–    setbacks are humbling experiences which will propel sector in 2011
Health Minister Dr. Leslie Ramsammy said 2010 had seen a continuation in the sector’s advancement , but he noted that the setbacks with maternal health and malaria were humbling experiences, which will push the sector to do better. “In the last 10 years, overall, we have seen improvements in the health sector,” he said in an interview with the Guyana Chronicle, “The setbacks were significant.”
Ramsammy stated that the target set for malaria cases was 8,000 by 2012, a significant move from an incidence level of 100,000 cases in the 1990s.
By 2003, that number came down to 48,000, and by 2008, it was 11,000 with another decrease to 10,000 in 2009.
“We were well on our way to meeting our targets…8,000 units was attainable,” he said.
However, the Health Minister noted that the incidence of malaria climbed to some 17,000 (most recent count) in 2010.

“To know that we were doing so well, but that it could be reversed, it was a humbling experience…we hope that in 2011 we get close to 10,000 cases and back on track to meeting our targets,” Ramsammy said.
The other setback, which brought the health sector severe criticisms, was the delivery of maternal health care.
The Health Minister pointed out that the 2015 target is to reduce maternal deaths to eight for every 100,000.
In 1990 that number was 32 for every 100,000; and in 2008; it was recorded at 8.9 deaths.
“We had almost reached our 2015 target, in 2008…we had almost 10 years of fewer maternal deaths and we were expected to meet our 2015 target last year, only to find out that we had 18 to 20 deaths for the year,” he said.According to him, this averages 13 deaths per 100,000, a significant jump from 8.9 deaths.
Ramsammy maintained that steps are being taken and mechanisms are in place to return Guyana to the downward spiral in the incidence of maternal deaths.

2011 Moves
The Health Minister made it clear that the successful efforts made over the years to effect a paradigm shift in the health sector will be advanced in 2011 to return to efficiency in areas where this was lacking and generally improve the delivery of quality health care to the Guyanese people.
According to him, the primary areas of focus include:
•    Further reduction of child mortality rates;
•    Elimination, not just reduction, of mother to child transmission of HIV/AIDS;
•    Increased emphasis on physical activity and healthier lifestyles of all Guyanese, whose Body Mass Index should ideally be between 20 and 22;
•    Increased human resources capacity in the health sector, including more personnel in specialist areas; and
•    Improvements in general public awareness of health issues.
Ramsammy stated that by succeeding in these areas, Guyana will have increased its life expectancy rate to 75 years and Guyanese will be able to live long and productive lives.
The Health Minister made it clear that the successes experienced by the sector in the past year will be the foundation on which advances are made in 2011.

Ramsammy stated that developments continue, particularly in the area of training for health workers, since in 2010 a number of programmes continued and others were introduced.
One of the more recently introduced programmes is the Post Graduate Diploma in Emergency Medicine, launched in October.
The new degree is being done in collaboration with the Institute of Health Science Education (IHSE) at the Georgetown Public Hospital Corporation (GPHC) and the University of Guyana (UG).
The Health Minister contends that improving the quality of workers in the system improved the scope of primary health care and guarantees Guyanese their fundamental right to health care.
Ramsammy stressed that such moves have to be accelerated if health workers are to be given the opportunity to take their skills to another level.
“The goal must be to develop the primary health care workers,” he said.
He alluded to the concept of Health for All and stated that Guyana has made moves in this regard, but noted that as the services offered are increasing, so is the need for more and more health workers.
At present, he said, Guyana rates 6.2 health workers for every 1,000 persons.
The Health Minister noted that a major need is for more specialists, if the sector is to move forward.
“We need more people like optometrists, who are important. We have ophthalmologists but we need primary health care service specialists…persons like rehabilitation assistants are also very important,” he said.
Ramsammy explained that for some services to be routinely provided across all 10 regions, there human resource capacity must be there.
Currently, he noted that the sector is making the best of its resources.
He added that there has been some progress, for example, with training general surgeons, but noted that even here there is a demand for special skills, since they need to be supported by anaesthesiologists.

