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Fifth Report PARLIAMENT OF THE REPUBLI C OF TRINIDAD AND TOBAGO Tenth Parliament [2012/2013 Session] FIFTH REPORT of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) on THE ADMINISTRATION AND OPERATIONS OF THE MINISTRYOF HEALTH WITH SPECIFIC FOCUS ON PRIMARY HEALTH CARE Ordered to be printed with the Minutes of Proceedings and Notes of Evidence H.O.R. PAPER NO: 11/2013 SENATE PAPER NO: 9/2013 PARL. NO. 14/5/14 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) Date Laid: HoR: 10/05/2013 Senate: 14/05/2013 ii 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) Table of Contents THE COMMITTEE................................................................................................................. 1 Establishment ....................................................................................................................... 1 Membership .......................................................................................................................... 1 Secretarial Support ............................................................................................................... 2 Powers ................................................................................................................................... 2 Background ........................................................................................................................... 3 Objectives .............................................................................................................................. 3 Conduct of the Inquiry .......................................................................................................... 3 THE EVIDENCE .................................................................................................................... 8 Primary Healthcare Overview .............................................................................................. 8 Organization and Management of Primary Health Care Services ...................................... 8 The National Health Service ...............................................................................................10 Strategies for Strengthening Primary Health Care Services .............................................11 Budgeting Procedures employed by the RHAs ....................................................................13 Eastern Regional Health Authority ....................................................................................14 North Central Regional Health Authority ..........................................................................15 North West Regional Health Authority...............................................................................16 South West Regional Health Authority ...............................................................................17 Annual Service Agreement ..................................................................................................19 Constraints in the RHAs......................................................................................................27 Mechanisms to deal with Complaints in the Health Sector ...............................................28 Patients’ Bill of Rights .........................................................................................................30 Quality Management in the Health Sector .........................................................................30 Human Resource Issues .......................................................................................................32 Human Resource Planning for the Public Health Sector ...................................................33 Scholarships .........................................................................................................................46 Public Oral Health Care Services ........................................................................................48 Public Health Care in Schools .............................................................................................51 RHAs Facilities and Property Management arrangement and guidelines ........................53 iii 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) Procurement in the MOH ....................................................................................................54 Effective, preventative maintenance for equipment ...........................................................56 Status of unused exercise equipment ..................................................................................59 Management of Drugs..........................................................................................................61 Infant Mortality Rate ...........................................................................................................68 OBSERVATIONS/FINDINGS .............................................................................................78 RECOMMENDATIONS ........................................................................................................81 APPENDIX I ..........................................................................................................................86 APPENDIX II .........................................................................................................................91 iv 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) THE COMMITTEE Establishment In pursuance of the directive encapsulated at section 66 of the Constitution of the Republic of Trinidad and Tobago, the House of Representatives and the Senate on September 17, 2010 and October 12, 2010 respectively, agreed to a motion, which among other things, established a Joint Select Committee to inquire into and report to Parliament on Ministries with responsibility for the business set out in the Schedule as Group 1, and on the Statutory Authorities and State Enterprises falling under their purview with regard to: o their administration; o the manner of exercise of their powers; o their methods of functioning; and o any criteria adopted by them in the exercise of their powers and functions. The business, as well as the entities which fall under the purview of the Committee are attached as Appendix I. Membership The current membership of the Committee is comprised as follows: . Mrs. Corinne Baptiste-Mc Knight - Chairman . Prof. Harold Ramkissoon - Vice-Chairman . Mrs. Carolyn Seepersad-Bachan, MP . Mr. Emmanuel George . Mr. Ganga Singh1 . Dr. Delmon Baker, MP . Mr. Jairam Seemungal, MP . Ms. Stacy Roopnarine, MP . Mrs. Christlyn Moore2 . Dr. Amery Browne, MP . Mrs. Patricia Mc Intosh, MP . Mr. Faris Al-Rawi 1Mr. Ganga Singh replaced Mrs. Verna St. Rose-Greaves with effect from October 16, 2012. 2 Mrs. Christlyn replaced Mr. Danny Maharaj with effect from October 16, 2012. 1 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) Secretarial Support Secretarial support for the Committee is provided as follows: Mrs. Lily Broomes - Secretary Ms. Khisha Peterkin - Assistant Secretary Ms. Sheranne Samuel - Assistant Secretary Mrs. Katharina Gokool-Mark - Graduate Research Assistant Powers Standing Orders 71B of the Senate and 79B of the House of Representatives delineate the core powers of the Committee which include inter alia: to send for persons, papers and records; to adjourn from place to place; to appoint specialist advisers either to supply information which is not otherwise readily available or to elucidate matters of complexity within the Committee’s order of reference; and to communicate with any other Committee of Parliament on matters of common interest. 2 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group 1) INTRODUCTION Background Primary Health Care (PHC) is one of the most integral aspects in any Health Care System. Essential basic Health Care Services that are impartially accessible and cost-effective is imperative to achieving a successful Health Care System. Too often though, PHC Services are limited by insufficient resources such as staff, facility equipment and medical supplies that plague the Health Care System. Increasingly, it is recognized that without adequate delivery of PHC services a crisis of an insalubrious state can occur since it is the underlying foundation to a healthy population. Accordingly, your Committee considered an inquiry into the administration and operation of the Ministry of Health (MOH) with specific focus on PHC. Objectives Your Committee identified the following as the primary objectives of the inquiry: To determine the progress made in filling the numerous vacancies in the health sector, at the PHC level; To ascertain what measures have been put in place for the improvement of the physical infrastructure of PHC facilities; and To determine the progress made in the realignment or strengthening of the vertical services/ national programs. Conduct of the Inquiry The Committee conducted three (3) public hearings with representatives of the MOH on the following dates: 1. Friday April 15, 2011; 2. Friday January 20, 2012; and 3. Friday March 16, 2012. 3 5th Report of the Joint Select Committee on Ministries, Statutory Authorities and State Enterprises (Group
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