PAHO officer credits Ja's primary health care system

By Eulalee Thompson, Staff Reporter

HOW DOES one explain Jamaica's health system being ranked at number eight in the World Health Organisation's (WHO's) 2000 health service efficiency table? After all, only about four per cent of its Gross Domestic Product (GDP) is spent on health compared to 12 per cent of GDP being spent on health by a developed country such as the United States.

Jamaica's per capita spending on health care is also small compared to that of developed countries and even of some sister Caribbean states. For instance, only about US$158 per capita is spent (in the public and private sectors combined) by Jamaica on health care compared to the massive US$4,000 per capita spent by the United States. Yet, the United States was ranked 72 on the table, the United Kingdom, 24 and Japan, nine.

"It shows that spending money on health care is not the only answer. A lot of the health issues relate to lifestyle. Americans for instance, lead mostly a sedentary lifestyle, children play computer games instead of playing outside and Americans eat out all the time," explained Gerald Lucas, Pan-American Health Organisation's (PAHO's), health management advisor.

He also pointed out that a formidable advantage for Jamaica "is its famous network of primary health care system started in the 1970s".

The primary health care tradition, Dr. Deanna Ashley, the Health Ministry's acting Chief Medical Officer, admits it is a major factor in explaining Jamaica's healthy population but she also explains that the trick is learning how to stretch the scarce health dollar ­ focusing less on the glamorous, high-tech medical advancements that benefit few individuals and more on the old adage "prevention is better than cure" that will benefit larger section of the population.

"We have learnt over the years to improve the health status of people by obtaining maximum outcomes from minimum resources. We have a tradition of intensified efforts on programmes that bring benefits to large sections of the population," she said.

Some of these low-cost but efficient health interventions include a focus on primary public care, immunisation, antenatal care, access to potable water and sanitation. These efforts have lead to an eradication of many communicable diseases that still exists in other parts of the world. Dr. Ashley pointed as well, to a simple, low-cost intervention as the little packet of oral rehydration salt (used to manage babies with diarrhoea) "as one of the best technologies developed and used to reduce child mortality" and to screening tests such as the Pap smear for cervical cancer.

Health systems in developed economies depend heavily on high-tech diagnostic equipment, expensive drugs and curative-based institutional care. All of this is costly and Dr. Ashley said would bring benefit at the individual level but not necessarily to large sections of the population.

But while the health sector is patting itself on the back, it recognises that there are many weaknesses that must be addressed such as the long waiting time in the secondary health care and the general inefficiency in the system.

Mr. Lucas said that Jamaica is currently on the brink "of seeing where it wants to go". Will it totally embrace the poor lifestyles habits of more developed countries or continue on a path of prevention and health promotion? Already, signs of a health profile typical of developed countries is rearing its ugly head with the emergence of chronic lifestyles diseases (such as diabetes, heart conditions, hypertension, obesity). There are also new pressures on the health system such as crime and violence, AIDS and motor vehicle accidents. It is these challenges, Dr. Ashley said, that the health experts must now begin to address in the public health system.

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