On another note, while there is great focus on training health workers, Ramsammy acknowledged that a handful of workers tarnish the sector’s reputation with inappropriate behaviours and attitudes.
The Health Minister stated that his Ministry has a “zero tolerance” for health workers whose attitudes and behaviours towards patients are not what they are supposed to be and contributes to painting a negative image of the health sector.
More importantly, he stressed that immediate disciplinary action will be taken when such incidents are brought to light.
That said, Ramsammy noted that coupled with training, health workers’ efforts are increasingly enhanced with the improvements made to infrastructure.
One of the major ongoing projects is the new $1.2B in-patient facility at the Georgetown Public Hospital Corporation (GPHC).
The upgrade of the facility is in keeping with GPHC’s master plan and the national development strategy to improve the quality and efficacy of health care services and at the end of the project the facility is expected to house approximately 300 patients.

Medical Supplies and Assistance
The Health Minister stated that there have been improvements in the supply of medical supplies and medical assistance.
The sector’s move to expand and improve the delivery of health care services in Guyana has been successful, and through the Medical Financial Assistance Programme, some $100M was expended in financial support to Guyanese.
“While we have subsidized costs for some services provided here, it is not always a small cost for many people…this is where the government steps in and assistance is provided for people to receive support here, as well as overseas,” he said.
Ramsammy noted that in the past year, over 60 persons have received support, with the majority being heart surgery patients costing some $43M.
The Health Minister ranked heart disease as the number one disease patients need support for, followed by cancer, eye disease and renal failure.
When asked about the procurement of drugs, Ramsammy pointed out that the procumbent process has been criticized, since the majority of supplies came from one company, the New Guyana Pharmaceutical Corporation (GPC).
“The costs were lower when we purchased from GPC…there was a bidding process as the critics called for, and still GPC supplies us,” he said.
According to him, the World Health Organisation (WHO) has defined a list of essential medicines which should be made available; and in Guyana’s case, there are over 500 medicines on that essential drug list.
“These medicines address things like hypertension, diabetes and heart disease,” he said.
However, Ramsammy pointed out that there are new drugs being introduced on the markets to address, not the disease, but the factors that pre-dispose an individual to the disease.
“The problem is that it is expensive,” he said.
The Health Minister stated that if Guyana were to procure such medicines, for example, to support between 12,000 and 14,000 persons who are diabetic and hypertensive, the cost would be some $1B.
Ramsammy added that the support in 2010 from various partners has been significant and without it the sector would be set back as much as a decade.

However, even with support from partners and massive investments by the government, Ramsammy says health cannot be a success in Guyana without the participation of the Guyanese people.
Citing once more diabetes and hypertenson cases, the Health Minister made it clear that these chronic non-communicable diseases are largely lifestyle problems, which can be reversed with healthier practices – hence the increased focus started  in 2010 on increasing physical activity.
Ramsammy and his ministry advocate five simple steps for healthier lives: eat healthy, control portions, be active, check health and be happy.
A staggering two of three deaths occurring among persons younger than 70 result from a chronic disease.
Chronic non-communicable diseases today account for about 60 percent of morbidity and mortality in the Caribbean, producing major suffering and costs for individuals, families, governments, and businesses. Chronic diseases have a disproportionate impact on the poor, further exacerbating health inequities.
The Health Minister pointed out that in Barbados, chronic non-communicable diseases account for over 80 per cent of deaths; in Trinidad and Tobago it is over 75 per cent; and in Guyana it is 71 per cent.
“We have about 6,000 deaths each year and chronic non-communicable diseases is the top cause of deaths, followed by things like suicide and accidents,” Ramsammy said.
He added that Guyana has also advanced the call for the Millennium Development Goals Plus (MDG Plus), a call to have chronic non-communicable diseases included in the MDGS.
Ramsammy said these efforts have yielded some success and pointed out that in September this year, there will be a global summit at the United Nations to address the issue of chronic non-communicable diseases.
He made it clear that reducing the risks of chronic non-communicable diseases will reduce the increasing financial demands and impact positively on Guyana’s development.
“We can’t prevent it, but we can take control,” Ramsammy posited.

