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Sectoral Debates 2008 - The Hon. Rudyard Spencer

Release Date: 
Monday, June 2, 2008 - 15:45

A BOLD VISION FOR THE HEALTH OF OUR PEOPLE

Mr. Speaker:
I rise to make my maiden presentation as Minister of Health and Environment at a time of great challenge and change in the global and local arenas.

But Mr. Speaker, we in this Honourable House are the beneficiaries of a legacy that has been passed on by some of the most outstanding men and women who have served in these hallowed halls.

I make reference in particular to two of our Founding Fathers and National Heroes, Sir Alexander Bustamante and Norman Manley.

Mr. Speaker, we may, at different times, have argued about their methods but there can be no argument about their sincere motive and their great love for the people of Jamaica.

It is incumbent upon us to proceed with the business of the nation guided by an equally sincere motive and an abundance of love for the people of this great country.

I want to make one thing abundantly clear. I am not interested in pointing fingers or laying blame on any side. There are some things which must take precedence over party and personalities.

Health is one of those things.

My modus operandi is to change direction where that is necessary given the global and local imperatives. I have no apologies to make about continuing with those programmes that are good in the interest of the people of Jamaica.

Acknowledgements

Mr. Speaker:
First of all, I would like to thank my extended family, the people of South East Clarendon, for giving me opportunity to serve as their representative in this Honourable House. The challenges are many in South East Clarendon. There is a lot of work to be accomplished. I give you my word, I will never leave you. I will not let you down.

I thank Prime Minister, the Hon. Bruce Golding for the faith he reposed in me by appointing me to this portfolio ministry. I applaud him for his insightful leadership of the country. I thank him for the continued support that he has given to the health and environment portfolios.

Mr. Speaker, I must also register my appreciation to Parliamentary Secretary, Senator Andre Franklin whose youthful energy has added vim, vigour and vitality to the political leadership of the Ministry.

I wish to publicly applaud the bureaucratic leadership of my Ministry, Permanent Secretary, Dr. Grace Allen-Young, Chief Medical Officer, Dr. Sheila Campbell-Forrester, Ms. Leonie Barnaby, the senior directorate and managers and every single member of staff at our corporate offices.

I salute the leadership and staff in the many agencies and departments that fall under the Ministry, including the Earthquake Unit, Meteorological Office, Real Estate Board, Registrar General’s Department, Health Corporation Limited, the National Environment and Planning Agency and National Health Fund.

Words cannot adequately express my appreciation to the Boards of the Regional Health Authorities, Regional Directors, Regional Technical Directors, CEOs of Hospitals, Senior Medical Officers and Matrons for their continued sterling contribution to the health of the nation.

Mr. Speaker:
I reserve my biggest thanks for the men and women on the front line in our hospitals and health centres who day after day labour under less than ideal conditions to provide health care to those who are sick, without hope and without help. Our workers in the 24 hospitals and over 330 health centres are the heartbeat of Jamaica.

Our porters, administrative groups, ward assistants, community health aides, pharmacy technicians, radiographers, pharmacists, nurses, public health inspectors, doctors- you have a friend in me.

I will work tirelessly and relentlessly to improve your working conditions. I give you my word.

Global Imperatives
Mr. Speaker:
I am giving this presentation on the heels of the just concluded 61st. World Health Assembly in Geneva. The preoccupations of that forum were of profound interest to Jamaica. They ranged from the influenza pandemic, prevention and control of noncommunicable diseases, public health innovation and intellectual property, strategies to achieve the MDGs and universal immunization, strategies to reduce the harmful use of tobacco and climate change and public health.

The global landscape portends difficult times for all countries but moreso for those of the developing world. The global food shortage that is being experienced in just about every country including developed countries is estimated to add 100 million people to the poverty line.

Mid-way into the time-frame for the achievement of the Millennium Declaration increased economic hardship, high national debt and rising oil prices have presented additional obstacles for low and middle income countries in meeting the Millennium Development Goals (MDGs).

International trade and travel have brought new challenges for health. The speed of travel within and across borders has increased the vulnerability of states to communicable diseases such as SARS and influenza viruses, malaria and measles.

Climate change has resulted in unprecedented rise in sea level leading to an increase in storm surges, erosion and other coastal hazards. Vital infrastructure, settlements and the sustainable livelihoods of communities are at risk. The health and well-being of our people are endangered. In addition, water resources will be reduced by mid century in the Caribbean and Pacific.

Mr. Speaker:
There is a tendency to focus on the environmental aspects of climate change and health and neglect other health implications including heat related illnesses, respiratory tract conditions, vector borne illnesses, diseases from urban air pollution, diseases and injuries related to extremes in weather, infectious water borne diseases resulting from poor water quality in insufficient quantities and mental health concerns.

Mr. Speaker:
These global imperatives have profound implications for Jamaica.

The Local Imperatives
Mr. Speaker:
Jamaica has set itself some lofty goals and a vision for 2030. There is no division in this Honourable House on the vision that was articulated. All of us on both sides of this House want Jamaica to be “the place of choice to live, work, raise families, and do business”.

This vision will not be realized without the fundamental repositioning of the health and environment sectors.

The achievement of the Millennium Development Goals will not take place without a paradigm shift in the health and environment sectors. These two sectors account (directly and or indirectly) for 75% of the Millennium Development Goals.

We will never beat back the persistent enemies of poverty, illhealth and environmental degradation if our health and environment sectors merely squat on the periphery of the country’s economic and development agendas.

A bold vision for the people

Mr. Speaker:
In 1957, one of our founding fathers, then Premier Norman Manley said, and I quote “This is a time for men of faith and hope and courage… to give our people some confidence in the future of their country”. I believe that those words are true today more than they were back then.

And so Mr. Speaker 51 years later we must proceed as a Government in a way that gives our people some confidence in the future of Jamaica.

I will outline to this Honourable House the broad vision for health in Jamaica and the main strategic planks upon which we will build the future of health care in this country. This vision is in keeping with the country’s 2030 Vision statement.

Mr. Speaker, the vision is for a 21st. century health care delivery system which addresses the health problems of the Jamaican people in a comprehensive and sustainable way.

This health care delivery system provides the conditions for private investment within the health sector to develop and deliver health tourism services and to contribute to the financing of Jamaica’s health sector.

Mr. Speaker:
We at the Ministry intend to build a framework of greatness and love to achieve this vision. We intend to bring the people of Jamaica to the centre of policy, planning and implementation.

A great health sector must rest on the foundation of the community ownership and participation and individual responsibility.

This vision starts with a paradigm shift that re-locates the responsibility for health to the individual and the community. It sets the framework and establishes the parameters within which policymakers, bureaucrats and technocrats will formulate health policies, and plan, implement and evaluate these policies.

Mr. Speaker:
This vision must be viewed within the broader context of a new social paradigm that embraces the fundamental principle that health is an inalienable right of the people of Jamaica.

The rationale is quite simple; a healthier population equals a more productive work force. A more productive workforce leads to more sustained economic growth, more employment and a stronger revenue base for Government. More importantly, a healthy population is the best guarantee for safe, secure and prosperous families, communities and nations.

Moving forward to achieve the vision

Mr. Speaker:
The Abuja Declaration which was drafted April 2001 in Nigeria by the Heads of State and Government of the Organisation of African Unity (OAU), stipulates that national governments need to invest 15% of their National Budgets to finance their health sector.

Jamaica has seen a consistent and dramatic decline in health financing since the 1960s reaching 4.5% in the 2007/08 financial year.

We have started to reverse that decline with a 34% increase over the 2007/08 figures. This represents that single largest increase to the health sector since the 2004/05 budget year. We know that a serious debate on the financing of the health sector must take place in this country and we have already started the work of developing a framework for the financing of the health sector.

Mr. Speaker, over the last eight months we have moved with consistency and determination to lay the foundation to achieve our vision. No one in this House will disagree that eight months is a short time within which to formulate and implement any major public policy.

