Last week, Minister of Health Dr Frank Anthony expounded on the need for data collection in the health sector, stressing its importance to planning and policy-making. While it is indeed necessary, Dr Anthony’s seemingly suddenly woke moment as regards data collection fails to impress. In fact, it is cause for consternation; a horse and cart story if ever one was heard, with the cart having rumbled off long before the horse was even in harness.
At the time, Dr Anthony was speaking specifically with regard to chronic non-communicable diseases (NCDs), which for the most part are the result of lifestyle choices whether owing to poverty, ignorance or undue influence. He lamented the lack of a national healthcare database to aid in strategic planning in light of the high incidence of lifestyle diseases, singling out diabetes for special mention and noting that the International Diabetes Federation had estimated that there were over 60,000 Guyanese who were suffering from the disease. He spelt out that with a national database, the government would not only be better able to track the healthcare needs of citizens, but find strategies to make them healthier.
In the same report, which this newspaper published on Monday, the Pan American Health Organisation’s (PAHO) Step Survey Country Report released in June 2021, attributed 68% of deaths in Guyana in 2016 to NCDs. These were broken down thus in part: cardiovascular disease, 34%; cancers, 8%; diabetes, 8%; and chronic respiratory diseases 3%.
Meanwhile, the report also quoted the National Commission on non-communicable diseases as pegging that overall death figure at 74% in April this year and noting that “more than 32% of all NCD deaths are premature.” In addition, the commission deplored the fact that it was still difficult to access haemoglobin A1c (HbA1c) testing in the public health sector, despite having advocated for it since 2021. First used around 1977, the A1c test has been modified and standardised over the years. It is a simple blood test that measures average blood sugar levels over three months and is commonly used to diagnose and manage prediabetes and diabetes. This is not an anomaly that requires data collection to be addressed, so why hasn’t the Ministry of Health attended to this?
It is also worth noting here that Guyana has a cancer registry, which was set up in 2000 to capture and record patient data as well as disease trends and patterns. However, a ten-year study conducted between 2003 and 2012 by the Ministry of Health in collaboration with PAHO/WHO, found that 79% of Guyanese diagnosed with cancer received no treatment; they had either not sought it or were unable to access it. The point is well made then that while data offers insight to what exists and allows for planning, it does not necessarily translate to an improvement in healthcare. At least not in this country; there are many other variables that usually have to be considered.
With regard to data collection, back in December 2011, former PAHO Caribbean Programme Coordinator Dr Ernest Pate had exhorted Caricom countries to become more data driven in the prevention and treatment of NCDs. Citing insufficient data as one of the sticking points in combatting NCDs, he had noted that the lack of accurate mortality and surveillance data meant that countries could not do proper planning. At that time the local Health Ministry was being led by Dr Bheri Ramsaran, who is currently an adviser to the health minister. However, Dr Anthony was a member of the Cabinet as minister of Culture, Youth and Sport.
In 2015, a High Level Advocacy Forum on Statistics noted that Caricom had made uneven progress in the area of modern data collection and analysis, mostly owing to a lack of investment. The next year, a PAHO/WHO report on the progress of health from 1966 to 2016 in Guyana deplored the dearth of operational planning that had negatively impacted the ability of the Ministry of Health to continuously provide comprehensive care. The report noted that owing to a lack of data, budgetary requests and allocations might not have been in sync with the true health needs of the population and could have also led to unwarranted spending.
With all of the above knowledge at its fingertips, the government had decided instead that a DNA database was of greater necessity. President Irfaan Ali had made the announcement in October 2020. It was followed up in June 2021 with the tabling of a Police (Amendment) Bill, to legally empower the Guyana Police Force to collect DNA from any person taken into lawful custody in connection with a crime or offence, for the purpose of identification. This raised the ire of numerous citizens and was subsequently removed before the amended bill was passed later that year.
Numerous references have been made in this column over the years regarding the deficiency in data collection and research that has plagued this country. In truth, it is not so much a matter of the availability of statistics, but that those in authority have been notoriously poor stewards of all forms of documentation, including that which informed our history.
Where lifestyle diseases are concerned, the causes, prevention, treatment and possible cures are all well known. So while a national health database would be welcome, as it is long overdue, the government could do much more.
Having already taken the right step against the tobacco industry to label cigarettes as harmful to health, it should go further and also label unhealthy packaged foods. There should also be a cap on fast food franchises and they should all be mandated to clearly state nutrition facts in restaurants and on packaging. Unfortunately, the cart would still be before the horse, but at least there would be a way to turn things around.
