Hon. Perry Gomez
Minister of Health
Budget Debate Contribution 2015/16
June 10th, 2015
Mr. Speaker,
I wish to begin by thanking our Heavenly Father for the great privilege and opportunity to represent the wonderful People of North Andros and the Berry Islands, in this Honourable House. As the Minister of Health with responsibility for the Department of Public Health inclusive of the Community Clinics throughout The Bahamas and the Public Hospitals Authority inclusive of the Prince Margaret Hospital, the Sandilands Rehabilitation Centre; the Grand Bahama Health Services National Emergency Medical Services; Bahamas National Drug Agency, the Materials Management Directorate and National Health Insurance, it is a privilege to make this contribution to the 2015/2016 Budget debate. My Ministry’s mandate speaks to ensuring equity in access to quality healthcare, promoting wellness, and addressing the social determinants of health as we build a better and stronger Bahamas.
The Ministry of Health
Mr. Speaker, I am pleased to confirm that the Ministry of Health is well poised to do its part in the government’s plan to bring positive changes in the nation’s development as we make real advances into the 21st Century. Our healthcare resources are being realigned to achieve the best results in the interest of our population in ensuring that healthcare services are more accessible, affordable and equitable at the point of service.
This year the sum of $274,093,702.00 will be appropriated to the public health sector, with $260 million to be shared with the implementation of National Health Insurance (NHI) among the Public Hospitals Authority (PHA) and the Department of Public Health (DPH) as follows: NHI – $24 million; PHA – $202,297,597.00; and DPH – $34, 023, 363.00 while $13,772,742.00 will be appropriated to the Ministry of Health.
Mr. Speaker, this is an exciting period for The Bahamas and particularly all of us in the delivery of healthcare services to contribute to the relief of pain and suffering among the most vulnerable members of the population. My Ministry is ensuring that Public Health and safety in The Bahamas are protected by continual improvements in surveillance and constant vigilance across the country and particularly at our borders.
Stem Cell Industry
Mr. Speaker, I am pleased to report that the work in this area is on-going, we are beginning to consolidate our activities and we are beginning to see signs of progress in this vital industry. I am also pleased to report that the government has approved the establishment of a local Team of Specialists led by the Minister of Health to negotiate a Memorandum of Understanding with the University of Miami Hospital.
Nursing
Generic Bachelor of Science in Nursing Programme
Mr. Speaker, the nursing profession continues to be the major group of health care providers. In this regard, my Ministry provides scholarships to qualified students studying nursing at the College of The Bahamas. This fiscal year, budgetary provisions have been made to accommodate thirty-five (35) new scholarships for nursing students in the Bachelor of Science in Nursing Program. Additionally, Mr. Speaker, funding has also been set aside to reinstate fourteen (14) students and continue the sponsorship of one hundred and forty (140) nursing students.
Nursing Internship Programme
Under the Nursing Internship programme, Mr. Speaker, students completing the last two Clinical Internships at The College of The Bahamas, receive a salary of $10,200.00 per annum. Sixty-four (64) students are scheduled to participate in this programme. They will sit the Nursing Council’s Final examination for Registration in December, 2015.
Nursing Cadet Programme
The Nursing Cadet Programme continues to be the main recruitment strategy for the nursing profession in The Bahamas. The programme continues to attract senior high school students. Provisions have been made to accommodate one hundred and fifty (150) students, twenty seven (27) school facilitators and ten (10) clinical facilitators in this programme.
National Allied Health Cadet Programme
Mr. Speaker, the National Allied Health Cadet Programme is a fast growing programme. We have made provisions for fifty (50) students and eight (8) facilitators to be accommodated in this programme.
Midwifery Diploma Programme
The programme commenced in January 2015 with an enrollment of twenty-three (23). Ten participants from the Department of Public Health were chosen and it will culminate in June 2016.
Trained Clinical Nurse Certificate Programme
Commencing in January 2015, with an enrollment of forty-six (46) students, Mr. Speaker, the Trained Clinical Nurse Certificate Programme includes thirty-four (34) students from the community being sponsored by the Ministry of Health. The programme will culminate in June 2016.
Bachelor of Pharmacy Programme
Mr. Speaker, six (6) students, sponsored by the Ministry of Health commenced the fourth and final year of the Bachelor of Pharmacy programme. Upon completion, they will be required to complete an Internship of two thousand hours.
HIV/AIDS
Mr. Speaker, the National HIV/AIDS Centre continues to function at a high level, of which we are proud of in the Ministry of Health. I am pleased to report that the Ministry and the National HIV/AIDS Programme hosted the official country visit of the Assistant General to the United Nations, Dr. Luiz Loures, and the Deputy Director, UNAIDS, 2014.
Mr. Speaker, there were no stock outs of lifesaving anti-retroviral medication which is available to patients in New Providence and every Family Island through the government mailing system. Further, a review of the current guidelines for prescription of antiretroviral medication is underway with a view towards scaling up antiretroviral therapy coverage. These initiatives will improve the health of people living with HIV and potentially reduce HIV transmission and the cost associated with this medication is likely to increase.
Establishment of the Cancer Registry
Mr. Speaker, well over thirty (30) years ago, during the Fifth Meeting of the Conference of Ministers responsible for Health, held in Antigua, July, 1979, member countries were encouraged to introduce Cancer Registries, so as to access the size and nature of Cancer in their country. Following many years of consultancies and staff training opportunities, a functioning yet partially staffed hospital-based Cancer Registry was established in The Bahamas in 1998. This however does not meet the national need.
Despite the efforts of dedicated and competent healthcare professionals cancer has become one of the leading causes of death in The Commonwealth of The Bahamas. The Bahamas has been identified as having the highest rate of BRCA mutation in a cohort of Breast Cancer patients. Our diaspora would lend itself to the belief that this may be the case for other cancers such as prostate, gastric and pancreatic.
Mr. Speaker, to aid the Ministry in achieving its goal of improved health status and quality of life, I am pleased to advise that the government led by our Prime Minister and Minister of Finance, the Rt. Hon. Perry G. Christie, recently approved the establishment of a population based National Cancer Registry, in the Ministry of Health, which will help to ascertain those factors, which will lead to a determination of the epidemiological profile of cancer in the country.
The development of a National Cancer Registry will support efforts to define suitable interventions, which will ultimately lead to the reduction in the incidence/prevalence and levels of mortality and morbidity due to cancer; as well as create a national system to determine and monitor factors affecting incidence, prevalence, morbidity and mortality especially those of gender, occupation and environment in The Bahamas as we build a better and stronger Bahamas.
