Calling maternal mortality “a painful story for all of us”, Minister of Health, Dr. Leslie Ramsammy said that over the decades significant strides have been made in addressing the issue.
“2010 was genuinely a setback for us”, he said as he contributed to the 2011 Budget debate in the National Assembly on Wednesday. “It is always a painful experience when we fail to achieve the only result that matters to us – delivering a healthy child all the time without complications”, Ramsammy said adding that the health workers of Guyana have worked hard and have improved the situation.
He noted that in 1991, the Maternal Mortality Ratio was 32 per 10 000 deliveries. “Since then significant strides have been made to reduce the maternal mortality and the results to date indicates that these interventions have had a positive impact on the overall health of pregnant mothers” said the Minister. He said that the rate was 8.01 in 2009 and a target of 8 per 10 000 was set for last year. Up to August, he said, it appeared they were going to attain the goal but then there was a reversal and for last year, the rate was 15 per 10 000 deliveries. “A few of these deaths were not related to pregnancy, but the health workers and the Ministry were shocked and pained by the fact that after years of significant improvement, 2010 was a heart rending year for us”, he said.
Ramsammy noted that “many wanted blood” and called for punishment of the health workers. But, he said, these were the same workers who reduced the mortality rate from 32 to 8. “We indeed let the people down and we are willing to take the punishment our country sees fit to deliver”, Ramsammy said to heckles of “resign”. He said that they look forward to returning to the trajectory of declining rates of maternal death and hope that 2010 was a temporary setback.
But PNCR 1-G MP Dr. George Norton said that while the health sector has made strides over the years, it faced setbacks with the string of maternal deaths within the last year.
To be critical of the public hospital translates into being critical of himself, according to Norton since he is part of management at the hospital. However, he said the hospital and the sector must be examined and the shortcomings made public. “I recall the Minister saying in his budget presentation last year that I want to be Minister of Health and he was questioning whether I would get votes for the position…but I don’t want to be Minister of Health, I want to be President!” Norton charged to rousing applause from the opposition benches.
The maternal mortality is too high in the country and there is need for sustained monitoring and supervision, Norton said. He emphasized that any preventable death is one too many, and decried the fact that some 17 women died at the public hospital alone.
Norton said also that critical equipment is in short supply at the hospital, but that many staff members are performing well under those conditions. Still, he noted that the problems are many. “I should not have to point out that the waiting time for the public to access the service can be significantly reduced, that the accountability of the health sector is deficient in many aspects and should be improved, that while there is a more reliable supply of medication health facilities do not always have medication in stock…,” Norton said.
The ambulance services need to be further improved, he said, adding that documentation also needs to be improved in the sector.
Further, he said that Ramsammy boasted of progress in the area of cataract surgeries, more specifically mentioning a new procedure but he observed that it was due to the intervention of a Chinese ophthalmologist who was at the public hospital for a short period. The doctor has since left, he said, adding that there seems to be no movement in this area since his departure.
In addition, he commended the government for the recent inclusion of two new vaccines on the national vaccination programme which he stressed needs improving, particularly in hinterland areas.
A long way
In relation to child mortality, the minister said that Guyana has come a long way in ensuring that the number of preventable deaths in children is reduced. He said that from between 100 and 120 deaths of children under 5 for every 1000 children in the 1980s and early 1990s, this has been reduced to about 20 deaths of children under 5. “Our goal has been to achieve a target of 16 per 1000 by 2015 and I am confident the health workers of Guyana will achieve this target”, he said.
According to Ramsammy, one of the major reasons for this turnaround is immunization. He said that Guyana today spends more than $400M on the immunization program and every child is now guaranteed life-saving vaccines.
Meantime, in relation to medicine, he noted that several parliamentarians had sought to raise the deficiencies and failures of the health sector and he acknowledged that some are “unfortunately real”.
“There are times when we have not been able to provide medicines. And humanity has not yet through the centuries and in the best jurisdictions today been able to prevent deaths in hospitals”, he said.
