Mr. Speaker, in my end of year report for 2003, I wrote that being the Minister of Health was an education in itself. Let me tell you why I thought so. It is simply because I am a woman.

 I have learnt over the past year that an assertive woman in politics is viewed as emotional, hysterical, lacking male attention just to name a few. Well I must say that standing in the Legislative Council today and delivering this budget speech saves me from all those possibilities because right now as you can see, I have all the male attention any woman can hope for, the men in the Turks and Caicos are listening, and I am obviously not hysterical right now.  Mr. Speaker if caring about Turks and Caicos Islanders and wanting to give them the best health care that this country can afford is being emotional and hysterical than I plead guilty.

Mr Speaker it is indeed ironic that the ministry of health was taken away from me just last week. It is now under the Ministry of Finance something that both I and constituency find insulting since the Minister of Finance would find himself in a conflict of interest being responsible for healthcare and finance. Where are the checks and balances that ensure transparency and accountability? Mr Speaker can you imagine the Chancellor of the Exchequer being responsible for health care in the British Parliament? Mr Speaker at the end of my budget speech I would have no longer be the Minister of Health and I can’t say who will be since the Minister of Finance will only be responsible for the medical department and Public health.

To the people of the Bight I want you to know that I have been your voice and will continue to be your voice. It was your vote that brought the PNP to power because if you did not vote for me there would have been no bi-elections.

Mr Speaker the budget addresses delivered by government ministers are mainly about the money spent and needed by their various ministries in order to function effectively during the fiscal year. As minister responsible for healthcare I would like to explain to the people of this country how much it truly costs to have the level of healthcare they enjoyed during the past fiscal year and what we can be done to improve the healthcare services in the Turks and Caicos Islands.

The true cost of healthcare is not what the government declares it spends on healthcare, it is really the amount it costs a person to acquire the level of healthcare he or she desires when sickness comes and believe me sickness and poor health visits us all, it does not discriminate. What the government spends shows how much healthcare is subsidised not how much it costs.

Healthcare in the Turks and Caicos occupies 20% of the national budget. To some one looking at this it will seem that our government is a prosperous one since spending in healthcare in all the countries around the world is hinged on the size and improvement of the economy. Healthcare as we all know is not an earner of revenue for the treasury but is an area that depletes the financial resources of the country. The resources spent on healthcare in this country can give more value for money if we can just change our out-dated policies and views on healthcare and adopt a more efficient and modern approach to the problem.

It may seem that I am about to deviate from the policies laid down in the pre election manifesto of my party but believe me, nothing beats 20/20 hindsight or to put it in more feminine language the taste of the pie is in the eating.

 Mr Speaker, it is a well known fact that private healthcare is much more costly to the recipient than government healthcare and that the quality, even though it appears higher, is generally lower than that offered by the government. What makes it appear better is the presentation, the apparent confidentiality patients enjoy and the better technology that is normally available. The apparent efficiency of private healthcare is as a result of their smaller size and the fact that they cater mainly for those who can afford to pay more for the care they offer. In the final analysis the health recipient pays more, the cost is higher and healthcare is not necessarily better than it would have been in the government institutions had they received the same planning and financing. My goal as minister responsible for health is to lessen the perception that there are two types of Turks Islanders those that can afford private healthcare and those that cannot.

In order to achieve this we need to lower the healthcare bill faced by the government and at the same time improve on the quality of healthcare offered by the government.

In order to achieve this we as a people need to pursue the following policies:

a) Lower the possibility of our people becoming sick by educating them to live a healthy lifestyle. ( avoiding recreational drug use and  alcohol, by encouraging safe sexual practices, by raising the level of education among our youth especially our girls, for it has been proven that educated people live healthier and longer lives; by involving the church in the drive to lift the level of morality among our young people.) 

b) Accidents will happen but 90% of accidents including domestic, industrial and vehicular are avoidable if rules and safety regulations are adhered to by our people. This is about respect for the laws of our country. As you can see Mr Speaker preserving health is not about medical and surgical care those only become important when health fails and fail it will. That is why I need a team of experience and qualified medical professionals, permanent within the Turks and Caicos who are dependable and will pay attention to those that are sick and need assistance.

c) Chronic diseases such as hypertension and diabetes need to be managed early and efficiently to avoid complications which will increase the healthcare cost. Mr Speaker, you may not know that 80% of what is spent on health during ones entire life is spent during the last week of his or her life provided he or she is not the victim of a sudden death.