Infectious Diseases
He noted that the current infectious diseases death rate of 6,000 is a significant reduction from a rate of between 8,000 and 17,000.
Partly responsible for this reduction, Ramsammy explained, is the success Guyana has had in dealing with infectious diseases.
According to him infectious diseases accounted for between 40 and 50 per cent of deaths, a number which has come down to only 10 per cent.
“The reduction of infectious diseases, which contributed to the deaths we had, reflects the improvements in the health sector,” he said.
Ramsammy noted that with tuberculosis, in particular, there has been a decline in the incidence.
Head of the Infectious Disease Ward (IDW), Dr. Sudheer Kumar, said over the last decade, the average number of deaths has been reduced and maintained that the ward was making progress.
He stated that on average, the number of deaths per month at the IDW was between 20 and 50; and currently that has dropped to between three and four.
The Health Minister said that Guyana’s robust vaccination programme has also contributed to this success.
Soon to be added to the list of approximately 15 vaccines provided in the health sector is the Human Papillomavirus (HPV) vaccine. The vaccine is expected to be introduced this year to support some 25,000 girls between nine and 11.
Studies have shown that the human papilloma virus is the causative agent for more than 85 per cent of cervical cancer and Guyana has a cervical cancer incidence rate of about 45 per 100,000 women.
Ramsammy added that currently, the provision of services by the health sector is guided by set guidelines.
In November, the Health Ministry made public its Standard Treatment Guide (STG) for primary health care.
The STG outlines the procedures to address approximately 60 diseases, including the prescription of medications and covers the provision of essential supplies, such as Oral Rehydration Solutions (ORS), which, if not available, represents a breakdown of management; and laboratory support, for example, the need for pregnancy tests. Every woman of reproductive age should be able to access laboratory services to have a pregnancy test done, according to Ramsammy, and support to test blood glucose, among others.
Other frameworks to improve the delivery of the sector’s services include the legislative successes of 2010.
In the past year, the Health Minister piloted two bills, now Acts, in the National Assembly: the Allied Health Professionals Act and the Disability Act.

Accreditation
The Health Minister stated that many Guyanese are skeptical when it comes to the quality of laboratory services provided locally.
However, he noted that this perception is changing with the successes made in accrediting local facilities, both public and private.
“What we want to ensure is that there is a high quality service provided, which is reliable,” Ramsammy said.
According to him, Guyanese must be confident about the results they receive.
“It is confidence which will empower them,” he said.
The Health Minister explained that in Guyana, there is a culture where, primarily in the private institutions, patients are asked to re-take certain tests if they go to different health care delivery institutions.
“This should not be…when people go to a doctor with their results they will be able to say that the results are from an accredited lab and have the power to question the need to take whatever test a second time,” he said.
To date, Ramsammy stated that significant moves have been made in the areas of accreditation, a process which will continue to ensure consistence in quality.
He pointed out that the laboratories are required to do a number of things: be registered; be licensed and subjected to “rigid inspections” to be re-licensed; acquire certification by the Bureau of Standards, which introduced a new standard last year that brings local facilities nearer to international standards; and proficiency testing.
The Health Minister added that proof to show compliance with these requirements must be displayed to the public being served.

Ramsammy acknowledged that there is much more to do and maintained that the sector’s trajectory is in line with further enhancement for the sector.
“Yes, we will get setbacks, but we are working to ensure that these do not lead to death…Guyanese can expect more and better from the health sector in 2011,” he said.
The Health Minister added that partly responsible for the sector stakeholders’ motivation to keep moving forward is the fact that Guyanese are increasingly believing that more is possible.
“The demand is increasing…Guyanese faith in the system is increasing…we will deliver more and better in 2011,” Ramsammy said.