Budget Debate 20132215 03 Apr, 2013
Minister of Health [Dr. Ramsaran]: As I rise to join the debate, the discussion, the conversation, surrounding this budget, I would like, first of all, to join with the Hon. Minister of Education when she said this budget has much for many. That is in the words of the Hon. Priya Devi Manickchand, Minister of Education, eloquently said, thereby endorsing the good work of the Minister and his team. Before I go into my discussion and my contribution on the good work that he has done I would also like to join in congratulating his technical team. We oft times forget those people behind closed doors, those persons working around the clock, who get things done. I would like to recognise those hard-working members of the Ministry of Finance who have been able to craft this budget which has so much for so many.
At the same time I would like to note that the Minister of Finance and the technical team, which I referred to, have recognised the good work that the Ministry of Health and the health sector have done to such an extent that they have moderately increased the absolute amount of moneys allocated to the sector. This endorsement or this recognition of the good work done by the health sector is also a recognition done by so many thousands of health care providers who we do not see on the front pages, we do hear about, but whose work has done so well.
I would like to recognise the work of this group of hard-working Guyanese who incidentally are predominantly women and who represent the significant group of our workforce. Minister, I thank you for recognising their contribution. At the same time, I would like to say that this is the group of workers who make us proud whilst at the same time protecting the nation twenty-four hours per day, protecting the nation to such an extent that we have continuously won international accolades.
Guyana has the distinction of being among the countries with one of the highest coverage for routine vaccines and antigens. That protects our children; that create the future. This is only possible from the hard work of those workers, who I referred to, oft times performing their functions in difficult challenging conditions. As I will show shortly that the Ministry of Health, the health sector, has achieved and continues to achieve but it still has significant challenges and the Members would have known of them. The Members would read about some of them in the newspapers – an outbreak there, a maternal death there. There are challenges, but there have also been significant gains.
Let us speak about some of those and, at the same time, let us take a pause to reflect all the structure of the budget in which I see, not only in the health sector, but right across other sectors in the budget, that it is an all-inclusive budget. A budget which allows all stakeholders to say, “Yes, this is my budget.” It is not only the Private Sector Commission can say that. My health sector workers, my patients, people needing rehabilitation services, they are all included. I asked the Members to give me their ears to look at some the achievements, some of the things that we have done, but whilst doing so I also have a little misgiving.
I have heard from over the other side of the aisle, from the very first gong, from the Hon. Member Greenidge, shadow Minister for Finance, who attempted to lay the foundation to vote against the budget or to cut it. What is a bit more alarming, in some other contributions, is that I recognised that some of the persons calling for cuts did not seem to understand the content of some of their own discussions. For example on the specialty hospital, on the retention moneys for capital works in the health sector, good colleagues, especially in the media and in the gallery, I shudder to think that it is as a child with a match. A match is a useful thing, but in the hands of a child, unschooled and unaccustomed to systems, it can do damage. Several of the contributions from the other side were passionate, showing that they were trying to grasp with material but not understanding it. [Laughter from the Government Members]. I do not want you to laugh at them. I want us to understand that we need to recruit them because they have constituencies and the passion with which they have approached the subject matter showed that we have made mistakes on this side. We have not been able to get over to them for a year because some of the said arguments that were raised here last year, in regard to the specialty hospital, keep coming back. [Mr. B. Williams: You are getting it wrong, as usual.] I hear a voice a wilderness. I will come to that again, but I am suspecting that in the coming days when we go line by line it will become apparent.