Mr. Speaker, the National Cancer Registry will be staffed with four (4) persons initially including a part-time Director and a full-time Registry Manager. I propose therefore, in the near future, to bring before this Honourable House a Bill for an Act to establish a Cancer Registry.
Department of Public Health
Mr. Speaker, I now wish to turn my attention to the Department of Public Health which is the agency, in my Ministry, with the responsibility for the delivery of primary health care in The Bahamas.
Mr. Speaker, my Ministry has been aggressively recruiting doctors to fill vacant posts in Cat Island, San Salvador, Berry Islands, Kemps Bay Andros, Bimini, North Eleuthera, Abaco and to strengthen the physician complement in New Providence as well. In the past few weeks, four new doctors have arrived and they are now being posted. Further, we are processing the appointment of another seven doctors and two dentists for Family Island posting in North Andros and North Eleuthera. Thus, effective the 1st July, 2015, every Family Island will have a resident Doctor and I believe that this is the first time that such a feat has been achieved in The Bahamas as we build a better and stronger Bahamas. Additionally, Mr. Speaker, we are reviewing application forms for Laboratory Technologists, Radiographers, Ultra Sound Technicians, Health Educators, a Nutritionist, Pharmacists and Pharmacy Technicians as well as other categories of workers; and this process will be completed before or by August 2015.
Mr. Speaker, among the many remits of the Ministry of Health, is the responsibility for the tracking of parameters and indicators that measure the public’s heath. Through a series of initiatives, programmes and strategies, the Ministry, supported by the Department of Public Health collects, analyses and reports information on various aspects of healthcare to paint and generate a picture of the health status of The Bahamas.
During the 2015/2016 fiscal period, Mr. Speaker, the monitoring and management of national population health programmes will be redesigned to ensure national coverage and ensure that the entire Bahamian health sector is made aware of our work toward the outcomes of better health access and management for all toward the provision of universal health coverage and universal access to care.
It is important to note here, Mr. Speaker, that the combined process of collecting both new and using existing data will help my Government document the improvements and advancements in the health status of the Bahamian people as we introduce a national health insurance toward providing universal health coverage for our people. The provision of universal health coverage, like the introduction of National Health Insurance will be through an involved phased process which will auger well for not only The Bahamas’ reputation on the global scene but the health and wealth of our nation.
Mr. Speaker, the Ministry of Health, in discharging its functions under Communicable Disease Surveillance, tracks activities among and provides services to the Bahamian population through – Tuberculosis Surveillance, Food Handlers Services, Prison Health Services, Port Health and International Health Regulations, Disaster Management, Sexually Transmitted infections Surveillance, Employee Health & Risk Management and General Surveillance.
Mr. Speaker, focusing on general disease surveillance, especially the current level of activity, we are seeing what has not been seen in recent years, which has given my Ministry a reason to pause to determine how to best strategically address the underlying challenges that arise with every threat we are being faced with. These hardworking staff of our Disease Surveillance Unit is responsible for the monitoring of all communicable diseases in the country and in the world, and advising healthcare workers and the general public about the precautions and preventative measures to mitigate against the contracting and spread of these illnesses.
Mr. Speaker, you would recall that in late October 2014, we were faced with the global threat of Ebola although the Ebola virus disease was discovered in West Africa in March. As a result of the threat of the outbreak of Ebola virus Disease, my Ministry convened a series of meetings with key stakeholders inclusive of government Ministries and Agencies, the Private Health Care providers, the Public Hospital Authority and PAHO to review plans and strategies to prevent the Ebola Virus Disease from entering our shores. This activity was further supported by the Office of the Prime Minister with the appointment of a national task force and the Ebola Coordinator.
Mr. Speaker, in years past attention has been focused primarily on the number of documented and undocumented visitors to our shores. This past year, our Disease Surveillance Unit has developed a need for the Unit to have an in-depth look at the persons who work on cruise lines that also frequent our shores in continuing its efforts to protect our shores from the import of communicable diseases.
Mr. Speaker, we will continue to work with the Ministry of the Environment and Department of Environmental Health Services to address the reduction of mosquitoes and their breeding sites. Just this month, Mr. Speaker, my Ministry was provided with an Epi Alert from the PAHO that spoke to the threat of a third viral illness transmitted through the Aedesaegypti mosquito.
This virus – the Zika Virus, Mr. Speaker, has found its way to Brazil in our hemisphere, being diagnosed in nine cases there. The Aedesaegypti mosquito may sound familiar to you, Mr. Speaker, because it is the same mosquito that transmits Dengue and Chikungunya. It must be recognized that the Surveillance Unit at the Department of Public Health, with a staff of six persons are doing a yeoman’s job in communicable disease surveillance and education among the healthcare workers in The Bahamas – in both the private and public sectors. During the next fiscal year, we will continue to support the necessary activities and workshops to assure the continued safety and integrity of our borders. We will also continue to travel throughout the archipelago to investigate possible outbreaks or disease occurrences while also providing training for our dispersed health worker staff.
Mr. Speaker, given the uncertainty of the threat of the Ebola virus disease; Dengue; Chikungunya; TB and other communicable diseases, it is essential for the Ministry of Finance to give my Ministry the flexible to redeployed at least five percent of the Department’s Budget to address any emergency when it arises to enhance our preparedness and response time.
Mr. Speaker, I am pleased to report that we have held meetings with the International Atomic Energy Agency (IAEA) to prepare mitigation documents for radiations disasters as well as strategies to enhance the detection and management of sources of radiation within our borders. Mr. Speaker, we have also participated in PAHO-led symposia to design the framework for emergency response to disasters caused by chemical spills. During the next fiscal year, my Ministry will continue to increase the opportunities and incidences of trainings of health care workers in the mitigation and management steps for these types of disasters, working to strengthen preparedness plans for our facilities as we build a better and stronger Bahamas.
Mr. Speaker, as communicated last year, and mandated by legislation, Food Handler’s certification is required by all persons who prepare, store and serve food to the general public. Food Handler certificates are also required for all workers in take away establishments, restaurants, supermarket delis (delicatessens), gourmet and native restaurants, hotel restaurants. Notice, Mr. Speaker, I said workers and not only cooks, as persons in these establishments all handle food to some extent, when there are staff shortages or as matter of their regular duties – though they may be listed as dishwasher or janitor in their job descriptions.
