FEATURE ADDRESS Hon. Moses V. Nagamootoo, Prime Minister and First Vice-President at National Health Symposium 13th May, 2016 Arthur Chung Conference Centre
Minister of Public Health Dr. George Norton
Minister within the Minister of Public Heath Dr. Karen Cummings
Minister within the Ministry of Education
Dr. William Adu-Krow, PAHO/WHO Representative
Former Minister of Health, Dr. Richard Van-West Charles
Excellencies and members of the Diplomatic Corps
Esteemed Medical personnel, nurses and students
You have a packed agenda reflecting on the last 50 years of health services in Guyana, analyzing the current situation and planning for the future. It’s a packed agenda but a rewarding one also: there is Lunch for all, which I will unfortunately miss to be at other engagements.
Aa you know, I have seldom read speeches that I have made at public events. But today will be an exception. For while I have gotten away with oral political rhetoric, I don’t think I’d be lucky in escaping scrutiny when dealing with medical prognostications. So, I ask that you bear with me as I read my presentation.
I was born and lived at a time, before Independence, when health was both a matter of medicine and miracle. I suppose, after 50 years of Independence, our people still rely though less so today, on the “Bush Doctor” who would “beat out” or as we would say in my home village, “jaraay” illnesses, which I referred to in my book, “Hendree’s Cure”.
The cynics would look back at the past and they would remember one such notorious bush doctors in the person of Jim Jones, who miraculously but falsely had rendered instant “cure” for cancer and other maladies.
In that period, the inadequacy of our health system and lack of confidence in it had made “other cures” deceptively attractive. That was so then and, to a great extent today, due to lack of funding for public health and the unavailability of qualified medical personnel, including specialists.
What is remarkable though is that while Guyana has a mix of public and private health care, our people benefit from a system of free care from the time of our independence to today. This is remarkable for a country such as ours.
We all know that Guyana’s public health system was initially set up to service the dominant, foreign-owned, economic activities in the then colony of British Guiana. That plantation-type, healthcare system was geared towards ensuring that workers and staff who were associated with the sugar and bauxite industries, had better access to health services.
Primary health care was almost unknown in the interior and riverain areas, where our people were wasted by all types of diseases such as malaria and tuberculosis. That had begun to change during the immediate pre-independence period, under the then limited government when rural, riverain and hinterland health services became a primary responsibility of the state. It would be remiss of me not to say that a great innovator of rural health services was the late Ms. Janet Jagan, a health minister before independence, who later became one of Guyana’s Heads of State.
After Independence, especially since 1980, the de-centralisation of health care was institutionalized. That came about with the formation of 10 administrative regions, The system was also changed to recognize as a fundamental right, Primary Health Care.
The Regional Democratic Council was responsible for delivery of health services in its respective region, with the Ministry of Health, now the Ministry of Public Health, providing policy guidance, technical and financial support and monitoring of health outcomes. The Ministry of Health was and still is responsible for policy formulation, standard setting and monitoring of service delivery by both the public and private sectors and the formation of at least two Regional Health Authorities that would be responsible for service delivery. One was dysfunctional and the other not properly constituted. At the moment Cabinet is considering a memorandum to have a Health Authority in each of the 10 regions, which is being advocated by Minister Norton. Dr. Adu-Krow has addressed Cabinet on this issue.
In all that happened and could have been possible in the health sector, state financial allocation was the major hurdle. It must be recognized though that all Governments since Independence laid emphasis on universal free health care and planned spending within affordable levels of the state budget. We might say that the health budgets were never enough or adequate but were justified on an argument that, for the greater part after independence, Guyana had remained marginally poor. Only more recently, we styled ourselves as a low, middle-income country, which is like saying that we are poor but not miserably poor. Our annual GDP per capita income floats at US$3,700,00 as compared to small Caribbean island states, except Haiti, where average incomes were two, three and four times higher than ours.
So, it must be recognized therefore that health had to compete with other social sectors for state allocation of what essentially have been scarce financial resources. Yet, the allocation from the budget for health increased from 5.1% in 2008 to 9.5% in 2015. For 2016, it went up marginally. It is going up incrementally but going up.
You should know that these amounts would never be enough since demands continue to be made for greater spending to meet changes in disease profile that we experience, periodically.
This is what the statistics show: In the early 1980s, infectious diseases such as malaria, dengue fever, typhoid fever and gastroenteritis provided the greatest disease burden in the health sector. In 2004, there was a decline in Malaria cases, which averaged around 25,000 cases but increased to an annual average of 30,000 until 2014, when there was a 63% reduction in cases to 12,603.
In 2006, there was a peak in reports of HIV/AIDS cases and the Secretariat benefitted from an unprecedented inflow of funds. I would still like to see the actual figures of monies coming for this project from international funding agencies, and hope that a study be done into this. There have been controversies over the credibility of information on actual cases, but the 2010-2015 figures disclosed an annual average of 1,035.
Other figures show that tuberculosis continued to increase annually and reached its maximum in 2012 with 725 new cases and thereafter there was a progressive reduction in the number of cases which reached 512 in 2015. I was informed that Directly Observed Treatment Short Course (DOTS) and vaccination of our children are some of the interventions which have led to the decrease in the number of tuberculosis cases.
