Name: Aliana Davis

Grade: 13E (C1)

Date: October 18, 2016.
Subject: Caribbean Studies
Internal Assessment
Theme: Health Care and the Economy
Topic: An Investigation into the Effects of Insufficient Government Funding and Lack of
Subsidiaries on the Provision of Sufficient Health Care at the St. Anns Bay Hospital During the
Time Period January 2013 December 2015.
Question: How Have Insufficient Government Funding and Lack of Subsidiaries Impeded the
Provision of Efficient Health Care at the St. Anns Bay Hospital during the Time Period January
2013 December 2015?
Hypothesis: Insufficient Funding and Lack of Subsidiaries Have Caused the Demise in Public
Health Care in the St. Anns Bay Hospital during the Time Period January 2013 December
2015.

Introduction
The Jamaican government has been constantly faced with challenges concerning proper
health care services, equipment and facilities. The health sector is one of the countrys core
requirements. However, due to the financial constraints and ongoing deterioration of other
important areas, it detracts government funds from this vital sector. In this case, lives are put in
jeopardy, creating in some instances a delay in emergency treatments and avoidable loss of lives.
This research will zoom into the negative effects the Jamaican economy has caused on the St.
Anns Bay Regional Hospital in order to better inform the residents in and around the area of the
hospital and to strive towards a solution for the betterment of our health care provisions.
The topic of this research is An investigation into the Effects of Insufficient Government
Funding and Lack of Subsidiaries on the Provision of Sufficient Health Care at the St. Anns Bay
Hospital during the Time Period January 2013 December 2015. This public hospital, located
on Seville Road in St. Anns Bay, serves the largest parish in the island St. Ann, along with
Trelawny, parts of Manchester and Clarendon providing health care services to approximately
360,000 patients. St. Anns Bay Hospital provides emergency health care, paediatrics, birth aid,
laboratory tests, etc. Therefore, it is necessary to maintain a well-equipped and functional
facility. The study will focus on the hospitals insufficient staff, lack of medical equipment,
unavailability of bed space, and shortage of medication.
By answering the question How Have Insufficient Government Funding and Lack of
Subsidiaries Impeded the Provision of Efficient Health Care at the St. Anns Bay Hospital during
the Time Period January 2013 December 2015, patients as well as staff and upper
management, can better understand the repercussions and offer a feasible and sustainable
solution in providing a more first world approach to treatments and research. Personally, this

study will also benefit me as my career interest to become a Biomedical Scientist will require of
me to work in the lab, therefore enhancing my awareness of the health sector.

Definition of Technical Terms:

Economy: An entire network of producers, distributors, and consumers of goods and
services in a local, regional or national community.
Government: A group of people that governs a community or unit. It sets and administers
public policy and exercises executive, political and sovereign power through customs,
institutions, and laws within a state.
Health Care: The act of taking preventative or necessary medical procedure to improve a
persons well-being.

Literature Review

Upon research of the issue How Have Insufficient Government Funding and Lack of
Subsidiaries Impeded the Provision of Efficient Health Care at the St. Anns Bay Hospital during
the Time Period January 2013 December 2015? it has been noted that indeed, the government
is the backbone of financing the health sector, therefore if adequate attention is not given by the
government to these facilities, there is a good chance that they will deteriorate and in effect, be
unable to provide adequate health care for the citizens. Poverty and ill-health are intertwined.
Poor countries tend to have worse health outcomes than better-off countries (Wagstaff, 2002).
Hence, if Jamaicas economy is not able to fully support all sectors, including health, there may
be a major issue in the immediate surroundings which may then lead to more detrimental issues,
for example viral outbreaks, that will not be able to be managed or contained by the government.
In zooming in on Jamaicas economy, a source from the World Bank comments on
Jamaicas financial status stating During the past three years economic growth rates have been
steadily rising although remaining lower than what is needed for eradicating poverty and
boosting shared prosperity.
In contrast to this research, the Honourable Dr. Christopher Tufton, had recently
conducted a face-lift at the St. Anns Bay Hospital in which $300 million was used to renovate
and upgrade the facility, through a mixture of public sector and private sector partnerships.
Tufton stated that the project, which was undertaken between December 2015 and April 2016,
included the expansion of the Paediatric Nursery, the procurement of medical equipment, the
construction of a new female ward, and improvement in patient areas (Davis, 2016). However,
the question still remains, is the enough improvement for a hospital making health care available
to over 360,000 persons?