However, Mr. Speaker, though it seems not to be widely known, I must stress further that food handlers certificates are also required by law for persons who cook or work at as well as for persons who work at cook-outs, bake sales, street vendors, and who prepare food for catered events to protect public health. This is not a new requirement, Mr. Speaker, but it must be emphasized. Too often there are persons providing foods to restaurants, to bake sales at school, and catering paid events from their personal kitchens and mobile food vans, who neither possess a valid food handler’s certificate nor realize that by law they should have one. Food Handler Certification sessions are held by the Department of Public Health twice daily, five days a week, except on holidays, on Meeting Street opposite St. John’s Baptist Church. Additionally, training is held in all Family Islands to ensure that we reduce the incidence and prevalent food borne illness and out breaks.
Mr. Speaker, the next major area of concern in population health matters is that of chronic non-communicable diseases or CNCDs. This area of management and tracking is composed of core CNCDs, vision & eye health, nutrition and hospital liaison. The CNCD team continues to work hard to find ways to improve the way that the management of CNCDs and the complications associated with CNCDs.
Mr. Speaker, the CNCD lends significant support to the areas of monitoring our countries response to hypertension, diabetes, asthma, and is in the process of developing tools to monitor rates and experience with cancer, tobacco use and regulation, and the monitoring of alcohol consumption and dietary salt intake. Also during the first half of this budget year, my Ministry has streamlined the duties of three related services – namely the Nutrition Programme, the CNCD programme and the Healthy Lifestyles Secretariat. It is anticipated that during this year, these programmes will increase their visibility and interaction with the wider public, especially the private sector as information and metrics are gathered to assist with the characterization of the health status in the country, and to measure how this improves with the introduction of the national health insurance.
Mr. Speaker, other items on the agenda for development and ratification this year are a national food and nutrition policy with action plan, a national chronic non communicable diseases (CNCD) strategic plan and a strategic plan to reduce obesity and increase the level of health among our adolescents.
The Vision and Eye Project initiative, Mr. Speaker, led by ophthalmic-trained nurses has done a great job in increasing the awareness of eye health in the Department and in the wider community. It is a popular saying that the eyes are the window to the world, and my Government is committed to executing the steps outlined in the global Vision 20/20 initiative to reduce the incidence of preventable blindness in our population.
Mr. Speaker, this past year, a further 100 health care workers were trained in the delivery of eye health through conducting visual acuity evaluations. In addition, the team has successfully completed two benchmark eye health services assessment reports. The Ministry has acquired equipment that will facilitate the probability of advanced eye health screening services, especially among diabetics, and it is anticipated that this will enhance the service scope available to the general public, across the archipelago.
The Ministry recommits to the proposal of ensuring that each of our hypertensive and diabetic patients who are on the national CNCD register receive a slit lamp examination at least every two to three years. Also, Mr. Speaker, during a recent retina screening exercise performed in the community by the private sector, preliminary assessment of the results indicate a greater undiagnosed problem with glaucoma or increased eye pressure than earlier thought. My Ministry is committed to introducing systems to ensure that the necessary attention is given to the prevention, early diagnoses and management of this vexing condition that silently steals the vision.
Mr. Speaker, I spoke earlier about the eye health aspect of CNCDs. Let me now talk about the kidney health aspect. My Ministry has committed to do more about the kidney health of our population. In a first step in this direction, a Kidney Health Initiative will be mobilized though the creation of community renal health services, led by a cadre of renal nurses deployed to the community.
Mr. Speaker, the team of specially-trained Renal Nurses will be tasked with ensuring that each of those individuals are identified and the appropriate tests undertaken to document the state of their kidney health, and determine with the help of these renal specialist doctors the best way to rehabilitate their kidneys or at least slow down the decline to further kidney damage and end-stage renal disease. Those with end-stage renal disease require dialysis, Mr. Speaker. We are spending too much money on dialysis treatment, and too many lives are being lost and quality life reduced due to this tragic condition – which can for the most part be prevented.
Mr. Speaker, the final area of Programmes overseen by my Ministry is that of Maternal and Child Health. Traditionally tied to the maternal and infant mortality rates management, this area’s components include core MCH services such as child health services, antenatal services, family planning, postnatal services as well as the Male Health Initiative, Suspected Child Abuse and Neglect Unit, School Health Services and Adolescent Health.
Mr. Speaker, we have introduced a new vaccine – the Human Papilloma Virus vaccine to our children aged 8-11 years. This vaccine has been introduced to reduce the likelihood of our girls later in life developing cervical cancer, a significant cause of morbidity and premature mortality among our females. Additionally, the MCH Unit has collaborated with the Ministry of Social Services and Community Development on the health component of the Conditional Cash Transfer Programme.
Ground and Air Transportation Services
Mr. Speaker, on assuming office in May 2012, 85% of service delivery vehicles in New Providence and the Family Islands were condemned. During the 2013/2014 and the 2014/2015 budget year, we have purchased new vehicles for services in New Providence, Mayaguana, Acklins, North and South Long Island, North, Central, and South Andros including Mangrove Cay and Kemps Bay, Bimini, Exuma and Abaco, and it is expected that before the end of September, ground transportation for service delivery areas in New Providence and the Family Islands; including ambulances will be purchased.
Mr. Speaker, on an annual basis over 400 patients are referred to hospital for specialists review or admission, with 50% of these patients requiring emergency air transportation. We are indeed grateful to air ambulance services and other charter companies, for their dedication and support in the delivery of emergency medical services. Toward this end my Ministry will enter into formal contractual agreements to ensure that patients with level one injury and illnesses are transported in the appropriate air carrier with the appropriate skilled personnel to hospital.
Repair and Maintenance of Health Care Facilities
Mr. Speaker, of the ninety eight health care facilities under the management of the Department of Public Health, over 60% are in need of repair or expansion or reconfiguration of works spaces to improve efficiency. While the Ministry of Works has been a tremendous help, the magnitude of work requires that the Department of Public Health engage the services of two experienced individuals to serve as Estates Officers in order to cope with the increasing need for repairs and renovations.
Mr. Speaker, beginning this week contracts will be signed for repair of a facility to provide for the first time a proper health care facility for the residents of Adelaide community. Contracts will also be signed for repairs to nurses’ residences in Kemps Bay South Andros and San Salvador, and bids have been received for Black Point Clinic, as well as clinics in Deadman’s Cay, Clarence Town and Roses Long Island. Plans are under way and contracts will be issued shortly for repairs of clinic facilities in all health districts in Cat Island. Further, scopes of works are being prepared for invitation to tender for repairs to health facilities in Central and North Andros. Work on the clinic in Mangrove Cay Andros is near completion.
