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Suggestions for Health Sector Reform in Trinidad and Tobago

Health reform refers to changes in health administration, health planning, and health research that place significant emphasis on local health challenges aimed at health administration, health planning, and healthcare reform.  They will combine to produce an efficient model of healthcare delivery capable of increasing the physical, medical, and psychological safety of the patient.  Health reform should be driven by empirical data, best practice, and evidence-based practice.  Various types of health statistics;  Such as mortality, manpower needs, technology functioning and patient satisfaction;  Analysis should be employed and strengthened in health systems.

  The current system of healthcare in Trinidad and Tobago is highly centralized.  The Ministry of Health maintains the operational oversight of five regional health authorities.  These are North West Regional, North Central Regional, Eastern Regional, South West Regional and Tobago Regional.  The largest regions are Southwest, Northwest and North Central;  Each catering for health care needs more than three hundred thousand people.

  There should be a significant reform of the Ministry of Health in the short term aimed at improving health care efficiency.  For example, it may focus on data compilation and analysis.  Experts should work with health researchers to analyze changes in epidemiology, and trends in morbidity and mortality.  In addition, the Ministry of Health should have the power to instruct regional authorities to make systemic and resource changes based on data collected and analyzed.  The regional bodies should be mandated to provide health-based data quarterly to the Ministry of Health.  The Ministry of Health should maintain general oversight of regional officials.  It should prepare an annual report based on self-monitoring and evaluation of systems, performance and challenges in each region.  Financial statements and audits should be submitted to the Ministry of Health every year and the factors for variance should be justified.  Recommendations should be made for improvements and incidents in white-collar crime lawsuits.

  One major reform that should be implemented is to provide full autonomy to the regional health authorities for the delivery of healthcare.  They should be able to generate their own funds by levying fees for their services.  This would eliminate dependence on the state or the Ministry of Finance for funding.  Each regional health authority should be able to invest in the stock market or initiate other income generating measures that make it possible.  Its funds should be spent according to the health needs of the population that serves it.  Regional officials should be responsible for primary, secondary and tertiary health care.  In addition, they should inspect private hospitals and health facilities in their geographic areas.  Private facilities should be subject to price controls to avoid excessive fees and the regional authority should be required to pay at least ten percent of their annual profit.

  In addition, regional authorities should have the power to ensure that all health institutions and providers adhere to national accreditation standards.  The Ministry of Health should take responsibility for developing national accreditation standards in all aspects of the operation of health institutions.  These should include hospitals, pharmacies, private practice.  In addition, traditional and alternative medicines should be subject to accreditation standards.  Everything and every health-based institution should be subject to accreditation standards comparable with more developed countries such as Canada and the United States.
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  It is clear that the boundaries of each regional authority have been redefined so that they are approximately the same population size.  At this time the Southwest Regional is responsible for over one lakh people.  Therefore, given its limited resources, it cannot be expected to perform with the greatest efficiency.  Given the fact that better health facilities are located in urban centers, this will be a challenge that must be judiciously overcome.  To accommodate this reform, regional authorities should reduce joint public and private participation in the provision of health care centers in rural and other districts that are less accessible to major hospitals and health centers.

  To make the health system efficient, a centralized electronic health record system must be developed and implemented.  This will ensure that patients are able to provide care in any area.  Thus it will make it easier to access health records from any health facility owned and administered by any regional authority.  It is expected that the Ministry of Health should play a leading role in this venture.  The records of patients in private hospitals should be given to the regional authorities, who can take them to the public hospital, they cannot be brought there if they need care.  Sometimes due to financial reasons such as excessive costs, patients may be taken to a public hospital.

  Employment policies should enable the free movement of skills and expertise across the region.  In some cases, highly specialized surgeons and caregivers should be made available to patients in other areas on a need basis.  In other words, one region can pay another for its efficient human or material resources demand.

  Regional bodies may cooperate in health planning.  They can cooperatively develop their strategic, business and budget plans.  Later they can bend their plans to meet the needs of their population.  The main benefits of centralized planning will be greater transparency, accountability and interoperability functionality.  Inter-planning can reduce competition between regions and ensure that scare resources are used efficiently.  In fact, the Ministry of Health can compare operational effectiveness and best practice across all sectors and provide opportunities to strengthen operational or institutional efficiency.

  The health system should be reformed so that it is able to provide high quality care for patients.  Patients must be well educated to take advantage of a competent, highly organized, and efficient health care system.  Finally, reform should involve all stakeholders;  Government, private practitioners and citizens.  A convergent bottom up and upside down model should be adopted so that there is a health improvement in universal procurement capable of contributing to the economic and social development of the country's human capital.

  This article contains suggestions for improving the health sector in the small island nation state of Trinidad and Tobago.  If these and other reforms are adopted, the overall health of the country will improve.  Its citizens would benefit from a well-administered system.