MEDICAL doctors are considering action if an increase in the health budget and a reform of the health system are not made, according to President of the Jamaica Medical Doctors Association (JMDA) Dr Alfred Dawes.

The association, he said, is mulling over the extent of action they will take if the situations affecting the delivery of health care, is not improved.

Dawes further appealed to Jamaicans to join them in applying pressure on the government for a complete overhaul of the health sector, and to not let the issue of poor health conditions at public hospitals be a nine-day wonder.

“The Medical Doctors Association cannot stand alone on this matter. The people must make their voices heard and for longer than the usual nine days. This should be a rallying cry to fix not just the health of our nation but all the broken systems we have put up with since independence. We need a complete overhaul of the health sector and only pressure applied by the people will effect this change,” Dawes told the Jamaica Observer.

He added that doctors sometimes opt to remain quiet because they fear repercussions, which can include termination of their contracts.

“Nobody wants to speak out publicly as they fear repercussions. The hiring of staff is done on a contractual basis and each region can alter the terms of employment as they see fit,” he said.

He added: “Staffing is a major issue as there is simply not enough money in the budget to hire the desired staff complement. As such there are unreasonably long waits when accessing medical care. To compound it the staff is demoralised because of the stressful and generally poor working conditions. With no central employment and deployment there may be a severe shortage of a speciality in one region and an abundance in other areas.”

In reference to the submission made to the Ministry of Finance by the health ministry for an increase in budgetary allocations for the new fiscal year to address the myriad of problems in the health sector, which were recently highlighted in Observer articles, Dawes said it is typical of the Government to apply a quick fix approach to each crisis that occurs.

“These problems are not new. There have been numerous meetings and consultations on the topics mentioned but very little has changed,” he said. A comprehensive review of the health sector was undertaken by Professor Winston Davidson in 2007. Solutions were offered to the myriad of problems but successive administrations have failed to act on the issue.

But, the main issues that affect the delivery of health care in Jamaica, according to the association, are the shortage of supplies, staff shortages and the absence of diagnostic equipment.

“These are perennial problems that have been significantly worsened over the last few years. The lack of adequate budgetary support and the loss of user fee revenue are only one aspect of the problem. A significant contributor to the poor state of the health system is its present structure. The operation of clinics and hospitals in a particular area falls under the regional health authorities of which there are four. The regional health authorities are supposed to be under the control of the central Ministry of Health,” Dawes said.

However, he explained that each region acts as their own boss and no one is held accountable when the health care meted out to patients deteriorate.

“This is far from the reality. Each region operates as if it is autonomous and hires and buys as they see fit. There is little flow of information between the regions and the Ministry of Health. As such nobody is willing to accept accountability for failures at the level of patient care,” he said.

Moreover, Dawes further explained that the equipment purchased for hospitals is often substandard.

“There is no standardisation of equipment and oftentimes the equipment purchased is far different and many times below the standard of what was initially recommended by those who would be using it,” Dawes said.

He added that along with the substandard purchases, there are no systems in place to repair equipment when they stop working.

“Needless to say many times the equipment are useless or break down often. With no reliable distributor or parts available it may take a while before they are able to be used again. This accounts partly for the long waits patients experience,” the JMDA president said.

He further added that there is need for a consistent supply of disposables, which are essential to the proper running of a health facility, as well as accountability when shortages occur.

“Hospitals use large volumes of disposables such as gloves and gauze as well as commonly used medication. There needs to be a regularised supply chain and stocks must be maintained. Unfortunately, this does not happen and nobody can explain why as those who ought to know are not made aware of the shortages. Is it that there is no money to purchase drugs and disposables, or is it that the persons responsible for procurement and distribution are incompetent and not held accountable?” the JMDA president questioned.

Subsequently, Dawes explained that patients are often left with no option but to get their own supplies, making the free health-care policy useless.

“The very same persons who are supposed to be benefiting from the abolishing of user fees are the same persons who are suffering the most because they do not have the funds to buy supplies or pay thousands of dollars for investigations privately,” he said.

He maintained that Jamaicans should continue to make their stories heard by publicising it on social media and through other modes of communication until the Government is left with no option but to effectively address the issues of the health sector.