Mr. Speaker, we have relocated clinic facilities in Farmers Cay and are in the process of relocating the clinic in Staniel Cay Exuma to ensure that residents receive care in proper facilities given the number of serious injuries occurring in the community…
In addition to repairs of our clinic facilities, Mr. Speaker, assessments of existing x-ray facilities in Bimini, and North Eleuthera are taking place and will continue for other Islands to have them up and running by September 2015; with the capability for electronic reading of x-rays taken in these Islands in, a matter of minutes, thus reducing unnecessary referral to hospital.
Further, Mr. Speaker, we have already developed a list of essential and critical diagnostic equipment for all main health care facilities. Some of these items have already been purchased and the remainder will be purchased by July 2015. We have recruited additional Biomedical Technicians to provide for preventative maintenance of equipment and cross training of staff in the Family Islands to maintain small equipment and resulting in reduced down time. As we speaker, we are already sending biomedical technicians into the family islands with good success and staff satisfaction.
Improving Access to Primary Health Care Services
Mr. Speaker, beginning July 2015, Elizabeth Estates and Fleming Streets Clinics will open for service from 8am to 9pm, while health care services at South Beach and Flamingo Gardens Clinics will be extended to 12 midnight as we seek to enhance the delivery of health care to our citizens.
Mr. Speaker the recruitment of additional Doctors, Nurses, Clerical and Administrative Staff, Laboratory Technologist, Technicians, Radiographers and Pharmacists will ensure that these services will be available as long as the clinics are opened. By the end of the year, Mr. Speaker, the South Beach Health Centre will be open on weekends and based on service needs other community clinics will be opened on weekends as well as part of our Quick Wins initiative.
In regards to the family islands, Mr. Speaker, improved access to services at the Marsh Harbour Clinic is occurring with the posting of an additional doctor and reported satisfaction by our patients. This initiative will occur with the opening of the new facility in George Town Exuma in the next few months, and every major Family Island with adequate nursing manpower and security support.
Mr. Speaker, in continuing with our efforts improve the delivery of healthcare to our citizens additional telephone lines will be installed in our four major clinics namely Flamingo Gardens, Elizabeth Estates, Fleming Street and South Beach, to facilitate the implementation of an appointment based system to eliminate persons coming to the clinic in the wee- hours of the morning. In fact the line at Elizabeth Estates Clinic is already installed and others will be completed shortly.
Improving Home Care Services
Mr. Speaker, home care services by nursing personnel to various at risk clients and persons home bound who are unable to visit our clinics have always been a part of our services. In the past year, physicians from our polyclinics commenced home visits to selected clients who are referred by the district nurses. With this new initiative under the Discharge Planning strategy, a team comprising a physician, community health nurse or nurse practitioner, community worker, pharmacist and social worker, will provide dedicated and sustained home care services to at risk infants, children, the disabled, elderly and other families with social, mental health and other chronic disease issues. The goal is to improve their health and well-being and prevent the need for hospitalization as we build a better and stronger Bahamas.
Community Participation in Health
Mr. Speaker, the involvement to the community in the planning, development, implementation, monitoring and evaluation of health care services in New Providence and the Family Islands will play a key role in health services delivery. There is a wealth of knowledge and skills among our residents and their involvement will ensure that the services provided are based on the needs of the population. By end of June 2015, strategies to assess the health care needs of the community will begin and by September, local health committees in each major health districts in New Providence will be established in September and by December in all major Family Island Districts.
Vital Health Statistics
Mr. Speaker, I turn to our Vital Health Statistics. A review of Vital Health Statistics for the year 2011 revealed that:
For infants and children under the age of one (1) year, the leading causes of death were due to respiratory diseases related to the perinatal period, congenital malformation, hemorrhagic and other blood disorders, Cardiovascular disorders, originating in the perinatal period (just 28 days of life) and bacterial sepsis.
For the age group 1-4 years Mr. Speaker, the leading causes of death were influenza, tuberculosis, HIV disease, conditions of the perinatal period, diabetes, hypertensive diseases, land transportation or road traffic accidents, accidental drowning and other undetermined causes.
As we look at school age children age 5-14 years, the statistics revealed that leading causes of death were accidental drowning, influenza and pneumonia, land transport accidents and assault due to homicide.
The cause of death among our 25-44 years old Mr. Speaker revealed that, assault due to homicide, HIV disease, land or road traffic accidents, malignant neoplasm of the breast, hypertension and diseases the heart, cerebrovascular diseases or strokes and undetermined causes were the main causes of death.
Mr. Speaker, as we further look at the causes of death among persons 25-45 years we began to see that cirrhosis and other disease of the liver, malignant neoplasma of the colon, rectum and anus, malignant neoplasm of the trachea, bronchitis and lungs, diabetes as well dementia and alzheimer diseases among the elderly population were leading causes. These causes Mr. Speaker are significant among both sex.
When we look more closely at the data for age group by sex Mr. Speaker, we see that the leading causes of death for males ages 25-44 years were assault; HIV disease; land transport accidents; cardiomyopathy. And when we look at male 45-65 years and older, the data revealed that ischemic heart diseases, HIV disease, hypertensive disease, cerebrovascular diseases and diabetes were main causes.
Mr. Speaker, note is also taken of the leading cause of death for females 25-44 years which were HIV diseases (which ranked higher for women than males in this age group), malignant neoplasma of the breast, assault or homicide, hypertensive diseases, influenza and pneumonia, cerebrovascular diseases and cardiac arrest. When we look at the causes of death for women 45 years and older, malignant neoplasma of the breast, ischemic heart diseases, HIV/AIDS, hypertensive diseases, cerebrovascular diseases, diabetes and dementia or alzheimers disease were main causes.
Mr. Speaker, while there has been a slight increase in the life expectancy of men from 69.9% in 1999-2001 to 70.6% in 2009-2011 based on our census. We can project that when the report from the next census is disseminated the life expectancy for men will be much lower.
The census data for 2009- 2011 showed just a slight increase in the life expectancy of females from 76.4 in 1999-2001 to 76.8 in 2009-2011. Again Mr. Speaker, we can expect a decrease in the life expectancy as well as the quality of life for males and females when the next census report is completed.