Let me just, in passing, say this: Having a voted provision does not mean that the contractor has been given that money. He has to go through a certain process. Last year, just about this time, about the same issue, that is, the specialty hospital, which we so much need, whether we are petite or whether we are hugely endowed we sometimes could end up with cardiac events… We will come to that later. What I am saying is that the provisions voted for in this case, for example, I think my good colleague, the Hon. Member Ms. Ferguson, spoke to this figure, $97 million, it does not mean that the person… That is the contract cost or the contract sum. I want to briefly assure her that those moneys have not been disbursed. There is a certain process and I advise that she should learn that process. I do not have the time for a pedagogic session now but I am willing to have a group… I think we need to do this. The Ministry of Finance, for example… For example, Minister Benn, from time to time, would call in the contractors and do a symposium. He would do a session so that they can speak the same language at the same time. I think this is a good model to follow Minister, the Hon. Dr. Ashni Kumar Singh, so that it would be understood that a provision, which you are looking at, has certain processes or procedures before you can touch that money.
The contractor, who, I think, was referred to by Ms. Ferguson as Mr. G. Bovell, has not been given that money because, indeed, he has not done that volume of work. I would like to say that he has been given moneys based on the measured works done, but we will have that discussion in the coming days as, no doubt, Ms. Ferguson will raise these issues and we will elucidate more and more on them.
The issue of moneys, which would be described as retention fees, was touched upon. I suspect that Ms. Ferguson was looking at the similar numbers of $25 million in last year’s budget and this year’s budget. The component parts, my honourable colleague, are different, that is, a small sum for the school in East Street and the annex in Kingston, bringing that to $25 million, and the retention referred to is a roll over since one contractor had to be dismissed and another engaged.
Let us move on, Mr. Speaker, Hon. Minister of Finance, to look at some of the positive things that the significant, solid and continuing investment by the Government of Guyana, the People’s Progressive Party Civic (PPP/C) administration, has allowed us to do over the past two years. Before we go into the actual analysis or before we take a pause to see what we have done with the moneys allocated by the Ministry of Finance, let us reflect on the fact that over the past few years the health sector has enjoyed the growing slice of the social sector budget, starting from 1992 when it was just five per cent of the national budget, then it grew, and it is now, in the past few years, ten per cent for the consecutive five years.
I note that the goodly pastor referred to the fact that he is a student of economics. I have not graduated to that level as yet, but I am told that when a country has consistent figures above five per cent in its GDP gain it indicates that the economy is - The goodly economist will tell me - buoyant. I see the smile; he agrees with me. I have read a bit of Keynes too. The continuous ten per cent, which we have noted of the health sector budget as compared to the ten per cent slice out of the national budget also indicates, a la Keynes, that the health sector is buoyant. The pulse beat is correct; we are getting it right.
However, it behoves us now, after enjoying, as a sector, that significant investment, to manage in austere conditions because, as the Minister of Finance pointed out, Guyana has gravitated from a Highly Indebted Poor Country (HIPC) to somewhere up the ladder, but he also indicated, in his discussions, when he made his presentations, that the things are still fragile, that there are still threats on the international scene. He warned us that we will have to continue to be vigilant, not complacent. That is why the Ministry of Health, and the health sector, noting that there was only a modest absolute increase, it is still grateful, which keeps it at the nine per cent level – a slightly lower level but in absolute terms, more money. We have to do things better.
The Ministry of Health has positioned itself to indulge in the economy of savings. Keynes did not speak of that pastor. That is my invention. We have to mange better… [Mrs. Backer: It is Paul Kneens-Douglas.] I have caught their attention. They are awoken and alive, that is how we like them. I like to hear when the Hon. Member Mrs. Debbie Barker is barking back.
Mr. Speaker: Hon. Member, you will refer to Members by their correct names.
Dr. Ramsaran: It is Mrs. Debbie Backer. We are alive and your guidance, Mr. Speaker, has brought some life to the Assembly.
Over the past few years investment in infrastructure has created a certain base. Let us look, for example, at the hospitals: Diamond is a gem, and I am not punning on the words, there are still problems there, Leonora, Mahaicony, Suddie, Port Mourant. Let us come to Lethem and Mabaruma. I do not know if I can coin a term that might be slightly unparliamentarily, but one of our colleagues was tending to be an untruther when he described a bleak situation in Region 9. The hospital in Region 9 is a boom to the people there. As a matter of fact you have not been told that regularly, Mr. Speaker,… [Ms. Ally: What do you know about Region 9?] I organised this over the past few years and I will invite you to join the team sometimes. It will now be on a monthly basis. I would like to remind the Hon. Member Ms. Wade that there will be problems. An air conditioner may not work now and then but my health workers still work under those conditions - praise them.