With the government’s ability to improve water, sanitation and housing conditions, the prevalence of these diseases has been reduced considerably. The country has also some recent challenges with vector borne viruses such as Chikungunya and Zika which, in spite of false prophesy, have not attained epidemic proportions. You recalled how during the recent budget debate, certain disclosures were made that Zika had assumed epidemic proportions in Guyana, which was just not true. I am informed that Zika has been restricted to six certified cases though the threat still remains and would require an intensification of the campaign to rid our communities of the mosquitos that transmit the virus. As regards Zika, I applaud the passion of Public Health Minister Dr. George Norton and Minister Dr. Karen Cummings, to tackle the spread of this virus. Minister Norton invariably reports to Cabinet weekly on the status of Zika and on efforts to combat the spread of it. Government hopes that we fight this threat with unyielding resolve.
However, I wish to warn that equally passionate about the outbreak of any disease is the pharmaceutical industry. I recall when we saw just the shadow of H1N1 in Guyana, with a single reported case, the pharmaceutical lobby went to work and wanted Government to single-sourced what could have been billions of dollars in medical supplies. When Zika was suspected, the same lobby stated that they had drugs already in Guyana to meet an epidemic. So, we must be warned that there are companies out there, even friends, that have placed tremendous pressures on our financial resources to sole-source drugs and medical supplies for every ailment, whether real or perceived. This lobby is like a huge snake, a hydra, with many heads and many mouths. They speak loudly and with many mouths and already you hear a new chorus that there is a drugs shortage in every region.
I say this: The need for an inventory of purchase of medical supplies over the last decade is outstanding since we ought to learn how we spent our limited resources and how to spread these resources, and not just respond to the insatiable appetite of supplies.
For us, we can say with confidence that our Coalition Government will continue to allocate the resources necessary to alleviate all of the health problems that continue to affect our population.
Regarding specialists to address specific health conditions, the country continues to experience challenges with the availability of skilled human resources. The brain drain has taken away many of our trained and capable nurses and mid-wives. Many others, including doctors, fell victims to attrition due to poor wages and incentives. We need time to repair this broken system of neglect of and ingratitude towards the people who have delivered us and who have kept us reasonably safe.
To alleviate these staff challenges, Guyana is currently training local doctors in the fields of obstetrics, pediatrics, surgery and medicine. The Government of Guyana is also investing in the health sector through the conduct of various capacity-building programmes for doctors and nurses at the primary health care level, and for personnel who must work away from the coastland.
We stand proud today and salute our front line health workers in the interior and remote areas who have played crucial roles in the development of the health sector. I salute you
Over the 50-year period of our independence, Guyana undertook several cycles in the immunization programme, where we have moved from 47% coverage around the 1970’s to over 90% of all antigens given to children under 1 year at the end of 2015. Coupled with this is the reduction in the level of anaemia for our pregnant mothers and children through numerous nutritional interventions.
Today, our challenge is to improve maternal health and reduce maternal mortality. It remains disgraceful and uncaring to have two mothers on a bed, or even a single mother on the floor. It brings back the imagery of the dreadful past where in isolated cases, patients were bitten by rats and our major public hospitals were deemed “death traps”. Today, efforts are underway to expand facilities at our maternity wards and to equip them with more beds. Our pregnant mothers must be treated with respect and given better care.
Guyana has crafted a millennium Development Goal (MDG) Accelerated Framework to improve Maternal Health, which will address the proposed solutions in order to meet the sustainable Development Goals of 2030.
Me3anwhile, mental health issues including suicide continue to pose major, if not sensational, challenges and I am encouraged by the sincere concerns shown from all sections of our community and the humanitarian help being given by overseas voluntary organisations, to fight these complex social diseases.
We have to work together. Today is the 13th and it is Friday. Are you fearful? The answer to our many concerns and even fear lies in togetherness, not only for better health service delivery, but to realise a clean environment and a green economy. We have to teach our children, healthy life styles, and to make sure that eventually all children in school get not only buses and boats, and boots and books. They are entitled to a healthy, hot meal, to make them strong and to be more receptive of educational values.
Our need for partnership today is greater than ever before. We need to pay more attention to preventative medicine, to curb the use of and addiction to illicit drugs, to discourage alcohol abuse, to regulate advertising and promotion of tobacco smoking, to take such administrative and other measures to guarantee that food manufacturers, suppliers and food handlers comply with safety and health standards and, last but not least, to remove garbage from our streets, our markets, our communities to ensure that the good life includes a clean environment.
Out health workers, tutors, managers and policy makers have been the backbone of our achievements and challenges. We salute you today for the tremendous work that you have done in moving the health sector forward.
Let us together on this historical occasion, reflect from where we have come, where we are now and where we would like to be in the future. Our responsibilities still remain great.
Let us take courage from your motto: “Every Guyanese citizen must live a productive and healthy life”.
Again our gratitude to PAHO/WHO and other sponsors and the organizers of this activity which provides the opportunity to highlight our achievements, our challenges and our future goals.
I thank you.