Health model revamp in $100m Dorian rebuilding


Tribune Business Editor

A Cabinet minister yesterday said the public health system’s $100m post-Dorian rebuild will likely create a “more efficient model” on the impacted islands, adding: “Necessity is the mother of invention.”

Dr Duane Sands, minister of health, told Tribune Business that the number of public health clinics on Grand Bahama was likely to fall from the nine that existed pre-storm to around five to six, supported by “augmented” services, once reconstruction was complete.

And he revealed that Dorian will spark the roll-out of “advanced medical care services in Abaco”, including the provision of trauma-related care and a host of other services that will help to produce cost savings from less reliance on patients being evacuated to New Providence for care.

Emphasising that Dorian will “force a rethink of all the government’s priorities”, Dr Sands said the National Health Insurance (NHI) scheme’s proposed expansion to include more costly secondary care treatments would now have to be “pushed back even more” due to the storm blowing out the government’s projected 2019-2020 fiscal deficit to around $574m.

Praising NHI for “punching above its weight” in the delivery of primary care services to more than 60,000 enrolled beneficiaries, he added that it had reduced the burden on an already-stretched public healthcare sector from high patient demand.

And, while “significant health infrastructure” has been lost to Dorian, Dr Sands pledged that it will ultimately be rebuilt so that the delivery of healthcare services on Abaco and Grand Bahama becomes more effective.

“We will rethink the architecture of the health services model in Grand Bahama and Abaco, and make it more efficient,” he told Tribune Business. “Whereas we had nine clinics and one major hospital in Grand Bahama, when all this is said and done I doubt we will have nine clinics in Grand Bahama; we will probably have five to six and an augmented healthcare system.

“We’ll probably make some changes to the deployment of healthcare services in Abaco. In Abaco, expect to see added services with an increased load being carried by the Marsh Harbour clinic.”

Dr Sands said trauma care, radiology, imaging and obstetrics were among some of the services likely to “emerge from Dorian” once repairs to the physical healthcare infrastructure are completed and sufficient medical professionals are stationed on the island.

“We can see some savings from air evacuation by providing more care in Abaco,” the minister explained. “Necessity is the mother of invention. As we’ve seen previously, these crises lead to progress. Dorian is going to result in the introduction of advanced medical care services in Abaco.

“We believe the direct impact of Dorian is as much as $90-$100m. We have lost significant health infrastructure all over Abaco and Grand Bahama. The Rand itself has been taken out of commission; at least the majority of it. We have begun the repairs but most medical services are being provided in temporary facilities - tents and other makeshift buildings.

“We have lost almost every ambulance in Grand Bahama.... If you go to High Rock, the clinic there is rubble. There’s absolutely nothing salvageable. The further east you go, the same kind of thing. The cost is tremendous... Sweeting’s Cay, MacLean’s Town, Pelican Point, all the way to Abaco and the likes of Cooper’s Town and Man O’ War Cay.”

Dr Sands said the Government, and Bahamian people, had no option but to finance the public health system’s rebuilding as access to, medical services was critical if the disaster-ravaged areas on both islands are to be rebuilt given the likely occurrence of construction-related injuries.

“I think it’s going to force a rethink of all the priorities of government,” he added of Dorian’s impact. “We have to look at all our capital works, look at all our current expenditures, and determine what the priorities are in a post-Dorian reality with revenue down and expenditure up. This will be an issue.

“Every single capital works in every single ministry will have to be re-evaluated to determine if it fits in with the strategic priorities for The Bahamas moving forward from this point on. We have huge unanticipated expenditures in Grand Bahama and Abaco, and virtually every ministry has unplanned spending to be funded. We don’t have the option of not funding them.”

Among those priorities that will have to be reassessed is NHI’s proposed expansion, which has already been delayed once, but Dr Sands said it would be unfair to single out the healthcare financing scheme as this would give the impression it has been “targeted”.

“We’ve 60,000-plus beneficiaries enjoying primary care services with a very high satisfaction rate,” he told Tribune Business. “The enrollment of NHI recipients has done an excellent job in decompressing the public health sector, and led to personal attention for a lot of people that would not have gotten it.

“As we look at the state of NHI, it is continuing. It’s making a huge impact and is probably punching above its weight. Its in the midst of rolling out its electronic medical records programme. The extension to high cost care we said would be pushed back six months from the time of the Budget, and I suspect it’s going to have to be pushed back even more.”

Dr Sands added that any timeline he gave for revisiting NHI’s expansion beyond primary care services would be “totally speculative”, and he said: “We’ve got to try and hold the ground in terms of providing basic services now.

“With revenue down, and having lost the contribution to the Consolidated Fund of Abaco and Grand Bahama, the Ministry of Finance will have made it very clear even with borrowing that have to be very careful in managing expenditure.

“Just maintaining services as they are is going to be a challenge. For us to say we now want to expand services is going to be a challenge.”

Dr Sands said the public healthcare system had managed to “hold the line” in providing both primary and secondary care post-Dorian, while also “ramping up” psychological care in Dorian’s aftermath.

However, in a warning to the healthcare industry’s trade unions, he added: “We’re running on overdrive but to sustain this is going to be costly bearing in mind we have significant demands being made by staff seeking additional benefits. Those demands have to be considered and managed.

“This is the task before us. We will give it our best go and try to make the best possible decisions. We can’t do anything better than that.”