On the other hand, complaints have been lodged concerning all public hospitals as
doctors blame the lack of resources the hospitals receive for the poor health care the patients
receive. This report went into detail with the Kingston Public Hospital, Spanish Town Hospital
and the University Hospital of the West Indies in which reporters interviewed a few doctors
from these hospitals in order to obtain first-hand details about what kind of situations take place
in these public hospitals. The doctors, who had requested of the reporters to remain anonymous,
spoke about the poor conditions in which they have no control over. Situations such as surgeries
being postponed or even cancelled due to the malfunctioning of necessary equipment or the lack
thereof, insufficient supply of medication and the shortage of sanitary gear needed by these
doctors. One surgeon at the Kingston Public Hospital stated, Emotionally it takes a toll on the
doctors to the point where they now have to withdraw themselves from the situation to not be
affected. It's not easy when 90 per cent of your patients are affected by the cost of free health
care and end up dying. Another doctor mentioned, Hospitals are having to deal with too many
patients. When the health services were built a few decades ago the population was roughly 1.8
million. Now the population is 2.8 million, which indicates a massive shift and also a larger
migration of people to urban areas. (Hibbert, 2015)

Poverty and ill-health are intertwined. Poor countries tend to have worse health
outcomes than better-off countries.

Wagstaff, Adam. (2002). Poverty and health sector inequalities. Bulletin of the World Health
Organization, 80(2), 97-105. https://dx.doi.org/10.1590/S0042-96862002000200004

(Obtained: Nov 12, 2016)

Minister of Health Dr. the Hon. Christopher Tufton says that some $300 million has been
spent on upgrading facilities at the St. Anns Bay Regional Hospital.
The Minister made the disclosure during a tour of the facility on Friday, June 17.
He stated that the upgrading was done through a mixture of public and private sector
partnerships.
Dr. Tufton noted that between December 2015 and April 2016, the Paediatric Nursery was
expanded and equipped at a cost of $23 million.
The project, he said, included the procurement of medical equipment such as incubators,
infant warmers, bassinets, suction machines and piped medical gas to each bed.
Dr. Tufton also pointed out the construction of the new female medical ward which was built
at a cost of $136.7 million, as well as an improvement to the patients waiting area.
The projects were funded by the National Health Fund and represented a substantial
investment to the secondary health-care delivery system, the Minister said.
The North-East Regional Health Authority, the Minister added, has also invested $2 million to
purchase 100 agronomic patient waiting chairs as part of improving the aesthetics and
comfort of the out-patient area.
Dr. Tufton also informed that the outpatient bathrooms were also renovated at a cost of $1
million.
He noted the procurement of equipment for the high dependency unit to increase
functionality, as well as a Fluoroscopic X-ray Machine, which is awaiting delivery.
The hospital is a Type B facility, and is the referral hospital for the three general hospitals and
70 health centres located in Portland, St. Mary and St. Ann.
The St. Anns Bay Hospital also serves Trelawny and parts of Manchester and Clarendon,
providing healthcare services to a population of approximately 360, 000, Dr. Tufton said.

St. Anns Bay Hospital Gets Multi-million Dollar Face Lift. Jamaica Information Service. 2016
Author: Garvin Davis (June 2016)
http://jis.gov.jm/st-anns-bay-hospital-gets-multi-million-dollar-facelift/
Also published in The Jamaica Gleaner on Sunday, June 19, 2016

http://www.jamaicaobserver.com/news/-300-m-upgrade-for-St-Ann-s-Bay-Hospital

During the past three years economic growth rates have been steadily rising,
although remaining lower than what is needed for eradicating poverty and
boosting shared prosperity.
http://www.worldbank.org/en/country/jamaica/overview
Overview (Of Jamaica). The World Bank. September 20, 2016.

