The Ministry of Health is the national entity charged with the responsibility for the organization and management of health services and for formulating health policy. The public sector provides both population and personal health services through its subsidiary divisions.
There are two parallel hierarchies within the Ministry namely medical/clinical and administrative. The Permanent Secretary is the Ministry’s Chief Accounting Officer and bears responsibility for the Ministry’s finance, budget and personnel administration. The Chief Medical Officer is the principal technical officer who advises the Minister and other Ministries on clinical matters. The role however goes beyond an advisory remit and includes responsibility for preparation and/or review of policies and plans, leading initiatives to improve quality and standards for clinical services and promoting and taking action to improve the population’s health.
The Ministry has an open access policy that guarantees citizens and residents the right to access health services according to need regardless of their ability to pay. The Ministry experimented with alternative means of financing health services through the limited application of user fees and outsourcing of services through public-private partnerships (e.g. CT scan services). Major challenges include ensuring universal access while sustaining health care financing; adequate supply and distribution of human resources; and reorienting service delivery to emphasize health promotion and prevention of diseases.
It is generally accepted that government is responsible for ensuring access to appropriate and timely health care to all citizens and residents. In recent years, it became evident that this commitment does not imply that government should bear sole responsibility for the financing and delivery of all health care services. Opportunities for private involvement in both financing and delivery of health care were explored. To this end, the current computerized tomography (CT) scanning and dialysis services became available through public/private partnerships.
Persons requiring tertiary-level care, such as e.g. chemotherapy and radiotherapy, are referred overseas often at considerably cost to the individual and public purse. The idea of shared services was discussed on a subregional level but a discrete initiative did not materialize. The government continues to explore options to secure affordable and convenient, high-quality tertiary care services for the population.
Equipment and technology
The Joseph N. France General Hospital on St. Kitts (156 beds total) is the major trauma facility. There are physicians and specialized surgeons on staff. Accidents and emergencies are dealt with immediately and minor cases are seen in order of severity. The hospital has an x-ray machine, blood bank and diagnostic laboratory. Patients requiring hemodialysis, CT scans, or a hyberbaric chamber have to be taken off island. There is no burn center. Ambulance crew/Emergency Medical Technicians (EMT) are allowed to perform CPR and start IV lines.