Mr Speaker where the health of the individual has already failed the government through the Ministry of Health needs to strengthen the government medical response and healthcare delivery system by:

a) Strengthening the government healthcare infrastructure by constructing tertiary healthcare facilities in both Grand Turk and Providenciales and equipping them with the relevant technology.

b) Recruiting and maintaining qualified and experienced healthcare professionals should be a priority. The present policy of inviting expatriates for a period of two or three years then sending them off when they are about to really function effectively, is a short-sighted and negative one. In the first year the professional is in the process of understanding the people and environment so he or she cannot give of his or her fullest potential. In the second year when they may now have a better understanding and can contribute to healthcare they are forced to begin making preparations to leave since their contract will soon come to an end, that is, provided they are not arbitrarily terminated by our public service. Healthcare in the Turks and Caicos can never improve using this policy. The USA and Canada recruit qualified professionals with an offer of stability and improvement for their families that is why they are always able to recruit the best professionals from our region. The policy of “seasonal healthcare professionals” apart from being insulting to any true self-respecting professional is one that gives the impression that our country is not interested in giving the best healthcare to our people. Qualified, experienced and law abiding professionals should be encouraged to remain, this will strengthen our healthcare system and lower the cost of healthcare.

c) Mr Speaker I support healthcare insurance. It shifts the burden of financing healthcare from the government to the private sector. That means that next year the healthcare budget may appear much healthier. The cost of healthcare however will not decrease for the recipient, it may even increase if the system of managed care is implemented and judging from the experiences of Australia, the USA, Canada and Antigua I will cautiously tread in this direction and consult with our people at every step. This fiscal year beginning on March 31st has been a challenging one.   As Minister of Health my function is to formulate sustainable healthcare policies and with the help of the public service implement them. 

HEALTH PRACTITIONERS BOARD
The Health Practitioners Board of the Turks and Caicos is a statutory body established to protect the people of the Turks and Caicos from the possible excesses of healthcare professionals. It is therefore ultimately answerable to the Legislative Council through the Minister of Health who is a member of the Legislative Council. Health Practitioners Boards are never there to protect the interest of members of the health professions, that is served by the various associations such as the Nursing Associations and the Medical Associations to name a few. These organizations are what provide support and protection for the healthcare professionals. I strongly suggest that our healthcare professionals establish their various associations and fell free to approach the Minister when issues arise. Mr Speaker we are a democracy and my party pledged in its manifesto to be transparent and accountable while in office. 

THE PUBLIC HEALTH DEPARTMENT
The Public Health Department within the ministry is at present concerned primarily with the disposal of solid waste. By virtue of the size of the population and its distribution the problem of solid waste disposal arises mainly in the capitol Grand Turk and the heavily populated island of Providenciales.

In Blue Hills the situation at the solid waste facility has always been deplorable and one that needed urgent attention.  The results of a study conducted during the former PDM administration for the implementation of solid waste disposal was brought to my attention. This study is quite adequate and I strongly support its recommendation. While waiting to pilot the necessary legislation for the establishment of a Solid Waste Management Authority through the Legislative Council, the problem of burning of refuse at the solid waste sites has been increasing in frequency. The media kept me reliably informed whenever there was a fire at the site. I ordered an investigation into the burning of the solid waste facility in Blue Hills. The results of this investigation showed that these fires were deliberately lit.  The Environmental Health Department on Providenciales began working assiduously to alleviate this problem and quickly succeeded in bringing this situation under control.  At this point I wish to thank The Acting Chief Environmental Health Officer Mr. Lorne Robinson, Mr. Desmond Hall and Mr. Kenrick Neeley without whose help and vigilance the problem might not have been brought under control.

THE MEDICAL DEPARTMENT
Our medical services have always been seriously affected by a shortage of qualified and experienced personnel.  My policy is to recruit qualified and experienced medical personnel in smaller numbers rather than unqualified and inexperienced in large numbers. This approach will not only improve and strengthen the confidence in medical care offered locally, but will lower the cost incurred by the treatment abroad program and afford the opportunity for Turks Islanders who recently graduated to be encouraged to give some service at home since they will be able to consult with professionals that are resident here.

The establishment of a National Health Contribution Plan may alleviate the financial burden faced by the government for overseas referrals and will underscore the need for the recruitment of qualified and experienced healthcare providers. My fears however are that any National Health Insurance will only serve as a substitution for the treatment abroad program now run by the government and may lead to a situation where Managed Care is implemented.

