I HAVE dwelt on the many facets of national life which impinge directly or indirectly on the general standard of health.

I have also alluded to the multi-faceted nature of the approaches to disease prevention and maintenance of health in the general population. If, for example, we take into account the general level of obesity in the country and the lack of engagement in physical exercise, we may conclude that, in considering corrective measures, a government should not only institute a programme of awareness but also offer incentives to the population by giving tax breaks on the purchase of exercise equipment and accessories. However, a simple measure such as providing a recreation ground with exercise facilities for all age groups in every community and equipped with lighting and security for night time use would stimulate exercise activities in the community with corresponding health benefits. Some communities have been fortunate in this regard but the majority are not. Perhaps we need a restructured Ministry of Sports to incorporate physical education, recreation and community health and to be so designated. The larger issue of how to moderate the unnecessary frenetic pace of living and the frenzied and, indeed, violent prone nature of the modalities of entertainment embraced by the majority is much more problematic. Associated with this are activities which encourage substance abuse. It is a supreme irony that we praise, promote and fund certain popular cultural forms and practices which turn out to be deleterious to good health and add to the burden on the health system.

With respect to the curative aspect of the public health care regime, the first priority here must be achieving a satisfactory level of efficiency in the delivery of health care in the existing public health institutions. It is a management problem which must direct attention to the proper deployment of existing staff and the optimum utilisation of existing physical and medical resources. It is only when such an assessment is made that the Ministry of Health would be in a position to identify the areas in which capacity and resources are inadequate and then embark on the requisite expansion.

If physical space is required for providing infrastructure, the built facilities at the EWMSC at Mount Hope are underutilised and can be made functional with the required refurbishment. There are many disused buildings in the compound of the San Fernando General Hospital which can be converted for appropriate use at minimum cost, including a spacious Children’s Wing. The Scarborough General Hospital has been completed and the Government is committed to building the Point Fortin General Hospital. Many district medical facilities have been upgraded. If the infrastructure at the EWMSC and SFGH can be refurbished and expanded and if an efficient airlift and ambulance system is put in place, why then is there an urgency to build a new hospital in Central or elsewhere without regard to the availability of staff, the ongoing maintenance requirements and the associated costs. The priority should, first and foremost, be on improving the quality of service at existing public health institutions instead of building, at this time, unnecessary additional physical capacity.

Even without an in-depth analysis of the current state of health care delivery at public health institutions, two areas of inadequacy cry out for urgent attention. The first is the perennial staff shortages at these institutions whether of doctors, nurses, technicians or administrative personnel.

This is an area in which additional expenditure on human resource development is justified. One merely has to observe the large gatherings at clinics, pharmacies, laboratories and elsewhere and the considerable waiting time occasioned to appreciate the need for increased staffing and their proper deployment. To depend on Cuban doctors and Filipino nurses to fill the vacuum can only be a temporary solution. The basic problem, however, remains.

There are three basic reasons advanced for restricting expenditure on training of health personnel. First it is argued that we already spend a significant amount in this area and, after training, the majority of beneficiaries migrate to foreign countries. Some corrective measures can be employed to stem the tide of migration, such as upgrading salaries, improving working conditions and providing additional scholarships with a longer service contract condition. But let us face the reality. This is a globalised world and the migration of skilled personnel is inevitable. This, however, is not a legitimate reason to circumscribe expenditure on training. One also has to bear mind some beneficial consequences of migration of health care personnel. Many of those who migrate send remittances to their families and relatives. In addition, those who return to this country bring with them enhanced expertise and skills which can be utilised to the advantage of the local health care system. By focusing on medical education, we could also attract many students from the Caribbean and further afield to our shores.