid workforce.” One People, One Nation, Our Aim Migration should be our motto owing to the cheery fact that our “emigration rate is among the highest in the world from a country not at war, engaged in civil war, or faced with serious insurrectionary conflicts.” (Thomas, 2014). More than 55% of our citizens reside abroad and this pervasive emigration of skilled workers deprives Guyana of professionals in healthcare and other key sectors (The United States Central Intelligence Agency (CIA) World Factbook, 2017). A significant number of healthcare professionals, particularly nurses, (Bleeker & Deonandan, 2016) migrate to Europe, North America, and other Caribbean countries due to challenging working conditions, limited opportunities for training, inadequate career development systems, and the absence of a comprehensive human resources development plan. (The Pan American Health Organisation [PAHO], 2012). This has resulted in a high prevalence of foreign health workers mainly from Cuba and India concentrated in the urban centres of Region 4 (PAHO, 2012). As a result of this trend, programmes for healthcare professionals have been bolstered increasing the intake for the training of nurses, medexes and other allied health professionals, such as pharmacy, laboratory, and rehabilitation assistants and audiology technicians. (University of Guyana [UG], 2010) A collaboration between the Ministries of Public Security and Public Health has resulted in a National Emergency Medical Services (EMS) Programme which has trained 110 Emergency Technical Technicians (EMT) and 27 dispatchers. Doctors who have benefited from the Cuban Scholarship opportunities have returned and the Government has invested substantially in improving the facilities of the UG Faculty of Health Sciences, providing millions in 2016 to upgrade the laboratories. (Government Information Agency [GINA], 2016). However, inequity still exists with qualified health care professionals unwilling to serve the rural and hinterland communities where approximately 59% of the population resides (PAHO, 2012). Winning the undesirable title of WHO’s highest suicide rate in the world in 2012 for a staggering 44.2 suicides per 100 people (WHO, 2012) has resulted in the long-overdue reformation of Mental Health Unit (MHU) at the MOH in 2016 and the formulation of a National Suicide Prevention Plan 2015-2020 in conjunction with the WHO. This plan details numerous strategies one of which is to offer Psychology and other Mental Health qualifications at UG. The MHU in 2016, has also made some improvements by employing five psychiatrists and eight social workers and working towards establishing a Mental Health Institute in Quamina Street whilst upgrading the Psychiatric Ward at the Georgetown Public Hospital (GPHC), (GINA, 2016). This seriously highlights the importance of proper mental health care, as the lack of it has been sighted as a contributing factor to our dangerously high suicide rate with psychiatrists working in the mental health sector only making up 0.50 per 100,000 people in 2015. (WHO, 2016)

The abundance of Donors and Non-Governmental Organisations (NGOs) means that there is a wealth of information on which to base decisions and policies. This however can sometimes prove to be a hindrance as a lack of coordination among NGOs due to different project management requirements and the inability to harmonise the management of several aid flows affects private-public partnerships and the use of funding. (WHO, 2015). At the local level, there is limited use of available data for evidence-based decision making and policy design. (WHO, 2015) Collection and analysis is poor as a result of a fragmented health information system which often neglects to accurately compile data from private and rural health infrastructures. Although Guyana has a Bureau of Statistics, data gathering and analysis is slow with results from the 2012 population census taking years to be published. Guyana therefore, has a high dependence on donor reports which sometimes results in variations in statistics collected by these agencies where data is not provided at the grassroots level. How can one make policy to better a health care system if it cannot properly diagnose the problem? However, efforts are being made to correct such issues with the Development of the Health Vision 2020, “Health for all in Guyana”- National Health Strategy for Guyana 2013-2020 which reflects the collaborative work of a number of governmental agencies, donors and stakeholders under the leadership of the MOH (MOH, 2013) which has been referenced by Finance Minister Jordan in the last three budgets. (Jordan, 2015, 2016). The Ministry of Public Health (as it is now called) has also recommitted to Guyana’s third Country Cooperation Strategy (CCS) 2016-2020 with PAHO/WHO in February 2017. The Bureau of Statistics is benefitting from an expansion programme and an E-Governance initiative has been developed by the newly formed Ministry of Public Telecommunications which seeks to connect all ministries through Information Communication Technology (ICT) and foster development by sharing and developing a higher knowledge based society. (GINA, 2016). An NGO, The Caribbean Voice (TCV) has committed to conducting a nationwide survey on Mental Health in October 2016 in partnership with other NGOs (Guyana Times, 2016)

