Wilberne Persaud, Financial Gleaner writer

Persaud

Last week in conversations with two friends, the topic of free health care came up. One of them was at the gathering of students to whom Michael Manley announced provision of free education to the tertiary level at the Assembly Hall of the University of the West Indies in the early 1970s. Nearly 40 ago, my friend suggests a similar initiative for which the country was unprepared financially led to a diminution of the spread and impact of truly 'good' education. He is sure the same will happen to the free health-care initiative. I pointed out that there are significant differences. Provision of health care for all was a campaign promise. People must have been working on this matter for months.

My other friend, younger and from a different discipline has another take on the matter. He sees the move as premature. Funds do not exist to implement it. UHWI is not on-board for this very reason, he argues. And it cannot because of its regional commitments and support. But he sees it as a positive, a distinct positive. Why? Because the move creates disjuncture. It is going to force changes that, in the end, will have positive impact.

So cliché

Both these takes on the situation have grains of truth to them. But the crux of the matter lies in the commitment to achieving the aim of health for the population. For at the end of the day, it is people who matter. That sounds oh so cliché, doesn't it? Yet it simply happens to be true.

Sometime ago I participated in studies of what was then called the health sector. This derived from two things. First, I was asked by the head of the department of Community Health, Prof Denise Eldemire-Shearer, to assist in her postgraduate programme for health practitioners doing the diploma in public health to introduce them to health economics. Second, the Ministry of Health was looking at the provision of health care relative to the merits and demerits of the organisation of the sector - the various regions, primary vs other types of health care, and so on. Third, I assisted a research student looking into the various problems that the then University Hospital of the West Indies' Casualty Department faced with 'oversupply' of clients who were by no means casualties!

These exposures lead me to the conclusion that like everything else, money was at the root of the evil. But that was not all. We had tinkered with the inherited system in so many ways and there was no apparent clear-cut consensus as to how we should get to the point we had chosen: a healthy nation with affordable care for all.

Overrated

If it is not only money, then what is it? And why does my friend believe the free health-care initiative will be like free education of the 1970s while providing unintended benefits derived from disjuncture? He is an engineer and believes that disruptions to a steady state or disequilibrium are overrated. He believes, in fact, that the world operates more in these chaotic states than the smooth ones that we normally believe to exist. Events move along in fits and bursts. In other words, the world is non-linear - not a straight line.

His thinking then is that pressures that will become evident on the system will reveal problems that will now have to be fixed. From this, there will be benefits and progress. Some might say this is cynical thinking. But is it really? Or is it thinking in the way of science?

First, we identify the facts: here is the problem, why does it present itself? If we can answer the question, we may be able to find a solution.

Highly rated

At the UHWI Casualty Department of over 30 years ago, people would go there for treatment of a simple sore or a common cold: no emergency these. They did so because care was free, doctors' skill was highly rated, nurses were caring and polite, the service was close for many and not too costly in transport.

There were many other reasons for their preference. But violence among the youth also created repeat 'patients' who came because of various wounds. Indeed, a matron was heard, in my presence, to chastise a young man who was becoming a too frequent 'visitor' with these 'wounds while deserving truly sick people had to wait'! She actually threatened him with not attending to him if he came back too soon.

Answers matter

Then there is the question: what should our health-care system be delivering? Is it that we treat disease as it erupts or should we be aiming at the whole, the person and health as governed by lifestyle? Answers to all of these questions matter. Yes, there is need for intervention and immediate responses to a clearly indicated need. But at the end of the day, my engineer friend may be correct. This exercise may point out fractures in the systems that were formerly masked and they shall have to be fixed.

We have a hybrid private/public health-care delivery system that for a variety of reasons has developed on a more or less ad hoc basis. Perhaps the future holds new developments that will recognise money as important, but also see defined objectives, organisation and systems as if not more, then at least equally important.

wilbe65@yahoo.com