There is a serious necessity for the construction of modern healthcare facilities both in our capital island of Grand Turk and in Providenciales. Based on recent data received from a feasibility study done by the Department For International Development (DIFID) in April 2003, and made available to me as Minister of Health, it is my firm belief, that the Turks and Caicos is in need of healthcare facilities totaling sixty beds (60); Twenty (20) being allotted to Grand Turk and Forty (40) in Providenciales.

Building materials for the extension of the Myrtle Rigby Complex are available as a result of a block drive which commenced in June 2002. This block drive is ongoing. Construction of any healthcare facility should be done in stages taking into consideration the immediate demands of the society and in keeping with a policy of sustainable development within the healthcare sector since the availability and quality of healthcare depends on the economic strength and development of the country. A total of 60 beds will guarantee a ratio of one bed to every five hundred people (1:500). This ratio is in keeping with PAHO/WHO expectations and is similar to the bed-to-population ratio in Bermuda, British Virgin Islands and other Caribbean territories. This, along with the establishment of Primary Healthcare Clinics within the various constituencies will guarantee adequate healthcare at an affordable cost to Turks and Caicos Islanders and will lower the cost incurred by overseas referrals on the government or any future National Health Insurance Plan.

On the issue of the procurement of medical supplies and equipment I would like to categorically state that I am never appraised, as Minister responsible for Health, as to what is being purchased and from whom, this information it seems, should only be made available to the Minister on her way to the Legislative Council for the presentation of the annual healthcare budget.  It is my sincere hope that the proposed Office for the Procurement of Health Services has been established under contract to the Ministry of Finance, as recommended in the study done in April 2003 by the Department For International Development (DFID), has been set up and is functioning. To date I have seen no evidence of this.

The financial burden for healthcare lies ultimately with the society. Whether our society pays directly or through a National Health Insurance Plan is irrelevant to the society as a whole. The only reliable way to lower the cost of healthcare is to provide it locally at the highest quality.

TREATMENT ABROAD POLICY
Mr. Speaker while we develop our health care delivery system The Turks and Caicos will still be dependent on treatment abroad for our people. I support the Treatment Abroad Policy in principal but in keeping with our promise of transparency and accountability I would like to see the treatment abroad program divided into three stages.

The first stage is the medical stage where the medical practitioners make the decision as to whether the patient will benefit from treatment abroad. This decision should then be taken to the second stage which is a committee made up of the Ministry of Health and the Ministry of Finance. This treatment abroad committee should decide whether it is financially feasible for the government to embark on sending the patient abroad.  Should there be an appeal on behalf of patients that appeal should be to the Minister of Health.

THE DEPARTMENT OF SOCIAL SERVICES AND GENDER AFFAIRS
The Departments of Social Services and Gender Affairs have seen various improvements in the short period that I have been in office. Credit for this I must give to the hard working members of those two key departments within the Ministry. They have been organized and dedicated in their duty. In October a Memorandum of Understanding was signed with One World Foundation for the continuing Partnership in Developing Programs, Services and Public Awareness for persons with special needs (disabilities). Training sessions on how to manage people with special needs were conducted for both members of the department of Social Services and workers in the hotel and tourism sector.

During this period there were discussions with the Labour Commissioner regarding employment opportunities, within the job market, for persons with special needs. In November 2003 National Child Health (N.C.H) Regional Director  and Legal Reform Project Director visited the Turks and Caicos and presented  The National Care Standards and Procedural Guidelines for Child Protection, Adoption and Foster Care to the Minister of Health.

The Turks and Caicos is now one of twelve countries that are signatories to the programme of Cooperation with UNICEF on MPO. This programme consist of two parts the first being the over all multi-country program with its goals and objectives, management responsibilities and commitments of the various governments and UNICEF. The second part of the programme deals with Early Childhood Development, Adolescents and the life skills and Social investments for child protection.

In October of 2003 the Gender Desk hosted a two day work shop on Gender Equality. This was as a result of the concern with the recent problems of discrimination that exist against women in the Turks and Caicos. The Gender Desk is proposing that the pilot programme Continued Education be brought back. This project was successful since young people who did not finish high school were given a second chance to develop themselves. On my initiative The Department of Gender Affairs began the process of continuing dialogue with the OECS on issues of Judicial Reform in the areas of Family Law, Domestic Violence and the protection of children and the vulnerable within our society.  A work shop on Judicial Reform for Family Law and Domestic Violence is planned for early January, 2004.

