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Universal Health Care: The Only Way Forward - April 17, 2006

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Universal Health Care: The Only Way Forward



Today I want to focus on health care, more specifically, Universal Health Care.

Have you, for example, wondered why I am so preoccupied with the establishment of a system of Universal Health Care in our country? Infact, why is health care important to me?

I can answer these questions from a number of different perspectives but let me start from a personal one. My family and I have been affected by serious, indeed, life-threatening conditions. So much so that in fact for a number of years some members of my family could not be here in Saint Lucia because the necessary health services to care for one of my family members was not available. Recently all of you will remember the situation with my wife, Rose-Marie, who had to travel abroad for surgery to her spine.

I understand the desperate situation that many of you find yourselves. As a fellow Saint Lucian I am moved to resolve this dilemma. Equally, as your leader and Prime Minister, I feel the need to resolve the dilemma. From before you elected me to office I was in discussion with health care workers encouraging them to find the solutions to the health problems facing us. Access to necessary health services has been a priority for me from that time. You may remember that one of the first actions I took on assuming office in 1997 was to remove the fees from Doctor’s visits at Health Centres.

I have been constantly agitating for the solutions including unrestricted access to medications and comprehensive care programmes for persons with diabetes and hypertension.

Health is important not just because of its value to each of us personally but because, as economists have clearly shown, appropriate investment in Health gives major returns for the national economy and is a fundamental pillar for national development. Allow me, please, just as a reminder to quote from the SLP manifesto of 1997, “The Contract of Faith”.

“We believe that access to efficient quality health is essential not only because it provides a healthy workforce and improves our productive potential but also, and perhaps more importantly because healthy individuals are more likely to realise their full human potential”


Four months after I assumed office, the Cabinet formed the Health Sector Reform Committee with the task of defining a way forward that would modernise our health services and establish a system that would be able to find effective solutions to the problems facing us. I wanted a health plan that would ensure that the health services would be driven to continuously develop.

That was the first step. In December 2000, the Cabinet approved the Health Sector Reform Policy entitled “Quality Services for Life”. The Cabinet at that time charged the Ministry of Health, Human Services, Family Affairs and Gender Relations to develop a plan to deliver the health reform.

In January 2002, the Cabinet of Ministers appointed the Task Force to examine the feasibility of introducing Unemployment Insurance, Pension Plan for Farmers and Fishers and National Health Insurance. This Task Force was chaired by the Director of the NIC, Ms. Emma Hippolyte. In November 2003 the Cabinet approved the Proposals contained in the NHI Task Force Report. In 2004, the Ministry of Health, Human Services, Family Affairs and Gender Relations commenced the development of the National Health Strategic Plan. European Union funds supported a consultancy in 2005 to further aid in the development of this plan. The Ministry is now ready to launch the National Strategic Plan 2006-2011, – entitled “Quality Health Care for Life”.

This entire process has been a thoughtful and consultative one. Many experts and, more importantly, people like you have contributed to the formation of this plan. I need to thank all of you. The contribution of Saint Lucian people to the Health Sector Reform Plan and the Universal Health Care Plan is what has made these plans real and in touch with the needs of people like you. I need to assure you that your work is not in vain because as leader you have now given me a plan that I can deliver.


The Health Sector Principles of equity, effectiveness and efficiency have resulted in us adopting the strategies of social solidarity and universal access to publicly guaranteed services. This simply translates into providing the right health services at the right time to all people.

Throughout my life, I have been acutely aware of the high level of social inequity and injustice in Saint Lucia. I have attacked inequity and injustice at every opportunity. The Health Plan built on the value of social justice is another strike that I will make against a system that has for decades developed an entrenched discrimination and marginalisation of many vulnerable persons but especially poor people. If you could see into my heart you would understand that I do not want any Saint Lucian to be left behind, to be denied health care, to be left to languish. I am distressed by the number of persons needing to raise funds for necessary services by any means necessary.


I need to ensure that in the new system a forty year old, unemployed woman with four children who discovers she has breast cancer can get all the appropriate care without having to worry about how she can raise the money to afford any component of her care including her radiotherapy.

I need to make sure that in a new system every person with diabetes is found and is placed in proper care and receives proper treatment so that that person need not suffer the devastation that that disease can wreak on his heart, his kidneys, his eyes, his limbs, his brain, indeed his life.