Let us go back to Region 9. The hospital there has such good equipment that one of the private sector doctors, and it is on tape, recently said…, because he had never travelled out to those areas. This is a goodly gentleman called Dr. Neville Gobin. I think I am allowed to call the name in a positive light and he has been one of the members of my medical-surgical team, with others from the private sector, who went in to Mabaruma - the Hon. Member Mr. Hamilton has been there - to Lethem and Dr. Gobin has said that he has recognised what this administration is doing for the indigenous people. In Region 9, as recent as the 9th and 10th of last month - Mr. Speaker, I hope I have your attention - there was a significant event. What we did was to send in a medical-surgical team. Who was on that team, Mr. Speaker? Who headed that team? It was the honourable Dr. Fawcett Jeffrey. Who else was on that team? He is one of the best bone specialists in the region, Dr. Amin; Dr. Bulkan, ultrasound specialist from the private sector, Dr. Raul, a Cuban, stationed at the Diamond facility, Dr. Monica Segala, a very bright woman, well educated, went overseas and came back. They did seventeen surgeries (Where is Mr. Allicock? Would you lend me your ears, Sir?) at the Lethem Hospital.
Previous to that, in the last quarter of last year, a similar team went and they did forty-nine similar surgeries. What type of surgeries they were? I want the persons in the gallery to listen to this and the cameras to show and tell it to the nation. They did cesarean sections. Cesarean section is a way of delivering a baby. Both mothers and children and, of course, the daddies are all happy. Thanks to Dr. Amin and his team - praise them. They go and work there and there are difficulties - thanks to Dr. Jeffery and team, thanks to Dr. Raul, thanks to Dr. Monica. They leave, in some cases, lucrative coastland private sector jobs for that long weekend – praise them.
Sometimes I wonder where my colleague the Hon. Member Mr. Sydney Allicock lives. If he did, and I know he does… My goodly colleague, let us embrace the truth a bit tighter, a bit cosier. Dr. Goddett is the doctor based in Lethem. He is one of the Jagdeo’s scholars. He comes from that region. I want to pull the carpet from under the feet of the argument of the Hon. Member Mr. Sydney Allicock, that this administration is doing nothing for the young people in those regions. Dr. Goddett, and others, and Dr. Torres, who should be known to the goodly gentleman, are from Lethem. He is a doctor who was trained in Cuba, a young full-blooded Amerindian, who has returned to served at Annai. I am going to dwell a bit on Region 9 because my colleague across the aisle did so much, I think, to the distress of the residents of Region 9 who have expressed so much good wishes and goodwill towards the PPP/C for providing these services.
Further to that, the goodly Dr. Torres was specially kept for a protracted period in Georgetown to give him additional skills. I remember when this young man came back, he wanted to go and serve his community. I said to him “Joe, slow, hold.” I want to keep you in Georgetown for several months to give you certain skills. He is now thankful that due to the additional training by this Government he has gone back to be able to do even better. Praise the Government for that. I would like to tell you, too, Mr. Speaker, since we are on Region 9… We were told… [Mr. Greenidge: Praise....] Yes. I did that, so I can blow my trumpet. I know what I am speaking about. I see my goodly friend the Hon. Member Mr. Norman Whittaker shaking his head because he knows what goes on at Mabaruma. He was the Chairman there when I was doing similar things in that region.
