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“Silent Revolution” In Health Care - December 13, 2004

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Good Morning again, citizens of Saint Lucia, I hope you had an enjoyable weekend and that you are in the best of health.

I have cast my salutations this way because I want us to talk about health and health care.

I get the impression that when we speak about health, we only think of the absence of diseases. But health and health care are much broader, much bigger than just the absence of diseases. It also involves a state of physical, mental, social and spiritual well-being or if you prefer the term in vogue these days, “wellness”. Health is a resource – a very, very important resource. It is a resource that enables people to take control over and improve their lives - a resource without which a country cannot hope to develop.

It is often said that the “health of the nation is the wealth of the nation.” You may have heard this saying so often, that you may now take it for granted. Have you ever stopped to think of the possible impact of an unhealthy population on the development of Saint Lucia? Frankly, the consequences are too dire to even consider. So I prefer to adopt the position of those wise persons, who often say that prevention is always far better than cure. Hence the reason we are investing so much in the health sector.


As we continue to adjust to changes in the health sector, we cannot ignore the expectations that, you the Saint Lucian public, rightfully demand of your health sector. I know that you want a health sector that is capable of providing quality services when and where it is required. You want a health sector that is capable of supplying timely and quality diagnosis and treatment at all times. You also want a health sector that works for everybody; rich, middle class and poor.

But I know too that you are also concerned about how much of your tax dollars is spent on the health sector. I have to tell you though, that it is very difficult to put a price tag on health care. You see, we are working with limited resources, and every dollar spent on health care is a dollar that cannot be spent on education, roads or the legal system. The health services we want must be paid for, whether by taxes or by you, the consumers of health care. It cannot be provided entirely free of cost. We simply do not have the means to do so. Nothing in life is free, they say.


This Government has embarked upon a programme of health sector reform which is broad and far reaching both in scale and in scope. These changes are occurring almost unnoticed and without fanfare. Indeed one may say that a “Silent Revolution” is underway in the Health Sector.

You may ask, what are the features of this “Silent Revolution”? Well, let me tell you. There are four clearly identifiable pillars of this “Silent Revolution”. Firstly, there are Infrastructural Developments to be undertaken. Secondly, there are initiatives to introduce Universal Health Care. Thirdly, efforts are underway to change the system of Governance of the health System. Fourthly, efforts will be made to empower the community and health service workers in the management and delivery of health services.


Let us quickly review the proposed infrastructural developments. In an attempt to relieve the ever mounting pressure on secondary care institutions, (Victoria Hospital in particular) and to further deepen access to health care, the Government has begun major renovation and expansion of all health centers island wide. But that is only the tip of the iceberg.

I am sure that most of you have heard but for those of you who still do not know, we will see the commencement of the construction of two new hospitals in the next year, a new general hospital and a psychiatric hospital.

The Government and people of Saint Lucia are once again the recipient of the goodwill and generosity of the Government and People of the People’s Republic of China, with whose assistance a new psychiatric hospital will be built. So, we must, once again, thank the people of that great country.

Whereas it is true that Golden Hope Hospital served us well for many years, I am certain that you too will agree that it is no longer capable of meeting the island’s mental health requirements. For a very long time mental health did not receive the type of attention it deserved. As a society we treated mental health issues as a social taboo. We even mystified mental health issues. We are ashamed of those who become mentally ill, even our own relatives. We must understand that mental illness is a medical condition. It is time that we make a fresh start and treat our psychiatric patients with dignity.

I must warn you though, that the construction of the new psychiatric hospital is meaningless if we do not change our perception, attitude and awareness of mental health issues and the way we treat persons who suffer from mental disorders.

With the assistance of the European Union, construction will also begin sometime late next year on a new modern general hospital. I know that this is a development that you keenly await. The construction of a new general hospital will permit the existing Victoria Hospital to be used as the Castries polyclinic, rehabilitation hospital and step-down facility. Moreover, the construction of a new general hospital would allow for the conversion of Saint Jude to a community hospital offering a range of services but referring to the main hospital for most elective and sophisticated services.


The second pillar of this “Silent Revolution” is the introduction of a Universal Health Care System. Basically, Universal Health Care will be introduced as a mechanism for financing and sustaining the health care sector. It will make health care accessible to all. The Universal Health Care System, which this government proposes to introduce, will address all aspects of health care be it general, mental, emergency, diagnostic, pharmaceutics and overseas care. But the broad intention of the introduction of a system of Universal Health Care is to deliver an improved quality of health care to the nation through the implementation of standards and the performance of regular health audits at the various service providers. The introduction of a system of Universal Health Care will ensure that the public interest is protected by making compulsory the licensing and monitoring of medical practitioners and health institutions and holding service providers accountable for the quality and quantity of health services.


The third pillar of this “Silent Revolution” is about the governance of the health sector. The Government intends to give the public and medical professionals an active role in health matters. How do we intend doing this? To begin with, the management structures of the health institutions are in for a major overhaul. Already St. Judes Hospital has been statutorised, that is, a board has been appointed by law to manage the affairs of the hospital. A similar system will be introduced to manage Victoria Hospital. In effect, the Ministry of Health will no longer be directly responsible for the management of the hospitals.


New rules and regulations will be introduced to protect the public interest and to empower the community and health personnel in the management of the hospital. This is the fourth pillar of the “Silent Revolution”. As a Government we want to empower you because we know that you have a stake in the efficient delivery of health services. This is why we seek to put in place clear rules for all players and practitioners. We will also seek to empower key groups by further training and development. We will seek to establish a basket of health care services and overseas care. We will introduce measures to ensure standards and quality assurance. We will also introduce health and information and management systems. Laws and rules will be introduced to govern the operations of persons and institutions involved in the health sector. The new legislation will strengthen the management of health personnel, define their functions, provide for surveillance of their performance and set education and competence requirements.

We have already established a Health Services (Complaints and Conciliation) Commission as a means of oversight, and to give you an avenue to address your complaints about the professional behaviour of doctors. We must ensure that the health system works for everyone, not just those with money.


Incidentally, I have not touched HIV/AIDS. That is a big issue. It deserves special attention. So it will be addressed in another Conversation with you.

Meanwhile take care of yourself, until we meet again, next Monday. God Bless!



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