Yet in that short period of time we have:

    Improved the access of the poor to health services through the abolition of user fees;
    Carried out reviews of the Regional Health Authorities
    Reviewed the renal dialysis programme;
    Negotiated the purchase of the St. Joseph Hospital to enhance health care delivery in the South East Regional Health Authority;
    Began the work of establishing a strong framework for public/private partnerships;
    Established a team to create the road map for the rehabilitation of Primary Health Care and the modernization of Secondary Health Care.
    Begun to examine what is required to develop health tourism; and,
    Began to pursue the development of the E-Health infrastructure

These are not interventions for the faint of heart. But this Government, Mr. Speaker, is not lacking in courage. We are not lacking in self-confidence. And we will not resile from our fundamental role of making public policies that are, to quote the late Sir Alexander Bustamante, a “demonstration of government’s interest” in the people of Jamaica.

Abolition of user fees

That is why Mr. Speaker, we implemented the most radical and far-reaching social policy of any Government in the last three decades when we abolished user fees at all public health facilities, except for the University Hospital of the West Indies. By way of reminder to this Honourable House, the policy:

     Aims to remove a major impediment to poor Jamaicans accessing health care;
    Levels the playing field as far as health in the public sector is concerned for the haves and haves not
    Hastens the repositioning of Primary Health Care as the foundation of any good and sustainable health system;
    Frees up several staff from the assessment of patients and collection of monies to concentrate on patient and customer care; and,
    Challenges policymakers and techno-bureaucrats to explore alternative financing and service delivery models.

Let me point out again that the abolition of user fees will not, in and of itself, wish away the systemic problems of the public health sector. What this policy will do is to infuse in all of us a sense of urgency and fixity of purpose in tackling these problems in a strategic, systematic, focused and consistent manner.

I have said elsewhere that the abolition of user fees is part of a comprehensive policy on health in Jamaica. This policy will be completed in this financial year and will provide the policy and strategic parameters within which we must move forward as a country to fulfill our mandate to the people of Jamaica and meet our obligation in the Regional and International arenas.

Under the new policy The National Health Services (Fees)

Regulations was amended to reflect the new policy. Effective April 1, 2008, a number of services was made available to the Jamaican people without charge, including but not limited to:

     Registration
    Doctor’s Examination
    Hospital Stay
    Diagnostic services (x-rays and lab tests of various kinds)
    Drugs
    Physiotherapy
    Surgeries
    Family Planning
    Immunization
    Antenatal Care
    Renal Dialysis
    Drugs for Chemotherapy
    Radiation Treatment
    Certain high cost diagnostic services, for example, Magnetic Resonance Imaging (MRI)
    Certain high cost appliances

Since the implementation of the policy on April 1, 2008, over 422,000 persons have benefited 217,565 at our hospitals and 204,950 at 75 types 3-5 health centres across the island.

Mr. Speaker, the fees foregone across these health facilities are in the region of 450 million. In seven short weeks we have increased the disposable income of poor people by some $450M because Mr. Speaker our Prime Minister, the Hon. Bruce Golding has put the people of this country at the centre of the concern of this Government.

The Ministry of Health and Environment as part of its monitoring of the policy undertook a limited user satisfaction survey. All public hospitals were targeted and the largest parish health centres (types 3 - 5). The sample size was based on 1000 respondents for
both hospitals and health centres.

The questionnaire was provided to the regions along with the sample numbers for their respective facilities for them to distribute. The actual completed forms received to date is about 65% overall. Though limited as far as scientific rigour is concerned it is very instructive as to the experience of the users in this new dispensation.

The government’s decision to abolish fees has been met with high approval with 83% being satisfied with the decision. Of this figure 66% were very satisfied compared with 34% who were only satisfied.

The majority of patients were satisfied with the attitude of the medical staff. For both nurses and doctors the satisfaction levels were in the high 80’s to low 90’s percentage; 88% and 93% respectively.

Mr. Speaker:
We continue to confront challenges in the area of pharmaceutical services. This area has continued to reflect the highest increase in patient load higher than 100% in some facilities. We have 45 pharmacists in the entire public sector. We are doing everything possible to attract some of the graduates of the University of Technology and we are working to establish public/private partnerships that will ease the burden on this category of staff.

In response to the increased demand for drugs in the public system, the Ministry will be expanding the number of Drug Serv pharmacies in public health facilities. Currently, similar types of pharmacies are in operation at the major hospitals in the Southern Region and Princess Margaret Hospital in the South East Region.

This intervention will bring the following benefits, improved access to drugs for patients, improved and timely supply of drugs; and improved management of the drug supply in the public health sector. It is also anticipated that this expansion of the Drug Serv operations could be a platform for attracting and retaining pharmacist to the public sector.

This Government is committed to the success of this policy. We will not fail. We will use the opportunity to address the age old problems of the sector.

I appeal to our staff to be patient. Help is on the way.

Review of Renal Dialysis Programme

Mr. Speaker:
It would have been easy to abolish fees for low cost services in the public sector. Indeed, many advised us to go that route. After very careful consideration, this Government came to the conclusion that a significant number of poor and not so poor Jamaicans who are suffering from various cancers and renal illnesses would continue to be denied access to health care. We did not have the heart to deny them a most fundamental right-the right to affordable health care. Today, hundreds of Jamaicans can now get relief from the public health sector for cancer and renal treatment.

We are going one step further. We have undertaken a review of renal dialysis services in the country with a view to determining the need for and accessibility to long term Renal Replacement Therapy and exploring the further development of the existing service.

Mr. Speaker:
The review has shown that about 400-600 new cases per million population of chronic renal failure occur in Jamaica per year. We estimate that Jamaica has about 1170 patients in need of dialysis at any given time. This means that some 502 dialysis sessions are required daily assuming a 7 day dialysis programme for each patient. Two hundred and nine units would be required in the island to meet this demand. We currently have 98 with 52 of these units in the public sector.

Renal dialysis treatment is very expensive. It costs an estimated one million dollars to dialyse one patient twice per week for one year. This does not include the cost of drugs, transportation and other necessary costs to access the service which we estimate would cost the patient an additional one million dollars per year.

The Government has a moral duty to help those who suffer and are in need of care.

At present, we provide renal dialysis services at the Kingston Public, Cornwall Regional Hospitals and the University Hospital of the West Indies. In April of this year we opened the Katie Hoo Haemodialysis Centre at the Spanish Town Hospital named for the late Katie Hoo whose son Ernest Hoo financed the facility to the tune of about $20M.

We would also like to applaud the Bank of Nova Scotia for their continued investment in this and other areas of health care.

I believe that this Honourable House will join me in registering the profound thanks and gratitude of the government and people of Jamaica to Mr. Hoo and his family.

This Government will expand the existing public units at the University Hospital of the West Indies and the Cornwall Regional and Kingston Public Hospitals. We will also establish a haemodialysis unit at the Mandeville Regional Hospital.

In addition, we will develop peritoneal dialysis throughout the island and train patients to do this at home.

Mr. Speaker, the health care industry is labour intensive. We need health workers who are trained to deliver services to our people. We will train nurses on the job in haemodialysis care.

Stronger more Effective and Efficient Regions

Mr. Speaker:
Government, through the Ministry of Health and Environment, commissioned a review of the Regional Health Authorities (RHAs) to, among other things, review and evaluate:

    The policies governing the RHAs;
    The organization of the Authorities with special regard to the structures, functions, manpower, supplies and financing of the related entities;
    Their capabilities in planning, managing and implementing programmes and projects;
    Their financial and technical efficiencies; and,
    The relationship of the RHAs to each other, the Ministry of Health and Environment and to the agencies and departments that fall under the Ministry.

We have received the report of the Task Force which was led by Dr. Winty Davidson and the Ministry has discussed the findings and recommendations. Presently, a presentation will be made to the Cabinet for decision making.

Mr. Speaker:
I want to make one thing abundantly clear. We are interested in having strong and effective Regions that are capable of implementing the policies of the Government and providing the highest quality of care to the people of Jamaica.

