Health reform refers to changes in health management, health planning, and health research that significantly emphasize local health challenges aimed at improving health management, health planning, and health care. They will combine to produce an efficient health care delivery model capable of increasing the physical, medical and psychological safety of the patient. Health reform must be driven by empirical data, best practices and evidence-based practices. A variety of health statistics; such as mortality, labor needs, technology functioning, and patient satisfaction; should be analyzed and used to strengthen health systems.
In Trinidad and Tobago, the current healthcare system is highly centralized. The Ministry of Health maintains operational oversight of five regional health authorities. These are the Northwest Regional, the North Central Regional, the East Regional, the Southwest Regional and the Tobago Regional. Southwest, Northwest and Center-North are the largest regions; each serving the health needs of more than three hundred thousand people.
A significant reform should be the specialization of the Ministry of Health in fewer functions aimed at improving health efficiency. For example, you can focus on data compilation and analysis. It should be staffed with specialist health researchers charged with analyzing changes in epidemiology and trends in morbidity and mortality. In addition, the Ministry of Health should have the power to instruct regional authorities to make systemic and resource changes based on the statistics collected and analyzed. Regional bodies should be mandated to provide health-based statistics to the Ministry of Health on a quarterly basis. The Ministry of Health must maintain general oversight of regional authorities. It should produce annual reports based on self-monitoring and evaluation of the systems, performances and challenges of each region. Financial statements and audits must be submitted annually to the Ministry of Health and the factors responsible for the variation must be justified. Recommendations should be made for improvements and incidences of white collar crimes prosecuted.
A major reform that must be implemented is to grant absolute autonomy to regional health authorities for the provision of health care. They must be able to generate their own funds by charging fees for their services. This would eliminate dependence on the state or the Ministry of Finance for funding. Each regional health authority should be able to invest in the stock market or undertake other income-generating measures that it deems feasible. Its resources must be spent according to the health needs of the population it serves. Regional authorities should be responsible for primary, secondary and tertiary health care. In addition, they must be supervised by private hospitals and healthcare facilities in their geographic regions. Private facilities must be subject to price controls to avoid exorbitant charges and must be required to pay at least ten percent of their annual profit to the regional authority.
In addition, regional authorities must be empowered to ensure that all healthcare institutions and providers comply with national accreditation standards. The Ministry of Health should be responsible for developing national accreditation standards in all aspects of the operations of health institutions. These should include hospitals, pharmacies, private practices. Conventional and alternative medicines must also be subject to accreditation standards. Each and every healthcare institution must be subject to accreditation standards comparable to those of more developed countries such as Canada and the United States.
It is palpable that the boundaries of each regional authority are being redefined so that they have an almost equal population size. At this time South West Regional accounts for just over half a million people. Therefore, due to its limited resources, it cannot be expected to run at the greatest efficiency. Given that the best health facilities are located in urban centers, this would be a challenge that must be carefully overcome. To accommodate this reform, regional authorities should induce joint public and private partnerships in the provision of health centers in rural areas and other districts less accessible to large hospitals and health centers.
To make the health system efficient, a centralized electronic health record system must be developed and implemented. This would ensure that patients could access care in any region. Thus, it would facilitate access to the health records of any health facility owned and administered by any authority.