Mr. Speaker, these statistics also leads me to address another priority area of focus in my Ministry – Maternal and Child Health Services.
Mr. Speaker, preliminary data for the year 2013, revealed that our infant mortality rate was 22.7 per 1,000 live births up from 16.2 in 2011 while for the year 2014, preliminary data are indicating an infant mortality rate around of 19 per 1,000 live births which is not acceptable. Considerable efforts will be taken to ensure that we begin to experience a downward trend in this area going forward.
According to PAHO Basic Indicators, Mr. Speaker, Jamaica’s infant mortality rate stood at 19.5 per 1000 live births in 2011 compared to Barbados which recorded 18.1 in 2011 and 10.7 in 2012 per 1000 live births showing a decline. In the case of Cuba, Mr. Speaker, her infant mortality stood at 4.9 per 1000 live births in 2011 and 4.6 per 1000 live births in 2012 representing a slight decline. I am advised that for 2013 Cuba’s infant mortality rate is around 3.0 per 1000 live births. This is a tremendous achievement for state with considerably less resources than The Bahamas and I commend them.
Immunization Programme
Mr. Speaker, the World Health Organization requires member states to ensure that infants under the age of 1 year old receive the recommended immunization and that Ministries should ensure coverage of 90% or over to prevent any disease out breaks in the country. I am pleased to report that in 2014, Mr. Speaker, the immunization coverage for Diphtheria, Pertussis, Tetanus, (DPT); Hemophilus Influenza (B) Prevnar 13-(Pneumococcal – conjugate) and Polio coverage was 96%; Measles, Mumps and Rubella and Varicella vaccine coverage was 92% and Tetanus toxoid coverage among pregnant women was 99%.
Mr. Speaker, our statistics for 2011 showed that pneumonia was leading cause of death among children. In 2012, my Ministry introduced the pneumococcal, vaccine into our immunization schedule and our statistics are showing a decline in the admission to hospital for pneumococcal infections and we are monitoring the data for a decline in the number of chicken pox cases since the introduction of the Chicken Pox Vaccine in 2012.
Mr. Speaker, recognizing the need to provide security, safety and quality control of the National vaccine supply, my Ministry began construction of the National Immunization cold room in July 2013 which is slated for completion in September, 2015. Nonetheless, I am pleased to state that my Ministry purchased the HPV Qudravalent vaccine in April 2015, which will assist in preventing cancer of the cervix and genital warts among females and males. Vaccines are administered to both males and females ages 9 -12 years of age.
Public Hospitals Authority
Mr. Speaker, the Public Hospitals Authority has been working tirelessly to improve and maintain the health of all Bahamians. At the start of the fiscal year, the PHA continued its initiatives for improving and strengthening the management and delivery of services under its span of responsibility. The Board, management and staff of the PHA are to be commended for their ongoing efforts to achieve greater effectiveness and efficiency in the delivery of services in its hospitals, clinics, medical and support agencies.
The proposed new budget of the PHA for the 2015/2016 fiscal year is in line with the current year’s budget $202,297,597.00. Mr. Speaker, with respect to Personal Emoluments, it should be noted that expenditure on Overtime exceeded the approved allocation, with nursing coverage continuing to be the biggest challenge due primarily to the shortages of specialized nurses in the hospitals. However, we are pleased to report that, institutional efforts to contain costs in this area are continuing. Additionally, the PHA will continue to give priority focused attention to significantly reducing overtime through better scheduling of staff and other cost cutting measures.
Mr. Speaker, with respect to Revenue generation over the 2014/15, the PHA’s performance is in line with estimates established at the start of the fiscal year. In the 2013/2014 fiscal year, a total of $8,060,788 was collected from user fees. Based on the fees collected as at April 30th, it is projected that this revenue stream will reach $8.9 million by June 30th 2015. It is noteworthy that the organization’s programme to enhance revenue and simultaneously contain costs is being rejuvenated. Mr. Speaker, the PHA is also reviewing the fees associated with selected services at our hospitals, so as to ensure that the cost is in line with the provision of the care provided.
Mr. Speaker, I am pleased now to expound on the important fiscal administrative change being implemented, with effect from 1st July 2015, to consolidate the budgets of the Public Hospitals Authority and the Department of Public Health. As would have been referenced by the Rt. Hon. Prime Minister and Minister of Finance during his presentation of the 2015/2016 Budget, this government is seeking to ensure that all critical structural, administrative and health system prerequisites are in place to support the rollout and sustainability of National Health Insurance.
Members will have heard that one of the main health system strengthening priorities in this regard is the establishment of a single governance structure for the management and development of all health services in the public sector. This will facilitate vital improvements in efficiency and continuity of healthcare across primary, secondary and tertiary services, leading to reduced costs, improved quality and aimed ultimately at improved health and well-being of the population. In this light, members will recall that the new allocation for 2015/2016 is presenting a consolidated Recurrent Budget allocation for the Public Hospitals Authority and the Department of Public Health that totals $236,480,960.00 as mentioned at the out-set of my contribution to the Budget debate.
Mr. Speaker, Contracts for Medical Services is an item in PHA’s budget that is required in situations where clinical support for the care of our patients must be outsourced to the private sector because; (a) these services do not exist in our facilities (such as Radiation Therapy) or (b) we do not have the resource capacity to accommodate the demand for these services (such as in Renal Dialysis). Contracts for Medical Services had a budget for fiscal year 2014/2015 of 5.1 million dollars. Expenditure through to June 2015 is projected to be $6.6 million. Again in this category, we see a steady growth in the number of patients requiring dialysis and radiation therapy which is having a significant impact on the levels of expenditure.
For example, Mr. Speaker, the number of Dialysis patients outsourced to private facilities, increased by nearly 100%, from 136 patients in the 2013/14 fiscal year, to 262 in the 2014/15 period. This continuing exponential growth in dialysis patients is a major concern that my Ministry is addressing with focused investments of appropriate time, effort and financial resources into our primary and secondary prevention strategies for reducing risks associated primarily with Non-Communicable Diseases such as Hypertension & Diabetes. Our overall goal is to improve the health of our population through Health education, promotion of healthy lifestyles, better nutrition, and increase physical activity in this regard.
Mr. Speaker, I must also draw member’s attention to the increases in costs for the Operations of Facilities that are associated with the full activation of the new Critical Care Block. The 2015/16 budget to facilitate contractual obligations for service agreements total $7.7 million. These include contracts for preventative maintenance of equipment, cleaning and security services and support of clinical software programmes.