The Government is projecting to spend $579.93 billion for the 2016/17 fiscal year.
This amount is 28 percent less than the $808 billion Revised budget for financial year 2015/16.
Details of the projections are contained in the Estimates of Expenditure, which were tabled in the
House of Representatives on Thursday (April 14), by Minister of Finance and Public Service, Hon.
Audley Shaw. The Revenue Estimates were also tabled.
Recurrent (housekeeping) expenses are earmarked at $459.37 billion, while capital (development)
spending is $120.56 billion.
The Ministry of Finance and Public Service has been allocated the largest sum, with $205.36 billion
for recurrent expenses and $84.64 billion for capital expenditure. A large portion of the sum will go
towards meeting debt obligations.
The Ministry of Education, Youth and Information gets the second largest sum of $90. 50 billion for
recurrent expenses and $2.6 billion for capital spending.
Ministry of National Security has received $55.67 billion for recurrent expenditure and $3.56 billion
for capital, while the Ministry of Health gets $52.90 billion for recurrent expenses and $1.54 billion for
capital projects.
For the Ministry of Justice, $5.96 billion has been allocated for recurrent and $899 million for capital;
Office of the Prime Minister, $3.98 billion recurrent, $2.10 billion capital; Ministry of Energy, Science
and Technology, $4.70 billion recurrent, $988 million for capital; and the Ministry of Transport and
Mining, $2.34 billion recurrent and $1.31 billion for capital.
Allocations to other Ministries are: Industry, Commerce, Agriculture and Fisheries, $5.34 billion
recurrent, $3.59 billion for capital; Economic Growth and Job Creation, $8.35 billion recurrent, $11.2
billion capital; Foreign Affairs and Foreign Trade, $3.93 billion recurrent; Labour and Social Security,
$2.54 billion recurrent, and $6.22 billion capital; Culture, Gender, Entertainment and Sport, $2.36
billion recurrent and $188 million capital; Tourism, $1.73 billion for recurrent, $17 million capital; and
Local Government and Community Development, $10.49 billion recurrent, $880 million capital.

The Office of the Cabinet has received $ 565 million for recurrent spending, and $733 million for
capital expenditure.
The Auditor General has received $535 million recurrent; Office of the Services Commissions, $195
million recurrent; the Governor-General and Staff, $181 million recurrent; Office of the Public
Defender, $91.7 million recurrent; Office of the Contractor General, $278 million recurrent; Office of
the Childrens Advocate, $140 million recurrent; Houses of Parliament $827 million recurrent; and
the Independent Commission of Investigations, $350 million for recurrent expenditure.
Budget for 2016/ 2017. Jamaica Information Service.
Author: Tracey Thompson (April 15, 2016)
http://jis.gov.jm/579-93-billion-budget-201617/

Jamaicas outlay of health facilities includes over 330 health centres, 24 public
hospitals, the University Hospital of the West Indies, a regional teaching institution
partially funded by Regional Governments including Jamaica, 10 private hospitals and
over 495 pharmacies. The public health sector accounts for some 5,000 hospital
beds, while the private sector provides approximately 200 beds serving a population
of 2.7 million. The 24 public hospitals are spread across the nations 14 parishes and
four Regional Health Authorities and are designated A, B and C based on the range of
services offered.

Health in Jamaica. http://www.commonwealthhealth.org/americas/jamaica/

(obtained November 13, 2016)

MEDICAL doctors yesterday blamed the lack of resources for the poor health care received by
citizens at the nation's public hospitals.
The doctors, who all requested anonymity, were responding to yesterday Sunday Observer story which
exposed the conditions under which doctors have to work at the Kingston Public Hospital (KPH) and
Spanish Town Hospital as well as the poor treatment received by patients, mostly poor Jamaicans.
One surgeon at the KPH told the Jamaica Observer on a number of occasions surgeries have had
to be cancelled or postponed because of a shortage of equipment and the malfunctioning of
others.
"The elevator is always a problem, as it hardly ever works. The issue gets worse when you have to tell a
patient 'I'm sorry, I can't do your surgery again because the elevator isn't working'," the surgeon said.

