INSTITUTIONS OFTEN change over time, but this rule doesn't seem to apply much for the island's 13 infirmaries, which haven't changed much in 100 years.
The buildings have run down, most need to be razed. The environs are often unsanitary, unhygienic and severe; under-funding keeps matrons scrambling to hold things together.
Infirmaries and their management structures have been classified as inadequate and unacceptable by a task force within the Programme Co-ordinating and Monitoring Unit of the Office of the Prime Minister. The task force is recommending a radical overhaul of the existing system and has put forward five alternatives.
"The study of the infirmaries provides overwhelming evidence that the existing system is failing to satisfy any of the Ministry of Health's regulatory standards, demonstrating weaknesses in management systems, structure and projects, an institutional image that requires significant improvement."
The task force commissioned feasibility studies examining the options of: divestment, privatisation or regionalisation of the infirmaries. Another recommendation is for new infirmaries to be modelled off the exemplary Golden Age Home in Kingston. This would require combining the Golden Age model with privately operated, community-based homes for the elderly. The most feasible option, however, was for Government to retain management of the infirmaries but with radically improved management and financing.
Another proposal would see the 13 infirmaries grouped into five regions to serve the indigent population collectively in those parishes. The regions would be Clarendon, Manchester, St. Elizabeth; Westmoreland, Hano-ver and St. James; Trelawny, St. Ann and St. Mary; Portland and St. Thomas; while, St. Catherine, given its size, would represent one region.
Some arguments for rationalisation are centralised management, discounts on bulk purchases and overall efficiencies. However, a drawback is that residents could be isolated from family members who may not be able to afford travel expenses. (Although many people in infirmaries are estranged from their families).
" ... each region could be headed by a matron/administrator with autonomy, as it relates to patient care and the general operation of the regional facility. Issues relating to admission, for example, would be dealt with by the matron/administrator, and the Inspectors of the Poor assigned to parishes in the region. Matters such as finance, human resource and development, purchasing and public relations could be centralised."
ATTRACTIVE ALTERNATIVE
Rationalisation is "an attractive alternative" to existing parochial infirmaries in that there is potential for both savings and revenue.
On the option of divesting infirmaries, there were further considerations whether Go-vernment should retain ownership of property but privatise management functions, or whe-ther Government should submit all control and ownership to private interests.
" ... infirmaries would be operated primarily as profit-making enterprises. The operators would generate income from government on a per head basis for the destitute and fees from paying residents."
DRAWBACKS
However, several drawbacks make this option untenable, including the need to change laws to allow private involvement; the risk of paying clients gaining preference over the destitute; and the possible decline in charitable gifts from organisations which would not give as much to a profit-making entity.
Privatisation was not found to be a better option than operating the infirmaries under an executive agency unless management fees were low. Given the success of existing executive agencies, this is considered a "viable option worthy of very serious consideration" for the management of infirmaries.
Opal Beharie, secretary/manager of the St. Elizabeth Parish Council, said plans to improve the infirmaries must be centred around increasing available finances. "The main need of infirmaries is adequate financing and staffing. The direction to go is to create facilities for paying clients as this could subsidise non-paying clients," said Mrs. Beharie.
