Health Minister Dr. Leslie Ramsammy yesterday took international agencies to task for using wrong data to compile reports on Guyana, while saying that the practice disrespected the country and undermined the efforts of local health workers.
Ramsammy, who cited PAHO/WHO, UNFPA and UNICEF, said he would not accept reports in the future if the organisations do not use the data tabulated locally. In a fiery address at the opening of a two-day caucus on maternal and child health at the Regency Hotel, Ramsammy said while the organisations have been good partners, they have been “absolutely unfair” to the country. “It is one thing to say to health workers that we have a formula and it is the formula that we would follow, to hell with the data that you have!” an angry sounding Ramsammy said.
His comments were prompted by PAHO/WHO Country Representative Dr Beverley Barnett’s reference to a 2007 report that said Guyana was unlikely to achieve its Millennium Development Goals (MDGs) in the health sector.
Ramsammy is scheduled to meet with the agencies next week on the issue. “As of next week, I am calling everybody, because the disregard for Guyana must stop now. I would not accept another publication that comes out with data that never applied to this country, [and] never applies to this country…” he said. “I have been working in the public sector in this country and I never know in all my tenure that 470 women died of child birth in Guyana, I never know,” he added, while noting that in the country’s worst days there was never such an occurrence.
As Ramsammy continued his attack, Dr Barnett and UNFPA representative Dervin Patrick both looked shocked. Two other representatives from international agencies also looked perplexed.
In her brief remarks, Dr Barnett had said the ministry has been working towards achieving the goals most directly pertaining to health—reducing child mortality, maternal health and combating HIV/AIDS, malaria and other diseases, which are MDGs 4, 5 and 6, respectively.
According to her, the progress report of Guyana’s achievement on the MDGs is currently under development. She added that the last official report, which dates back to 2007, suggested that the country was “and I said this in quotes ‘unlikely’ to achieve MDGs 4 and 5 and the malaria target of MDG 6.
“I think that this assessment not only raised the ire of the minister and the Ministry of Health personnel…but it also made everyone more determined than ever to prove that assessment wrong.” She added that several steps have been taken to achieve the goals, including implementation of the national strategic plan for the reduction of maternal and infant mortality.
Dr Barnett also indicated that the two-day meeting will examine the weaknesses that occurred in the maternal child health (MCH) area last year, when there was an “upsurge” in maternal deaths.
“The analysis that was undertaken almost immediately to determine underlining causes and the review of the MCH programme that will be undertaken over the next two days are typical to the process of learning lessons, identifying strengths, identifying gaps and making corrections,” she said.
Dr Barnett noted that generally when people think about evaluation, especially when outcomes have been negative, there is an assumption that all findings would be negative and sometimes no one even notices if there are any positive factors that would have caused the negative not to be more severe. However, she quickly said she did not wish to downplay the importance of finding the gaps and the things that are going wrong and taking corrective actions. “I do wish to say, however, that in the rush to finding wrongs and perhaps apportion blame, we should not lose sight of the things that are working well, which can be expanded…those should also be documented and shared,” Dr Barnett said.
‘Totally
unrelated’
Speaking later with Stabroek News about what triggered his outburst and whether the seminar may have been the wrong forum to make the statements, Ramsammy said that he was forced to make matters clear following Dr Barnett’s comments. “…When she talked about ‘unlikely’ I had to address the issue, because you can’t keep doing this to me and I keep ignoring it and talking to you. If you are going to come and say that at a forum like this, then as the Minister of Health of this country I can’t stay quiet,” he explained.
He said that next week’s meeting was planned before yesterday’s blow up as he has been previously concerned and he wanted an agreement on “what the numbers are.” He also revealed that at a past meeting with all of the agencies it was agreed what the numbers are but since then no one has done anything.
Ramsammy said that PAHO/WHO and others “keep putting numbers that are totally unrelated to us as it relates to everything.” He said that the health sector is being very meticulous when it comes to deaths and he noted that every maternal death has to be reported within 24 hours. He said the every death certificate is checked by his ministry as it attempts to do “checks and balances.”
He contended that no formula devised in Geneva, Switzerland, where the WHO is based, is better than what he knows on the ground. He added that his health workers work hard. He said if a problem with the data is detected by the organisations then “come and show me.” “I work with the representatives of the organisations in this country, they dispute the data and I say to them ‘show me what, show me what’ and until you can do that use my data, use my data,” he declared.
He urged the organisations not to disrespect and demoralise the health workers in Guyana as they deserve better. “So when you published and you refused to accept our data and say it is 470, it is absolutely wrong, absolutely,” he said. According to him, there has to be accountability. “Come and show me where you got that from and unless you can show me then you cannot publish those numbers.”
Ramsammy also said that the excuse used by some that they are using old numbers cannot suffice any longer. He noted that the wrongly reported figure for maternal deaths, which he said was published in a local newspaper, does not apply to old numbers and no one can tell him from where it was pulled.
He noted the publication of another report on life expectancy and the ministry did the numbers using the same raw data and later wrote the agency responsible and indicated that their findings were wrong. “They wrote me back and say ‘Sorry, we went through it again and you are right,’ but they proceeded to publish the wrong number. It is utter disrespect for a country,” he said.
He added that he is standing up for Guyana as it is time that the country is respected.
‘On pace’
Ramsammy said in 1991, 57 women died in Guyana and it worked out to a rate of 32 per every 10,000 deliveries. Fast forward to 2009, the rate is “eight point something,” he said. “Are we on pace for the MDGs? My answer is ‘Yes,’ because if you want to say there is underreporting today, then the underreporting had to be massive in 1991. No one can say that our information system is not better than it was in 1991. Simple logic. Everyone knows that our information system today is superior to 1991,” he added.
He said that “superior system” has produced a number which says that the country has already met the MDGs but the agencies think there is some underreporting and as a result adjust current statistics while not applying the same principle to past statistics. “That is why I am saying that it is time that people are a little bit fairer,” he declared.
Ramsammy said the health sector has a lot to be proud of in terms of immunisation. The country, he said, is getting to the level where there is 100% immunisation and in terms of the Prevention of Mother To Child Transmission Guyana is also ranked with the top countries.
However, he did admit that “we are not always perfect” and as a result there is need to ensure that everything is done when it comes to caring for pregnant mothers and infants. “Last year was painful for me as I know it was painful for you, during the months of September, October, November, December, I saw the desperate looks… because it was a shocking experience for all of us,” he said, in reference to the spike in maternal deaths late last year.
But he noted that in 1991, 17% of all the deaths in Guyana were of children under the age of five. By 2010, he said that demographic accounted for approximately 4% of all the deaths. “We are keeping our children alive better but we are not keeping all of the children alive and the goal is to keep all of our children alive,” he told health workers at the seminar.
He said that by 2015, he hopes that 60% of all the deaths in Guyana would be of persons 65 years and over.
The minister told workers that there is work to be done and their first task is to put 2010 behind them and let the trajectory of decline in maternal deaths, which was achieved before the upsurge, continue.
