The Tribune

• Ex-minister queries IDB’s investment doubling

• But ‘can’t kick can down road’ on care access

• ‘Unreachable’ with 500-strong nurse shortage

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

The Bahamas may never achieve universal health care (UHC) if it “kicks the can down the road another five years”, an ex-Cabinet minister warned yesterday, while voicing “shock” at estimates it needs to increase investment by 106 percent.

Dr Duane Sands, former minister of health during the Minnis administration’s first three years in office, told Tribune Business he was surprised that an Inter-American Development Bank (IDB) report had called on The Bahamas to more than double existing healthcare spend to make UHC a reality given that it already invests significant sums in the industry via both the public and private sectors.

The IDB report, Future Health Spending in Latin America, projected that The Bahamas needed to increase current healthcare spending by 106 percent between now and 2030 to achieve ‘90’ on the UHC index. This would mark the greatest increase in the Western Hemisphere, but the IDB provided no empirical basis or calculations to show how it had reached this percentage figure.

Dr Sands, suggesting that the IDB’s projections were calling for a near $1bn increase in The Bahamas’ healthcare spending, told this newspaper: “The total spend that we make is almost $800m to $1bn a year. I would be shocked if the recommendation is that The Bahamas go from $2,500 per capita, per year, to $5,000 per capita. We spend more per capita than almost every other country in the hemisphere except the US and Canada.”

Nevertheless, the now-FNM chairman conceded that significant obstacles must be overcome to achieve UHC, which would mean the Bahamian people have access to all the healthcare services they need when and where they want them without enduring financial hardship as a result.

These barriers have only increased as a result of the COVID-19 pandemic, and the deepening of The Bahamas’ twin debt and fiscal crises, which is forcing government to prioritise where it dedicates increasingly scarce resources. With healthcare outcomes failing to match The Bahamas’ investment, Dr Sands also warned that the current “massive 400-500 nurses’ shortage” threatened to make UHC “an unreachable goal”.

“There needs to be significant investment or redistribution of healthcare spend to accomplish UHC, and we’re certainly not there yet,” he affirmed. “There’s been significant discussion about the expansion of National Health Insurance (NHI) and the benefits of including catastrophic care.

“Against the backdrop of discussions about the cost of living, increases in National Insurance Board (NIB) contributions and the like, we now find this conversation to be increasingly more challenging, increasingly more difficult, but still a very important conversation, particularly since as a country we are lagging behind on our journey to accomplish real, comprehensive UHC.

“It’s a very important conversation. It’s how you direct the spend, and particularly the spend of central government, to accomplish the greatest bang for the buck. That conversation is extremely topical right now: ‘Where do we put all of these dollars particularly when you’re having difficulty capturing all the dollars you need for education, healthcare, the Defence Force, national security?” Dr Sands asked.

“It’s going to determine not only the position but the agenda of this government; how they will apply tax dollars? It’s going to be very challenging to see whether they can accomplish the progressive type of social development and still spend in the way they seem to want to be spending.”

Turning to UHC directly, Dr Sands said that while there are multiple definitions, “in terms of access to the necessary care with limited to no expenses out-of-pocket at the time of care, we are a very long way away”. He added: “Let me put it to you this way: It depends on whether or not NHI and catastrophic care/ the expansion of primary care services is a priority item on the radar.

“If it is, the spending and timelines required are not that great. If it isn’t, and we kick this can down the road another four to five years, we may never get there. We’ve been having this conversation since 1978. There have been fits and starts, but we’re not quite there yet.”

This, Dr Sands told Tribune Business, is despite the significant sums invested in healthcare by The Bahamas annually. “We are certainly, in terms of healthcare expenditure per capita, among the biggest spenders in the world,” he added. “I would venture to say definitely in the top third, absolutely in the top half, but our healthcare outcomes are certainly nowhere consistent with the amount of spend we have.”

Pointing to The Bahamas’ challenges with non-communicable diseases such as diabetes, hypertension and cancer, the former minister said The Bahamas’ multi-island nature “makes it very challenging to have the type of healthcare system that serves the needs of all the people across all the islands of The Bahamas.

“There have been efforts to bridge this gap, but it requires considerable ongoing effort,” Dr Sands told Tribune Business. “It also requires nurses, and we have a massive shortage of nurses in-country. I would venture to say it’s [UHC] an unreachable goal unless we solve the problem of the massive nurses shortage in The Bahamas.

“If you include the private and public healthcare systems, you have a massive shortage of 400-500 nurses right now. When you think of critical care, emergency room, operating room, dialysis, and consider the healthcare realities and talk about universal access to care, the problems that plague Bahamians, one of the greatest challenges is providing these services. They are the most labour-intensive services.”

As a result, Dr Sands said that to achieve UHC in The Bahamas is “going to require tremendous effort”.