I was listening to a BBC discussion that centered on Ethiopia’s economic performance and prospects going forward. The participants were really forthright in their comments, both supportive and critical. In the process I learned a new word that seems to be relevant to much of the world, and is a major description of our own Jamaican and Caribbean situations.
That coined word is “Lootocrat” and is a great description of our decades of scandals that have drained the public purse through our contracts; poor negotiations; helping party faithful and family members; and plain bribery and corruption. “Lootocracy” is endemic. It has the capacity to make us unproductive; lack consistency; and lose any or all competitive or comparative advantages that we may have had.
My main focus today is based on the presentation of Hon. Dr Christopher Tufton in Parliament recently. For the second straight time I have to commend our Parliamentarians for their attention to the details of national health issues, the planned path forward, and the lack of petty interruptions. They were interested and participated in a mature manner. However the other items on the agenda had no such restraint.
I am sure there will be some disagreements or further refinements offered as the debate is expanded. I detected a realization from the parliamentarians that healthcare is important and deserves serious consideration beyond party lines, or maybe all have accepted that we will all require medical attention before we face the inevitability of death.
The Minister dealt with an assessment of our poorly maintained facilities island wide; and the fact that an ageing infrastructure cannot support the quickly evolving procedures and care that are offered in countries that we like to emulate. He was quite right in acknowledging that the time spent waiting is a systemic inability to change to new methods for dealing with modern procedures and equipment and supplies that are rapidly becoming more effective.
The Minister stated his intermediate plans to utilize private services at agreed rates to supplement the shortfalls in the public system. However, the very fact that some of these facilities are owned by practitioners in the public sector who have private investments may be that they dedicate more effort and efficiency to those efforts than their government jobs.
This shows that they can be and are efficient for their own pockets and are frustrated by the undue bureaucracy and uncaring nature of government remuneration practices that are decades out of date. Such is the nature of private investment in a free economy.
Therefore the stated intention of finding a way to efficiently operate a good national health insurance scheme is of paramount importance. This is extremely important, for helping to fund new equipment to train doctors, nurses, radiologists, and other allied medical groups, will still remain in the hands of the Government as the private investors will not continue to keep pace with the new equipment and inventions needed to teach modern medical practice and research. Constant equipment upgrades will only come after there is a well-developed medical tourism market.
In the same way that taxi fleet operators like Yellow Cab, and JUTA started with new vehicles, today they often replace these with old second-hand units that frequently exceed seven years old. The only exceptions are probably those in tourism who may be granted duty free importation status.
So despite the short-term intention to alleviate the current situation, I am certain that the Minister understands the longer term imperatives of the educational aspects as we try to produce better and more internationally aware medical personnel. This is critical as we continue to train excellent medical professionals for Jamaica and the Caribbean.
I wish to outline two major contributors that affect the genuine attempts being made to improve healthcare.
First are the antiquated systems that do not allow for the effective and timely accountability of many normal daily activities. This creates a gap that really cannot be checked on a real time basis, and the reliance on paper-based systems is an easy excuse for items being missing, hidden, or worse still stolen from the premises. Internal audits and calling the police rarely bear fruit as the reaction to normal international surveillance and the use of other electronic deterrents within premises is being resisted. It is a resistance that facilitates obfuscation and corruption.
Secondly, many persons within the government system are unwilling to perform at the pace of international health facilities. This is not a function of inadequate work ethics (except here in Jamaica), as many who have been recruited to work overseas actually outperform their foreign counterparts and work extra shifts without complaint.
The simple reasons are that their perception that their remuneration in Jamaica is inadequate and there is therefore little opportunity for wealth creation such as real estate investments, and second and third jobs that have been the hallmark of our Diaspora. They also feel disrespected by managers who have little or no ability, agility, or imagination to introduce motivational rewards for excellence, and disciplinary action for non-performers. They are all bound/constrained by an ancient system of HR and Trade Union governance that has changed very little since Colonial days.
So the Minister needs support and vigilance for carrying out this vision, and he must be aware that the previously mentioned “lootocrats” are lining up to get favoured contracts that they are technically and administratively incompetent to perform. This is the payback for having party supporters who expect contracts in return for being “community leaders” and rabble rousers at election time, whether they can perform installation and maintenance or not.
Citizens with honed skills must come forward to assist in the process of healthcare reform, regardless of real or perceived party loyalties. It is a time for truth and honesty as disease does not respect colours.
I simply remember an old adage that says “You may live in hope and yet die in Constant Spring”.