Politics and governance don't mix

I believe that, in any good government, politics should play no direct role in governance. Ideally, politicians should only be elected based on their past, present or anticipated good works in their constituency (irrespective of party affiliation). And, if chosen to serve (at whatever level), they should make decisions and represent the needs of everyone with absolutely no influence from 'politics'. Parliamentarians (politicians) will always vehemently deny or remain mum about the (often significant) role of politics in governmental policy programmes.

During his Sectoral presentation to Parliament on Tuesday, September 21, 2010, the minister of health, made a valiant effort to validate and defend the public-health sector 'no-user-fee' policy instituted by his Jamaica Labour Party. The policy started out as part of an election campaign promise in their manifesto.

I surmised that the no-user-fee plan was hatched because user fees were (only) contributing about 11 per cent to the (public health) budget. Even though there was an assessment system in place, no one was ever forced to pay or hounded for fees owed to any public health-care facility. In other words, public health care was free for the poor because patients only contributed if and what they could. This political no-user-fee "stroke of genius" cost the Jamaican taxpayer about $1.7 billion annually and markedly increased the number of people accessing the already badly underfunded, inadequate and unprepared system.

The health minister recited lists of patient-access percentages, numbers of medical personnel recently trained and in training, numbers and costs of expanding and improving medical services, and he also reportedly stated that 'poor Jamaicans' had saved $4.14 billion in two years. Everyone that I spoke with saw this revelation as dutiful political point scoring.

Significant barrier

What really caught my eye was the minister's carefully selected quote from the UN 2010 Report on the World Social Situation: "Most key players in the health arena now recognise that user fees constitute a significant barrier to health services. Even when user-fees systems include waivers for the poor, in practice they are often difficult to access or tend to be abused by the relatively better off."

Remember, no-user-fee public health care was always easily available to our poor. And now, more than ever, it is being abused by the relatively better off (because nobody pays any user fees, even when he or she can afford to do so). Interestingly, I found two omitted but very relevant quotes from that same section of the UN report (Box VII. 3 User fees: health and poverty effects). The paragraph preceding the minister's chosen quote contains a World Bank research finding which states, "... there is no one approach to user fees in poor countries, and that alternative mechanisms for publicly funding health care need to be explored".

Far more important is the statement in the paragraph immediately following the minister's chosen quote: "At the same time, removing fees will entail additional resource requirements. It is, therefore, important to ensure that additional funding is available for countries that want to remove fees. To support the permanent removal of user fees and to ensure that the poor benefit from such actions, fee removal needs to be part of a broader package of reforms that includes increased budgets to offset lost fee revenue".

Financial challenges

I hope that the health ministry will not tell us that the "additional funding" (the discarded $1.7 billion, plus billions more for needed systems improvement) will come from the National Health Fund ... that entity already has its own mushrooming financial challenges.

The no-user-fee policy needs revision. If we continue to put politics above governance, people will continue to suffer.

Garth A. Rattray is a medical doctor with a family practice. Feedback may be sent to garthrattray@gmail.com.