Health sector development -- a shared objective By Michael Khan, Chief Executive Officer, Georgetown Public Hospital Guyana Chronicle April 11, 2000 PERHAPS the development phrase frequently penetrates the sensitivity of our eardrums as a much-talked about thing in Guyana. But sometimes we are mistaken to believe that development is singular. Consequently, there is an overlooked phenomenon of its many forms. Development finds its basis in a process betokened by improved standards, that add comfort to life. And living has its various facets inclusive of the physical and non-physical environments. We know that society has its genesis in the emergence of family units which contribute in various ways to development. But the birth of the family comes out of a health process. Furthermore, it is the maintenance of good health that provides the contributory elements for development. Therefore, any government with anthropological objectives will continually concentrate on the health of its people. Our incumbent Government since the 1992 elections, brings no exception to this civilised belief and has always had health identified as a priority for development. In more recent times, the inevitably changing world brought a new dimension to civilisation in the developmental thrust, and has consciously influenced decision-makers to adapt to new innovations that will supposedly satiate the demands of such changes. Guyana, nevertheless, has hitched its ride on this journey and has been examining areas for possible changes all along. Health has been the forerunner in this kind of frontal approach, hence, an initiative such as the Inter-American Development Bank (IDB) Health Sector Reform Programme for Guyana. The health sector reform will result in a well managed health sector of the 21st century in Guyana, committed to keeping abreast with good health care practices and procedures, maximising community involvement and ensuring that all citizens have access to effective, efficient and equitable health care services provided by compassionate, caring, adequately trained, creative and resourceful personnel within an appropriately equipped, financially comfortable and empowering health care environment. It is believed that the best testing ground for failures and successes of most decisions relating to the health sector is at the level of the Georgetown Public Hospital, which caters for the larger portion of the burden of health care delivery. This must not come over to mean that institutional and other developments in this sector are not equally significant factors. The practice of inclusivity adopted by this Government, continually leads to consultative underpinnings for more formalised and systematically realistic projections towards achievements in this sector. The Georgetown Public Hospital (GPH) Management Committee, chaired by Dr. Leslie Ramsammy, and the reformed hospital administrative team, now being headed by Michael Khan as Chief Executive Officer, command a renewed optimism for a more responsive health sector. You may wonder, `why single out the GPH from a much wider sector?' But this institution is a major stakeholder in the health sector. We've had our share of trial and errors and have seen the detriment of supporting systems that ignore changing elements in trends and the changing characteristics in formulas. We've recognised this just about when the world was changing in many forms and the civilisation mode entered into new confines. From this, one also recognises that development is continuous. How then do we continue to urge appreciation for its phases? Development seeps into cultural attitudes, and influences bahavioural patterns. Therefore, this must be considered as we keep moving ahead. We must be able to educate people of the development taking place so that they will appreciate the process and its results. But this is usually a hard task. The truth is that people look forward to two things generally if they will participate in a process: 1. to be directly involved, and 2. tangible benefits These go beyond what we are thinking at present, because they help us to reduce pressures on governments, and ease the dependency level people display on these governments. People generally look forward to too much from governments. That's why the concept of participatory democracy should become prominent in sharing the burden of developmental responsibilities with civil society. From my analysis, it was felt that if this concept is promoted, then we (could) reduce the dependency stress on governments by having civil society directly involved in decision making. This forces them to take much more care for what they would have contributed to create. More than that though, health managers could increase their knowledge base of how to reduce pressures and failures by a more informed approach to decision making. The scope to achieve the shared objective of improving our health sector is much wider, and we must be able to take advantage of this fact. Civil society must be prepared to cushion all efforts that will result in us having a healthier nation. There are negative realities that sometimes deduce from the insurmountable positivities even with restraint in our resource capacity and financial opportunities. But the overall image of the health sector must be reflected in our attitudes, hearts and work by the level of our contribution. Dr. Leslie Ramsammy, at a health planning retreat said: "The new Georgetown Public Hospital now endeavours to do a better job, to redesign itself structurally and functionally so that it could better serve the people of Guyana. While we seek to improve quality and reduce costs, we also hope to put an end to irritants such as: long waiting lists; irritating delays in waiting rooms; closed beds and wards; overcrowding beds and wards; frustrated staff; and needless deaths." This certainly tells a lot. The importance of having an understanding of what is taking place and acknowledging it, is essential to solving the problems. Everyone must be impressed. The management team of the hospital will try to employ new and innovative strategies for effective delivery of health care and continually consolidate our gains achieved over recent unforgettable years. While we remember some of the negative occurrences, let's simultaneously remember the following accomplishments of the hospital: 1. Completely new wards opened for maternity and gynecology patients. 2. The Dermatology Department has been partially re-opened after being closed for several years without a dermatologist. 3. The mortuary has reopened after being closed for decades and post mortems are now being done at the hospital Pathology Centre. 4. The Medical Out-patient Department was rehabilitated. 5. New transformers have been installed to improve electricity supply at the hospital (This will improve the performance of sensitive equipment) 6. Water supply is more reliable. 7. Air conditioning has improved. 8. Housekeeping in the compound has improved. 9. A new Blood Bank is operational. 10. A new Chest Clinic is operational. 11. The vacant pediatric building is being replaced with a concrete structure to accommodate the medical wards. 12. Improved mammography, ultra sound, laboratory and pharmacy services. We believe there is an overall strong political commitment to achieve the health-for-all goals by the incumbent Government so that Guyanese can become more socially and economically productive. As we continue our task, it is hoped that our existing health services will be totally reoriented taking into account the role of the individual, the family and community at large. Political will is so essential for the development of health and this unmistakable attitude must not made to be frustrated by those of us who manage the health system in a direct manner.