But, Ramsammy said that it is unfair to select a few instances and seek to make people think that this is the situation all the time, “that every time someone comes to the hospital or health center, there is no medicine and that the only result we have in our hospitals is that everyone dies”. He noted that opposition speakers had spoken about the unavailability of medicine as a major problem and said it is one of the persistent but reducing deficiencies.
However, he said, it is important that the achievement of providing all of the essential medicines in accordance with and going beyond the WHO recommendation most of the time in all of the health centres and health posts, be acknowledged. “We have shifted from another era when most of the time most of the medicines was unavailable. And colleagues, we have moved from the sad and disgraceful days when most of our medicines were gifts of expired medicines, when the diabetes medicines changed from week to week depending on what we received that week as gifts”, the Minister declared.
Further, he said Guyana is today one of very few countries where all medicines in the public sector are free and for some essential medicines, these are also free in the private sector. In the Budget, he noted, more than $3B has been allocated for medicines. He noted that another $1B for medicines will result from partnership and donations and in 2011 therefore; approximately $5333 or US$26 per capita will be spent on medicines and medical supplies.
But he noted that in order to meet total demand for the essential medicines and medical supplies, some $5B to $6B needs to be spent and this demand will increase as more doctors and as more specialist doctors spread across Guyana and as illnesses are diagnosed earlier.
As an example, he cited the $300M in medicines for diabetes and hypertension dispensed free last year to more than 40 000 persons in the public health sector. This is set to escalate and the Ministry has estimated that that the amount of medicines for the non-communicable diseases to be distributed in 2011 would exceed $500M.
There are occasional shortages of these medicines, he admitted but said that most of the time, today, it is unrelated to the availability of these medicines at the Government’s warehouse and has much to do with the supply chain system. One problem that continues to be experienced is the timeliness of reporting and of requesting medicines, he said.
Statins
Further, he said, in terms of the 75 000 persons with or at risk for heart diseases, diabetes and hypertension, there are about 15 000 persons that can benefit now from treatment with statins – cholesterol-lowering medicines – of which about 14 000 are attending public sector health facilities. Presently, about 1500 of them are being supplied with statins which are very expensive, he said. The goal is to soon make these medicines available on a universal access model. But, he noted that in order to make these medicines available for everyone, almost $1B for one medicine alone will have to be spent. He noted that in 2009 and 2010, more than $75M was expended to procure and make available the statins for about 1500 persons.
Ramsammy also noted that a Patient Rights Charter is being developed and the draft is now undergoing extensive national consultation before being presented to the Policy Committee of the Ministry.
And, the minister said, investment in health is up and about 10% of the total current expenditure in the 2011 budget is on health. With almost $14B allocated to health, it means that Guyana will spend about US$95 per capita on health, he said.
The health of Guyanese people has been improved significantly and Ramsammy said that he could tell many stories of this success but also many of challenges, constraints and disappointments. “I have to balance the hard work and success of the health workers with the disappointments and in the end I believe that as Guyanese we can be proud of the work of our health professionals”, he said. The setbacks of 2010 will be eliminated in 2011, he added.
Also making presentations on Wednesday was PNCR parliamentarian, Dawn Hastings who urged the authorities to look at several issues in Region Seven. She raised concerns of shortages of school furniture and staffing issues in the region. She urged that when projects are done, it must be ensured that they get value for money. Hastings noted that in some health centres, the absence of basic equipment leaves workers unable to make diagnoses.
Meantime, PPP parliamentarian, Bernard De Santos said that there is a need to ensure that the investigative arm of law enforcement agencies is strengthened. The Senior Counsel noted that investigators of today do not have the calibre of those 25 years ago and big cases collapses and the prosecutor or the judges get blamed “and all of it undeservedly”. He said that there is a need to ensure that the investigative arm of the agencies are strengthened so that when cases are strong when it comes to the court.
AFC Member of Parliament, Latchmin Punalall, meantime said that while the budget is bigger, there has been no corresponding increase in the standard of living. She also said that it is time for a Freedom of Information Bill to be brought before the National Assembly and passed.
