Is it adequately meeting and addressing the needs of the under serve?

by Hubert Pipersburgh

Access to effective medical technologies, such as vaccines and HIV treatment, has dramatically lowered child mortality across the globe and afforded millions the opportunity to lead productive lives. Yet, the recent deaths of a dozen or more newborn babies in the neonatal intensive care unit in the first 21 days of the month of May at Karl Heusner Memorial Hospital (KHMH) appears to be a tipping point in Belize’s public consciousness. Belizeans have been asking themselves some tough questions: why does this happen so often and so much more in Belize than in other countries?

Additionally, the national attention over these babies’ deaths are shedding more light on how unsafe infants and the general public actually are in KHMH. It is apparent that the country of Belize has a broken healthcare system, with little to no public surveillance and limited accountability.

Perhaps more damning, is that most of all, this type of neglect happens simply because it is allowed to happen. There is a culture of impunity. It is also a focusing event and indicator that KHMH handling of its patients is a problem and not just a condition. As such it is now front and center and a legitimate public policy issue that demands a comprehensive rational approach.

In the U.S. the central debate between Democrats and Republicans is over whether the free market works well in healthcare. Republicans make the case for the market, arguing that people need to become consumers of healthcare so that they, not insurance companies, not the government, actually see, feel and pay the bills. That will force primary producers of healthcare such as doctors and hospitals to push down prices and drive up quality. At least, that’s what happens with groceries, television sets or computers.

To a certain extent that may well hold true, it may also be well and good for the U.S. However, Belize seem to have adopted that policy as it relates to healthcare availability and delivery. Simply adopting from up north without first examining how it effectively applies to our local circumstances is typical of the way things are done in Belize. This leaving the poor to fend for themselves attitude have further widen the gap between the disenfranchised masses and the well to do.

This discriminatory way of providing healthcare neglects the fact that even in rich countries markets don’t function efficiently in healthcare. In Belize’s case we do not necessarily approach our health needs from a public health standpoint meeting the needs of the under serve, rather it is a preferential classicist, income based system.

Chief among the reasons are healthcare unlike public safety is not considered a public good which by definition is non-rival non-exclusive. Therefore, it must be avaiable to all without discrimination because it is underwritten by the taxpayers.

Conversely, Belizeans now generally view access to medical care as a right. According to this view no one should be denied medical care or suffer remedial illness for lack of financial resources. There is widespread agreement on this ethical principle. The tough questions arise when we seek rational strategies to implement it.

There is also something fundamentally flawed and very telling when the very leaders of our country including the minister of health that pushes these bottom line neo-liberal policies in healthcare preferred choice for treatment for them and their families are elsewhere and not at the KHMH facility. Furthermore, this underscore the perception to the poor in our society that the economic deck is stacked against them and that the economic system favors the wealthy. Those who are suffering economically are also extremely concerned about inequality. This should be of major concern to all in our society because unequal societies, with less-inclusive institutions, have greater difficulty sustaining growth.

Consider the following: according to the CIA fact book Belize’s infant mortality rate is 21.37/1000 live births as compared to Cuba 4.83/1000, Guatemala 25.16/1000, and Mexico 16.26/1000. This comparison is alarmingly high because it is disproportionate to the relative size of our population. Cuba a country that has endured one of the worst economic embargo in contemporary times by the world’s most powerful economy. Yet and still, Cuba’s infant mortality is among the lowest in the world and the lowest in the Americas including the U.S. In addition, Cuba’s population is approximately 11 million, Mexico 112 million, and Guatemala 15 million respectively. Belize have a population of approximately 350,000. Viewed within this empirical data context, it is painfully obvious that healthcare in Belize to the vast majority of poor disenfranchised, Belizeans is not a priority. That fact is further buttress by World Bank data that shows Belize only spending an anemic 5.2 % of GDP expenditure on healthcare for the past fiscal year.

Moreover, there is no way given the relative size of our population that our infant mortality rate should be that high. This apparent paradox a small population combined with poor health statistics for the vast majority suggest that Belize’s healthcare problems center more on access to care, education, and prevention of health problems than on the quality of care available.

In addition, providing adequate healthcare to one’s population is also an indicator of a country’s level of commitment to arguably its most important resources the people. In short, this data also helps to highlight the fact that those babies tragic death at KHMH is by no means an anomaly, but an endemic systematic failure of our healthcare system in Belize. Hence, we cannot return to the status quo ante. This tragedy must never be allowed to happen again.

The protests must not subsides, the anger that many feels must remain palpable and media attention must continue to highlight the problem. People are genuinely upset, but it needs to sustain itself to lead to real structural reform and change in our healthcare delivery. It is a cruel irony the Belizean people are humble and caring, but they have some of the worst governance and politics that may prevent any thoughtful policy formulation and implementation as it relates to healthcare.