Mr Speaker, policy makers, planners of the NHI Programme and leaders (at executive and operational levels) throughout the health system all recognize that success of the impending NHI scheme is dependent on the achievement of vital changes within the health system leading to improved client satisfaction, clinical quality, fiscal stewardship and infrastructural environments.
In this regard, PHA and DPH are collaborating to ensure the earliest possible achievement of many of the changes that are critical, prior to the implementation of NHI. Six areas of doable “Quick Wins” have been identified for service improvement initiatives to be implemented over the short/medium-term, within respective agencies. These are as follows:
Firstly, there is a set of strategies to Reduce Patient Wait Times particularly in critical, high volume service areas such as the Emergency Rooms, Radiology, Laboratory, Rehabilitation Therapy and Pharmacy Services, Specialty Clinics, General Surgery, Oral Maxillary & Hospital Dentistry Services, etc.
Secondly, the PHA and DPH have identified a number of opportunities to Extend the Hours of Service for (a) family medicine and community clinics in New Providence and Grand Bahama; and (b) Hospital and relevant Clinic pharmacies.
Thirdly, there are a number of quick-win initiatives that are targeting Improvements in Customer Service, Patient Care and Patient Education. These are aimed at enhancing customer satisfaction and health outcomes in defined priority areas. One of the initiatives is the implementation of a Family Island Desk.
Mr. Speaker, as a family island representative, I am aware of how important it is to family island residents to know that when there is a need to be referred to the Princess Margaret Hospital in New Providence, they will have someone who will not only navigate them through the system, but will monitor the services they may require so as to ensure a seamless process in the care to be delivered.
The fourth package of Quick-Wins encompasses those capital works initiatives for addressing critical developments and improvements in the Physical Environments of Care in the three hospitals and select Community Clinics in New Providence, Grand Bahama, and the Family Islands.
Fifthly, there is a set of Quick-Wins that focus specifically on Reducing Outages of Essential Drugs & Other Medical Supplies. An evaluation of the supply chain management system in this regard is currently underway. This exercise is expected to be completed in June 2015 and will provide recommendations to strengthen the system over the short, medium and long term; resulting in improved efficiencies and effectiveness in terms of product selection, procurement, storage, distribution, availability and use of drugs and other medical supplies.
Finally, we have grouped all the interventions related to Information Systems Improvements as the Sixth cluster of Quick-Win items. A major development in this regard includes the expansion of the patient information systems and network infrastructure within PHA to serve the Community Clinics under the DPH. This will foster goals of having one record for each patient across the public healthcare system. It will enable the achievement of important targets related to continuity of care; and will provide consistent reporting across all public healthcare settings.
Mr. Speaker, another noteworthy development under our Information Systems projects is the procurement and implementation of the specialized Perioperative Information System for the surgical theatres at PMH, Rand Memorial and the new community based facilities in Marsh Harbour, Abaco and George Town, Exuma. This system will be implemented before the end of this calendar year and will bring significant opportunities for maximizing the use of resources in this area, reducing the wait list for elective surgeries and provide critical timely information for management decision-making to further improve operations and manage costs.
Mr. Speaker, one of the strategies being undertaken for addressing the quick-wins agenda include the recruitment of additional staff to reduce critical shortages, where required. It is noted there is a significant shortage of available Bahamian health professionals in a number of areas of need; and recruitment from abroad is often required. I therefore take this opportunity, to advise members that in addition to the recruitment for the Critical Care Block which was undertaken late last year and earlier this year, a special recruitment exercise took place in April, to recruit forty-six (46) health professionals in areas where the entire public healthcare sector is experiencing serious deficits, including: Medicine, Pharmacy, Biomedical Equipment Engineering, Rehabilitation Therapy and Information Technology. It is anticipated that all required Health Council licensing and contracts will be executed in short order, to allow for these new recruits to begin work shortly.
Mr. Speaker, other corrective action involves the acquisition of equipment to address critical deficits. For example, the procurement of state-of-the-art clinically necessary and technologically appropriate equipment for the Departments of Radiology, Imaging, and Hospital Dentistry Services is planned for the 2015/16 fiscal period. This exercise will result in the replacement of the present analogue equipment and through a lease arrangement, put in place state-of-the-art digital equipment, resulting in greater efficiency and easy access to patient records. The tender for this important exercise is on the way and will be completed in early July, 2015, followed by the selection of the successful vendor.
Additionally, Mr. Speaker, under the quick-wins agenda, focus is being placed on the reassignment or redeployment of staff as required. For example, the mechanism for physician assignments to provide specialist on-call response to the Emergency Room for case review and/or to facilitate patient admission to the ward is being reviewed to address the delays in the discharge or admission or ER patients. Also targeted are strategies for improving work flows and re-engineering patient throughput to improve waiting times in the relevant clinical and administrative areas.
Grand Bahama Health Services
Mr. Speaker, we are pleased with achievements at Grand Bahama Health Services, in establishing additional clinic services. For example, an after-hours Primary Care Clinic was established at the Rand Memorial Hospital to alleviate the bottlenecks in the Accident & Emergency Department. Furthermore, since February 2015, we have extended the hours of operation at the Eight Mile Rock Clinic until 9:00 p.m. (this is inclusive of the availability of Pharmacy, Radiology and EKG services during these extended hours). GBHS has also established a Family Medicine Clinic at the Pearce Plaza Clinic to decrease the load on Rand Memorial’s medical specialty clinic. The Rand Hospital’s pharmacy has also extended its hours of operation to 11:00 p.m.
Princess Margaret Hospital
Mr. Speaker, with respect to the Princess Margaret Hospital, the hours of operation at the Family Medicine Agape Clinic at Agape House on 4th Terrace East is being extended to further reduce patient waiting times. PMH is also seeking to establish additional specialty clinics as necessary in the first quarter of the 2015/2016 fiscal year, to address long wait times for clinic appointments and better accommodate patient loads and any unmet needs.
Mr. Speaker, I turn now to those initiatives related to “Improvement in the Physical Environment”. As would be expected, these items constitute the single largest set of investments being undertaken at a total estimated cost of 24.6 million dollars.