We have also sent similar teams to Mabaruma. What have we done there? Surgical correction of club foot, surgeries that would have had to be done on the coast in the past - hysterectomies - those things are happening. We keep increasing the number of doctors in those regions. I empathise with Mr. Allicock when he noted that presently Aishalton does not have a doctor, but I must correct him to say that it still has the pre-retired medex. What I want to tell you, Mr. Speaker, and Mr. Allicock is that Dr. Celestine Haynes, who up to a few years ago was in the region, had to be withdrawn to be sent overseas to become an eye specialist. She will be coming back shortly.
Further to that, I will tell you, Mr. Speaker, that very shortly two doctors have been identified to travel to Lethem. One will be travelling on April 22nd and the other on May 3rd to add to the already expanded capacity of doctors in Region 9. Remember the time when it used to be only the hard-working Dr. Idun [Ms. Wade: You like to gaffe.] This is called gaffe. The fact is that it will be having two more doctors, and they were just complaining. What respect do you have for our indigenous folks if we call this gaffe?
I would like to say that at Aishalton there is now a medex who is on pre-retirement, but in the meantime we are in the final stages of training. [Mrs. Backer: What would the medex do?] Those were the people you had there for decades before the PPP/C started to send doctors in droves. What I am going to say is that there are some twenty-eight medexes in training and some of them will be going to Lethem and the other parts of Region 9 to assist the two doctors, in which my goodly colleague, here, is preparing, because they are the angels, should I say, of the Public Service Ministry, their contracts to go ahead.
Mr. Speaker, I see that I have your attention, we are strengthening Region 9. What I want to say is this: That there was a continuous refrain that there is unemployment - that this administration does not help young people; that this administration does not help indigenous regions and that this administration marginalises. What could be marginalisation here when I am sending my young doctors who have just passed through the Georgetown Public Hospital Corporation?
What I want to say further is this: There are lots of doctors coming back. Over two hundred and seventy doctors will soon be in the system and the Opposition Members can applaud the PPP/C Government for that. What do they know besides that bland figure? They need to know that a significant number of them are indigenous youths. Under the past two administrations of the PPP/C, indigenous health has been put on the front burner. Indigenous health has been given a massive shot in the arm. Nurses from the hinterland are being trained at the New Amsterdam Nursing School. Besides that, take from Karasabai, the nurse now is a trained anaesthetic nurse, and so on and so forth.
I will not dwell exclusively on Region 9 and at the same time I will move on but must emphasise that the PPP/C, not only is looking at training young people, but it is looking at putting them in the jobs. [Dr. Norton: Training of Amerindians?] Yes. We will continue to train Amerindians. Do you have an objection to that? How can that be offensive? Mr. Speaker, protect me. Training of Amerindians is offensive. Where are we going?
We are training young people to get into the health sector and at the same time to achieve our Millennium Development Goals. We have taken a commitment with the international community to achieve the Millennium Development Goal number 4. Let me tell the Opposition Members what this is all about because they seem to be floating a bit. They are really in deep waters. It also referred to as MDG 4. It refers to safe motherhood. Yet another batch of midwives has been graduated and there is yet a small batch, small but significant, of trainee midwives.
There is a postgraduate programme in obstetrics and gynaecology right here in Guyana, but colleagues it is not a wishy-washy Third World invention. It is a programme that is stewarded, mentored and assisted by international centres of excellence, so that when, in a few years, those obstetricians/gynaecologist will be graduated they will be internationally certifiable. This, again, is to ensure that our under-five mortality and our safe motherhood, under MDGs 4 and 5, are achieved. We are in the process; it is in our grasp. We do not have to part the waves to cross, to get there. We are sailing smoothly to that. I am happy that this budget, although it has only given us a modest absolute increase, is positioning the health sector and my health sector provider to build, as the Hon. Member Ms. Manickchand said, on the gains of the previous investments.
Now under the effort to introduce other services, a neonatal Intensive Care Unit (ICU) service has been introduced, that is, intensive care services at the Georgetown Public Hospital Corporation. These services, even as we speak, are in the process of being rolled out at Linden Hospital Complex. Linden Hospital Complex, incidentally, is one of the best run hospitals in the country. It has also been introduced in the West Demerara Regional Hospital and later in the year it will be at the New Amsterdam Hospital. What does that mean honourable ladies of the audience? It means that the under-five mortality should further decrease because the neonates accounts for as much as forty-five per cent of deaths in that subgroup. We are getting there. The health sector is on the move; Guyana is on the move as far as health is concerned.