I need to ensure that in the new system anyone with an emergency is met with competent emergency service personnel, quickly and is rapidly and professionally transported to well equipped and staffed emergency rooms in hospitals with full support services and rapid access to proper care so that their lives and limbs are saved.

I need to ensure that every person with a mental illness is treated in a comfortable environment conducive to recovery. I need to ensure that the patient with mental illness receives the most modern treatment and gets all the necessary support. I need to ensure that this person is treated with respect and dignity as a fellow human being.


We have been guided by the basic principles that are embodied in the code of Human Rights, the basic principles outlined as the foundation of all great religions. Consider these words of Jesus Christ as captured by Matthew,

“Thou shalt love the Lord thy God with all thy heart, and with all thy soul and with all thy mind. This is the first and great commandment. And the second is like unto it, Thou shalt love thy neighbour as thyself. On these two commandments hang all the law and the prophets”
Matthew 22:37-40

These are the principles that form the core of our approach to Health. We fully appreciate that sustainability demands careful planning and design to ensure that the plan is feasible now and into the future. For this reason, I ensured that much time was spent and many experts reviewed these proposals to design the most practical system that can be true to the principles I hold dear. Let me explain the system.


The Universal Health Care is a plan that gives access to health services at no charge at the point of service. The services are not free because the money will be raised through a special tax and from Government Revenues. These monies will be placed in the UHC fund which will be managed by the NIC. This fund will be completely separate for the other NIC funds. The UHC will have service agreements with hospitals. These agreements will detail the expected services and the necessary money to be paid from the UHC fund to deliver these services.

The hospitals will be paid a budget for the services agreed. The budget is determined by the number of persons identified in the hospital catchment population. The hospital is bound by the service agreements it has made with the UHC to deliver all the services for this population at the standard detailed in the agreement.


Despite this progress, all the carefully laid plans, Sir John Compton, Leader of the UWP says, if elected, his party will go back to what he describes as the National Health Service. Actually, I believe he meant the National Health Insurance. According to him “we shall ensure that the National Health Service, began eight years ago by the UWP Government, but abandoned by the SLP, is inaugurated and managed and staffed by competent professionals and not by persons appointed because of politics.” I leave the latter part of that statement to your imagination.

Let us compare the UWPs’ NHI and the SLPs’ UHC.


The previously proposed National Health Insurance contained in the National Health Insurance Act, No. 28 of 1996, was designed along the principles of private insurance. It was a contribution system in which salary deductions were to be taken and limited services were to be provided.

The services were divided into two main components—the Basic Hospitalisation Plan and the Basic Non-Hospitalisation Plan. Benefits were to be restricted to a maximum number of interventions per person per year and a financial limit was placed on each intervention.

In the previously proposed NHI only contributors and their immediate families would be entitled to benefits. The NHI was proposed to commence coverage of NIS contributors and Government Employees and their dependents. Other persons namely the self-employed persons, pensioners were to be considered in a later phase. The indigent would remain a responsibility of the Central Government. The unemployed were not going to be included.

Actuarial reviews suggested a 7% salary deduction although the UWP Government of the day was considering commencing at 3%.

The UHC intends to cover all Saint Lucians from the onset. It will include the elderly, the disabled, the indigent, the unemployed, the self employed, NIS contributors, children and government workers.

The UHC will provide all necessary care to treat the diseases and health conditions affecting Saint Lucians.

The UHC services were detailed before and include hospitalization for all hospital services presently done in Saint Lucia. The UHC will provide medication for all major conditions. The UHC includes all mental health services and substance abuse rehabilitation services.


The UHC will include overseas care and special services for certain conditions that cannot be treated in the general services. The UHC is intended to leave no one out; we will leave no one behind. What is necessary for any of us is necessary for all of us.

The UHC will be financed through a tax mechanism and not salary deduction. The taxes proposed are on certain goods sold in St Lucia so that everyone will contribute, but only in proportion to how much they consume.

The UHC is much more than a financing mechanism. It is a health development fund. It is an insurance fund for the health infrastructure. It is a contingency fund. It will also ensure that the quality of health care improves.

So, here you have it. The choices are before you.

Next week I shall share with you the services which will be included in the UHC plan. So, until next week, God bless and have a wonderful Easter holiday. But remember, please, do take care!.


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