The Tribune

By NEIL HARTNELL

Tribune Business Editor

nhartnell@tribunemedia.net

A former health minister yesterday argued that the Government's message of expanded services "doesn't jive" with 2023-2024 Budget cuts, asserting: "The numbers don't add up."

Dr Duane Sands, also the FNM's current chairman, told Tribune Business that the Davis administration's proposed new $290m hospital at Perpall Tract was an "absolutely absurd concept" given that it would reduce efficiency by splitting staff between two different sites.

The Ministry of Health and Wellness' recurrent spending allocation for the upcoming 2023-2024 fiscal year is being cut by almost $16m year-over-year, from just over $315m in the present year to $299m. Much of the reduction, just over $10m, is coming from a drop in the Public Hospitals Authority's (PHA) subsidy from the current $232.456m to $222.156m.

Dr Michael Darville, the current minister of health and wellness, could not be reached for comment yesterday via phone call or text message. Dr Sands, though, argued that the public healthcare sector is in effect receiving a financial "haircut" even though the PHA, which operates Princess Margaret Hospital (PMH) and the Rand in Grand Bahama, plus the Sandilands Rehabilitation Centre, has traditionally been under-funded "by between $30m-$50m per year".

Arguing that a sustainable financing mechanism for public healthcare in The Bahamas should be a priority, Dr Sands argued that the Davis administration's planned $290m New Providence hospital "is mortgaging the future of our children and grandchildren with more debt for a white elephant that will not solve the fundamental problems of healthcare".

He said of the incumbent minister's 2023-2034 Budget presentation: "Dr Darville, while he sounded good, said some pretty startling and worrying things about the planned investment in healthcare. Now he is walking back this whole discussion about a new hospital, the earmarked $290m investment. He acknowledged that they cannot replace the [existing] hospital.

"For now, the story is that they're going to leave part of the hospital on the downtown campus, which is an absolutely absurd concept. We are literally splitting our resources, and whatever efficiencies are required we are not going to have them. Where is your emergency room facility going to be, where is your x-ray facility going to be. Are they going to be at both campuses?"

Dr Darville previously said the Perpall Tract hospital will feature maternal, child and adolescent care, along with the blood bank and advanced diagnostic facilities. It will also provide "mass casualty" facilities in terms of sufficient bed and care capacity in the event of emergencies such as the recent COVID-19 pandemic.

He added that the new hospital will free up space at Princess Margaret Hospital's existing facilities for greater medical and surgical services expansion, and said he was moving to ensure there is adequate staffing for the Government's hospital plans amid the ongoing "bleed" of talent that is being lost to the US, Canada and other healthcare markets.

However, Dr Sands queried why the Davis administration is focused on two hospital sites as opposed to "sticking with the plan for the phased redevelopment of the PMH campus which was to be bitten off in chunks that you can not only chew but digest".

And he also challenged the Government on whether it is "preparing to walk away from the single largest investment in healthcare in The Bahamas", namely PMH's Critical Care Block, which "is less than a decade old". He added: "It has the most expensive infrastructure in the country in terms of health, but for years the Government of The Bahamas and Ministry of Health have not been able to maintain it.

"I find it absurd that this administration is now talking about building a new hospital when the Government cannot afford to maintain what it has now. We have a facility operating at anywhere between 25-40 percent utilisation. I'm talking about the Critical Care Block, and it doesn't make sense to walk away from a seven-year old investment, particularly one that is not adequately funded."

Turning to the PHA's reduced 2023-2024 Budget allocation, Dr Sands argued: "Here we have a situation where they are talking about reducing the subvention to healthcare. How are they going to make up the shortfall? You have National Health Insurance (NHI), which is growing at 2-3 percent enrollment per month, and they are holding the line on NHI which absolutely makes no sense. The numbers don't add up."

The NHI Authority's 2023-2024 Budget allocation is being held flat with the current fiscal year at just over $46m, with the Government also seeking to merge and combine the National Prescription Drug Plan (NPDP) with NHI. The drug plan has been allocated some $18m under the Ministry of Finance for the upcoming 2023-2024 fiscal year.

"The impression that I got as I heard and read his [Dr Darville's] contribution is that health is getting a haircut, and they are spinning it as if they are expanding healthcare services," Dr Sands told Tribune Business. "The two things just don't jive. I'd like to know how the PHA will survive when it is under-funded for however many years it takes to build this new hospital. That has been a chronic problem and is one that needs to be addressed."

Dr Darville, in his Budget presentation, said combining NHI with the National Prescription Drug Plan will help to curb healthcare waste and inefficiency in the public sector. He added that merging the two initiatives will progress The Bahamas' universal health coverage ambitions.

The minister said: “The Budget allocation for the National Health Insurance Authority (NHIA) remained unchanged at $46.2m. With the passing of the new NHI Bill that would replace the 2016 NHI Act, my ministry will finally address the vexing reality of duplication and wastage across the board in healthcare delivery systems, and begin the important steps to move the NIB prescription drug plan to the Nation Health Insurance Authority.

“This move is part of my ministry’s healthcare strengthening strategy outlined in the initial Sanigest report that foreshadowed NHI as the funding engine for the country’s universal health coverage model.” The minister added that the NHI and drug plan merger will eliminate delays in getting medication to the Family Islands and create savings that will be funnelled into the Authority for screening and diagnostic programmes.

He said: “We in health believe this new policy decision will end the need for two pharmacies co-existing at our public clinics. This change would help decentralise pharmacy services and eliminate the delays we are currently experiencing in getting drugs and medical supplies to our Family Islands on a timely basis.

“There will be cost savings associated with this move that would be channelled to NHI [along with] additional screening and diagnostics programmes outlined in the new NHI Bill.”