These RHAs were established under the National Health Services Act of 1997 to improve efficiency and accountability in the use of resources and to facilitate more timely decision making. The four Regions- the South East, Southern, North Eastern and Western Regional Health Authorities- operate under Service Level Agreements that are signed with the Ministry and which stipulate certain performance criteria.

The new dispensation will place importance on ensuring that service level operations are informed by epidemiological trends and contexts.

Based on the findings and recommendations of the Task Force some changes are likely relating to autonomy and the accountability framework governing the operations of these Regions, their structures, some reporting relationships and roles and functions.

Some functions are also likely to be reverted to the Ministry’s Head Office to achieve economy of scale and efficiency.

The Ministry will streamline its roles and functions and will strengthen its monitoring and evaluating capacity. Some of this work is already being undertaken under the change management and transformation process.

Purchase of St. Josephs Hospital and expansion of Bustamante Hospital for Children

Mr. Speaker:
We cannot achieve our vision of a modern health system without expanding our services, pursuing different service delivery modalities and upgrading and re-equipping our plants.

The purchase of St. Josephs Hospital will allow us to expand our offerings to the growing population of Kingston and St. Andrew. We recognize that our major facility, the Kingston Public Hospital, is over its capacity and there is limited capacity for extending services at that location.

The St. Josephs Hospital location and ready made facilities provide opportunities for us to relocate some services from the KPH and to expand others. The purchase of the hospital is therefore in the best interest of the people of Jamaica.

The institution is a fully accredited 44-bed general hospital that sits on 12 acres of land. It is centrally located and provides a wide range of Surgical, Medical, Ophthalmic, Psychiatric, Renal Dialysis, Rehabilitation and other specialized facilities including all diagnostic services.

We intend to develop this hospital as a centre of excellence in health care delivery in the Western Hemisphere.

We have started the dialogue with the staff of the hospital as well as with partners who operate from that location. We will continue these discussions and will apprise the Parliament and the country of the road map to achieving our objective of expanding our service delivery operations in the South East Regional Health Authority.

Mr. Speaker, we have taken a keen interest in the Bustamante Hospital for Children. There is strong support within the public health sector for the facility to provide services to children up to the age of 18 years old. We intend to upgrade that institution systematically over time to facilitate the expansion of services to the child and adolescent population. After we have carried out our due diligence, we will inform the country on the way forward.

Renewal of Primary Care

Mr. Speaker:
At the outset of my presentation I pointed to the fact that I was making this presentation 30 years after the Alma Ata Declaration. Jamaica’s model of Primary Health Care (PHC) became the standard by which health systems around the world built their Primary Health Care system.

It is an undisputed fact that a primary health approach is both comprehensive and integrated, involving communities, public private partnerships and significant inter-sectoral collaboration. It has been demonstrated time and again, that the foundation of a good health system begins at the Primary Health Care level. It is also intrinsically linked to the essential public health functions

Mr. Speaker:
The global and local imperatives demand that we re-define the PHC approach. While the core values, principles and elements remain; new and emerging models will need to be applied taking into consideration the:

    Demographic and Epidemiology transition
    Social and economic determinants
    Environmental considerations
    Communication and technological advances

We have established a committee that has been mandated to accomplish the following objectives by September 2008:

    Develop the concept and framework for a renewed Primary Health Care System in Jamaica;
    Develop a strategic plan for a comprehensive and renewed system;
    Document the policy and legislative framework needed in support of this system;
    Document the immediate and short term needs for implementing a renewed Primary Health Care System.

Primary Health Care is not just a concept or a philosophy. It is both a strategy and an approach to the delivery of health care based on certain fundamental principles such as:

     Equity
    Social justice
    Quality
    Collaboration
    Active community participation
    Focus on health promotion and prevention
    Focus on families and communities
    Sustainability

A renewed approach to Primary Health Care is viewed in the international arena as an essential condition to address the fundamental causes of health as articulated by the WHO Commission on Social Determinants of Health and to codify health as a human right.

Mr. Speaker, I am holding this Committee to the time frame announced as the successful achievement of the MDGs and Vision 2030 and the future of the health sector will be determined by the quality of our Primary Health Care System.

Health Tourism

Mr. Speaker the development of a viable health tourism industry is an integral part of the vision of this Government for Jamaica’s health care system.

Jamaica has an unrivalled opportunity to develop a thriving health tourism and wellness industry. Our location to the North American market, language, climate and the outlay of our health infrastructure are among our distinct advantages.

It is estimated that there are more than 40 million uninsured Americans and that about 20% or 8 million of these are likely to seek health care overseas. Jamaica must position itself to penetrate this market.

Mr. Speaker:
The countries that have taken advantage of the medical outsourcing and health tourism opportunity share similar characteristics as follows:

    The Governments have recognized the enormous economic advantage of health tourism and have deliberately pursued health tourism as a high priority government policy;
    These countries have put in place well defined incentive packages to encourage private sector healthcare development recognizing that indigenous development of healthcare elevates the level of care for the local population while at the same time generating new revenue source for the economy;
    Generous Incentive Packages to health care investors including tax holidays, land donations, duty and import tax waivers/concessions etc.;
    Enterprise free zones to encourage the establishment of specific health care delivery services niche markets for the country;

We intend to look at models in other countries including incentive packages, labour movement, healthcare financing, training and education and we would make appropriate recommendations to our partner Ministries including the Ministries of Finance, Labor, Tourism, Commerce and Foreign Affairs as we believe that this opportunity must not be lost by Jamaica.

We see health tourism as not only a major revenue source for Jamaica, but also a catalyst for the infrastructural and technical improvement of the healthcare quality and standards in Jamaica in all areas of healthcare services including wellness, spa services, cosmetic, preventive and therapeutic care.

We will complete our due diligence in this financial year and will inform this Honourable House and the nation of the specific plans to develop this industry.

Development of E-Health infrastructure

Mr. Speaker:
Developing countries such as Jamaica have a high prevalence and incidence of several diseases. These countries are also struggling to finance health care and to keep their skilled health workers who are indispensable to a quality and sustainable health care system.

E-health provides an appropriate response to the optimal use of our scarce resources. E-health includes clinical e-health and telehealth.

This infrastructure must relate to and interface with other government agencies. We anticipate a number of benefits from the development of our e-health infrastructure such as:

    Real time access to patient information;
    Reliable connectivity
    Greater efficiency in the management of all levels of the health services
    Improved ability to monitor service delivery islandwide
    Better and more efficient access to morbidity data at the parish and regional levels
    Effective referral system for patients
    Ability to quickly and accurately establish norms and standards.

Mr. Speaker:
Already, the final acceptance test for the National Health Records System of the NHF was passed last week. The pilot is being carried out at the Comprehensive Clinic after which there will be an islandwide deployment of the System.

The National Health Fund will play a critical role in leading the development of the e-infrastructure.

Strengthening existing programmes

Mr. Speaker:
I have outlined the main planks that will drive the pursuit of a new and bold vision for health.

As we move forward with alacrity with these strategies, we commit to continuing and indeed strengthening a number of existing programmes including:

     Immunization
    Vector control and environmental health
    HIV/AIDS
    Mental Health
    Jamaica/Cuba Eye Care Programme
    Health Promotion and Healthy Lifestyle
    National Health Fund
    National Registration

Mr. Speaker:
The first three programmes are linked to Jamaica’s achievement of the health related UN MDGs I will update this Honourable House on our progress in the six of the 8 MDGs for which this Ministry must assume leadership responsibility and indicate how we intend to proceed with a coordinated cross-sector collaborative mechanism to ensure that we achieve.

Jamaica’s report card for the health related MDGs clearly points to some areas of success and other areas that could benefit from the intervention of our international partners and a more focused and strategic implementation agenda.

Millennium Development Goal 1: Eradicate extreme poverty and hunger

Jamaica has had some success in poverty reduction which has moved from 18.7% in 2000 to 14.3% in 2006 through a National Poverty Eradication Programme which saw two major introductions to the country’s poverty reduction strategies, namely:

    The consolidation of Jamaica’s welfare programmes into the Programme for Advancement through Health and Education (PATH);
    The introduction of a National Health Fund that provides individual benefit to assist in meeting the cost of drugs for specific illnesses and institutional benefit to the public and private health sectors in the areas of health promotion and illness prevention.

