Tyrone Reid, Enterprise Reporter

Despite having its head office diagnosed as 'top-heavy' by international consultants more than two years ago, and committing itself even before that to shave the size of its staff, the Ministry of Health has failed to make good on its reform projections.

DAH Consulting, Inc. in a multimillion-dollar performance assessment which The Gleaner gleaned through the Access to Information (ATI) Act, also pointed out that despite a reduction in the number of employees at the ministry's head office, there was no cost savings.

"In fact, the costs increased because the positions that were removed were mostly clerical rather than higher grade staff," the report said.

When contacted, the Health Ministry challenged the accuracy of the assessment and argued that the advice of the Government-hired consultants, who were paid approximately US$206,000 (close to J$12.5 million at that time) to do the study, should not be taken at face value.

The ministry argued that its head office was a technical, specialised health institution that gives medical direction to the four regional health authorities and supervises and gives medical direction to some 3,455 medical professionals.

Critical issue

"The critical issue, therefore, is not to measure the head office of the Ministry of Health in terms of top-heavy but rather to measure the cost-benefit of health service delivery, and the role of the head office of the Ministry of Health in terms of efficiencies and effectiveness in overall national health service delivery," the ministry said in response to The Gleaner's queries.

The health sector already accounts for a huge chunk of the Government's wage bill. The Jamaica Memorandum on the Budget 2006/07 said the health sector, along with education and national security, accounted for 65 per cent of the projected $73 billion wage bill.

Apparently not satisfied with the state of affairs at the time, the consultants recommended that "the Ministry of Health continue with the reorganisation process."

The consultants from the Wall Street, New York-based firm, which also highlighted that some cash-strapped clinics and hospitals were overcharging their patients in an attempt to better their financial standing, also disclosed that interviews with staff from the Ministry of Health and the Regional Health Authorities revealed that there was "some concern about the large number of directors in the system."

The report said that the decentralisation of the health sector in the late 1990s meant that the number of staff members at the ministry's head office should have been slashed significantly.

"It was thought that because the responsibility for providing health care services was being given to the regions, there would not be the need for so many head office staff," read the report.

Number expected to drop

"The number of head office staff was expected to drop in 1998 from 681 positions to 248. This did not happen. There was still 391 head office staff in 2002," read the report that was submitted in January 2004.

Almost three years after the report was submitted, the ministry's head office still has more than the initially proposed staff complement. Currently, the head office has 309 staff members with 20 senior directors.

However, the ministry admitted that "instead of reducing the cadre of health professionals from the planned 681 to the targeted figure of 248, the number of in-post positions was reduced to 309, reflecting a net difference of 61 professionals."

In addition to the "in-post positions", the Health Ministry also revealed that there were 141 contract workers. This would push the total number of employees-in-post, and on contract, to 450.

The ministry explained that, after the advent of decentralisation, four critical divisions were created and additional staff members had to be employed.

It also said the higher grade staff members are medical professionals, primarily senior medical directors, who are critical to the success of the system. "These critical positions can only be filled by such persons, a junior doctor could not be relied on to do the job, the national health risk would be too great."