Mr. Speaker, an important initiative that will be undertaken this year is the completion of a Master Plan for the redevelopment of the Princess Margaret Hospital on its existing site. In May 2015 the PHA executed a contract with the Health Facilities Planning firm “The BECK Group Ltd” (headquartered in Atlanta Georgia) to provide these services. This master planning exercise for the site also includes activities for the development of detailed functional programmes for all areas of this hospital. These set of plans and functional programmes are critical on two levels. Firstly, to guide the medium-to-long term redevelopment of PMH in appropriate phases and secondly to ensure the ongoing investments in any infrastructural renovations and upgrades of this facility during the interim period in a manner that will best diminish risk to patients, visitors, and employers of the PHA.
In the interim, considerable effort and resources are being directed towards increasing the space available within the Accident and Emergency Department for clinicians to examine and treat patients with a view to minimizing concerns related to compromised confidentiality, and violations of privacy and personal dignity resulting from patients being seen on the open floor or in cubicles with other patients present, as is now the case. To address the extensive delays in moving newly admitted patients to the wards, plans are underway for renovation of the original Male Surgical ward which upon completion will restore hospital bed capacity.
Notwithstanding the aforementioned Master Plan for PMH, Mr. Speaker, Maternal and Child Health is of upmost importance to this government and as such, it is anticipated that the expansion of the Maternity Ward will be a component of the next phase of the PMH onsite redevelopment plan. In this vein, a renovation program is also underway for improving the delivery of pediatric care. The southern area of the Children’s Ward is being redeveloped to create more appropriate child-friendly accommodations for our nation’s little darlings.
Mr. Speaker, you will be pleased to note that other selected clinical areas in PMH that will be receiving critical infrastructural repairs and upgrade include (but not limited to):
1) Builders works at the Oncology Centre, example flooring, painting, minor roof works, and structural cracks repair);
2) Remediation works in the Dialysis Unit involves replacing all water boxes, repairing floors and walls and installation of 19 new dialysis chairs (which has been purchased); and
3) Expansion of the Family Medicine Clinic into the section of Agape House occupied by Material Management Directorate, in order to accommodate required increases in the number of clients of this important primary care service.
Mr. Speaker, members will recall that during the final quarter of 2014, there was worldwide concern about the emergence and global spread of Ebola Virus Disease. As the Bahamas sought to develop preparedness plans and other response measures, it became apparent that our acute hospitals lack the appropriately adapted areas to accommodate and treat suspected and confirmed cases of highly infectious and lethal diseases such as Cholera and Ebola, etc. To address this deficiency, the PHA will be establishing two purpose-built Infectious Diseases Isolation Suites in the country, one at PMH (in the vacant area to the north of the Blood Bank building), and another in Grand Bahama (at Hawksbill Clinic).
Mr. Speaker, my government is also seeking to undertake significant redevelopment and expansion works at the Rand Memorial Hospital, to address major constraints in patient care areas. This includes severe shortages in floor space to accommodate the high and growing volume of patients. Another thorny problem is the fact that the hospital’s kitchen and cafeteria are located in the middle of the inpatient care areas; which is a longstanding situation that is highly inappropriate in terms of standards for both the provision of care and the preparation or service of food.
To address these concerns, Mr. Speaker, the Kitchen and Cafeteria will be relocated to appropriately renovated areas in the property adjacent to the Rand (the former Island Palm Hotel) which was purchased by the PHA a few years ago. The plan also calls for the construction of a connecting corridor between the two properties; together with the renovation and upgrade of the decanted spaces to accommodate two new 4-bed inpatient units, the renovation of the vacant space on the East Atlantic Drive side of the hospital to accommodate for the first time at the Rand Hospital, a 8-beded private suite and the relocation of the present administration department to make way for the return and upgrading of the physiotherapy department from the Hawksbill Clinic site.
Mr. Speaker, the children’s ward at the Rand Hospital will also be expanded and upgraded to modern standards. The Architectural/Planning firm of Lawrence Chisholm & Associates was engaged in May 2015 to design and oversee the construction works for this project. It is expected that the design and construction drawings will be completed and ready to go out to tender during the month of July, 2015.
Mr. Speaker, I now wish to turn your attention to improvements planned for the Sandilands Rehabilitation Centre. Geriatric patients residing on the Culmer’s ward do not have the benefit of support areas, namely, examination and treatment rooms and waiting areas. Therefore, critical renovations in this regard will be undertaken over the new fiscal year at an estimated cost of $320,000. Priority is also being given to renovation and outfitting of the vacant building owned by PHA on Collins Ave (North of 2nd Terrace West) for the relocation of our outpatient mental health care facility on Market Street known as Community Counseling and Assessment Centre. The cost in this regard is estimated at $250,000.
Finally, Mr. Speaker, this Honourable House will be pleased to know that this Government will establish (beginning as early as June, 2015) a programme for the decentralization of Ambulance Base Stations to selected Community Clinics in New Providence and Grand Bahama. This initiative is aimed at decreasing response times from an average of 30 minutes (in New Providence) to a standard average of 5-8 minutes from receipt of call to arrival on the scene. These EMS out stations are proposed for:
Elizabeth Estates Clinic;
South Beach Clinic;
Flamingo Gardens Clinic;
Lynden Pindling International Airport; and
Eight Mile Rock Clinic.
In this regard, the PHA will purchase a total of twenty-Five (25) new ambulances to replace those that are now no longer suitable to meet the increased demand and international standard. Of the 25 vehicles, seventeen (17) will be deployed to New Providence, six (6) to Grand Bahama and two (2) in Abaco. Mr. Speaker, this investment, at a cost of over ten million dollars is the single largest investment in pre-hospital care this country has ever seen and will ensure that we are able to meet the increased need for this essential service. The initiatives which I have outlined above, Mr. Speaker, are in keeping with our government’s goal to build a better and stronger Bahamas.
Supply Chain System
Mr. Speaker, the PHA with the assistance of PAHO engaged the services of a consultant during May 2015 to carry out an extensive assessment of our public healthcare supply chain system. The engagement is divided into two parts. The first part of the engagement was designed to complete an extensive assessment of the pharmaceutical and Medical Supplies chain which focus on drugs and medical supplies delivered to clients through the three (3) public hospitals; ten (10) community clinics in New Providence; the ten (10) community clinics in Grand Bahama and the two (2) poly-clinics located respectively in Marsh Harbour (Abaco) and George Town (Exuma). That exercise was completed during May of this year.
Mr. Speaker, the second part of the engagement of the Consultant will focus on the implementation of the recommendations contained in the initial Report and the consolidation of BNDA and MDM to form a single governance under a new structure that will bring together all components of the two agencies to ensure standardization, greater efficiency, transparency. In addition, we will develop and implement a supplies management training program across the public health system for all staff involved in the supply chain system.