Millennium Development Goal 4: Reduce Child Mortality

Child Mortality has declined from 32 per 1,000 live births to 25 per 1,000 live births. Infant Mortality has remained at 19.8 per 1,000 live births. We have to reduce this.

Millennium Development Goal 5: Improve Maternal Health

The Maternal Mortality rate has declined from 110 per100,000 in 2000 to 95 per 100,000

Millennium Development Goal 6: Combat HIV/AIDS, Malaria and other diseases

Jamaica’s comprehensive HIV control programme has maintained adult HIV prevalence at 1.5% for the past 10 years. Over 60% of persons with advanced HIV and AIDS are on free antiretroviral treatment through Global Fund Grant.

HIV transmission from mother to child has been reduced from 25% to 5%. Jamaica needs financial and technical support to achieve the behaviour change necessary to control the epidemic.

During late 2006 to early 2007, Jamaica experienced an outbreak of malaria in Kingston following the importation of malaria from abroad. Due to the outstanding work of our health team Jamaica fully controlled this outbreak and eliminated local transmission of malaria.

Jamaica had 127 cases of tuberculosis in 2000 and 100 in 2007. We need to maintain our vigilance to ensure that we maintain stable prevalence.

Millennium Development Goal 7: Ensure Environmental Sustainability

Access to safe water has increased from 60% in 2000 to 77%. Access to sanitary means of excreta disposal is 98%. Under-nutrition remains low at 4%.

Interventions to assist toward achievement of MDGs related activities

Mr. Speaker:
At the recently concluded World Health Assembly, developing countries recommended an extension of the 2015 time-frame for the achievement of the MDGs. Jamaica supports that position given the considerable challenges that are facing the developing world including but not limited to the migration of our health workers.

Despite these challenges, we remain committed to achieving the Goals and will pursue some interventions in this regard.
We will:

    Establish a monitoring team in the Ministry of Health and Environment to track the performance of the Goals and to provide consistent focus and direction in the implementation activities;
    Rehabilitate Primary Care including upgrading of plants;
    Publish semi-annual and annual reports in health related MDGs;
    Improve inter-agency collaboration;
    Implement effective public education strategy to get the public aware and involved.

Immunization

Mr. Speaker:
In the area of immunization, Jamaica has been a leader in the English-speaking Caribbean and has prided itself in eradicating diseases through the Expanded Programme on Immunization. Jamaica had its last case of polio in 1982, the last case of locally transmitted measles in 1991, the last case of congenital rubella in 1998 and the last case of rubella and neonatal tetanus in 2001.

While we have maintained relatively high vaccination coverage for many years since 1985, we have become complacent over the past ten years and our vaccination coverage has been slipping and now averages 83% with the exception of MMR which is at 77% for 2007. Our target is 100% coverage for all the vaccines given. It is estimated that approximately 30-40,000 children under age 6 years are susceptible to measles.

Although Jamaica has been blessed with the absence of vaccine preventable diseases, we must be reminded that many of these diseases are still occurring throughout the world. There are currently measles outbreaks in Austria, Switzerland, Spain, the UK, Canada and the USA. Polio is still occurring in India, Pakistan, Afghanistan and Nigeria. As Jamaica has a very vibrant tourism industry receiving visitors from all over the world, persons who are not adequately vaccinated would be susceptible to disease.

Jamaica is now on record as having an imported case of measles. Unfortunately, after seventeen years of no local transmission of measles, we now have a case in a seventeen month old who did not receive her MMR vaccine at the recommended age of one year. This just re-affirms that persons who are not vaccinated will get disease when exposed.

We have too many missed opportunities because of the way that we work. We should make it mandatory for caregivers to produce the immunization card of all patients up to age 18 when they seek care at any health facility. We must be prepared to provide immunization services at every point of the health care delivery system. We will pursue strategies that will enable us to utilize the resources, including and especially our human resources, in times of emergencies and national crises.

We intend to address this matter in the interest of the people of Jamaica. We must go back to the old approach of giving vaccinations daily in the clinics and doing vaccinations in the community by going house to house.

All children who go to clinics or to their private doctors must take their Immunization Cards with them every time so that they can be checked and given vaccines if needed. Schools must not accept children unless they are adequately vaccinated.

We are asking all school principals to contact the nearest public health department with a list of the names of those students who do not present their immunization cards to the institution.

We will use the law governing immunization to prosecute persons who prevent children from being vaccinated if necessary. If we want to keep Jamaica free of measles, polio, rubella and other vaccine preventable diseases, we must get serious and implement the strategies which we know will work

Mr. Speaker:
I want every Member of this Honourable House to pass on these messages door to door to their constituents. I want the media to publicise these messages again and again.

    All children aged 1 year and over who have not yet received the first dose of MMR must go immediately to the Health Centres or their doctors to receive the vaccine.
    Children aged 1-6 years who have not yet received a second dose of MMR must go immediately to the health centres or their doctors to receive the second dose of MMR.
    All basic schools, nurseries and day care centres must ensure that their children are vaccinated - get copies of the immunization cards and contact the local Health Department to verify the status and vaccinate children who need it. The Immunization Law requires all children under the age of 7 years to be fully vaccinated for age before being allowed to enter school.

Vector Control and Environmental Health

Mr. Speaker:
Climate change poses a significant threat to public health and the Jamaican people need to be informed of the continuous efforts of the Ministry to improve the public health security of the population.

The recent outbreak of malaria has taught us hard lessons: the penalty of ignoring traditional public health prevention programmes, the need to strengthen interagency collaboration and linkages among agencies such as the National Solid Waste Management Authority, National Works Agency, the KSAC and Parish Councils, private sector organizations, NGOs and CBOs.

The present vector control programme is heavily depended on the use of chemicals and insecticides. These control inputs can have adverse effects on human health and the environment, if not properly managed and controlled. A strategic shift will be made to place greater dependence on biological control measures; allowing the Ministry to deliver a more environmentally friendly and sustainable programme.

The Ministry of Health and Environment is concerned about the impact of climate change on its vector control activities. A study carried out by the University of the West Indies, Mona and the Caribbean Epidemiology Centre (CAREC) entitled “The Threat of Dengue Fever - Assessment of Impacts and Adaptation to Climate Change in Human Health in the Caribbean”, is the main scientific reference providing us with greater understanding of the impact of climate change on Dengue Fever.

Mr. Speaker:
We are taking steps to deal with Medical Waste. We are far advanced with the construction of a medical waste facility in Kingston. This is a pilot facility, which uses the autoclaving and shredding technology. When the facility is operational it will accept medical waste generated from all government health care facilities in the Southeast Region. Funding support for the facility is from the World Bank Project through the HIV/AIDS programme at a cost of J$114M.

Mr. Speaker:
The United Nations General Assembly has designated 2008 as The International Year of Sanitation. Last month, Jamaica hosted a Caribbean Sanitation Workshop (CARIBSAN) under the theme “Integration of Sanitation Policies into National Development Plans in the Caribbean Region”.

The Workshop was sponsored by Department of Economic & Social Affairs - United Nations, Water and Sanitation Programme-World Bank, Global Water Partnership-Caribbean, Environmental Foundation of Jamaica and the Pan American Health Organization. A Kingston Declaration was produced by the participants.

In support of the main objectives in the International Year of Sanitation the Declaration reads in part “Ensure real commitments to develop national sanitation policies to establish the legislative and institutional frameworks to improve sanitation, allocate clear responsibilities to achieve this objective within the national and international context as well as develop and implement effective actions leading to the implementation of sanitation programs” Jamaica supports the Declaration and has started to develop a National Sanitation Policy. The Policy is in its final draft and will be taken to Cabinet this year for approval.

