Public health is a public good
We live in a dangerous world. Transnational public health challenges have become more frequent and fatal. International trade, travel, tourism and migration increase the incidence and virulence of communicable disease. The world, in this last decade of disease, has reeled from the adverse impacts of epidemics:
. H1N1 influenza (swine flu), in 2009, affected 59 million persons in the Americas and may have caused between 150, 000 and 475,000 deaths;
. Chikungunya, since 2013, affected more than two million persons;
. Severe Acute Respiratory Syndrome (SARS), in 2003, affected 8,098 in 26 countries and resulted in 774 deaths;
. Zika, in 2015-2016, is suspected to have affected millions in more than 86 countries; and,
. The COVID19 coronavirus had infected 63,851 persons and caused 1,380 deaths, as at 13th February 2020.
The prevalence of these transnational health challenges has the potential to overwhelm national public health systems of small states.
Guyana, recognising the need to respond to local and transnational public health challenges, refocussed its attention to protecting the population from harm and rebranded the former Ministry of Health as the Ministry of Public Health.
Guyana, the largest state in the Anglophone Caribbean, is bigger than England and Scotland. The country’s landscape of coastlands, grasslands, highlands, islands, wetlands, lakes, rainforests, rivers and waterfalls, intersected by a web of waterways, is complex.
Its extensive and unmanned borders, unmonitored movement of migrants from neighbouring states and international travel carry the risk of the spread of disease over these vast and difficult distances.
The national public health system has an obligation to deliver public health services to citizens regardless of where they reside, on the coastland or in the hinterland.
The ‘hinterland’ – comprising the greater part of the Barima-Waini; Cuyuni-Mazaruni; Potaro-Siparuni and Rupununi and some parts of the East Berbice-Corentyne Regions – occupies over three quarters of the country. Many communities are small and scattered and are accessible only by air; others only by river and still many others only overland through difficult terrain.
The country’s varied geographical landscape and its diverse demographic characteristics and settlement patterns present challenges for the delivery of public services. These challenges are being overcome in ensuring universal access to public health coverage.
Public health services are mandated by the Constitution of the Cooperative Republic of Guyana. The Constitution at [Article 24] states:
Every citizen has the right to free medical attention and also to social care in the case of old age or disability.
Universal access to public health coverage is a right and an entitlement. The United Nations Declaration of Human Rights Universal Declaration of proclaims everyone’s:
…right to a standard of living adequate for the health and well-being of himself [and herself] and of his [or her] family including food, clothing, housing and medical care…
Universal public health coverage is a fundamental principle of the Constitution of the World Health Organization (WHO) which declared that “…the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”
Universal health coverage is a target of Sustainable Development Goals No. 3, to:
Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
Universal public health care coverage, if every citizen is to be guaranteed access to essential public health services without falling into financial distress, requires resources and a system that are accessible, affordable and manned by competent medical professionals, including doctors, nurses and other trained professionals.
Guyana’s public health system operates at three levels: the national, regional and municipal, that is, neighbourhood or community. All three levels are essential to ensuring that every citizen has access to health care.
. The national public health system, under the Ministry of Public Health, and in accordance with the Health Act of 2005, has the responsibility “… to deliver and where necessary oversee the delivery of health care throughout Guyana and to effect plans and policies, monitor quality and evaluate [health] outcomes.”
The Ministry’s mandate includes ensuring citizens’ mental, physical and social health by promoting health services which are accessible, acceptable, affordable and appropriate within its means.
. The regional public health system is responsible for coordinating the work of regional health workers, assisting in the provision of specialist medical personnel, referring patients to tertiary health institutions and managing the region’s soft and hard health infrastructure.
. The neighbourhood health system is the main provider of public health services within communities and the most accessible to the citizen. Centres should guarantee citizens’ access to public health care, especially primary health care.
Health institutions, at all three levels of the public health system, must be adequately resourced to ensure the delivery of essential and quality public health services. Diagnostic centres, hospitals, clinics and health centres should possess sound infrastructure, sufficient equipment and medicines and be manned by competent and committed medical personnel.
The national public health system is being reorganized to ensure that every citizen will have access to universal public health coverage. Citizens should receive service that is accessible, timely and of a high quality.
Our Government has made substantial investments in the public health sector with expenditure moving from 3.19 per cent of nominal GDP in 2014 to 4.10 per cent in 2019 and, for the corresponding period, from 9.6 percent of total public sector expenditure to 11.32 per cent. Investment will be increased during the Decade of Development 2020-2029.
We are now into the second month of the Decade of Development: 2020-2029. The Decade will witness accelerated progress in promoting human development, particularly human health.
Our Government will increase investment in the public health system during the Decade. Public expenditure on health care will achieve or surpass the PAHO-WHO target of 6 per cent of GDP, by the end of the Decade. This will allow for the continued protection of the country’s most valued resource – its citizens.
Our Government will establish a more inclusive public health system over the Decade. Attention will be paid to ensuring access and delivery of quality healthcare to at-risk and vulnerable persons and groups such as women, children, adolescents, the elderly, hinterland communities and the disabled.
Our Government will continue to ensure that primary health care will remain the priority for universal health coverage. Preventive health care will be emphasized with a view to reducing the incidence of non-communicable diseases which now account for more than 70 per cent of all deaths.
The Ministry of Public health will be expected to strengthen its surveillance and treatment of communicable diseases, such as Human immunodeficiency virus (HIV), tuberculosis and malaria as well as transnational health threats.
The national suicide rate is almost three times regional and global averages. Suicide accounts for 13 per cent of all deaths in the country. Guyana hopes by the end of the ‘Decade’ to reduce the incidence of suicide through interventions aimed at strengthening family life and mental health and through the provision of more counselling services.
The achievement of these and other public health objectives will depend on the quality of health personnel within the public health system. Incentives – including living and working conditions – will be provided to and retain highly-skilled medical personnel.
Medical personnel – including doctors, nurses, pharmacists, technologists and therapists – constitute the sinews of any public health system. The quality of healthcare is dependent on the quality of doctors without whom the national public health system would collapse.
Our Government will continue to train doctors so that the country can provide medical treatment and care to everyone, everywhere. No community should be without the services of medical personnel. The service which medical personnel provide should be seen as obligatory, not optional. Everyone is entitled to access to healthcare.
Our Government recognizes the immeasurable contributions which the medical brigades, from the People’s Republic of China and the Republic of Cuba, continue to make to our public health system. Guyana values the contributions of their medical personnel. It is grateful for their untiring efforts at providing care to those who are unwell.
Many doctors work ‘on call’ and it is always desirable if they can reside somewhere where they would be able to respond faster to their “calls”. The Staff Quarters, just a short distance away from the Georgetown Public Hospital Corporation (GPHC), will make it easier for the doctors to respond more quickly to emergencies.
The Ministry of Public Health and the Georgetown Public Hospital Corporation are commended for their collaboration on this project. It is testament to our Government’s commitment to ensuring universal access to public health coverage by ensuring that our doctors are comfortably housed.