Caribbean Medical Journal CHALLENGES OF PROVIDING COMPREHENSIVE CLINICAL SERVICE WITHIN THE PUBLIC HEALTH SECTOR: A CASE STUDY OF THE PAEDIATRIC ONCOLOGY SERVICE
Discussion The need for an increase in the number of staff was identified as a high priority in all six departments. Trinidad and Tobago face an ongoing shortage of qualified health care professionals with many migrating to the United States, United Kingdom and other Caribbean islands (3). Members of staff also felt that access to continuing professional education was lacking with low wages identified as a major issue in the social work, laboratory and pharmacy departments. These departments form the key support framework for effective patient-centred care. The constant demands on staff where understaffing is the norm, in addition to working in a mentally and physically demanding field, often lead to “burnt out syndrome”, highlighting the importance of having a support service catering for staff mental health. Ongoing training both in-house and through collaborative effort with international centres utilising distance learning methodologies can meet the challenge of physician isolation and the need for continuing professional education [5, 6]. Infrastructural issues were another high priority area identified across all departments. Prolonged downtime for repairs of equipment and limited telephone and internet access contributed to inefficiencies in service delivery as the ability to carry out departmental functions and have good interdepartmental and inter-institutional communication were affected. Administrative challenges can be addressed through regular meetings of multidisciplinary staff to communicate changes in service procedure and process, identify specific challenges and share updates.
The results of this study could be interpreted as advocating for efficiency and change in the public health sector. It identifies the need for staff to be appraised of the administrative structure including staffing norms, recruitment, deployment, career path development and continuing professional development of the institution. It speaks to the fact that staff needs to feel a sense of ownership and be appreciated and respected. The issues of infrastructure, procurement and maintenance of fixed assets and the assurance of continuous and reliable supply of consumable items which haunt the public sector must be addressed. The paediatric oncology service is one example reflecting the bigger picture of the shortcomings in the public health sector. In order to move the services forward, a more in-depth assessment to solicit and examine key issues and priorities for improving the quality of service delivery needs to be conducted among the various departments contributing to health care. This will ensure “buy-in” by all stakeholders. This is not an easy task since the potential for conflict, paralysis or failure to move forward is always a possibility. Apart from manpower needs, the availability of data to inform decision-making is crucial. ICT has enormous potential as a tool to facilitate information flow, disseminate evidence –based knowledge and to empower the staff to ensure that the health care workers, the health system and the users of the system all benefit. Acknowledgements We wish to thank The UWI Telehealth Programme for developing this project and the staff of the Eric Williams Medical Sciences Complex who participated in the assessment.
With the exception of the pharmacy, operational issues were of great concern. The main challenges were data management practices and expertise. The limited storage space available made the collection, storage, retrieval and analysis of service data and the conduct of service audits extremely difficult, if not impossible. However, although data are currently paper based, there is a national plan to implement a patient information system and a complete integrated IT platform. In the interim, the staff suggested that existing protocols and procedures should be observed, including accurate labelling and registration of specimens and the completion of laboratory request forms giving patient information to assist in the performance of appropriate tests for the diagnosis of the patient.
Competing Interests None declared.
Although challenges identified are not unique to the services provided within the public health sector, provision of a basic acceptable service is heavily dependant on the use of functioning specialised laboratory equipment to support diagnosis and timely procurement of adequate supplies of consumables and reagents. The laboratory staff identified a lack of patient data to assist them in conducting tests in a timely or efficient manner. It was also felt that clear definition of roles and interdepartmental communication was necessary to make a significant change in service delivery. This chronic problem may be due to management issues or may be directly linked to financial limitations on the service.
REFERENCES 1. The National Cancer Registry of Trinidad and Tobago. Cancer in Trinidad and Tobago 2000-2002. Dr. Elizabeth Quamina Cancer Registry. Undated. 2. Government of Trinidad and Tobago. Trinidad and Tobago health sector reform programme: National Health Services Plan. Annex 3; 1994 3. Pan American Health Organization. Health Systems Profile Trinidad & Tobago: Monitoring and Analyzing Health Systems Change/Reform, Third Edition (October 2008), Pan American Health Organization Health Systems Profile: Trinidad & Tobago. Washington, D.C.: PAHO, 2008 4. Government of Trinidad and Tobago. Functional programme for Trinidad and Tobago. National Oncology Centre, CCI Facilities Team; 2001 5. Dutta, PK, Jena, TK, SK Panda. A plea for health manpower training through distance education. Med Educ Online [serial online]. 1996. Retrieved from http://www.med-ed-online.org/f0000005.htm November 1 2011 6. Webb, MA. Interactive technology in healthcare education [Internet]. 2005. Retrieved from http://www.roseindia.net/articles/interactive-technologyhealthcare.page November 1 2011.
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Corresponding Author: Professor Zulaika Ali Professor of Child Health (Neonatology) Department of Clinical Medical Sciences. The University of the West Indies Eric Williams Medical Sciences Complex Trinidad and Tobago Tel.: 868-620-8538 Telefax.: 868-662-9596 E-mail: zulaika.ali@gmail.com