The Ministry has already established the policy framework, completed the situational analysis and extensive stakeholder consultation and will be promulgating two new regulations during the course of this legislative year under the Public Health Act. The Regulations are:

    2 National Drinking Water Regulations and
    3 Regulations for Permitting and Licensing of Septage Haulers and Portable Toilet Operators

Mr. Speaker:
We have made certain decisions that we are confident will help us to scale-up activities in environmental health.

We will bolster the area of environmental health and public health inspection by creating a support group of staff in environmental health to be called Auxiliary Environmental Health Officers/ Auxiliary Public Health Inspectors to ease the severe shortage of Environmental Health Officer/Public Health Inspectors.

The Ministry will be seeking to recruit, train and deploy a minimum of 130 candidates – young graduates/high school leavers to join the environmental health system.

We will also proceed in a more strategic way with our vector control programme. In this regard, the Ministry is finalising aCabinet Submission for a National Vector Control Programme.

The Submission will outline the financing of the national programme in areas such as staffing, procurement of supplies, adaptation of new technologies and strategies for vector control, strengthening the surveillance systems and improving our intersectoral and interagency capacities.

HIV/AIDS

Mr. Speaker:
The HIV/AIDS pandemic has devastated some countries that have recorded significant declines in life expectancy and quality of life indicators. We must appreciate the impact that this pandemic can have on the future and prosperity of our nation.

Our general adult HIV prevalence has remained at 1.5 for over a decade. As leaders we need to be aware of a number of issues that must be taken into consideration as we move forward.

    Persistent behavioural, social and cultural factors continue to fuel the epidemic in high risk groups
    High rates of multiple sex partners among men, increased transactional sex and early age of sexual debut are important ingredients for further spread of HIV.
    Increasing poverty, population dynamics, and wellestablished gender roles in which men are sexual decision makers drive some of these behaviours.

The National HIV/STI Programme aims to strengthen the current national response to HIV by implementing strategies to achieve universal access to prevention, treatment care and support. These include:

    Implementation of a National HIV Policy approved by Parliament in 2005 with increased lobbying for law reform.
    Expansion of the multi-sectoral response through the National AIDS Committee – the partnership arm of the National HIV/STI Programme
    Expansion of the national monitoring and evaluation system to include all partners.
    Development and implementation of HIV sector and workplace policies
    Sensitisation and identification of advocates among highlevel leadership
    Scaling up of prevention services including interventions for persons most at risk for HIV infection, targeted community interventions and social marketing.
    Increased access to prevention services for adolescents by development and implementation of a revised Health and Family Life Education (HFLE) curriculum that increases knowledge and skills that support risk reduction.
    Expansion of HIV testing programs to ensure early diagnosis of HIV infection, appropriate timing of treatment and access to positive prevention.
    Scaling up of access to treatment for Persons Living With HIV and ensuring that services are of a high quality.

Health Promotion and Healthy Lifestyle

Mr. Speaker:
The Ministry views health promotion as a major strategy towards the realization of the vision of attaining the highest possible level of health for the population of Jamaica. Health promotion is an integral part of all programmes, projects and interventions executed.

We will continue to prioritise our health promotion and healthy lifestyle programme. The shift in our epidemiological profile from communicable and infectious diseases to chronic disease conditions has placed our public health sector under increased burden. For example:

    We will spend some J$2 Billion of our health budget this year to treat injuries from violence including motor vehicle crashes;
    We will spend on chronic diseases;
    Studies on the impact of HIV on productivity showed projected GDP declined by 6.4% (2005)
    The age group that is most affected by HIV and Crime and violence is the 20-39 age group. This is the productive age group.
    The 2006 Global Youth Tobacco Survey found that the prevalence of cigarette smoking among the 13 – 15 year olds was 37%, compared with 33% in 2000 when the same study was conducted. Tobacco consumption has serious effects on the health of its users, particularly the youth, who have a propensity to become addicted to tobacco products and to exhibit the adverse consequences 10, 15 or 20 years after commencing the habit.

It is imperative that we continue to focus on creating healthy schools, healthy workplaces and healthy communities. We will work with businesses, especially the food industry to ensure that the Jamaican people have healthy choices and are better informed consumers.

Last September, the Hon. Prime Minister led a delegation to the Chronic Disease Summit in Trinidad. The Summit examined the chronic disease situation in the Region and agreed on a regional approach to the prevention and control of these diseases.

Out of this Summit came the Declaration of Port of Spain as well as a project on Regional Public Goods. There was also an agreement to implement a Caribbean Wellness Day to be observed on the second Saturday of September annually.

We will undertake certain specific interventions to safeguard the health and well-being of our people.

We will bring to this Parliament a Tobacco Control Legislation that will reflect the Framework Convention on Tobacco Control. It will address the continued stepwise increase in taxation on cigarettes, already dealt by the relevant Ministry.

The total ban on tobacco advertising, sponsorship and promotion of all forms will be proposed; smokefree environments in all enclosed spaces will be included in the law, prohibition of sale of tobacco products to minors, the matter of illicit trade of these tobacco products and other areas are to be addressed. We will continue the creation of healthy, supportive environments in the form of certain settings where people have social interactions can create and sustain health. The healthy zones built in the Communities of Sabina and Hamilton Gardens are a demonstration of such healthy settings. Others are in progress in Braeton Phase IV, Rockmore in St. Mary and Longville in Clarendon. This concept will be expanded in terms of building additional spaces such as these, as well as widening the participation of other public and private entities.

We will seek to have sustainable activities such as healthy nutrition, physical activity at all levels, proper sanitary facilities, safe and continuous water supplies, and a clean, healthy and peaceful environment in our schools. The aim is to inculcate healthy habits into the children that they will carry with them for life even into adulthood, as parents themselves.

We will continue and expand the Workplace Wellness Programme that we launched recently.

Mental Health

Mr. Speaker:
Our vision for mental health is for the full development of a community mental health service. We will continue to push all levels of care closer to the community. It is a fundamental right of every patient to be treated closer to their community. This community based service will be supported by an Emergency crisis and Outreach Team and a Rehabilitative Service at the parish level and acute service at each Regional Hospital.

We will work with Government and non-governmental entities to encourage these to provide sheltered work for individuals where they are protected from stressful situations. This is already happening in Local Government in Montego Bay.

Mr. Speaker:
Long term institutional care is extremely expensive and not in the best interest of persons who are suffering from mental illness.

Alternative living arrangements are required in a supportive environment that will help them to cope with their illness.

Mr. Speaker:
All of us in this Honourable House have a stake in this matter. Mental illnesses which range from depression to the more severe schizophrenia, cost the health sector US$600M annually. Our Health Indices show that some 29% of our 15-74 age group suffers from some kind of mental disorder. We have certain conditions in the country that are impacting adversely on the mental health of our people:

     Drug use and alcohol abuse among the youth is on the increase;
    The increasingly violent environment that is creating fear and anxiety;
    Families are disrupted and dislocated because of violent loss of lives and in many instances multiple killings in communities and families;
    Harsh economic climate and destitution;
    Natural disasters;
    Our people are living longer and more of the elderly are experiencing some form of mental disorder.

Let me pause here Mr. Speaker to express my condolence to the Member from South Central St. Catherine on the brutal death of her uncle, the late Mr. Calvin Fitz Henley.

No one deserves to die like that. And it is abominable that someone who has served his country as an educator and with such distinction could be cut down on our streets at a time in his life when he should have been protected.

Mr. Speaker:
To quote from a World Health Organization Publication, “a society that treats its most vulnerable members with compassion is a more just and caring society for all”.

We need to make some shifts in how we approach the mental health services. It needs to be fully integrated into family health and especially our maternal and child health programmes. Our health system has a major opportunity to provide preventative mental care to patients who visit us for reasons other than to access mental services.

Irrespective of the policies and programmes that we put in place not much will be accomplished without the de-stigmatisation of mental illness. People are reluctant to access care because of the stigma that is associated with mental illness.

Our rehabilitation of Primary Health Care must include an integrated system that can prevent, identify and treat holistically.

We will also scale up inter-agency and NGO collaboration to improve our services.

