Dr. Mahadeo: Mr. Speaker, we all, in this honourable House, are familiar with the immortal poem/prayer of Rabindranauth Tagore. It should set the tone, in my mind, and should be the guiding principle of this and all budget debates in this honourable House.
“Where the mind is without fear and the head is held high,
Where knowledge is free,
Where the world has not been broken up into fragments
By narrow domestic walls,
Where words come out from the depth of truth,
Where tireless striving stretches its arms towards perfection,
Where the clear stream of reason has not lost its way,
Into the dreary desert sands of dead habits.
It is an honour for me to stand and support Budget 2013. Congratulations are due to the Hon. Minister of Finance and his team for producing one of the best Budgets of free Guyana. In addition, I want to congratulate the Hon. Dr. Ashni Singh on an erudite presentation that was done in simple language. The figures presented in his speech gave us a synopsis of what achievements were made over the last year and what are the goals and some targets that are set for this year.
I stand proud as a Guyanese and, even more so, proud to be a representative of the people, representing the PPP/C on this side of the House, being a part of the Government that presented the Budget that has introduced the first step that assists with electricity cost for all pensioners as compared to the rest of electricity consumers in the country. I am sure the Minister of Finance would have liked to do more but we have to live within our means.
Before I continue with my prepared presentation, I would like to divert and deal a little bit with some of the points raised by my Hon. Colleague, Dr. Norton, Hon. Member – he is not here – and to point out that I received a note from the representative of Region 7 which stated that it is not accurate that the Bartica Hospital does not have reagents to do laboratory tests. Reagents are available at the hospital and they were bought through the Region 7 health budget.
Mr. Speaker: I have asked that Dr. Norton return to the Chamber. I have noticed that Members are making presentations and leaving after. It is important, courteous and good debating to be able to hear both sides because there may be a point of clarification that may be needed.
Dr. Mahadeo: I want to point out that it is not always the case that we get everything from the Materials Management Unit (MMU) of the Ministry of Health, but within each Region we have funds available that we could use to buy reagents, drugs, and materials to tide us over until supplies come from Georgetown. In this case, that is exactly what officials from Region 7 did.
In addition to that, I would like to point out that every death is one death too many, especially if it is deemed avoidable. But the reality is that people die. The reality is that whenever, in particular, medivacs have to be done, it just does not happen. It takes a lot of preparation and it takes a lot of coordination for a successful medivac. In the particular case that the Hon. Member mentioned, I am advised that to fly in the night, two Instrument Rating (IR) pilots are needed by law and that cannot be changed by the Ministry of Health. In that particular case, the pilots were ready and the plane was ready to leave at minutes to 6.00 p.m. but the patient succumbed shortly after.
In 2011, 105 successful medivacs were done, and in 2012, 112 successful medivacs were done. In addition to this, we heard the Hon. Minister of Health mention that there would be more professional teams going into the hinterland areas to assist people in those areas so that they would not have these issues that can be complicated later on.
The diarrhoeal outbreak had multiple causes, and any medical person would know that. There was not just a single cause. It was mentioned to me, also, that at that time when there was the diarrhoeal outbreak in the Interior, were ships with people in it and they were defecating in the water. That would cause the outbreak; also a lot of rubbish was being thrown in the water. The Ministry of Health’s response was adequate and, as we saw in the newspapers, there have been no additional cases recently.
In his speech, the Hon. Member also mentioned staff shortages. But, as my Hon. Colleague Dr. Persaud mentioned, I really do not like to go back in time, way back in time. But if we are to compare the numbers in the healthcare system with when I started working in the health system in 1990, it is a major difference. My experience at the New Amsterdam Hospital is that there were two doctors.
In addition, I remember that when the issue of mental health was raised when I did my maiden speech in 2009 – that was the first speech I made when Dr. Austin, who was a Member of this House had raised the issue – I reminded Members that from the time when it was the Hon. Member Gail Teixeira, who was then Minister, to Minister Jeffrey and Minister Ramsammy, there was special emphasis placed on mental health. We have not resolved the problem and that is a fact. We have not resolved the problems but we are making progress.
