Within minutes of its appointment, a shot was fired across the bow of the new Health Care Delivery Review Committee reminding us, lest we had forgotten, of the trials of bringing change to the public health sector.
In condemning Committee chairman Dr Winston Welch, former Health Minister Dr Fuad Khan cast his objection in the political terms of a PNM campaign against “UNC doctors.” But Dr Welch and his team should have enough experience to know that even the noisiest politics is no match for the far more serious money interests which are strangling the public health system.
It is not that we don’t know the problems or are unfamiliar with their causes and symptoms.
Starting with the Moyne Report of 1946, every review of the public health sector has described a comprehensively inadequate state of affairs in recommending more resources, better management and greater accountability for delivering anything approximating quality health care.
Since the last report submitted in 2009 by the Gafoor Commission of Enquiry, the only things likely to have changed might be the names and faces of betrayed patients and the bank accounts of those with a major investment in keeping the public health system dysfunctional.
Today, we are long past the old problem of individual fortunes being built on the backs of a broken public health system.
Thanks to a combination of ineffective policy and emboldened political investors, the roles are now fully reversed. The public health system now exists at the mercy of private suppliers of goods and services while the private health sector has grown into a full-fledged, highly integrated industry whose survival no longer depends on an ailing public health system even if its enrichment always will.
Six years ago, the Gafoor report had turned up enough information about phantom companies operating in the health sector along with accounting discrepancies to prompt then Prime Minister Patrick Manning to send the findings to the Director of Public Prosecutions.
If anything ever came out of that, it must’ve occurred outside of the public eye.
Since then, the problem has spiralled with taxpayers now paying twice for the same health service.
At least, this is the impact of the previous government’s policy of paying private hospitals to fill gaps in the public health system even as it finances the free public health system through taxes.
The Welch Committee can be in no doubt about the deep structural nature of the health sector’s problems which go well beyond the problem of personal culpabilities, as widespread as these might be. Interfere with one part of the problem and the whole thing could come crashing down.
Former Health Minister Hamza Rafeeq learnt this the hard way during the first Panday administration when his attempt triggered rebellion in the medical ranks that extended to a lengthy strike by nurses.
Right from the beginning, the best option for improving health care delivery has been the one least favoured by both government and medical professionals.
A public health system that rests on a decentralised base of well-resourced community hospitals linked to a modern local government system would be more manageable while spreading quality health care more evenly across the country.
Decentralised governance structures, however, are not features of the post-colonial world where the centralisation of power, and therefore of resources, has remained the dominant theme.
Combine this with the insecurities that make us easy prey to global hawkers of dazzling mega projects and you begin to understand the crazy logic behind the decisions, particularly in health and education, that have both sectors in the mess they are today.
If the past 53 years have taught us anything it is the urgent need to complete the independence process by redistributing power into the hands of the people so that each one of us can share the responsibility for governing our communities and, by extension, our country.
In this, local government reform is a key strategy but its success will be determined by the extent to which the centre is prepared to devolve power and to which people are drawn into the process of government.
This is no overnight affair. It requires the budding of a new culture steeped in rational thought and which rejects the mindlessness of ethnic solidarity. The more we build our power systems around communities, the greater the chance that the national power system will reflect the reality of our lives on the ground.
Hopefully, in reviewing the national health care delivery service, the Welch Committee will focus on the underlying conditions that have allowed its problems to mushroom to today’s unmanageable proportions.
Hopefully, too, the committee will avoid the political pitfalls that could snuff it out even before it gets going. Having requested the review, it will be up to the Prime Minister to manage the political process once he gets the committee’s report.
Given the substantial health industry interests with no stake in change, the government’s greatest ally will have to be the public.
Without public support, Dr Keith Rowley might discover that winning an election is a cake walk compared to transforming the health sector.