Jamaica/Cuba Eye Care Programme

Mr. Speaker:
I signed a Memorandum of Understanding in Cuba with my counterpart on May 6, 2008 that formalizes the framework for the efficient implementation of the Eye Care Programme (Miracle Mission) as well as to expand and formulate new areas of cooperation in the field of Ophthalmology.

This is a good programme that started under the previous Administration and we intend to continue and improve on it. The first phase of the programme which was implemented from September 2005- March 2008 saw 30,440 persons being screened and over 4,594 benefiting from surgery.

Under phase two which commenced April 1, 2008, 12,000 patients will be screened. Screening activities will take place on a parish by parish basis.

One thousand and sixty-six persons have been screened in St. Thomas and 194 persons have been selected to undergo surgery in Cuba. Four hundred and fifty eight persons from that parish are awaiting surgery.

We have already identified a location in St. Mary to establish an Ophthalmology facility to treat persons with eye ailments. Specific details of the facility will be discussed at a Jamaica/Cuba joint commission that is to be held in Havana June 8-10, 2008.

National Health Fund

Mr. Speaker:
Since its establishment, the NHF has matured into a formidable force in the financing of healthcare in Jamaica for both individuals and health institutions.

Enrollment in the NHF Individual Benefits programmes has climbed steadily throughout the years. At the end of March 2008, 350,307 persons had been enrolled that is, 172,540 persons for the NHFcard, which is for persons of all ages, and 177,767 for the Jamaica Drug for the Elderly Programme (JADEP) which is for persons 60 years and older.

NHFcard

Mr. Speaker:
Over 1.8 million claims for prescriptions for the NHFcard were paid during the year. The total cost to patients for these prescriptions was 2.2 billion dollars of which the NHF paid 1.3 billion – 59% of the Beneficiaries’ cost.

Hypertension accounted for 44% and diabetes 26% of claims subsidised. In fact, over 80% of persons using the NHFcard filled prescriptions for Diabetes and/or Hypertension.

The number of pharmacies providing NHFcard services reached an all time high of 400 and the NHF continued to pay providers on time every week. Ninety two percent of persons accessed their NHF benefit at private pharmacies showing that this sector is an important contributor to the effective delivery of pharmaceutical services to the country.

JADEP card

Seven hundred and forty nine thousand seven hundred and fifty six (749,756) JADEP prescriptions were filled during the year at over 300 JADEP Provider pharmacies. Again, 92% of persons accessed their benefits at private pharmacies. The NHF purchases JADEP drugs and provides these free of cost to Beneficiaries through the JADEP Provider Pharmacies.

In order to maintain a consistent and reliable supply of these drugs for its beneficiaries, the NHF commenced direct purchasing and distribution of JADEP items with the private sector in February 2007. The NHF has achieved these objectives and, in addition, realised savings of 16.8% on the cost of purchases and seen significant improvement in its management of JADEP inventories at the over 300 Provider pharmacy locations.

Institutional Benefits

During the financial year fifteen projects were approved under the Institutional Benefits Programme at a total $274.73 million.

Projects include research, training, construction and infrastructure and equipment for health facilities. A total of 34 projects costing $502.07 million were completed during the 2007/2008 financial year.

The 2008/2009 budget presented has reversed the decline in revenue faced by the NHF for the past three years with the provision of increased revenue from the additional tax on tobacco products.

Co-ordination of Benefits

The NHF has developed a software application, NHFCoB, to facilitate the automatic coordination of benefits between the NHFcard and other health insurance plans – private and public.

NHFCoB secures the maximum benefit for the Beneficiary by automatically assigning benefits from the NHFcard and other insurance plans with any card. Life of Jamaica has entered into a contract with the NHF and commenced use of this feature.

National Health Records System

The NHF has developed another computer-based application, NHFNHRs, to provide a health record service for all residents. This system shall provide persons with free access to a database that will store basic critical health information which can be made available to health and emergency care professionals.

These will be important developments as we seek to create an effective referral system across all three levels of the health system, achieve real time access to patient information and to improve our monitoring of health service delivery islandwide.

National Identification System

Mr. Speaker:
If there is a programme about which we should be disappointed it would be the National Identification System that is being developed since 1993 when preparatory work began. It is now time to move from talk to implementation.

A multi-agency team was established in 2007 and a decision was taken to prepare a comprehensive implementation plan for the National Identification System (NIDS) formerly called the National Registration System (NRS).

Mr. Speaker:
The Prime Minister has given me instructions to implement this System in this financial year. We are going to hit the ground running to deliver this long awaited System.

Developing our infrastructure

There are two areas that I would like to address before I turn my attention to the environment portfolio- the rehabilitation of our plants and our strategies to address the chronic shortage of critical health workers.

Rehabilitation of plants

Mr. Speaker:
We cannot achieve a modern health system with run down facilities. We estimate that it will cost some $6 billion to carry out the necessary rehabilitative work at facilities across the island. We cannot afford to undertake this level of work in this financial year.

However, in keeping with our focus on Primary Health Care the following health centres will be repaired under the JSIF Hurricane Dean Emergency Recovery Loan Project at a cost of US$ 1M:

South East Region

Watermount

    Parks Road
    Rollington Town
    Harbour View
    Sydenham
    Stony Hill
    Windward Road
    Norman Gardens

Northeast Region

    Fruitful Vale
    Nonsuch
    Moore Town
    Fairy Hill

Southern Region

     May Pen
    Christiana
    Race Course
    Toll Gate

Western Region

     Duncans
     Lucea
    Dias
    Bethel Town

Mr. Speaker, I have instructed the team at the Ministry to carry out an inspection of our facilities and to see what repairs can be carried out in light of the hurricane season. We are advanced in our plans to build a new Type 3 health centre under the US Southern Command HAP Construction Project in the Greenwich Town area. The new health centre in James Hill Clarendon will be completed during this year.

In addition to this work I would like to announce a $500 million rehabilitation programme to commence this year. We have had discussions with the National Health Fund for the financing of this programme.

Confronting the human resource constraints

Mr. Speaker:
There is a global shortage of health workers. The World Health Organisation (WHO) estimates that there are 59.8 million health workers and a shortage of 4.3 m worldwide. In Jamaica, we are short of over 1,660 based on our cadre but the shortage is much more severe given the population size and epidemiological profile.

The shortage is acute in some areas such as pharmacy and if not addressed in the short term will result in grave consequences for the health sector. Director-General of the World Health Organisation Dr. Margaret Chan puts it rather simply: “You cannot deliver health care if the staff you trained at home are working abroad.”

The shortage of critical health staff is no longer a problem just for the Ministry of Health. It is a national problem and the public sector must provide leadership by pursuing an enlightened approach and human resource policy in the interest of the nation.

We have no choice. Our lives depend on it. We intend to pursue a mix of strategies to address this systemic problem because we cannot deliver health care without health workers:
1. A national health workforce development plan is to be completed this financial year to provide the strategic and policy frameworks for the training, recruitment, remuneration and retention of health workers in the public health sector;2. We will develop a proposal for more direct investment in training and support of health workers;3. Working with our professional groups we will pursue a more efficient use of existing resources such as engaging in task shifting;4. We will develop career incentives to encourage service in rural/remote areas.

Even as we seek to implement those strategic measures, we will continue to support the 545 health workers who are now being trained and funded by the NHF. We now have 171 Registered Nurses in training which will cost us $33.38M. In addition, we have 21 Direct Entry Midwives, 40 Community Health Nurses, 29 Medical Technologists and 65 Pharmacists in training. Since 2004, the Government of Jamaica has spent over $204m to train health workers and has committed a further $142.47m.

I believe that we need to decide whether we can continue to spend this kind of money to train our workers and then allow other countries to recruit them and leave us to start all over again.

Mr. Speaker:
We continue to source workers from outside of Jamaica. This year, we will benefit from 92 health workers from Cuba, some of whom will be engaged in training.

We have made a major step in the transfer of training to the Ministry of Education. At the end of April we signed a Memorandum of Understanding with that Ministry and UTech for the transfer of nursing training to Utech. The Ministry of Health will now focus its attention on developing the national workforce policy and plan.

