- One principle is constant. There is a consistent miscue in healthcare financing and policy formulation in Saint Lucia.
- The current construct of multiple boards of directors and variable composites that do not conform to the “science of medicine” is the compromise to the deficit that exists.
- “So that’s my plan, but in the meantime, it will not happen immediately. You won’t get change in the hospital tomorrow.” ~ Prime Minister Philip J. Pierre.
By Caribbean News Global
CASTRIES, St Lucia – The disparity in public health services and policy towards the delivery of healthcare in Saint Lucia has resurfaced in the abnormal distribution of government finances to Owen King European Union (OKEU) hospital and St Jude hospital.
The OKEU and St Jude hospital are governed by statutory boards under the guidance and direction of the ministry of health (the minister) and the policy direction of the cabinet of ministers and the government of the day.
In a letter dated July 31, 2024, to the board of directors Millennium Heights Medical Complex, the St Lucia Medical and Dental Association (SLMDA), president, Dr Merle Clarke reprimanded the healthcare system.
St Lucia Medical and Dental Association scolds healthcare system
The letter stated in part that, “The consensus of the physician body is that the board of directors, ostensibly tasked with drafting policy to allow for the efficient running of the hospital, has failed miserably in said task.”
Nobody disputes the rift between the government, the political directorate and healthcare (finance/policy), played behind the scenes have not shepherded the transition with plugged-in ‘Moses disciples.’
Thus, the SLMDA letter was of no surprise, but rather late to the multiple articles published by Caribbean News Global (CNG), much to the displeasure of the government of the day, and “plausible willful blindness” to the obvious.
On Monday, August 19, 2024, Prime Minister Philip J Pierre, announced “We are going to invest XCD 10 million in the first instance, and we are very happy to know that it will come from the CIP Program into the OKEU hospital to pay debts that were there before July 2021.
Interestingly, the Health and Security Levy (2.5%) is not referenced in this allocation. Investing in our Future and Wellbeing. The legislation establishing The Health and Citizen Security Levy (HCSL) was passed in the parliament of Saint Lucia in July 2023. The HCSL is charged on imported goods and services at a rate of 2.5 percent.
Medical liability
Reportedly, among the outstanding medical debt is $2M owed to the French government for overseas medical care, a liability that has lingered since 2001.
“There are suppliers that have been owed since pre-COVID,” Pierre confirmed, “We are paying these debts,” he continued. The ministry of finance is set to contribute an additional $5M, bringing the total investment in the OKEU hospital to $15M.”
Prime Minister Pierre’s financing moduled explained:
“I am going to try to put the health sector on a proper financial footing. So I’ll start with the $15 million and I’m going to make an announcement very shortly on how we going to deal with the financial woes of the health sector. Hopefully, when I do that I will be able tofree the hands of the health administrators to get their act together because the supplies would have been there, they would have been able to buy medicines, etc, etc, and they can move forward.” The financing modelling continued: “So that’s my plan, but in the meantime, it will not happen immediately. You won’t get change in the hospital tomorrow.”
CNG Insights
How can XCD15M be an investment in healthcare, when neither OKEU, St Jude hospital, Soufriere hospital, Denery hospital, and the government of Saint Lucia are able to service current debt obligations from 2001 to the present; and are also unable to service operational costs?
Notable, the XCD15M is far from covering accrued debt and service recurring (payables) liabilities. Saint Lucia’s government ‘controlled’ health care institutions are historically unable to operate proficiently.
Understandably, Saint Lucia’s healthcare cost and policy formulation remain a mystery in the comprehension of applied bookkeeping, accounting, budgeting, and policy formulation.
The recent affirmations and announcements conclude the continued and prolonged management ineptitude of successive government control boards (of variable degrees) and annual estimates of revenue and expenditure (budgetary allocation) that are far-fetched.
Admittedly, one principle is constant. There is a consistent miscue in healthcare financing and policy formulation in Saint Lucia.
The exception is political projects for the contagious power and exhalation that – by hook or by crook – “Saint Lucia is on the cusp of takeoff.”
Estimates of Revenue and Expenditure 2024/2025
“An analysis of the country’s health and security obligations should place into context the need for the levy and the need to be proactive in taking measures that would help the government keep pace with rising costs, especially in health,” said Prime Minister Pierre.
St Lucia’s 2.5 percent health and security levy is an investment, says OPM
“Let us take a closer look at what the government spent in this fiscal year 2023-2024.
- Direct cost of health care:
- Provision of health care services $160.0M
- Capital Expenses:
- St Jude hospital reconstruction project: $17M
- Health system strengthening project: $5.3M
- OECS regional health project: $2.3M
- Universal Health Coverage: $0.7M
- Other projects under health: $3.4M
Total Capital Expenses: $28.7M – Total Expenses: $188.7M
Other expenses – The government is indebted to several private local and foreign healthcare facilities that provide medical care to citizens.”
New Soufriere hospital
“Negotiations are well advanced with the investment partners Caribbean Infrastructure Development and New Generation Hospital. […] The BOLT will be for a period of 17 years with a two-year grace period and a repayment period of 15 years. The cost of the facility is USD$31.6M (XCD$85.3M). USD$1M has been included in the BOLT to allow for the replacement of all medical equipment over a seven-year cycle.” ~ Fiscal Year 2024-2025.
The politics of healthcare
“In the 2021 manifesto, the Saint Lucia Labour Party pledged to pursue a health policy that is patient-centred, evidence-based, equitable, accessible and affordable. The centrepiece of that policy was a Universal Health Care programme,” said Prime Minister Pierre, ‘ Building our infrastructure for a resilient economy, 2024/25 budget address. “The high cost of the provision of health services by third-party and private health service providers remains a matter of concern to the government. […] In this budget, $1M has been allocated for further study of the rationalisation of the provision of health services abroad with a view to reducing cost.”~ Budget Address 2024/2025.
Universal Health Care programme?
- Maternal and child care;
- The 80-plus- health coverage, and this year, we will incorporate cervical and prostate screening, chronic kidney disease screening and snake bite management as part of the essential package of health services;
- Free medicines for diabetics and hypertensive patients will also be available under the programme;
- It is the intention of the government that all citizens will possess a health card to access health care services.
- The Performance Based Financing system at eight health centres around the island. This system is intended to assess and reward health services provided by these centres. This program will be expanded this year.
Establish a Working Group
The government of Saint Lucia is hampered in financing, communication, policy formulation and execution.
The current construct of multiple boards of directors and variable composites that do not conform to the “science of medicine” is the compromise to the deficit that exists.
Establishing a working group, a collaborative body to spearhead the revision and execution of health care and related services can pattern a significant step towards a progressive and inclusive approach that serves the interests of the people and country.
The objective is simple:
- The revision of the health system and refine legislation;
- Enhance governance and systems;
- Identifying structural solutions;
- Strong reporting and accountability mechanisms;
- Facilitating resource mobilization;
- Leverage sustainable development, medical construction practices, disaster risk management, etc.
A fundamental cure derived from science and technology, medical finance and policy medical knowledge that works, is the timeless guiding principle – building a solid medical architecture.
A proactive and concerted approach towards fostering structural solutions to Saint Lucia’s myriad health problems deserves and demands real solutions, not platitudes and status quo vulnerability that is – not sustainable.