Financial Controls and Management Strengthening
Mr. Speaker, with respect to Financial Controls and Management Strengthening, the Public Hospitals Authority (PHA), commissioned four (4) audits during 2013/14, to identify weaknesses in the functional areas with recommendations for improvements. The functional areas were: (i) Supply of Pharmaceuticals and Medical/Surgical items; (ii) Human Resources and Payrolls; (iii) Accounts Receivables and Internal Controls; and (iv) Information Systems Review.
Mr. Speaker, I am advised that the majority of the reports acknowledged that there has been significant progress in an effort to strengthen systems and controls while highlighting areas where controls can be enhanced. I am also advised that the PHA has developed a strategic action plan to address the issues raised in the Reports in the short, medium and long term and the implementation is well underway.
Legislative Agenda
Mr. Speaker, the Pan American Health Organization is continuing its conduct of the assessment of the regulatory framework for pharmaceuticals in The Bahamas to identify gaps in our legislation. The first basic section has been completed, and initiation of the In-Depth assessment of the prioritized areas of the system will begin shortly
Mr. Speaker, the Government has taken the decision to establish a single governance structure for the Public Health Authority and Department of Public Health, to create a new entity that would consolidate all existing public care delivery services, that is, primary, specialist and hospital care under one entity, with the Ministry of Health retaining all stewardship functions with particular consideration for the incorporation of the private sector. This will mean a review and possibly the repeal of the Public Hospitals Authority Act and my Ministry has since written to the Office of the Attorney-General to prepare the necessary legislation so that it can be brought to this Honourable House following approval by the government as soon as possible.
Mr. Speaker, you would recall that early in this intervention, I stated that a bill for an Act to establish a Cancer Registry will be brought before you. The objectives of development of a national system are to monitor the incidence and prevalence of cancer in The Bahamas and to determine factors affecting incidence, prevalence, morbidity and mortality especially those of gender, occupation and environment.
NATIONAL HEALTH INSURANCE
Mr. Speaker, there is absolutely no question, after listening on 27th May, 2015 to the Right Hon. Prime Minister and Minister of Finance’s 2015/2016 Budget Communication that the country has been rescued from fiscal collapse and is now on a pathway to a better economic developmental situation. The Rt. Hon. Perry Gladstone Christie, Prime Minister and Minister of Finance, must be commended for his outstanding leadership in restoring fiscal discipline to the management of our public finance.
Indeed, Mr. Speaker, you would recall that when the Prime Minister and Minister of Finance embarked upon the initiative to restore fiscal discipline in 2013/2014 Budget, the government had inherited the 2012/2013 Budget which was fashioned against the backdrop of fiscal mismanagement, high budget deficits and escalating debt burden. The state of public finances was in disarray marked by declining revenues, runaway expenses, increasing deficits and national debt.
Mr. Speaker, to emphasize this point, you would recall that during my contribution to the 2014/2015 Mid-term Budget Review, I made the point that when this PLP government came into office in May 2012, we inherited a fiscal situation where there was a little over $4 million in the Budget. The FNM government had left the state of our country’s financial position in a terrible state and to exacerbate the situation the public wage bill stood at a whopping $50 million which means we started with a deficit of $46 million alone with respect to defraying the cost of salary for of public servants.
Today, Mr. Speaker, the Prime Minister and Minister of Finance has not only reduced our Budget deficits by two-thirds but he has also reduced government borrowing from $600 million in 2012 to $182 million in 2015 representing a reduction of $418 million or 70 percent. Mr. Speaker, this is excellent news because it means that for the average citizen and business the cost of borrowing should be significantly reduced because the government is no longer borrowing at high cost (that is, high interest rates) thereby crowding them out of the financial and banking sector. So, Mr. Speaker, good times are ahead and our economy is on its way to a strong renaissance as we build a better and stronger Bahamas.
Mr. Speaker, with the introduction of Universal Health Coverage (UHC) through the vehicle of National Health Insurance (NHI) in January, 2016 by this caring PLP administration led by the Rt. Hon. Perry Gladstone Christie, we shall experience the fulfillment of an overdue commitment to the people of the Commonwealth of The Bahamas; this is being welcomed by all well thinking members of the society who have an appreciation of the old adage “The Health of a Nation is the Wealth of the Nation”.
Mr. Speaker, as the Minister of Health with the responsibility to lead this initiative, it is with a sense of pride and purpose, that I lead this diverse capable group of professionals on the journey that will culminate the preparatory phase with the launch in January, 2016. The team is hard at work because we appreciated that the clock is steadily ticking and every moment now is important to the execution of the accomplishment of this very significant national milestone. At the recent 68th World Health Assembly held in Geneva Switzerland, Universal Health Coverage was heralded as a goal that all Member States of that global body of more 194 should seek to implement because it is the correct action to improve the quality of life of its citizens. This is achieved when the cost of healthcare is removed at the point of healthcare service delivery.
Mr. Speaker, we in this Parliament are aware that The Bahamas has been on this path for some time now; as far back as 1987 or thereabout. And in 2002 when the Rt. Hon. Prime Minister appointed The Blue Ribbon Commission, which I chaired, in another capacity, that resulted in this Honourable House passing the NHI Act, 2007 which was assented to by the Governor-General on the 23rd January, 2007 and Gazetted on the 24th January, 2007 which pointed the legal direction of a caring government to the implementation of National Health Insurance. All that was required was for the then Minister of Health, the Hon. B. J. Nottage to has signed the Appointed Day Notice thereby bringing the National Health Insurance Act 2007 into force.
However, Mr. Speaker, regrettably, there was a change of administration in 2007 which resulted in a delay in the implementation of NHI. But truth be told, this present administration led by the Rt. Hon. Perry Galdstone Christie will not deny the citizens of The Bahamas the promise the PLP administration has made to them. Therefore, in January, 2016 the phased implementation of National Health Insurance will be launched and borrowing the words of our esteem Prime Minister and Minister of Finance “so said so done”. A redraft of the National Health Insurance Act 2007 will be undertaken as well as further amendments to several Acts which will affect the Implementation of National Health Insurance.
Mr. Speaker, the preparedness for National Health Insurance Implementation will require a change in the work culture and the mindset of all stakeholders in The Bahamas, as well as, the public at large. It will be a welcomed paradigm shift in the manner in which citizens and residents in The Bahamas access available healthcare resources from Abaco in the North to