I also remember that during that presentation, I invited the Hon. Members, Dr. John Austin and Dr. Norton to come, whenever they had an issue or situation that they thought they wanted to discuss, to discuss it with me and the Minister of Health and at the Ministry of Health. I had also mentioned then that we should not wait for occasions like these to raise the issue. Again, I am going to invite the Hon. Member. Let us not wait until Budget time and let us not keep all of these things like we are keeping secrets in our pockets to come at Budget time, one year after, to say, “Remember I said so and in the course of the year, this is what happened.” If a Member identifies a problem or issue, we are open and willing to discuss it. We want to share our ideas; we want you to share your ideas and we would really like to have your suggestions so that when it comes time for the Budget debate, we can all stand and say, “I made this suggestion; it was implemented; it worked and so we avoided…” I think that would be a better presentation to make.
I want to outline briefly how the Budget was prepared in Region 6. Each of the 5 programmes – Regional Administration and Finance, Agriculture, Public Works, Education Delivery and Health Services – prepared their own submissions. This was done after extensive consultations with the different areas and departments. In the case of Health in Region 6, for example, each of the hospital, the Maternal and Child Health Department (MCH), and the Environmental Health Department made submissions. All were then put together at a meeting of the Heads where prioritisation was done. This was submitted to the Ministry of Health and then to the Regional Executive Officer (REO). It was put together with all the other submissions from the other four programmes in the Region and submitted to the Regional Democratic Council (RDC), then to the Ministry of Local Government and Regional Development, and then the Ministry of Finance.
At each step, questions were asked and justifications were given where necessary. The sum total of all the Regions is what is here after the Minister of Finance and his hardworking staff have done the hard work of fine tuning based on resources available.
The document we have as Budget 2013 has the input of the people from all ten Administrative Regions of Guyana. It details the proposed developmental works that can be achieved within the year, taking into account the finances we have available and, also, the capacity of the different entities and bodies to utilise the available finances for development in their specific areas.
I want to look at Region 6, along with my colleague, Hon. Member Jafarally. I am sure that Region 6 holds a special interest for quite a few Members in this honourable House with quite a few of us having our roots there.
In looking back at year 2012, I will be one of those who will openly say that there are areas that we could have done better in. Did we get complaints? Yes, we did. Did we hear that some staff were rude? Yes, we did. Should we have had a maternal death? No, we should not. Should we have had blackouts? No, we should not. Should we have had a generator that malfunctioned, even once? No, we should not.
From all these experiences we have learnt. We have gained experience and we have taken corrective measures as far as humanly possible. Taking all of this into consideration, Region 6 has progressed over the last year and I can say, with a clear conscience, that we are better now than where we were before. I will try to highlight a few instances of what we would have done and some of our achievements for the last year whilst, at the same time, indicate some of our plans for 2013.
In Region 6, there are monthly RDC meetings, quarterly Regional Advisory Committee (RAC) meetings, and monthly Heads of the Department meetings within different programmes. A monthly report is submitted to the Regional Executive Officer (REO) from the Heads of the different programmes.
Contracts are awarded for works to be done using the Tender Board procedure, a process that is transparent.
The Regional Chairman visits the community on a scheduled programme of visits and also on an as needs basis. There are regular face-the-community meetings with the last round just being completed. At these meetings, we get feedback from the community as to how they see the developments taking place in their area. Where there are issues, the opinion of the community is sought on how the problem can be best dealt with.
Within Region 6, there are some areas of concern that are being targeted by the Regional Administration along with the Central Guyana. One such area that I would like to mention is Angoy’s Avenue, a very large community. The sad thing is that over the years, there have been some issues which are out of the hands of the Government and RDC and these issues are in court. This has hindered development in some areas, especially in the regularisation of the area. In spite of this, the RDC of Region 6 has managed to construct and staff a health centre – one that is fully functional – in Angoy’s Avenue. In addition, seven roads were constructed and a playground was developed.
The Regional Chairman of Region 6, Mr. Armogan, has been in discussion with those persons who have the court matter pending and the news that he gave me yesterday is that those people have indicated that they are willing to withdraw the matter so that the Hon. Minister Ali can do the necessaries. This will clear the way for the people to get electricity and, of course, to also enjoy the benefits of this Budget’s subsidy to Guyana Power and Light (GPL).
