BRADES – Will Montserrat be getting a new hospital or a refurbished one? The Honourable Minister of Health Mrs Delmaude Ryan is expected to give an update on the Montserrat Hospital and Health Improvement Project in Friday’s sitting of the Legislative Assembly.
Although since taking office, Minister Ryan has spoken about the project which had been approved by the Department of International Development (DfID) since 2012, there has been different versions of it’s status which has resulted in public confusion on the matter.
In several sittings of the Legislative Assembly and radio interviews including one with mnialive.com back in December 2015, the minister has been speaking about the Montserrat Hospital and Health Improvement Project which according to reports had been halted.
Minister Ryan explained that only the infrastructural portion of the EC$33,000,000 was put on hold. The non-infrastructural portion which included elderly care, Non-Communicable Diseases (NCDs), emergency response and the acquisition of new health equipment is still in the works.
The health minister said “a six to nine month work plan has been developed to continue work on the non-infrastructure aspects of the previous project, which covers areas of emergency care, elderly care, NCD prevention, a functional review and health financing while the new business case is being developed for approval by DFID.”
According to the latest DfID Review of the project “There have been substantial delays and progress is now well behind the original planned timetable. The major reason for this is the preliminary decision to change the construction of the new hospital from a renovation/remodelling option, to a new-build adjacent to the existing site. There have been substantial delays in procurement. This includes equipment, technical assistance/consultancy studies, and in implementation of individual outputs on the ground. There has been some good progress on care of the elderly, primary prevention of obesity, working with primary school children, and early progress on care of diabetics. Once the construction work has been formally approved and re-designed, there will need to be a concerted effort from all stakeholders, in GoM, MoHSS and DFID OTD, to expedite the programme and ensure its success.”
DfID gave the project a C in its second review at the end of 2014. “As the construction and equipping of the new hospital form 50% of the project, and these have been substantially delayed, it is inevitable that the project scores a C. However some good work has been completed and there is evidence that the pace of the non-construction parts of the programme has slightly improved since the last review. Under normal DFID regulations, the project should now be placed under a Project Improvement Plan (PIP) but this may not be helpful because a PIP normally lasts for six months and would place considerable strain on the management capacity of GoM, which is already heavily stretched. Instead, a new business case (BC) should be developed, to take account of the proposals for a new-build hospital, and the existing BC should be permitted to continue, until the new BC is negotiated and approved. At that stage, the existing BC should be closed.”
The new government along with the Ministry of Health and Social Services feel strongly, the report notes, that the new hospital should not be smaller than the existing facilities, but this will require considerable work and political will to make the necessary changes in health care financing.
The minister of health pointed out in a recent Legislative Assembly meeting that “the DFID Health Advisor, suggested in his draft report that a 25 bed hospital might be most appropriate. However, it is this Government’s position that the new hospital should make provision for addressing the current and future health care needs of Montserrat. And secondly, the hospital must be financially sustainable, therefore we have asked that the hospital have no less beds than the current and that the design that was recently submitted be scaled to take these into account. Amendments to the design has been made and the technical team is currently analyzing the design drawings to determine if these were done in line with our request.”
A hesitation by the new government to implement health care finance reform which will remove some of the exemptions in the current system was one of the points the review noted needed to be dealt with as a matter of urgency. The current administration feels the population cannot handle new or increased health fees due to the current economic situation.
This is one area that Minister Ryan will need to give clarity to as DfID is of the view that a larger hospital would have increased recurrent expenditure and needs an established system to recover those costs from clients.