Mr. Speaker:
I am proud to announce a one million dollar training programme specifically designed to undertake short term training of a cadre of workers that will support the team of highly skilled health workers who are now in the system. We will train over five hundred of these people at a cost of $100 million with funding support from the NHF. The training will target:

     Patient care Assistants
    Lab Technician Assistants
    Medical Records Technicians
    Pharmacy Technicians
    Psychiatric Aides
    Operating Theatre Technicians
    Anaesthetics Technicians

ENVIRONMENT PORTFOLIO

Mr. Speaker:
A lot has been said about this aspect of the portfolio and where it is located. It is abundantly clear to me that irrespective of where it is located, this area of governance requires strong leadership at both the political and bureaucratic levels.

This is critical at this time as issues such as climate change and its impact on health and the sustainable livelihoods of people are farreaching and devastating.

There is no area of comparable importance to human development and none that poses an equally unparalleled threat to sustainable livelihoods and the achievement of human security for the world’s people. These areas require the joined-up government approach across the areas of policy formulation, implementation and monitoring and evaluation.

Policymakers must advance a national framework that is embedded in poverty reduction and national development plans.

On this, there can be no divide in our political spaces, no disagreements across sectors and no divisions among our people.

We should commit to enhancing capacity building, focus on coordination and coherence at the policy and implementation levels and mobilizing domestic resources in order to make a significant impact on the achievement of the Millennium Development Goals and Vision 2030.

The National Transformation Plan that advances that great 2030 vision for this country must stand on the secure foundation of a sustainable environment. Anything less will lead to the collapse of the dreams and hopes of the Jamaican people.

There is work to be done to achieve the environment related goals We should commit to enhancing capacity building, focus on coordination and coherence at the policy and implementation levels and mobilizing domestic resources in order to make a significant impact on the achievement of the Millennium Development Goals and Vision 2030 of vision 2030. These goals include creating:

    Healthy, productive and biologically diverse ecosystems;
    Sustainable management and utilization of natural resources;
    Effective, efficient and accountable governance framework for environment and natural resources management; and,
    A culture of hazard risk reduction.

Mr. Speaker:
We are in the hurricane season and if the forecast from world leading experts at the Department of Atmospheric Science at Colorado State University is anything to go by we should expect a very active season. The current forecast is for:

    15 named storms;
    8 hurricanes;
    4 intense hurricanes (Category 3-5)

This kind of adverse weather disrupts and dislocates families and communities, undermine the livelihoods of people, present public health risks and generally impacts negatively on the social and economic fabric of the country.

Mr. Speaker:
I will now provide a report on my stewardship thus far and pinpoint some areas that need to be addressed presently.

The Government of Jamaica continues to develop and implement policies and programmes for the sustainable management and use of the island’s natural resources. The major areas of focus for 2007/8 were:

     The Development of Policies and Plans
    Legislation Development
    Chemicals and Hazardous Waste Management,and
    Global Environmental Issues, including Climate Change

Policies and plans

The following policy proposals have been finalized and are to be sent to Cabinet for approval:

    Orchid Policy - To establish guidelines for the conservation and management of orchids listed under the Convention for International Trade in Endangered Species (CITES)
    Watersheds Policy - To provide guidance towards the integrated management, protection, conservation, and development of land and water resources in watersheds for their sustainable use and for the benefit of Jamaica as a whole

The following policies have been completed and are undergoing final reviews:

    Environmental Management Systems Policy & Strategy –To establish the framework within which an organization (private or public) can improve their performance by addressing the impacts of their products, processes, and services on the environment
    Environmental Stewardship of Government Operations - To promote environmental stewardship principles within the operations of the public sector by setting out measures towards the reduction and elimination of unsustainable production and consumption patterns, with particular focus on resource conservation, pollution prevention, occupational health and safety, waste reduction, green procurement and more effective and efficient management of assets.
    Dolphin Policy- To establish guidelines towards dolphin protection and conservation in Jamaica.

The following policies are being developed:
Hazardous Substances and Hazardous Wastes Management Policy - To set out the institutional arrangements and guiding principles for the environmentally sound management of hazardous waste in Jamaica.

Biosafety Policy - To set out the institutional framework for experimentation, handling, management, release, use and trade of genetically modified organisms; risk assessment and risk management.

New approaches are being considered regarding the following policies:

     Beach Policy, and
    Wetlands Policy

The draft Beach Policy addresses wetlands, wildlife habitat, mangroves. There are already guidelines and draft policies on wetlands, sea grass, mangroves, coral reefs. It is proposed that a coastal policy incorporating these elements could be developed as an update of the National Policy on Oceans and Coastal Zone Management (2002) and the Beach Policy could address access issues.

National Implementation Plan (NIP) for Persistent Organic Pollutants

Work is ongoing on the finalization of the country’s National Implementation Plan (NIP) for Persistent Organic Pollutants (POPs). These chemicals pose a serious threat to human health and the environment. The NIP outlines the country’s status in relation to the twelve POPs, commonly referred to as the ‘dirty dozen’, listed under the Stockholm Convention on Persistent Organic Pollutants.

It is anticipated that the NIP will be finalized and submitted to Cabinet for approval in the first quarter of the 2008/9 financial year.

Legislation Development

Work continued towards the completion of the following pieces of environmental legislation

    Act for the Preservation of the Ozone Layer To facilitate the phase-out of the importation of Ozone Depleting Substances (ODS).
    Natural Resources Conservation (Wastewater and Sludge)

Regulations

These Regulations will regulate the treatment and discharge of wastewater and sludge to the environment. It is anticipated that the Regulations will be promulgated in the 2008/9 financial year.

Mr. Speaker:
The following new pieces of legislation are being developed:

    Bio-safety Bill This Bill deals with the issue of genetically modified organisms (GMOs) and will facilitate the country’s accession to Protocol on Biosafety under the Convention on Biological Diversity (CBD).
    National Environment and Planning Legislation Through funding from the ENACT Programme, an MOU has been signed between the MLGE and the NEPA for the review of the existing environment and planning framework and the development of a new environment and planning regime in Jamaica. A consultant was contracted to conduct this review.

Chemicals and Hazardous Wastes Management

Globally Harmonized System (GHS) of the Classification and Labeling of Chemicals. Given the extensive trade in chemicals worldwide, there is need for a globally harmonized system (GHS) for the classification and labeling of these toxic products.

At the 1992 United Nations Conference on Environment and Development (UNCED), commonly referred to as the ‘Earth Summit’, there was a call for the development of the GHS. The call was again reinforced at the 2002 World Summit on Sustainable Development (WSSD), where the international community committed to having the GHS implemented by 2008.

The institution of the GHS will assist in safeguarding the worker, particularly transport workers, the consumer and emergency responders from exposure, through the provision of hazard information, to chemicals and chemical mixtures.

The Government of Jamaica in recognizing the importance of the GHS and mindful of the WSSD 2008 deadline will be implementing a 2-year Government of Jamaica/United Nations Institute of Training and Research (UNITAR) project to institute the GHS in Jamaica.

Environmentally Sound Management of Used Lead Acid Batteries Discussions continued on the development of a financially sustainable National Programme to address the management of used lead acid batteries (ULAB), which are classified as hazardous wastes.

There have been several cases of lead poisonings in Jamaica, particularly of children below the age of twelve years, due to exposure to lead and lead contaminated soils from the smelting of lead plates derived from used lead acid batteries.

Mr. Speaker:
The health effects of lead poisoning, particularly in children, are severe and in some instances can be long-term and irreversible. The ULAB Programme development is being done in collaboration with private sector entities involved in the distribution/retailing of lead acid batteries. Elements of the Programme will include the promulgation of legislation as well as the institution of economic instruments to facilitate the recovery of ULAB from the domestic market.

Environmentally Sound Management of Used and End-of-life Mobile Phones

During the 2008/9 financial year, we will continue discussions with the major mobile phone distributors and service providers on the development of a National Programme for the environmentally sound management of used and end-of-life mobile phones.