A doctor is attached to the health centre at Angoy’s Avenue and will be working one day per week from 1.00 p.m. to 9.00 p.m. to facilitate persons who are working the regular 8.00 a.m. to 4.00 p.m. shifts, especially working mothers. This, for us in Region 6, is an experiment although it was successfully implemented in other parts. If this experiment is successful, it will be implemented in other large health centres in Region 6.
In 2012, in the area of capital public works, $115,700,000 was spent. Some $26 million was spent on bridges. Just to give an idea, it was all across the Region. Bridges were built at Port Mourant, Warren, New Amsterdam, Letter Kenny, Friendship, Limlair, No. 19 Village, Crabwood Creek, Whim, No. 72 Village, Yakusari, Nigg, Belvedere, and Tain.
Some $67.7 million was spent on community roads at No. 68 Village, No. 71 Village, Friendship, Crabwood Creek, Mibicuri, Cumberland, Manchester, Albion, Joanna and Auchlyne. And $22 million was spent on existing and new housing schemes to set up road networks at Canefield New Area, Albion back and Market Street at Adelphi.
Each one of these roads and bridges were inspected by the RDC Works Committee before payments were made. I hasten to add that the Work Committee comprises of members of all three parties, PPP/C, the Alliance For Change (AFC) and A Partnership for National Unity (APNU).
For 2013, for urban and miscellaneous roads, 69 roads, at a cost of $850 million, will be constructed through the Ministry of Public Works; 15 roads under the Urban Roads Programme in the three municipalities will be built at a cost of $67.7 million; and 32 roads will be constructed in 14 Neighbourhood Democratic Councils (NDCs), under the Miscellaneous Road Programme, at a cost of $262 million.
In the health sector, $31.5 million was spent on buildings, $6.5 million was spent on an ambulance, and $21.5 million was spent on medical equipment.
A building was constructed to house a new X-Ray at the Port Mourant Hospital and a new health centre was also constructed at Port Mourant. Within the last few years in Region 6, we have had new health centres built in Siparuta up the Corentyne River, in Skeldon, at No. 53 Village, at Whim, at Port Mourant, and in Angoy’s Avenue.
I have said already that we learn from our shortcomings and, along this line, I asked the REO of Region 6, Mr. Paul Ramrattan, if he has put any systems in place for better management and accountability. He replied that the regional administration will ensure that all programme managers manage their voted provisions prudently in order to get value for money and to reflect greater accountability and transparency for all transactions.
In fact, after the last meeting with the Public Accounts Committee (PAC), held a few weeks ago, the REO is implementing a number of changes that were recommended by Mr. Greenidge, Hon. Ms. Gail Teixeira, Hon. Mr. Lumumba, and Hon. Mr. Manzoor Nadir. Some of the suggestions that they made and advice that was given include the stores and logbooks monitoring and the clearance of cheque orders within the stipulated timeframe. He has already implemented a stronger system of internal controls by boosting the internal audit department.
In addition, the regional administration has enforced the rule that all variations of works, whether it is a change of scope or additional works that involve the use of contingency and provisional sums, must get the relevant National Procurement Tender and Administration Board’s (NPTAB) approval before the execution of such works.
Health Care Delivery
Although no one can claim to have achieved perfection in Region 6, the Maternal and Child Health Department, at the primary health care level, has done exceptionally well over the years and, in particular, in 2012. Whilst for 2011 the MCH Department won the national award for the best introduction of a new vaccine, for 2012, it copped all three national awards, those being best introduction of a new vaccine – the Human Papillomavirus (HPV) vaccine, Best Immunisation Coverage, and the best Maternal and Child Health Department in the country.
I want to specifically point out immunisation coverage because the whole of Guyana has done well, consistently, under the guidance of the Ministers of Health, including our present Minister of Health. But Berbice Regional Health Authority (BRHA) got the Best Immunisation coverage because of the 16 vaccines the staff managed to get, 98.3 per cent vaccination coverage for one vaccine, and 100 per cent coverage in all 15 of the rest. Yes, Mr. Speaker, it was 100 per cent.
