The Tribune

By YOURI KEMP

and NEIL HARTNELL

Tribune Business Reporters

A Cabinet minister yesterday said COVID-19 has cost the public health system some $120m to-date, leaving it with $50m in “unbudgeted debt” which he discovered upon taking office.

Dr Michael Darville, minister of health and wellness, speaking at the unveiling of research forecasting that the pandemic will inflict $9.5bn in losses and extra costs on The Bahamas, said: “Our record demonstrates direct costs to the PHA (Public Hospital Authority) of about $88.6m, and the Ministry of Health at just over $31.5m.”

He added that the Davis administration had to move rapidly in crafting its 2021/2022 supplementary Budget because the financial drain imposed by COVID-19 had left the public health system with “no resources” to work with. “When I came into office, I found about $50m of unbudgeted debt at the Ministry of Health and Wellness,” Dr Darville said.

“The Government in its 2021-2022 supplementary Budget revised expenditure to our agencies at $271.1m of recurrent [spending]. The PHA received $223.5m, NHIA (the National Health Insurance Authority) received $45m, the Ministry of Health and Wellness in the Department of Public Health had $28.6m, and there was a capital budget of $36.6m on the capital side.”

Dr Darville hinted that the Government, through the Ministry of Health, is seeking more financing from the Inter-American Development Bank (IDB) on top of the $65m in loans and grants it had already received in the last 12 months to help strengthen the public health infrastructure in COVID-19’s aftermath.

“We are moving with a degree of speed because we don’t know what’s around the corner as a result of climate change,” he added. “We anticipate that we will have an active [hurricane] season, and so while I’m here with our IDB counterparts, this is the reason why we’re pushing so hard.

“Even though the loan facility extends to five years, if I have another natural disaster, in the current state that I’m in it can actually almost knock out our primary health care systems throughout the Family Islands. So I beg you to work with us so that we can be able to get brick and mortar on the ground to improve the clinic infrastructure.”

The Ministry of Health has hired 478 new employees for this upcoming 2022-2023 fiscal year, with a provision for 15 extra doctors and 70 nurses. Dr Darville said: “The Bahamas spent $17.8m to execute strategies aimed at suppressing the SARS-CoV-2 (COVID-19 virus). Sixty-four percent of the total sum spent was for the protection of our frontline workers, PPEs (personal protective equipment).

“I want to thank all the countries around the world, as well as all of those agencies that came to our needs and are still coming to our need, to provide these essential PPEs. For the frontline workers, it was a cost of $11.4m.” In addition, $17.8m was spent on free testing facilities and equipment.

The IDB’s assessment of COVID-19’s impact on The Bahamas, conducted with the United Nations (UN) Economic Commission for Latin America and the Caribbean (ECLAC), estimated that the pandemic imposed some $50m in extra costs on the public health system at its peak in 2020.

These additional expenses were related to COVID treatment and prevention, which were forecast to have cost $16.041m and $18.37m, respectively plus the purchase of extra supplies and $5.724m in infrastructure upgrades as well as “death management”.

The report acknowledged that the Bahamian public healthcare system was already strained prior to COVID-19, and said: “These challenges are related to the fragmentation of its health system, unequal quality of care, and inadequate health facilities and medical equipment conditions due to poor maintenance and the effects of Hurricane Dorian.

“The COVID-19 pandemic is an additional critical challenge. Although the number of cases and deaths is below the regional average, it still represents a significant public health emergency given the limitations of the healthcare services. Moreover, the disruption of preventive and curative care for patients other than COVID-19 cases reduced access to healthcare, particularly for patients with chronic conditions.”

The IDB/ECLAC report found that the closure of public health facilities to all services bar life-threatening emergencies during the pandemic’s first phase, marked by lockdowns and other restrictions, caused significant disruption to treatment access for hundreds of Bahamians. This, it added, had resulted in “excess morbidity and mortality” stemming from non-COVID illnesses and other complications.

“Disruptions to hospital admissions, and access to community and outpatient services during COVID-19, are tangible. Significant disruptions to hospital utilisation yielded negative magnitudes of change that far exceed the pre-COVID findings,” the report said.

“Specifically, in fiscal year 2019-2020, when compared to the prior five-year pre-COVID-19 average, disruption in access to services resulted in an almost homogeneous decline in utilisation data ranging from 27 percent to 7 percent. Service types experiencing the most significant disruptions were critical care, psychiatry, and internal medicine services, with 29 percent, 22 percent and 22 percent declines, respectively.

The IDB/ECLAC assessment continued: “The non-ward services offered through the public hospitals were halted during the first wave of the pandemic in The Bahamas. Most routine healthcare appointments were cancelled or postponed. It is noted that tele-health modalities did support mental health strategies and initiatives, even while the Community Counselling and Assessment Centre (CCAC) was closed.

“These observed interruptions to health services have had implications for the level of control of chronic diseases, delayed demand for essential health screening (for breast cancer, cervical cancer, diabetes, and hypertension – among others) and, ultimately, excess morbidity and mortality from non-COVID conditions and complications.”