We have also introduced other services and are expanding them, specialised services, even before we come to the specialty hospital. Cardiac services are being or have already been introduced and are being expanded. If one goes into the mountains, for example, or if one goes on a fishing expedition into our rainforest and gets a seizure, we are continuously there. The Ministry of Health does not sleep, and, of course, the Minister too, with the Ministry of Health, so we can extract that person and will bring him or her to the Caribbean Heart Institute. We will have our own trained Guyanese cardiologist backed by a Canadian-supported cardiologist who will be able to do an echocardiogram on that person and decide the way forward and then take that person to the catheterisation laboratory (cath lab) and patch that person’s heart up. This is important because we are now experiencing an epidemic of non-communicable diseases. It is now in the lexicon and incidentally it touches high and low, slim and chubby and even those who are hugely endowed, smokers and non-smokers and abusers of alcohol and those of us who use too much salt. The services have been expended and I would like to point that this budget allows us to consolidate. We will be, for example, able to manage our medications and medical supplies better.
On International Women’s Day, this year, we commissioned a huge, a massive, a modern, a state-of-the-art - I like that term - warehouse for our medications. It is computerised but still it is having problems because it cannot exist outside of the system. Sometimes there are human errors on the periphery, ordering the drugs too late or collecting them too late. The Minister of Finance, over the past few years, has joined the Government of Guyana’s budget with international donor agencies to contribute, or get moneys, enough to build an half of a billion dollars structure. This is what I mean by the economy of savings. I want to thank the United States Agency for International Development (USAID) to join in partnering with the Government of Guyana and the Ministry of Finance in helping us with that facility. This is what I mean by the economy of savings. Too often, in the recent past, we were allocating adequate moneys for medications and supplies but some got expired, some got spoilt. Definitely, this new facility, which is located not far from the ‘buster’ sign in the new Diamond housing estate, will put pay to those losses. As a matter of fact, it is finished. The Ministry has gone through the teething stages of the introduction of this facility and we are seeing some positive changes.
I heard from across the way that someone from Linden is indicating that Linden might be marginalised and that person seemed to be emphasising the reaching to that person’s constituency, grandstanding, I suspect, for the cameras. I decided to flip my notes to things that are not in the health sector but at the same time support them, what we now refer to as the determinants of health - good water, good electricity.
Let us take Linden. I am told, for example, that the national per capita expenditure on water is some $15,000. My calculation shows that for Linden, Mr. Pastor, the honourable, and Region 10, it is some $30,000 or twice that figure per capita per year. That is what is the per capita. Now I hear the resounding silence. [Mrs. Backer: It is because of nobody is listening.] Well, how did you hear me say that? I am really enjoying this. Linden is listening. The per capita of national investment in water in Linden, by the Ministry of Housing and Water, under the able leadership of my honourable friend, Mr. Irfaan Ali, is $30,000, whereas nationally it is $15,000. Do the higher mathematics, Mr. Greenidge. The higher mathematics implies that we are discriminating in that social determinant of health called water in favour of Linden by a factor multiplied by two. Linden is listening. [Mr. Greenidge: Nonsense.] That is not nonsense; that is water.
Electricity, which also benefits our hospital: I understand, for example, that the electricity subsidy for Linden is five times the national per capita, average. If we were to look at the entire package for our beloved old-aged pensioners in Linden, many of whom enjoyed the services of one of the best run hospitals in the country – I want to thank the team that is running that hospital, especial the Medical Superintendant, my good friend, Dr. Riystat - are also enjoying a discriminatory status. They are having two times more of the sum benefits of the national average.