Please permit me to publicly thank the Senior Health Visitor ,Terry Davis, and her staff in the 26 health centres and health posts across the Region. Like the Hon. Minister of Health pointed out, the staff went out on holidays, Saturdays and Sundays, at 6 a.m. in the mornings, in the evenings and at all hours to make sure our children are vaccinated against vaccine preventable diseases.
I need to mention that the HPV Vaccination Programme has been a tremendous success in Region 6, with 100 per cent coverage for the first dose, 63 per cent for the second dose and already 30 per cent is receiving the third dose. I am also asking for help because there are some who are peddling misinformation about the vaccine. In fact, at one of our riverain health centres, a mother has indicated that her two daughters received the first and second doses but she will not allow them to get the third dose because of advice she got from someone. This, we need to correct.
In addition to this, at the primary health care level, the Berbice Regional Health Authority has been delivering health care guided by the package of publicly guaranteed health services in Guyana, using the primary health care team approach.
I also need to mention the 15 additional staff, including midwives, nurses, community health workers and health visitors, who have joined the primary health care team. This is across the board; it is not only in Region 6, but in all institutions, health centres and hospitals. Across the country, we have had an influx of trained, qualified staff. We had a successful health march across the Region. It was our third such annual health march where health education, health promotion and sensitisation for healthy lifestyles were the main focus.
In our Budget 2013, we are proposing to purchase All Terrain Vehicle (ATV) for the use of the health staff at Orealla and Siparuta. The midwife at Siparuta already has a motor bike and does her rounds and visits to Orealla using it.
We are also purchasing a boat engine for use by that hinterland community. Baracara has its own boat and engine and Siparuta will have its own boat and engine; and taking into consideration the terrain, an ATV for the health care delivery to the communities of Orealla and Siparuta will be provided. Of course, we also provide fuel for the Government’s work. It means therefore, that all our hinterland communities within Region No.6 have the necessary means of transport to deliver quality healthcare.
We will be demanding of our primary health care staff that they provide the same and even a better level of care across Region No.6. And we expect them to again reach their targets.
Accountability to the Public for Health Care Delivery - for 2012 we had 25 Face the Community meetings at 25 different Health Facilities across the region where the staff reported to the public on the achievements and constraints of the last year. Of note, is that each one of these facilities organised a blood drive either on the day itself or just before; these meetings were highly successful and productive. Communities are slowly but surely taking ownership and the citizens are coming to the realisation that they pay the Public Servants and are, therefore, the ones to determine the quality of service they receive. The people of the community are empowering themselves. They are now more interested in the management committees of the different health centres and . In fact, our award ceremony has prizes of a trip for two to Kaieteur Falls for the champion worker, overnight trips for two to Mainstay Resort for the best eight workers, two peoples’ choice award of $50,000, and a best health centre award. All these prizes are donated and sponsored by private individuals and companies. And I want to thank them publicly. This annual ceremony proves to be a good incentive and a morale boosting stimulus to our workers.
• Blood Collection – last year we sent 1,006 Units of Blood to National Blood Transfusion Service. Of note, is that Orealla and Siparuta, two Amerindian villages located up the Corentyne River, demanded that blood drives be done in their communities and the drives were very successful.
• Basic Nutrition Programme – adequate sprinkles were given to all mothers and infants at all the different health posts and health centres.
• Diabetic Foot Care Centre – saw patients with diabetic foot in their hundreds and nearly 1,000 patients had the 60-second screening done at the health centres. This programme will be expanded in 2013.
• Visual Inspection using Ascetic Acid was offered at the New Amsterdam Hospital and the Skeldon Hospital with a satellite clinic in the Health Centre. This service will be expanded in 2013.
• VCT – this service continued to be offered at all the centres with a 100% acceptance in pregnant women. Our two treatment sites are now managed by our locally trained doctors
• Monitoring & Evaluation – 4 Patient/Client satisfaction surveys were done. Over 600 complaints were received by that department and were all investigated and 95 percent resolved within a very short time.
Our hospitals continue to get more staff to assist in the delivery of Health Care. At the National Psychiatric Hospital we have the specially trained Psychiatric Nurses and the Psychiatric Patient Care Assistants to boost Health Care Delivery. The compound is being improved and we hope within a short time the cricket ground will be used to play cricket again. The Occupational Therapy Department will soon be establishing a garden to assist with the reintegration of patients.
