Speeches in the National Assembly

Dr. Cummings: Mr. Speaker, I am delightfully honoured and cheerfully thankful to be given this opportunity to speak and to contribute to the Budget 2014 entitled, A Better Guyana for All Guyanese. This caption comes close to APNU’s Manifesto theme A Good Life for All Guyanese. Permit me to sound a warning, that the APNU party will not be easily led, flattered, bribed or terrified by such a move but will analyse the Budget 2014 rationally and carefully and offer constructive criticisms and the necessary recommendations in order to move Guyana forward. 
I do join with my colleagues to say that Budget 2014, which was prepared and presented to this noble House by the Hon. Minister of Finance, lacks luster and has omissions. It was certainly not the best financial report. In fact, the cover page, notwithstanding some excerpts which appeared to be plagiarised, has shown and signalled the intention to the Guyanese populace that the future looks dismal and depressing. I staggered from what I saw and was bewildered by what I heard from the Hon. Members from the opposite side. I can only say that the Government’s Budget 2014 is full of ironies and eye water. The ironies put the country in a state of anxiety but the eye water exposes APNU’s depth of the Government’s callousness.
This minority Government brags a Gross Domestic Product (GDP) expanding 5.2%, real growth compared to a global growth of 3.6%, an inflation rate of 0.9% and a possible projected growth of 5.6% for 2014. It is a Government that boasts of surpluses and savings but leaves the masses and working poor in a state of dispossession, and the jobless poor in bewilderment and hopelessness. Development is a many-sided process, therefore it does not only involve an increase in material wealth but must include the general welfare of the citizenry.
On the matter of eye water, from the evidence given to us, we have seen that the Government’s mathematics has gone south of nation building because its leadership morality is sour to good governance which embraces accountability, transparency, disclosure and redress. The Government has not a single clue that the wealth of any nation is rooted in the health and well-being of its people. Nation building appears to be calculated and measured on which Ministry gets what and which supporter gets how much, but the nation’s health care system is in need of rescue and recovery.
It is my intention to share some concerns, to make some recommendations and to offer gain changing solutions that would put Guyana’s health care system on the road to recovery. The wish is for the Government to implement initiatives that will reflect a 20/20 vision of health care for Guyana.
Concern 1. Nowhere in the Budget 2014 is provision made for the improvement in the socio- economic status of the health care providers. Theory and evidence, yes, Mr. Speaker, the praxis has shown that carefully designed performance, based approaches, can align the incentives of the health workers with the societal goals of improving the population’s health which is a prerequisite for our nation’s development.
Health care workers are finding it difficult to make ends meet. Only a week ago approximately 19 nurses did not report for duty at the Georgetown Public Hospital Corporation (GPHC), owing to the unavailability of money as they struggle to pay utility, transportation, food and rent bills with the meagre salaries they earn. What kind of family would allow its members to go hungry?  What prevents the Government, which claims to be caring, from doing something about it? In our context, monetary motivation is still the preferred manner of encouragement for the health care workers, who provide preventive, curative, promotional or rehabilitative services in a systematic way to individuals, families or communities.
These health care workers look forward for the further 10%, after tax, increase in their salaries which had been budgeted for them one year ago. The health care workers have been deprived and are still to be paid their earned money. The health care workers look forward with great expectation to the said emolument with the requisite interest per annum.
The recommendation is that the Government provides significant improvement of benefits to the health sector workers to enhance retention and guarantee a higher level commitment and efficiency.
Concern 2. Mention was made relative to the extension of the wards of the Obstetrics and Gynaecology Department of the Georgetown Public Hospital Corporation, however, the Hon. Minister has not provided the methods that would be used to recruit more nurses or informed this august body of the anticipated additional burden which will be placed on the already drained and depleted nursing staff as a result of this expansion of service delivery. The Kaieteur News, page 11 of March 8, 2014, stated that over $364 million of the taxpayers money was spent on nursing education annually but the graduates are lost to migration to foreign countries. The taxpayers are certainly not looking forward to a brain drain but brain circulation.
To establish the point of shortages of trained nurses, it must be emphasised that out of the 120 eligible nurses from 255, who had enrolled for the three-year nursing course, less than 50% proved eligible to write the finals and out of the 50%, who were qualified to write the final exams, 15% passed, and in one county less than 1% of the nurses passed. This situation is a direct reflection of the large student to tutor ratio among other factors such as overcrowding, insufficient training materials and inadequate infrastructure. These are not nurses but these are postgraduate nurses who wrote the exams. Twenty-nine postgraduate nurses wrote exams and five passed. Thirty medex wrote their exams and one passed, and in this case the curriculum was not changed. This scenario leaves this noble House in uncertainty regarding the requirement of adequate nursing staff that will be available to aid the provision of safe motherhood, to attend to high risk mothers and babies who are being delivered.