No-one wants to go to a broken-down health care facility, especially if you’re in an unwell state which may add to your woes by giving you anxiety. Well maintained facilities and means of delivering quality medicines and technologies are vital in determining the ‘properness’ of health care. Guyana has been found severely lacking in this area. According to the PAHO/WHO Country Cooperation Strategy 2010-2015, listed under challenges is limited infrastructural facilities, weak strategic planning and management processes, incomplete decentralisation of health services, and difficult terrain particularly in the sparsely populated hinterland making delivery and monitoring of health services quite a task. The Health Vision 2020 strives to combat these problems by continuing to support decentralisation efforts and the strengthening of health resource management and networks across the facility, district and regional level through better monitoring and assessments. (National Health Strategy, 2013). Scholarship awardees who are now Doctors have also been dispatched to the hinterland areas to better serve communities there. Infrastructural improvements have been made to the GPHC and the Neonatal Intensive Care Unit at the West Demerara Hospital in 2016. Promises were also made in 2015, with the establishment of the MHU to improve the “disgraceful state of the National Psychiatric Hospital” (Norton, 2015). Two billion dollars is set to be invested into infrastructural upgrades and maintenance to health facilities. This will enable the construction and rehabilitation of comfortable living quarters at health facilities for on-call and live in healthcare providers in areas such as Barmita, Bartica, Kamarang, Mahdia, Port Kaituma and Annai. Four hundred and sixty-five million is budgeted to upgrade and construct local laboratory facilities. All Regional Hospitals will also have Medical Superintendents to maintain and guide medical standards. (GINA, 2017) These measures represent some incredible growth in the health sector, however medicine procurement and distribution still suffer in the areas of accountability and rural distribution. The new open bidding procurement process in acquiring drugs has resulted in shortages and allegations of bribery and inside information being passed to bidders by public health officials caught on tape. (Stabroek News, 2017) The Region 6 Drug bond has also come under investigation in 2016 for drug shortages and in mid 2016 The former Minister of Public Health, Dr George Norton came under fire over the procurement of a Sussex Street Drug Bond.

Life is already difficult. Being healthy is important to effectively combat the challenges we face from simply existing. Think of how you felt during the Ebola pandemic as we witnessed it devour Guinea, Liberia and Sierra Leone and then nibble at Europe and the United States where almost miraculously, a vaccine was created. The Ebola Outbreak shows why quality healthcare is important. The three countries most affected had poor health systems resulting in high death rates which have left over 16,600 children without one or both parents, depleting tourism and weighing down already sluggish economies. (WHO, 2017) Compare the response of the developed nations who were able to immediately quarantine the infected and ultimately create immunisation. Think about if Ebola reached here. Would we have been able to handle it? Reflect on the impact of HIV/AIDS since its discovery over 30 years ago on the “social capital, population structure and economic growth” especially on developing nations (Piot, Bartos, Ghys1, Walker & Schwartländer, 2001).Even dare to contemplate pop culture’s obsession with the Zombie Apocalypse which commonly deals with a world overrun by people that have been turned into flesh-eating creatures from a disease, and are capable of movement but not of rational thought. This, albeit an extreme example, shows what can happen if health systems are unable to complete their mandate. Article 25 (1) of The Universal Declaration of Human Rights, to which Guyana is a party state:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care… (United Nations, 1948)

As Guyanese, we are all guaranteed this right but the reality is that within our existing health infrastructure, we don’t all receive quality care especially those of us that reside far away from urban centres. Improving our health system will be slow, but it has to be deliberate because bettering care will save lives, and “ultimately reduce the burden of injury and disease in both human and financial terms” which is key to developing our beautiful country. (Teleki, Damberg, Reville, 2003)

References

Bleeker, H. & Deonandan, R. (2016).Factors Influencing Guyanese Health Worker Migration to Canada. Nurse migration in Guyana" Washington, D.C.: 2011 Human Resources Series Nº 64. Retrieved February 08, 2017, from http://www.paho.org/hq/index.php?option=com_content&view=article&id=7441:2012-nurse-migration-guyana&catid=526:info&Itemid=2054&lang=en

Chinitz, D. (2010, 12). Migration and the Globalisation of Health Care: The Health Worker Exodus? Jama, 304(24), 2747. doi:10.1001/jama.2010.1867

Jordan, W. D. (2016). National Budget Speech 2017. Building a Diversified Economy: Delivering

The Good Life to All Guyanese. Retrieved from http://finance.gov.gy/images/uploads/documents/542-budget_2017_speech_full_opt.pdf

Human Development Reports. (n.d.). Retrieved February 10, 2017, from

http://hdr.undp.org/en/countries/profiles/GUY

Healthcare [Def.1], (n.d.). In Merriam-Webster Online, Retrieved February 06, 2017, from

https://www.merriam-ebster.com/dictionary/healthcare

Kahler, R., Mr. (n.d.). A Riddle Without a Clear Answer. Retrieved February 06, 2017, from

http://kahlerfinancial.com/financial-awakenings/weekly-column/a-riddle-without-a-clear-answer

Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.

The Definition has not been amended since 1948.