The New Amsterdam Hospital has additions to its complement of Doctors with some junior doctors improving their skills under guidance. Hopefully within the year the Neonatal Intensive Care Unit will be functional. And with the present Budget we will be able to replace some of the old equipment we have in the present Intensive Care Unit of the Hospital. We also propose to purchase two Ultrasound Units to be placed in New Amsterdam and Skeldon Hospitals.
We had four patient/client satisfaction surveys done, and we had external assessment and evaluation by Pan American Health Organisation/World Health Organisation (PAHO/ WHO).
Care for the elderly and bedridden - our special home-based care programme entered its third year. On our register we have 424 patients that are receiving visits from a doctor and a medical team on a planned, regular, basis based on their needs. The Programme has been expanded a year ago to include those over 70 years who would like to be on register. And six months ago was again expanded to include mothers and infants who do not come to the primary health care facilities during the first 11 days of the infant’s life that is after delivery.
It is a well-established fact the average life span in Guyana has increased into the 70s, and this brings about its own challenges especially for health care delivery. In Region No.6 we have introduced a special day per month at the primary health care facilities to provide care for the elderly. This has started at a few large health centres and then will be spread across the region.
Taking into consideration the threat of chronic non-communicable diseases, within the month we will also be embarking on a new project using a village to village approach to check diabetics using the 60 seconds foot screening test – a test that has helped to identify potential problems with diabetics. This has helped to drastically reduce amputations across the country. We will also be checking the eyes of the diabetics and the elderly based on a request from the Minister of Health. We expect to complete this exercise across Region No.6 within the next six months and to share our experience.
Environmental Health - with a staff of three Environmental Health Officers, one Port Health Officer and seven Environmental Health Assistants, the Department has managed to achieve quite a bit. In addition to being attached to the different NDCs and Municipalities they managed to do water sampling once per month from different wells plus the water filtration systems that we have at the New Amsterdam, Port Mourant and National Psychiatric Hospitals.
In addition, 5,092 inspections were done and defaulters were advised and some even taken to court. 552 food handlers were trained. We plan to continue the same work in 2013. There are lots more to be said. For example, I heard one Member heckle saying that comparing the moneys public servants are getting now to before shows that they were better off. As a junior doctor in 1990 I received just over $1,000 per month, at an exchange rate of G$94 to US$1, giving me just about US$10 whilst now the minimum wage is about US$200.
My colleague, Dr Persaud, said one should not go back to those days, so I will not. Those are the real days of black holes to quote Hon. Mr. Carl Greenidge; and scary budgets. However, one does not expect that the truth to be twisted. Mr. Speaker, I would like to say that I have heard from both sides of this Hon. House Members stating that we need to be fair, we need to be honest and we need to be open. I agree with all of this. It is in that spirit I would like to ask the following questions:
• Who can deny sitting in this Assembly that 300 teachers had scholarships last year?
• That we have had over 2,450 new health care professionals?
• That we have doctors doing post graduate studies in paediatrics, surgery, obstetrics Gynecological , emergency medicine and orthopeadics?
• Who can deny that we now have heart surgery being done in Guyana?
• Who can deny that we have the largest rice crop ever in the history of Guyana?
• Who can deny that we had 518 Information Technology professionals added to our system?
• Who can deny that we have had 2,700 persons trained at the technical level? I dare anyone sitting in this Assembly to deny that we have had continuous growth over the last 7 years.
So in closing Mr. Speaker, we have not built all the roads, dug all the drains, built all the schools; we did the best we could with the resources available. The best description of this Budget is that it is an elections budget, meaning it has a special package for everybody. That came from the opposition. So this Budget throws at us a challenge to take Guyana to new heights. Let us accept this challenge in the interest of Guyana. Let us hold our head high, Let us not break Guyana into fragments, By narrow domestic interests, Let our words come out from the depth of truth, Let our tireless striving stretches its arms towards perfection, Let the clear stream of reason not lose its way, Into the dreary desert sands of dead habits, Let us allow our mind to be led forward by thee, Into ever-widening thoughts and actions, Into that heaven of freedom my Father, Let my country awake!
Thank you, Mr. Speaker. [Applause]