It is recommended that the technical capabilities of the health care workers be strengthened, at all levels, through training and retraining, with the major emphasis being placed on strengthening supervisory skills.
Concern 3. In the Kaieteur News, page 11 of March 27, 2014, UNICEF’s representative, Marianne Flach, stated that Guyana is battling to achieve the elusive Millennium Development Goals (MDG) 4 and 5 which address specifically the reduction of infant and maternal mortality. Neonatal mortality, she said, is still a critical issue.
There are health indicators. Neonatal mortality rate – it means less than 28 days of the infant - the value here in 2004 was 15 per 1,000, which is higher than usual. Infant mortality rate, 2004, was 20.8 per 1,000. Infant mortality in 2013 was 34.4 per 1,000, it is increasing. Maternal mortality rate in 2004 was 115.9 per 100,000. Mortality rate in 2010 was 280 per 100,000.  There is the increase all of the time.
While the construction and outfitting of the proposed maternity waiting homes in Lethem and Bartica is a good gesture, this facility should be more decentralised with trained staff to respond to the growing needs in this area of health care service. The nine-bed Dr. C. C. Nicholson Hospital at Nabaclis, on the East Coast, should be staffed with more midwives to allow for a twenty-four-hour service.
Concern 4, the specialty hospital. Mentioned on page 40, section 4.78 of the Hon. Finance Minister’s speech:
“Efforts continue to advance the construction of Guyana’s first specialty hospital which aims to deliver tertiary level health care not previously available to our people.”
From time immemorial Guyana boasts five levels of health care service - level 1 - the health post, level 2 – the health centre, level 3 - the district hospital, level 4 - the regional hospital and level 5 - a tertiary level institution with specialists. It is a referral and a teaching hospital and I speak of none other than the Georgetown Public Hospital Corporation.
I think the wise thing would be to develop the already and existing tertiary level institution, which will result in less cost for the taxpayers. The specialist programmes, which are  done at the Georgetown Public Hospital Corporation with the University of Guyana, the Universities of Vander Belt and Ohio in the USA and the Columbia University in Canada, have begun to train specialists in areas of Orthopaedics, General Surgery, Internal Medicine, Paediatrics and in Obstetrics and Gynaecology to name a few. Those should be sustained.
The remuneration package of such doctors should be attractive with specialist salaries. The doctors should be encouraged and deployed to work in the three counties where they would be able to manage the patients efficiently and monitor them accurately. This would significantly reduce the incidents of patients arriving at the GPHC at a late stage of their illnesses. They should spearhead procedures such as mammograms, pap smears and visual inspection with acetic acid (VIA) among others.
Concern 5, emphasis on the specialty hospital rather than primary care. There has been a renewal of primary health care focus in the lead up to having healthy people and healthy communities. In fact, this approach has been touted to strengthen society’s ability to reduce inequities and it is as an essential condition for meeting commitments, including the United Nations’ millennium declaration. The latter addresses the social determinants of health and the achievement of the highest attainable level of health by everyone.
We recommend that primary care service should be complemented by different levels of specialised care, whether it is ambulatory or inpatient, but the focus should be at this time on improving the primary care system.
The APNU agrees, and joins with the authors of the Integrated Prevention and Control of Non Communicable Disease Strategic Plan 2013-2020, that there should be wellness centres and primary care services to promote greater integration of services to meet the needs of remote communities, including environmental surveillance.   
The APNU asks this august body to pay more attention to primary health care which would have wider scope and greater impact in promoting health and human development, rather than the deliberate orchestration to put in place mechanisms to foster the distribution of patronage to those who are perceived to be loyal or satisfied certain prescribed conditions.
Concern 6. Page 42, section 4.84 speaks about recognising the growing incidence of domestic violence and having a service to focus on the prevention and management of suicidal behaviours. We are fatigued with rhetoric and grandiloquence.
