Trinidad and Tobago’s shadow health system is the only one of its kind in the world, said Maryam Abdool-Richards, chief medical officer of the institutions, in an interview with the Sunday Express last week.
A parallel care system for Covid-19 patients was put in place in March 2020 and was intended to treat Covid-19 patients, while leaving T & T’s existing health infrastructure unchanged.
The parallel health system is a series of hospitals and hotels set up to handle Covid-19 cases, from quarantine to healthcare to withdrawal facilities, and has been one of the responses keys of the Ministry of Health to the Covid-19 pandemic. .
When it became operational on March 12, 2020, there were only two bed units at the Caura hospital.
Currently, T&T is the only island in the Caribbean and one of the few countries in the world that has a parallel system to manage its Covid cases.
“Uruguay and Mexico have hybrid systems in place, but T & T’s parallel health system remains unique,” said Abdool-Richards, who was responsible for implementing, leading and operationalizing the system.
Abdool-Richards said: “The parallel health system is one of the most complex, high-risk, high-value-added projects executed in T&T given the level of global uncertainty and the scale of the pandemic of Covid-19. Its continued survival over the past 21 months is attributed to the whole-of-society approach and effective teamwork exemplified by the multitude of local and international actors who collectively contribute to their strengths.
“It has proven to be resilient despite the worsening waves of Covid-19, and has rapidly evolved and adapted. However, its resilience and durability after 21 months continues to be threatened, and its survival now depends heavily on the support of the population to be fully immunized, ”she said.
“The parallel health system has continued to be resilient in the face of the dynamic realities of Covid-19. Resources have been increased and dedicated public health workers are responding to the various pushes and lulls in Covid-19 cases, ”Prime Minister Dr Keith Rowley said in his address to the nation on November 25.
“We continued to expand and improve the capacity of the parallel health system. Additionally, in May 2021, we were grateful to receive from the United States government two field hospitals to be used, as needed, to increase the availability of beds for the parallel health system. The parallel health system now has 16 health establishments (nine hospitals and seven graduate establishments). As of November 22, 2021, our parallel hospital bed capacity now stands at a total of 999 beds, of which 898 are in Trinidad and 101 are in Tobago, ”he said.
Asked about the procurement system adopted for the system, Abdool-Richards said: “All procurement activities in the parallel health system comply with the proclaimed sections of the Public Procurement and Disposal of Public Goods Act. from 2015. The Ministry of Health and RHAs perform all contracts. activities in accordance with the law and the respective proclaimed elements. Each procurement transaction respects the objects of the law; to know:
a) the principles of accountability, integrity, transparency and value for money;
b) efficiency, equity, equity and public confidence; and
c) development of local industry, sustainable purchasing and sustainable development, in public procurement and disposal of public goods.
the money is gone
In his address to the nation on November 25, Prime Minister Dr Keith Rowley said that between March 2020 and September 2021, T&T spent $ 509.7 million on the national response to Covid-19.
“We have created a robust parallel health system to respond specifically to the pandemic, which has been and continues to be an extremely effective approach,” Dr Rowley said.
More than 50 percent of the money spent on the shadow health system has been used to pay the salaries of doctors, nurses and other health professionals, according to data provided by the Department of Health.
Six months after sending questions to the Department of Health on the cost and sustainability of the parallel health system, the answers were provided by Dr Maryam Abdool-Richards yesterday.
According to the breakdown provided to the Sunday Express, for the period from March 2020 to September 2021: $ 509,714,461.04 was spent to equip and equip the parallel health system with:
• consumables – $ 154,142,427.57;
• equipment – $ 42,048,470.99;
• human resources – $ 277,313,450.29; and
• infrastructure – $ 36,201,112.19.
The Department of Health included vaccine costs of $ 9.4 million in the cost of the shadow health system, for a total of $ 518.4 million.
This means that 53.5% of the expenses of the parallel health system went to cover the costs of human resources.
Of the money spent on alternative health care, some $ 32 million was spent on the state-sanctioned quarantine for the period.
For the cost of quarantine since the start of the pandemic, it has been broken down into regional health authorities (RRS):
1. For the South West Regional Health Authority (SWRHA) – $ 10,901,209
2. For the North Central Regional Health Authority (NCRHA) – $ 1,572,809
3. For the Northwestern Regional Health Authority (NWRHA) – $ 2,748,007
4. For the Eastern Regional Health Authority (ERHA) – $ 16,780,812.
Funding for the parallel health system is separate from the annual allocations made to the Ministry of Health. In Budget 2021 this was $ 6.050 billion, and in Budget 2022 it is expected to increase to $ 6.395 billion.
The cost of the shadow health system is just one cost that taxpayers have borne as the government deals with the country’s economic and health challenges caused by the pandemic.
In his 2021 budget speech, Finance Minister Colm Imbert said: “A safety net for the most vulnerable households and businesses was immediately put in place. It has been rightly targeted at a cost of $ 6.0 billion, of which we have spent over $ 4 billion so far. We are leaving no one behind.
At its peak, the system managed 1,700 places in 29 establishments.
But is the system viable?
“At present, the state-sanctioned quarantine comprises a small proportion of the resources allocated to the parallel health system (since the borders reopened on July 17, 2021 and the change in policy for unvaccinated people to take charge of the costs of their stay) and therefore cannot be considered as a significant cost driver for the PHCS. However, the cost of hospital care and the resources required continue to increase every day.
“After 20 months, the parallel health system continues to be resilient despite the worsening clinical presentation of patients, the increase in the number of critically and critically ill patients.
“At this point, resources continue to be limited and are being spent on a daily basis. Overall, human resources are a limiting factor and this trend is noted in T&T. In this regard, the sustainability of this system depends on the support and collaboration of the population regarding the taking of vaccines, and the continued respect of 3W and public health regulations. It is imperative to note that the majority of people hospitalized in the parallel health system are not fully vaccinated. “
According to the press release from the Ministry of Health of December 3, 89.8% of patients in the alternative care system were not vaccinated.
Since October 17, traditional health systems have assigned specialized teams dedicated to the care of critically ill patients and several patients in accident and emergency departments.
Richards said there is currently a total intensive care unit (ICU) capacity of 77 beds, with A&E standing at 29, for a total of 106. She said 18 beds will be added this month. ci — four beds at Augustus Long Hospital (HDU being converted to an intensive care unit), six beds at Point Fortin Regional Hospital and two at St James Medical.
Now. there are now five state-supervised establishments for the return of unvaccinated nationals (all costs are the responsibility of returning nationals): Kapok Hotel, Cascadia Hotel, Regent Star Hotel, Paria Suites and the Chancellor.
“These facilities are under the supervision of the Department of Health, as daily reports are provided as well as monitoring and surveillance through the county medical officer of health.
“Bed allocation is a dynamic situation based on the clinical need for care and the optimal allocation of resources, and is therefore reviewed daily,” she said.