Stabroek News. (2016, November 17). Emergency medical services launched. Retrieved February 09, 2017, from http://www.stabroeknews.com/2016/news/stories/11/18/emergency-medical-services-launched/

Thomas, C., Dr. (2014, August 09). Guyana's 2012 population census: Runaway brain drain rules! Retrieved February 10, 2017, from http://www.stabroeknews.com/2014/features/08/10/guyanas-2012-population-census-runaway-brain-drain-rules/

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daswainy · 8 years ago

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Loan in the Jungle

“University of Guyana brings out the animal in you” is the phrase that ran through my head as I stood in the snaking line in front of Student Loan agency. The ‘pokers’ were out in full force, boring in front of the young hyenas at the head of the line. The little cretins just laughed. Each giggle incensed me more as I felt my inner bad ‘oman will to be unleashed. “Sigh.” I didn’t even have a right to be mad, I thought. It was my own full-blooded Guyanese procrastinating that led me to this predicament in the first place. In my defence, finding glittering El Dorado was probably easier than finding a guarantor for this wonderful institution. Why do you ask? Because almost everyone over 18 in Guyana owed two places…Courts and UG. The line plodded along whilst simultaneously gobbling my lunch hour. I never felt so third world than I did in that moment. It was like I was begging for this loan like Loan Agency was a big lady getting into her car and I was a street urchin pitifully annoying her with my pleas of “Ow Aunty, please fuh dis loan nah?”. I checked the time. My lunch hour was long gone. My manager had no doubt laid an egg by now and I was nowhere near the steps of that little quaint building of misery. Everyone smelled of sun and the air was still, budding with a ‘busing. The little hyenas chattered with accents over-ripe from too much Barney. I wondered if I was so ‘annoying’ at that age. Suddenly, a ‘poker’, flew like a cockroach to the head of the line, with cries of he “had a child”. The hyenas laughed. At that point, I’d had enough and snapped saying “You little clowns have people 'boring’ in front of you all the time, some of us have jobs to get back to!” It was, of course, a domino effect, and 'busings began to pelt left right and centre. “You musy doan even care ya child!”, “Somebody call Travis Chase, I fed up.” “I got a child too, so what!” Someone from the loan agency peeped outside. The cockroach, in true cockroach fashion took the blows, unmoved. Everyone knows, you can’t crush a cockroach. The ruckus grew louder as two hours of waiting in the sun boiled over. A woman came out of the building and asked us to remain calm, she said they were trying their best. The line began to trot a bit faster. I chuckled to myself thinking, “Guyanese 'bai, they only respond to animal behaviour. I think they secretly like it.” I was beginning to make some progress, only three people away from the steps. My relief quickly turned to anxiety as student after student emerged crestfallen as if their US Visa application had been rejected. I pulled out my application and guarantor’s form, double and triple checking everything. No chances could be taken with this ‘go back come back’ organization. An agency of sadists that took great pleasure in wasting your time. Fifty shades of student loans. At that time, a fellow mature UG hopeful brought a most unwelcome distraction by firing up a discussion on the recent decision to increase ministers’ wages. “Oh 'gash!” I thought, all of us were already in a kiss-me-ass mood, this conversation was pouring gasoline. She then proceeded to say that she agreed with the increase, eloquently stating her reasons. I felt like I was witnessing a chapter of Animal Farm in living colour and madam was Squealer, the pig saying, “Comrades,” … “I trust that every animal here appreciates the sacrifice that Comrade Napoleon (the pig) has made in taking this extra labour upon himself. Do not imagine, comrades, that leadership is a pleasure! On the contrary, it is a deep and heavy responsibility.” I fought the urge to roll my eyes, thinking that all she needed was a podium. I turned my attention back to the line, I was already angry. It was best I kept George Orwell to myself after all everyone had the right to their opinion. I was finally at the head of the line, feeling like a drug mule that was trying to pass pellets through customs. I silently prayed. One of the clerks started to extoll herself loudly, saying “I hungry! I in able wid dis!” I prayed harder as she snatched documents from the young man in front of her. I hoped that I would get the other lady. Angry clerk barked at him, “That look like a trace over, come back.” The poor thing looked traumatized. “Please.” He pleaded. “I was here already…” She glared at him, uncaring. “Please move aside. Next! Next!” “Uh oh.” I thought. I walked up to her plastering a smile on my face. She collected my documents and I said: “U must be tired.” She nodded. I held my breath. I looked up and saw the honourable Finance Minister hung right below a hole in the water stained ceiling. My smile broadened at the irony. Angry clerk handed me a piece of paper “Come back next week Thursday to sign your contract.”. I exhaled. “Thank you very much!” I replied. I was hearing colours and seeing sounds, relieved and happy. As I tried to exit, a poker pushed past me and the next rightful heir to angry clerk, fumbling with her documents. Overcome with rage, Angry clerk flew up and screamed “I DONE! I DONE! I FED UPPPP!” She left the counter in a huff. I counted my lucky stars. The line had come to an abrupt halt and I gave my condolences to the poor students that were behind me. I made my way off campus, silently praying that I would not be in trouble for having spent an entire half day up at U.G. As I sat in the bus whilst it wormed its way to town, I couldn’t help but think of Dave Martin and the Trade Winds. They had sung many years ago about Cricket in the jungle. I had an idea for a remix.

#universitylifeinguyana #stillloveitthough

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