APNU recommends that there be proper data and documents to capture the factors and aetiologies that have attributed to this social problem, for example, the percentage of persons who are frustrated and jobless, the percentage of persons who are engaged in substance abuse and the age ranges of such persons who commit suicide. APNU recommends that this information be provided so that a matrix can be developed to look at the host, environment and agent for to address the cause and thus provide prevention strategies at a primary, secondary or tertiary level.
Concern 7. The Budget 2014 has not addressed the numerous cases of early childhood and teenage sex molestation which health care workers are asked to examine weekly or monthly, especially those who have teenage children. One police division had over 100 such cases in a year, the assaults ranging from the formative year of the child to the early to mid teens. These young children and teenagers are at risk of developing cervical cancers owing to early sex and with multiple partners in addition to sexually transmitted diseases.
APNU suggests that there be a structured guidance programme in schools and health clubs to address these issues. Also there be a revival of the child & youth friendly schools to disseminate information on health and what the children and youths need to know in life.
Concern 8. There has been an increased in human capital in the health sector by the return of 278 Cuban trained doctors but insight was not sought and adequate provision was not made for the young doctors, as they are being deployed and being made to work and function at facilities and health centres which promote a breach of patient privacy and confidentiality, as working space is inadequate, and supportive supervision is not encouraged.
The majority Opposition believes that visits should be made to the health centres with the expectation of addressing the concerns of confidentiality and making these young doctors comfortable to execute their functions.
Concern 9, the ambulances. One hundred and seventeenth million dollars has been allocated for the purchase of 12 ambulances. The Hon. Minister did not say if they were new or reconditioned ambulances. We are unsure if the words “new ambulances” will in effect be a minibus with a stretcher and Ambu bag. We request further information as to whether or not it will be a real ambulance that can sustain a patient’s life in the case of an emergency.
We are recommending that ambulances be sent to the hinterland and in areas in which  they are needed most and that they be fully equipped with life saving medical equipment so that they can really be used as a mobile intensive care ambulance.
Concern 10, procurement.  This topical issue has been addressed adequately by the Hon. Dr. George Norton. Concerns have been raised about the drug procurement and the New Guyana Pharmaceutical Corporation (New GPC), being the sole supplier of the nation’s drugs to public health facilities, the sourcing of medical drugs and pharmaceuticals and the implications.
Mr. Speaker: Hon. Member, you have five minutes to wrap up.
Dr. Cummings: While I am yet speaking, there is an insufficiency of essentials such as saline drops and infusion liquids, panadol tablets, soma. If a person suffers from arthritis that person is in trouble. The ordinary man on the street has to pay a higher price for medication, not only in the case of topical drugs such as ketoconazole and myconazole, but for other important drugs. The Kaieteur News, January 5 2014, revealed that His Excellency, President Donald Ramotar publicly blasted the health sector over the incidence of shortages of drugs and wastage of pharmaceuticals at hospitals and other health facilities, nationwide. He said:
“We spend billions of dollars every year to buy drugs yet we are confronted with shortage of drugs at health facilities nationwide”.
He went on to say:
“Millions of dollars of expired drugs are written off and dumped in large quantities, this is totally unacceptable.”
There had been two studies published approximately a year ago in journal on malaria that emphasised the use of fake or expired drugs in our non-governmental commercial sector which had led to deaths. We would hope that good sense would prevail and that the drugs to combat malaria, which are stated in the treatment guidelines, will be the correct and genuine drug being available and given to the Guyanese populace.
It is the expectation of this august body that the procurement practices be strengthened and there be an increased oversight of the quality of consumables. The clarion call goes out for the establishment of the Public Procurement Commission.
My last concern, sanitation.  It does seem that the Hon. Minister of Finance, and by extension the minority Government, is bent on not getting it right. Over $2.5 billion is allocated to the sector on the sanitation system which is established for the management and disposal of municipal solid waste and sewage. However, no plan has been posited or evidence of consultations being made among non-governmental organizations (NGOs), the residents, the business sector or the city council as to the way forward for an integrated solid waste management plan.
It is the wish that a plan be developed that will consider waste prevention, waste disposal and combustion or controlled burning and recycling and composting.
I will conclude by saying that the Budget 2014, which has been proposed, seeks to have us embrace the achievement of financial goals by clandestinely forbidding and disallowing the Guyanese people and the honourable House to identify wasteful expenditures.
The Budget 2014 disregards and has neglected the working poor and vulnerable. It attempts to focus on numbers rather than trying to have a direct impact on the quality of service being rendered. The spending projected does not reflect value for money.
I will reiterate that the Government’s Budget 2014 is full