NATIONAL AIDS PROGRAMME
The National Aids Programme saw a boost during the week of December 1st-7th with the observance of World Aids Day with the Ministry implementing programmes to heighten awareness and aid in the fight against discrimination and stigmatization in this I will like to thank Mrs. Cheryl-Ann Sanderson-Jones and Mrs. Aldora Robinson for the dedication and support that they gave to the minister. I am convinced that AIDS is a social problem and should be recognized as such and managed as a social issue.

The National Program embarked on the development of a comprehensive Treatment and Care Plan in an attempt to further enhance HIV and AIDS care in the Turks and Caicos Islands. This activity was given assistance from CDC and CAREC. The broad aim of the plan is to extend and improve the quality of life and care for people living with HIV/AIDS, while maintaining programs aimed at prevention of the disease. It is the aim of the department, by implementing this approach, to be able to gain control of this disease within a few years.

Official links are being pursued between Nassau and the Turks and Caicos on the possibility of implementing shared programs of management in keeping with the international approach to the control and management of HIV/AIDS.  Since September of 2003 five persons have been able to access treatment in the comprehensive care HIV facility there. Through negotiations the Bahamas will be able to assist us in the establishment of our treatment and care programs. Other areas of assistance will include training of health care and volunteer staff, management of clients on HIV drugs and the purchasing of drugs at reduced and affordable prices.

In an effort to strengthen the capacity of the nation’s schools to adequately include in their curriculum HIV and AIDS, a training workshop for teachers was conducted. It is imperative that the nation’s youths are reached in a trusting and able environment, hence the need to train teachers to reach children with the right information and in a consistent manner.

The development of the youth arm of the National AIDS Program was extended to the High Schools in North and South Caicos. Twenty young persons from these islands were involved in a one week training course of the Rapport Peer education program geared to improve the skills of young people in communication. A similar program was conducted in August and involved primary school teachers being exposed to the Focus on Youth after school teaching manual. This program will ensure that students at the primary school level are consistently exposed to information on prevention. It is the hope that these programs will receive greater support for extension into all schools.

The Minister of Health and the Chief Minister showed their support for HIV prevention efforts by becoming involved in the Leaders against HIV poster campaign. The doors of the hospice in Providenciales were reopened from September 2003 thanks to the collaborative effort of the private sector including Beaches, the Rotary club and the AIDS Awareness Foundation. This is a good example of how the private sector can play an effective role in the fight against social diseases and in the provision of healthcare on the whole.

A new National AIDS Committee was formed this committee reflects the nature of the problem. Members are from both non-government and government departments and across islands.

Political leadership and support was also evident when under the Patronage of the Minister of Health and with financial support from her ministry the Bahamian play was brought to the nation’s capital Grand Turk in collaboration with The AIDS Awareness Foundation and Provo Little theater. This event was successful and the Stigma and discrimination theme reached hundreds of people.

THE NATIONAL DRUG PROGRAM

The National Drug Unit has been successfully engaged in Drug Prevention and rehabilitation thanks to the acting Drug Coordinator Ms. Alicia Missick and the members of the National Drug Council.

In August 2003 two patients were sent abroad to Teen Challenge where they are to receive further help with their recovery from addiction.

During the month of September 2003 the National Drug Unit visited schools on the Islands of Grand Turk, South Caicos and Providenciales and hundred of books on drug prevention literature were distributed to students. In the community, outreach activities with the assistance of the Drug Prevention Committee, were carried out in Providenciales. This took the form of house visits, street counseling and the distribution of pamphlets.

In November of 2003 the Turks and Caicos saw the first Alcohol Awareness Month Campaign. A number of activities were conducted with the aim of enlightening the public of the dangers of the abuse of alcohol; these included sporting activities, school visits, public service announcements and community outreach programs.

A national alcohol use survey was conducted with a total of 102 persons taking part. This was disappointing since there are a greater number of individuals who consume alcohol. This is an indication that there are still those who refuse to view alcohol as an addictive substance.

In November the Chairperson of the National Drug Council along with the acting Drug Coordinator visited the Islands of South Caicos, North Caicos and Providenciales to assess the programs offered in these islands.

The Bight
I must say a special thank you to my Constituents of Chapel Hill, Thompson Cove, Blue Mountain, Turtle Cove, The Lower Bight, Grace Bay, Leeward and Pine Cay.  I am standing here in this Legislative Council because of your faith and trust in me. After 27 years of voting for The PDM you decided to take a chance on me, a woman and a single parent, I will not disappoint you. As I said during the Campaign we will have sidewalks, a Community Center, a Primary Health Care Clinic and a Sub-Fire Station. I am committed to you my people of The Bight.