Several components of the phones, including the batteries, are categorized as hazardous materials and as such measures need to be instituted at the national and local levels to recover these instruments and the accessories(including their batteries) once they are no longer used.

Environmentally Sound Management of Electronic Wastes

We began discussions with public and private sector stakeholders on the development of strategies to manage the most critical categories of electrical and electronic wastes, including end-of-life computers and computer accessories.

Regional and International Environmental Issues

The country continued to participate in regional and international environmental issues.

Climate Change

Mr. Speaker:
The year 2007 was an exceptional one both globally and nationally for climate change activities. The release of the 2006 Fourth Assessment Report of the Intergovernmental Panel on Climate Change (IPCC) brought into sharp focus the realization that climate change is one of the most serious threats facing the global community as its impact on human lives and the natural environment, poses serious challenges to reducing poverty and achieving sustainable development.

The IPCC Report concluded that there was little doubt that global warming was caused by human-induced activity. It predicted a continuous rise in global temperatures and stated inter alia, that the world’s lakes, coastal areas and rivers are already responding to the effects of a human-induced climate change and that lowlying coastal and small island states in particular, are most at risk due to the threat of sea-level rise.

Of importance was the awarding of the 2007 Nobel Peace Prize jointly to Mr. Al Gore, the former Vice-President of the United States of America and the Intergovernmental Panel on Climate Change. Jamaica’s Professor Anthony Chen of the University of the West Indies, a member of the IPCC, shares this prize.

The 13th Conference of Parties to the United Nations Framework Convention on Climate Change was held in Bali, Indonesia in December 2007. It laid the foundation for negotiations towards the development of a comprehensive climate change agreement by 2012, the time when the first commitment period for developed countries under the Kyoto Protocol comes to an end.

The main outcome of the Conference was the “Bali Action Plan”. The Plan launched the process for negotiations towards the development of a new global agreement for substantial emission reductions to include developing countries by 31 December 2012.

The process, to be completed by December 2009, will enable the full, effective and sustainable implementation of the Convention.

At the Conference, Jamaica:

    Reiterated the Government’s commitment to reducing significantly the country’s dependency on the use of fossil fuels for energy production by 2017 and to increase the use of renewable energy sources to about 25% of the energy mix.
    Highlighted Jamaica’s programme to achieve developed country status by the year 2030 through inter alia, the development, diffusion and transfer of clean, less carbon intensive technologies along with the building of institutional and human capacities.
    Articulated Jamaica’s support for a second commitment period that will see the Annex I Parties taking on ambitious and significant emission reduction limitation  objectives and the country’s readiness to begin the discussions that will result in the establishment of a platform for negotiations.

At the national level, several initiatives to allow the country to adapt to or mitigate against the effects of climate change are being implemented. Adaptation planning continues to be the main area of focus to address the impacts of climate change in Jamaica.

Work started in 2007 on the preparation of Jamaica’s 2nd. National Communication on Climate Change which is expected to be completed in 2009. This Report will update the 1st National Communication and will set out the vulnerability and adaptation options in the water resources, coastal zone, human health, human settlement and agriculture sectors.

The implementation of a community-based adaptation project under the Global Environment Facility Small Grants Programme started in 2007. The goal of the project is to reduce vulnerability and enhance the capacity of selected communities to adapt to climate change and variability.

During the year, work started on the development of a Climate Change Communications Strategy by the National Environmental Education Committee (NEEC), Panos Caribbean and the Government.

A National Climate Change Committee is expected to be established in 2008 to effectively oversee and guide the process of integrating climate change considerations into national development.

PUBLIC EDUCATION AND AWARENESS

We continued our public awareness programmes to foster greater awareness of the environment, including climate change.

Mr. Speaker:
Increasing the general awareness and public education of the importance of climate change to national development will result in the implementation of more effective measures to effectively reduce our risk to those hazards that regularly affect the country.

APPEALS

Mr. Speaker:
Shortly after I was sworn in as Minister of Health and Environment, I gave my word that I would begin to address the backlog of appeals under the Town and Country Planning Act and the Local Improvement Act. Since September 2007, I have heard a total of twenty four appeals. Fourteen were upheld, three with conditions and ten dismissed.

Way Forward

Mr. Speaker:
There are three areas that we must give priority attention as we move forward. One, we should seek to strengthen partnerships with the Nongovernmental Organisation community both locally and internationally, the private sector and key public sector entities.

Two, it is time for us to take matter of enforcement of our environmental and health regulations seriously.

We are adopting a zero tolerance for developments that breach guidelines and that are not environmentally friendly.

We in Jamaica have seen the adverse effects of environmental degradation. We must strengthen our monitoring and enforcement mechanisms to ensure that developments are done in accordance with the requirements for the protection of the environment and wastes are disposed of in an appropriate manner.

Three, most of the Jamaican people do not know how to do basic things such as how to dispose of waste-household waste. There is need for an aggressive and effective public education strategy that will inform our people of acceptable patterns of behaviour.

Mr. Speaker:
The truth is that the worst enemies of the environment include those of us who have been entrusted by the people to formulate and implement policies to protect the environment.

Ignorance, poverty, a lack of political will, greed and corruption, the lifestyle of the wealthy, weak state entities have all contributed to the wreck and ruin of this country.

It is time to embrace our NGOs and CBOs that have been working consistently over the years doing what we have been mandated by the people to do.

No more shall we abandon our moral obligation to the people of Jamaica.

Mr. Speaker, wherever this portfolio resides presently, let us commit to start the education in this House if we must lead by example.

Thanking our Partners

Mr. Speaker:
It would be remiss of me not to express my sincere appreciation to the countless NGOs, CBOs, service clubs, churches, our international partners such as Global Fund for HIV/AIDS malaria and TB, USAID, WHO, PAHO, World Bank, UNICEF and the EU. Our local partners such as the Heart Foundation, the Diabetes Foundation, Jamaica AIDS Support, Environmental Foundation of Jamaica, our lobbyists, especially in the environment sector for continuing to put service above self.

This country is grateful for the tireless and often thankless job that you do to give our people hope and confidence in the future of their country.

Conclusion

Mr. Speaker:
I have outlined the vision for health and shared with this Honourable House the areas of focus to achieve that vision.

I have outlined how we intend to proceed with certain key programmes which we will continue and seek to strengthen. I have also reported on the work that has been undertaken in the area of environment and shared with you the way forward for an area that has been largely neglected by successive governments. Our sense of shame must now spur us to action.

Mr. Speaker:
These are times that we have never before witnessed in our country. But we in this House have inherited something of immeasurable value from those who preceded us. They had an abiding faith in the people of this country. We share that faith. And so Mr. Speaker, I believe that we owe it to the Jamaican people to show courage and strength of character in these difficult times.

We owe it the Jamaican people to help them do what they cannot do for themselves. As Government and leaders, we have a moral obligation to ensure that every Jamaican has access to quality health care.

Our Prime Minister puts it succinctly but with characteristic brilliance when he said: “I simply want

    to right the wrongs that should not exist
    to help the poor to escape from their poverty
    to enable that young man on the streets of the ghetto to walk around with a smile on his face instead of a gun in his waist

I do not dream an impossible dream!
I simply want to make this a better place for all Jamaican people to live a better life”.

Mr. Speaker:
That is why over 422, 000 Jamaicans could access health care without having to pay user fees … to right the wrongs that should not exist.

That is why we have put back over $450m into the pockets of poor Jamaicans… to help them escape from their poverty.

That is why, Mr. Speaker, we are committed to a sustainable environment where future generations of Jamaicans can enjoy a better quality of life.

We are laying the foundation for the Jamaican people to again have confidence in the future of their country.

Mr. Speaker:
500 million will be pumped into the rehabilitation of health facilities. Over 500 health workers are to be trained for the workforce.

We, Mr. Speaker, are demonstrating our interest in the Jamaican people by advancing a bold vision for health.

We will not shrink back. We will not fail.

I thank you.

 

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