IN the wake of the release of the report of the audits of health facilities that are part of the Regional Health Authorities (RHAs) to the public, the Medical Association of Jamaica (MAJ) has said that, in moving forward, immediate and medium-term remedies must be explored.

Members of the MAJ in a news release last week said they are happy that the Ministry of Health has finally released the report to the public, adding that they have always maintained that it was an error to withhold the results. According to the MAJ, that decision fuelled the belief that the ministry was involved in a “cover-up” and served to further heighten everyone’s curiosity.

The body, which represents the interests of medical professionals, said if the ministry is serious about addressing the health sector in a holistic and positive manner, stakeholder involvement is vital.

Noting that the released report confirmed the complaints that were made by health care workers, and pointing out that it paints a picture of a health care system that is underfunded and/or poorly managed and in dire need of systematic improvements, the MAJ went on to identify nine remedies.

One of those remedies is to address the issue of accountability.

“It is very important to ensure accountability within the sector at all levels, but this does not necessarily mean resignations, reassignments and separation from jobs,” the release said. “Accountability could also mean assigning tasks to various persons to be accomplished within specific timelines, demanding timely reports.”

According to the MAJ, funds must be allocated to provide basic supplies for hand-washing and sanitation. The association said all pipes should be retrofitted to allow for no-touch techniques, especially in critical areas such as the Maternity, Operating Theatre, Nursery, Intensive Care Unit/High Dependency Unit, and Accident and Emergency (MONIA) areas. The group posited that hot water should also be run into these areas to help to contain infections.

The release also said that immediate steps must be taken to improve the infrastructure of the facilities to enable easy cleaning of walls, sinks, floors, doors and ceilings. Another remedy, according to the MAJ, is that communication has to be improved between the health care providers/workers and the administrators who have the responsibility to provide the necessary facilities.

The group also suggested enforcing a monthly reporting requirement from all hospital management teams to the boards of RHAs and the University Hospital of the West Indies Board. This, the MAJ said, should then be shared with the Ministry of Health, including the minister.

“The staff in all hospitals and health centres needs to undergo retraining on infection-control measures. This must include the members of the ancillary staff who are charged with maintaining cleanliness and sanitation of the facilities,” the MAJ’s release continued.

The group also pointed out that health care financing needs to be reviewed, which might mean ensuring that those who can pay do pay, whether out of pocket or through health insurance, or both.

“Consideration should be given to retaining the no-user-fee policy for the vulnerable in society: the very young, the very old and the poor, as determined by the same process used to determine those on the Programme of Advancement Through Health and Education (PATH),” the MAJ explained.

Since several recommendations have been made by the audit team, which could see an improvement in the sector, the MAJ suggested that these could provide a “good starting point”, but said that broader consensus must be sought from other stakeholders, such as doctors, nurses, professionals allied to medicine, administrators, and representatives of the general public.

And, insisting that any measure that is put in place will fail without patient education, the MAJ identified it as an important responsibility of the ministry and members of the health team.

Outside of the deficits outlined in the audit report, such as issues with physical infrastructure, equipment and supplies, health and safety, the MAJ said there are some positive aspects identified within the audits that can give Jamaicans hope.

“It was obvious that the Ministry of Health has established and documented standards that should govern good practices in public health facilities, although these need to be shared regularly with staff and measures put in place to ensure compliance,” the release said, adding that these guidelines were especially highlighted in the report on the South East Regional Health Authority.

“The audit teams made comments that suggested in several areas improvements and changes had already been implemented or were in the process of being implemented, by the RHAs to address some of the deficiencies,” the MAJ continued. “In the largest region, the audit team noted ‘substantial’ levels of implementation and integration of evidence-based practices and clinical practice guidelines.”

However, the association also made a few other observations.

The MAJ insisted that he University Hospital of the West Indies should have been included in the audit and pointed out that the terms of reference of the audit were unclear.

“In fact, the team at the Southern Regional Health Authority described the instructing letter as ‘vague’,” the news release noted.

Also, this particular audit focused on infection control, but the MAJ said other issues need to be examined if the sector is to be improved.

“The diagnostic services need significant improvement, requiring rightsizing of staff and equipment to allow for timely treatment. This includes laboratory services, such as pathology histology and cytology, which are critical elements in timely cancer care,” the MAJ said. “While improvements have been made in chemotherapeutic care for cancer patients, the improvement in access to radiation therapy needs to be fast-tracked. Reliable radiologic services are also required.”

Another observer was the gaps in financing the health sector.

“There are obvious gaps in the financing of the sector despite the much-touted 18 per cent increase in the health budget to over $49 billion,” the MAJ said. “These gaps are seen in the infrastructural deficiencies in the areas studied.”

The Ministry of Health bowed to public pressure recently and released the full findings of the audit after refusing to do so for over two months. Since then, Horace Dalley has taken over as minister of health and Dr Fenton Ferguson reassigned to the Ministry of Labour and Social Security.