I will now move off from Linden. I just thought that I should have ruffled some feathers because I know Linden is listening. I have succeeded, Ms. Teixeira; you are right. I will enjoy looking at this, again, when I go to Linden, on the television there. I think I have made the point.
I would like to close by saying… [An Hon. Member: You do not have to close]. I usually have long closures. Whilst embarking on this closure I would like to tell you, Mr. Speaker, that one of the five underlying principles of the health sector, which was mentioned by Ms. Ferguson, equity of access, the number one, we cannot, as a poor nation, hold a fully trained team in every corner of the country, but we can bring the patient having certain needs to that team. This is the gist of why Mabaruma Hospital was. Listen to the story. Listen to the legend. Why Lethem Hospital was built and basic staff was put there? Every time a team, led by Dr. Fawcett Jeffery, goes in the young doctor who works with them will get some of their skills and then after three to four to five years that youngster will come out for postgraduate training. Many of them will want to go back. As a matter of fact, some of them are so dedicated, such as the present head of the Lethem Hospital, that they do not want to come out in the first place. Praise those young people. Mr. Speaker, how do we, in such a huge country…? Do you know that this country is large as the United Kingdom? But we have a population that is small as one borough in London and it is spread all over. This PPP/Civic administration is committed to taking those services to them or bringing them to the services.
Let me tell you about the medical evacuation programme of the Ministry of Health. We are able to, and as I told the Member, this is not… Can I get a wee bit more silent or noiselessness? If we can bring out an Amerindian woman who is having a difficult labour, now and then, or a snake bitten patient, we now have thanks to the efforts of Mr. Harry Persaud Nokta, in the recent past and Mr. Robeson Benn, now. There are over one hundred and fifty serviceable airstrips in this country. In 1992, this Government inherited seventeen bruk down ones and it repaired and expanded. [Mrs. Backer: The drug lords know about them.] You seem, my dear Mrs. Backer, to be very in amoured with the drug lords. I would not want to go there.
The medical evacuation programme for the past year, 2011, we were able to bring out one hundred and twelve flights bringing out one hundred and forty-six patients, predominantly indigenous persons, but also anyone else, and that does not preclude a person being a professor, a politician. Once that person is sick I will go and get that person. I will bring that person out. These are expensive undertakings. I want to congratulate our pilots on this hundredth anniversary of aviation. I want to recognise the Dalgetys of the air wings of the Guyana Defence Force (GDF), the Jerry Gouveias, the Captain Fazil Khans, the Chan A Sues who would almost at any time of the night respond to a mercy call. Those incidentally are some of the same pilots who take my medical-surgical missions back in.
Mr. Speaker, in wrapping up, in these three last minutes, in 2011, we brought one hundred and twelve flights, sometime in the death of night whilst you are sleeping, four feet in bed, we are working. The aviators of this country are working; praise them in the hundredth anniversary, the centenary of aviation in Guyana. Then in the year 2012, we brought out one hundred and seven flights with one hundred and fifty patients. I am told that one hundred and thirty-five of those were indigenous people. These are costly things. I would like to… [Mr. Greenidge: That is an abstraction.] This is not abstraction. Mr. Greenidge seems to be going wack. Those were patients; those were women in labour; those were people with gunshot wounds.
Mr. Speaker, I would like to close, after having caught your attention, by quoting the Hon. Minister of Education, my good colleague, Ms. Priya Devi Manickchand, by saying:
“This budget has much for many. It must not be cut by persons who do not understand processes; it must not be cut by persons who are uninformed and you need to consult with your constituents.”
This budget, in closing has much for many and I will like to fully endorse it. I would like to recommend it to the press corps that is here; I would like to recommend it to the public in the public gallery and, more so, I would like to recommend it to those conscientious Members across the aisle, in the Opposition. Let us support it. I know I would not get the support of Mr. Greenidge, but I did not say that he was conscientious.
Mr. Speaker, thank you and I would like to endorse the budget presented by the Hon. Dr. Ashni Kumar Singh. [Applause]
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