Vincentians spending up to US$20 million a year to obtain health care overseas

Residents of St Vincent and the Grenadines (SVG) who seek medical care abroad due to the unavailability of certain services at home fork out between US$15 million and US$20 million a year for such medical care.

This was the revelation of Minister of Finance, Camillo Gonsalves as he presented a bill last week Monday, October 17 seeking the approval of Parliament to authorize the borrowing of US$30 million in additional funding for a project to strengthen the health system in SVG.

Both sides in the House of Parliament gave support for the loan to be obtained from the OPEC Fund for International Development (OFID) to supplement other funds already borrowed from the World Bank for the “Strengthening Health System Resilience Project.

The main element of the Project is the construction of the 140 bed Acute Referral Hospital at Arnos Vale on lands once used for the E.T Joshua Airport that has now been decommissioned.

Gonsalves said once this facility becomes operational “Some of that money will be saved with that care now being provided” in-country at the Acute Referral Hospital.

Giving a global sketch of the project, the Minister of Finance acknowledged that there are “major constraints in public service health care delivery” and he identified a paucity in tertiary level care among these constraints. Lack of this level of care is what causes patients to have to travel abroad.

As well, he noted the lack of regulatory oversight of facilities which offer private medical care, the reliance within the public health system on the services of visiting medical missions, and structural and functional deficiencies at the Milton Cato Memorial Hospital, the nation’s main health facility.

“We are going to strengthen hospital financing,” Gonsalves declared noting “We currently don’t make enough money from the hospital services, as some people say, the dance don’t pay for the light.”

He said the MCMH currently has an outdated fee schedule, a “collection system that is indifferent at best”, which is borne out in the practice of chronic non-payment of fees for services provided to patients.

The daily cost of a bed at the facility is $10 “but 80% of people who can pay don’t pay,” he said.

The finance minister said the “Project also seeks to address this management deficiency and overall reform the management of the health administration”.

The ‘Strengthen Health System Resilience Project’ has three components which together will cost around US$100 million.

The World Bank is providing the bulk of the funding through a soft loan of US$63.8 million at a half of one per cent interest over 40 years, with a 10 year grace period. However, this amount was not sufficient to finance the project, hence the decision to approach OPEC Fund with the blessings of the World Bank.

The OPEC Fund is providing the US$ 30 million loan at an annual interest rate of 1.5 %, a commitment fee of a quarter percent on funds not drawn down, and a front end fee of another quarter of a percent. The loan will mature over a period of 20 years with a grace period of five years.

The World Bank has given the government a five year window to complete the project, although the construction of the Acute Referral Hospital is scheduled to be completed within three years, towards the end of 2025 or early in 2026, Gonsalves said.

The project is jointly driven by the Ministry of Health and Ministry of Finance and Economic Planning.

Gonsalves said further than when the new hospital becomes operational it will be not just a building with equipment but one with “structures and reforms in place to ensure that the hospital is not run like hospitals of yesteryear…”.

In his presentation to Parliament, Gonsalves noted that this country has met several major health targets, including in such areas as maternal and child health care, tubercolosis, and births attended by trained health personnel. However where the Sustainable Development Goals (SDGs) are concerned these health targets have been uneven, and recent occurrences have impeded progress in attaining the health sector goals.

“Due to the health system’s limited resilience to climate shocks and non-climate shocks, the combined impacts of COVID, the volcanic eruption, and hurricane Elsa and all those other challenges, we are at risk of jeopardizing health gains and threatening some of our national ambitions in health,” Gonsalves elaborated.

With several clinics and other health facilities having had to be closed because of these occurrences, and services at the MCMH reduced by one-third “we felt and understood anew… the challenges that our health care system faces”.

On completion of the Acute Referral Hospital, the MCMH will be repurposed for use as a Maternal and Child Health Hospital providing maternity and paediatric care as well as Accident and Emergency services.