In June last year elective surgeries were cancelled at the KPH because of repairs being carried out on
one of the main elevators at the hospital, according to the surgeon. He said that, to date, the elevator
does not function properly.
"A man is required to be posted in the elevator at all times to get you to the floor the surgery is being
done. That's not a functioning elevator if someone has to be posted in it to allow it to go up and come
down," the surgeon said.
He said that only emergency surgeries can be done because of the risks patients face when the elevator
doesn't work.
"When the elevator doesn't work and the patient doesn't get to do the surgery, it can result in death.
Sometimes patients are moved manually up and downstairs, which is a major risk because if you drop the
patient no one will understand and look at it and say you were trying to help a situation. Plus, no one is
covered by insurance if they drop a patient," the doctor lamented.
"Because of this, you will find that people who have hernias unfortunately have their surgeries cancelled
and only cancer cases are dealt with because they are considered urgent," he added.
In addition to the malfunctioning elevator, there is insufficient supply of medication, surgery gowns, and
surgery equipment, while the list of patients awaiting surgeries grows.
"There are no antibiotics and patients have to be asked to buy their own and take to the hospital.
The gowns are not appropriate for surgery as the plastic aprons do not cover anything," said the
surgeon. "Once I went into surgery, and when I was finished, the blood from the patient soaked
right through the apron onto my skin and that's a risk to ourselves right there. But we put
ourselves at risk for them to get their surgeries done...," he said.
The surgeon mentioned, too, that there was only one functioning ultrasound machine for the entire KPH,
which means if a patient needed to do an ultrasound they might be required to wait several days.
"The health care might be free, but it becomes costly when a patient is waiting for several days for
one test. They have to be given clean linen, meals and medication, which is an expense," the
doctor said.
He added: "There's one CT machine, and when it's up it's great, but when it's down it's a big backlog of
persons waiting to be tested. It even gets to the point where you have to bargain to get your patient in first
to be tested."
The surgeon described the conditions as depressing and told the Observer that doctors on a number of
occasions have to bring surgery equipment from their private practice.
"From a human point of view, I feel very bad. This is something that affects mainly poor people. I would
not want my relatives to go through this, so I pay for private care. But some just can't afford it. Emotionally
it takes a toll on the doctors to the point where they now have to withdraw themselves from the situation
to not be affected. It's not easy when 90 per cent of your patients are affected by the cost of free health
care and end up dying," the KPH surgeon said.
At the University Hospital of the West Indies (UHWI), the situation is not much better.

"There are no purple top tubes which are used to check your blood count. There are no branulas used to
insert the IV drip. There is no prednisone -- an anti inflammatory drug -- so if anyone comes in with an
allergic reaction, asthma or auto immune disease there's nothing that can be done here [at the UHWI].
Also there's no lidocaine, which is used as an anesthesia so anyone who needs to get stitches will feel
the pain and this is a huge issue as the doctors have to reschedule many procedures," the doctor said.
"There is no barium enema (a special X-ray of the large intestine), so if you have abnormal bleeding from
your rectum you can't check to determine if it's cancer or something serious causing the bleeding," one
doctor said.
He also said the X-ray machine has been without film so patients have to be sent to KPH or elsewhere to
do their X-ray.
The doctor added: "There is also an ultrasound problem, so you have people here waiting for an
ultrasound and can't get a date."
In addition, he pointed to a shortage of toilet tissue, hand towels and bedlinen, which pose a problem
when admitting patients.
At the Mandeville Regional Hospital, a doctor said basic supplies are often out of stock.
"I think either the Government has no money or the hospitals aren't getting what they're supposed to get,
because basic things like hand towels and tubes for basic blood tests are hardly or never here. The
[Accident and Emergency] Department has none, and we have to put off something as simple as a
complete blood test because there are no tubes," the doctor said. He added that, for the last two months,
there have been problems with the ECG machine.
The hospital also faces a staffing issue, which the doctor explained is a major risk.
"...There is one nurse in the department, and you can't run an A&E Department with one nurse. Ideally
three to four should be there," the doctor said. He said also that, because of the shortage of beds on the
wards after surgery, some patients are housed in the A&E Department, while are sometimes placed in a
reclining chair, which the doctor said is a further risk to their health.
Last night, acting permanent secretary in the Ministry of Health, Dr Kevin Harvey said the complaints
were alarming, and an investigation would be conducted in an attempt to alleviate much of the problems
the doctors face.
"I was not aware that there were a shortage of tubes at specific hospitals, and I will personally have to
investigate that. While specific hospitals might be out of items, the country is not out of items. If these
problems are made known in a timely manner we can move to have the hospitals supplied," Harvey said.
However, he mentioned that at times there are problems regarding ordering the supplies at the regional
level, but once the ministry is made aware they are willing to address the complaints and discuss them
with the doctors.
With regards to the UHWI, Harvey explained that this hospital is managed differently from the rest of the
health services.
"It is still a fee-charging facility and it has its own management. Where shortages there are concerned,
while we will assist where we can, it is really managed by the UHWI management board and structure
that exists there," he said.

