By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

THE Medical Association of the Bahamas' (MAB) president has described revelations of an $89 million public healthcare funding shortage as "a bombshell", and "warranting extreme concern".

Dr Sy Pierre told Tribune Business that the problems laid out by Dr Herbert Brown, recently-retired Public Hospitals Authority (PHA) managing director, called into question the viability of the existing public healthcare system as well as National Health Insurance (NHI).

He added that Dr Brown's September 25, 2017, letter to Dr Duane Sands, minister of health, describing the public healthcare system's numerous challenges had also validated the many concerns raised by the healthcare industry over the former government's grandiose NHI scheme.

"That was a bombshell," Dr Pierre said of Dr Brown's letter. "It warrants extreme concern. The question is: How can we have NHI, or any kind of public healthcare system, if these things are not fixed. And how are we going to fix them?

"Those things in the paper are very concerning as to how we're going to make not just NHI, but any public healthcare system, work."

Dr Brown's letter, disclosed last week by The Tribune, warned that the broken Bahamian public healthcare system, afflicted by "collapsing infrastructure"; staff and equipment shortages; and a lack of funding, preventative maintenance and proper management, poses a threat to patient health, safety and "dignity".

In particular, it revealed that less than 10 per cent of the PHA and wider healthcare system's financing needs have been funded, leaving a 'gap' or shortfall of $89 million.

For the PHA alone, only 3.1 per cent of the $44.583 million capital works deemed essential for the Princess Margaret and Rand Memorial hospitals in 2017-2018 have been funded to-date, with Dr Brown's letter implying that the Christie government approved numerous projects without any idea - or monies - of how to pay for them.

The PHA's 'health systems strengthening' projects are in slightly better shape, with just $27.051 million needing to be found for initiatives costed at $35.289 million. However, Dr Brown's letter revealed that another $14.413 million is required to renovate the Department of Public Health's clinics.

And it also points out that the Government's 2017-2018 Budget failed to fund the $4.2 million increase in salaries and allowances for junior doctors in the public healthcare system. The increase came from the Bahamas Doctors Union's (BDU) new industrial agreement.

The end result, according to Tribune Business's calculations, is that out of $98.484 million worth in public healthcare financing needs, some $88.844 million remains to be found. Less than $10 million, or under 10 per cent, has been provided to-date.

Many of the problems identified in Dr Brown's letter are well-known, especially to healthcare industry professionals, but the document is one of the first to pull 'all the threads together' that has emerged publicly.

Some doctors, speaking on condition of anonymity, were more blunt than Dr Pierre, accusing the former Christie administration of attempting to "deceive" the Bahamian people with the much-trumpeted NHI scheme.

"This just confirms all the concerns we have had as a medical community all along," one doctor told Tribune Business of Dr Brown's letter. "This completely validates every single concern that has been put forward by the MAB and all sectors of the allied healthcare professional industries.

"These are the exact concerns we have had all along. This thing, from a government agency, validates concerns we have known about all along, yet they have been totally ignored by the Government, Ministry of Health and NHI Secretariat.

"The former government were pushing along their agenda to the public and deceiving the public in terms of what they were able to do, and not able to do, and the quality of care they were able to deliver."

Many doctors and others repeatedly banged on to the Christie administration that the public healthcare system needed to be strengthened, reformed and improved before it contemplated introducing NHI - an argument Dr Brown's letter effectively backs.

The doctor spoken to by Tribune Business called for "the creation of a new culture" within the public healthcare system, with an emphasis on accountability and improved patient care.

"That mandates we do things differently," he added. "We cannot do what we have been doing in the past."

Dr Pierre, meanwhile, agreed that the public healthcare system needed "serious strengthening", and that Dr Brown's letter had validated medical industry concerns over the former government's NHI scheme.

"It's brought to light all of these things within the system," he told Tribune Business. "Coming from a source like that, it says all of these things people were thinking and saying [on NHI] were true."

Dr Pierre suggested that correcting, and financing, the public healthcare system's current ailments would be difficult given the Government's fiscal constraints and the economy's struggles.

"I've always said poor healthcare is a symptom of a bad economy," he said. "I don't care if you tax at 50 per cent of a person's income; if you have a poor economy you're not going to have a good healthcare system.

"We have to fix the issue of a poor economy. If you have 95 per cent employment, economic diversification, people have meaningful jobs and salaries, and are able to educate their children here, you will have a large group of people able to afford private health insurance and make NHI a moot point.

"These are the things we need to sort out, and we're not hearing anything in terms of stimulus to this economy."