The ministry, he said, was aware of the elevator problem at the KPH and was in the process of having it
fixed, but said it would take some time to finalise.
"Our plants are old and have suffered from a lack of maintenance over decades. To keep them up and
running is a challenge," Dr Harvey said.
He added that the primary care and health services system is in need of an upgradem to manage the
number of patients and health care distribution.
"Hospitals are having to deal with too many patients. When the health services were built a few decades
ago the population was roughly 1.8 million. Now the population is 2.8 million, which indicates a massive
shift and also a larger migration of people to urban areas," he said.
"Forty-seven per cent of the population lives in the South East Regional area, which is St Catherine,
Kingston and St Andrew, and St Thomas. If we intend to provide good health care, there needs to be an
overall restructuring to match the shift and deal with issues of overcrowding as the doctors and health
care workers are dealing with more than they can handle because of the population shift," Harvey said.

Kimberley Hibbert Jan 5, 2015.

http://www.jamaicaobserver.com/news/Hospital-woes_18175063

2013 2015

MONTEGO BAY One of the facilities in the Health sector where major upgrading works will be
carried out in the coming months is the St. Anns Bay Regional Hospital, in St. Ann.
Minister of Health, Hon. Dr. Fenton Ferguson, tells JIS News that there has been an increase in the
Capital allocation for the health sector for 2013/14, pointing out that approximately $2 billion has
been allocated for development projects, as against $611 million which was allocated last year.
This, he says, will facilitate the planned improvements at health facilities across the island, including
the St. Anns Bay Regional Hospital.
Recently the Minister broke ground for a 47-bed female medical ward at the hospital, to be
constructed at a cost of $73 million.
The health facility currently has a 250-bed capacity, and is the regional referral hospital for the North
Eastern parishes of St. Ann, St. Mary and Portland. It provides a range of services to an estimated
population of approximately 365,000 persons.
The decision to add the female medical ward came about after Minister Ferguson visited the hospital
in November 2012, and was briefed on the need for such a facility.

On that occasion I gave my word to have the ward added, recognizing that one of the main
problems that was affecting the throughput, relative to the accident and emergency area, was the
absence of a female medical ward, the Minister says.
The project, which includes the construction of the ward, two on-call rooms for doctors, a conference
room, a staff room, a Sisters Office and a medical department, is scheduled to be completed in eight
months, and will increase the hospitals overall bed capacity by approximately 20 percent.
Also on the agenda for the St. Anns Bay Regional Hospital for this financial year is the building of an
Obstetric Operating Theatre and a maternal high dependency unit.
In fact, this has been put in the Ministrys 2013/2014 budget. This is expected to take us closer
toward meeting our Millenium Development Goals (MDGs) with respect to improvements in the
maternal, infant and child mortality ratios, the Health Minister stated, while addressing the ground
breaking ceremony for the female medical ward.
He tells JIS News that with overseas partners presenting the St. Anns Bay Hospital with two
refurbished ambulances on April 9, and the Ministrys plan to purchase 17 more ambulances by
September this year to distribute to health facilities across the island, the hospital should have
adequate ambulance service in the future.
The Minister says that all these improvements are with a view to moving the health service at the St.
Anns Bay Regional Hospital to another level.
It is my intention, and that of the Government of Jamaica, that the St. Anns Bay Regional Hospital
must become a Centre of Excellence, Dr. Ferguson emphasizes.
He adds that some four Centres of Excellence in the area of primary health care are also being
established across the island.
The Minister notes that all this is taking place against the background of the Government continuing
to embrace a patient centred approach to health care delivery.
Meanwhile, Mayor of St. Anns Bay, Councillor Desmond Gilmore, tells JIS News that the
improvements at the St. Anns Bay Regional Hospital could not have come at a better time, bearing
in mind the relevance of that health facility to the demand of local citizens and overseas visitors to
the North Coast.
For her part, Senior Medical Officer of Health at the facility, Dr. Nicole Dawkins, says the
improvements will have a tremendous impact on service delivery at the institution.
April 21, 2013
http://jis.gov.jm/major-upgrading-for-st-anns-bay-hospital/

http://intranet.cda.gov.jm/wp-content/uploads/2014/06/ESSJ-2013-FINAL-PDF.pdf

http://www.boj.org.jm/uploads/pdf/boj_annual/boj_annual_2013.pdf