Dr Maryam Abdool-Richards

‘System CONTINUES TO BE RESILIENT’: Dr Maryam Abdool-Richards, Principal Medical Officer for Institutions, Ministry of Health.

Trinidad and Tobago’s parallel healthcare system is the only one of its kind in the world, said Principal Medical Officer for Institutions Maryam Abdool-Richards, in an interview with the Sunday Express last week.

A system of parallel healthcare for Covid-19 patients was put in place in March 2020 and was meant to treat Covid-19 patients, while leaving T&T’s existing health infrastructure unaffected.

The parallel healthcare system is a series of hospitals and hotels put in place to manage Covid-19 cases, from quarantine to healthcare to step-down facilities, and has been one of the key responses by the Ministry of Health to the Covid-19 pandemic.

When it was operationalised on March 12, 2020, there were just two bed units at the Caura Hospital.

As it stands, T&T is the only island in the Caribbean and one of a few countries in the world which has a parallel system to manage its Covid cases.

“Uruguay and Mexico have implemented hybrid systems, but T&T’s parallel healthcare system continues to be unique,” said Abdool-Richards, who was tasked with the responsibility to implement, lead and operationalise the system.

Abdool-Richards said: “The parallel healthcare system is one of the most complex, high-risk and high-value projects executed in T&T based on the level of global uncertainty and the magnitude of the Covid-19 pandemic. Its continued survival over the last 21 months is attributed to the Whole-of-Society approach and the effective teamwork exemplified by the multitude of local and international stakeholders collectively contributing their strengths.

“It has proven to be resilient in spite of worsening waves of Covid-19, and has rapidly evolved and adapted. However, its resilience and sustainability after 21 months continues to be threatened, and its survival is now heavily dependent on the population’s support in becoming fully vaccinated,” she said.

“The parallel healthcare system continued to be resilient in the face of the dynamic realities of Covid-19. Resources were increased and dedicated public health workers are responding to the various surges and lulls in Covid-19 cases,” Prime Minister Dr Keith Rowley had said in his address to the nation on November 25.

“We have continued to expand and enhance the capacity of the parallel healthcare system. Additionally, in May 2021, we were grateful to receive from the government of the United States two field hospitals for use, as required, to increase the availability of beds for the parallel healthcare system. The parallel healthcare system now has 16 healthcare facilities (nine hospitals and seven step-down facilities). As of November 22, 2021, our parallel hospital bed capacity now stands at a total of 999 beds—898 in Trinidad and 101 in Tobago,” he said.

Asked about the procurement system adopted for the system, Abdool-Richards said: “All procurement activities in the parallel healthcare system are in compliance with the proclaimed sections of the Public Procurement and Disposal of Public Property Act 2015. The MOH and RHAs execute all procurement activities in compliance with the act and the respective proclaimed components. Every procurement transaction follows the Objects of the Act; namely:

a) the principles of accountability, integrity, transparency and value for money;

b) efficiency, fairness, equity and public confidence; and

c) local industry development, sustainable procurement and sustainable development, in public procurement and disposal of public property.”

Where the

money went

In his address to the nation on November 25, Prime Minister Dr Keith Rowley said between March 2020 and September 2021, T&T spent $509.7 million on the national Covid-19 response.

“We have created a robust parallel health system to respond specifically to the pandemic, which has been and continues to be an extremely effective approach,” Dr Rowley had said.

More than 50 per cent of the money spent on the parallel heathcare system was used to pay the salaries of doctors, nurses and other healthcare professionals, according to data provided by the Ministry of Health.

Six months after questions were sent to the Ministry of Health on the cost and sustainability of the parallel healthcare system, the answers were provided by Dr Maryam Abdool-Richards yesterday.

According to the breakdown provided to the Sunday Express, for the period March 2020 to September 2021: $509,714,461.04 was spent to outfit and staff the parallel healthcare system on:

• consumables — $154,142,427.57;

• equipment — $42,048,470.99;

• human resources — $277,313,450.29; and

• infrastructure — $36,201,112.19.

The Ministry of Health included the costs of vaccines at $9.4 million in the cost of the parallel healthcare system, for a total of $518.4 million.

That means 53.5 per cent of the expenditure on the parallel healthcare system went to underwrite human resource costs.

Of the money spent on parallel healthcare, some $32 million has been spent on State-sanctioned quarantine for the period.

For the cost of quarantine since the pandemic began, it has been broken down into Regional Health Authorities (RHAs):

1. For the South-West Regional Health Authority (SWRHA)—$10,901,209

2. For the North Central Regional Health Authority (NCRHA)—$1,572,809

3. For the North-West Regional Health Authority (NWRHA)—$2,748,007

4. For the Eastern Regional Health Authority (ERHA)—$16,780,812.

The funding for the parallel healthcare system is separate from annual allocations made to the Ministry of Health. In the 2021 budget, that sum was $6.050 billion, and in budget 2022 it is expected to increase to $6.395 billion.

The cost of the parallel healthcare system is just one cost that taxpayers have borne as the Government manages the economic and health challenges to the country brought on by the ­pandemic.

In his 2021 budget speech, Finance Minister Colm Imbert said: “A safety net for the most vulnerable households and businesses was immediately established. It was appropriately targeted at a cost of $6.0 billion, of which we have spent over $4 billion so far. We are leaving no one behind.”

Sustainable?

At its height, the system managed 1,700 spaces in 29 facilities.

But is the system sustainable?

“At present, State-sanctioned quarantine comprises a small proportion of the resources allocated to the parallel healthcare system (since the reopening of borders on July 17 2021, and the policy change for unvaccinated persons to bear the costs of their stay) and so cannot be considered a significant cost driver to the PHCS. However, the cost of hospital care and the resources required ­continue to increase daily.

“After 20 months, the parallel healthcare system continues to be resilient despite worsening clinical presentation of patients, increasing numbers of critically and severely ill patients.

“At this point, resources continue to be limited, and are being expended on a daily basis. Globally, human resources are a limiting factor and this trend is noted in T&T. In this regard, the sustainability of this system is based on the population’s support and collaboration regarding the uptake of vaccines, and continued compliance with the 3Ws and the public health regulations. It is imperative to note that the majority of persons hospitalised in the parallel healthcare system are not fully vaccinated.”

According to the Ministry of Health’s media release of December 3, 89.8 per cent of patients in the parallel care system were ­unvaccinated.

Since October 17, the traditional healthcare systems have assigned dedicated specialist teams to manage critically and several ill patients at Accident and Emergency departments.

Richards said at present there is a total Intensive Care Unit (ICU) capacity of 77 beds, with A&E amounting to 29, for a total of 106. She said 18 beds will be added this month—four beds at the Augustus Long hospital (HDU being upscaled to ICU), six beds at the Point Fortin Area Hospital, and two at St James Medical.

At present. there are now five State-supervised facilities for retuning, unvaccinated nationals (all costs borne by returning nationals): Kapok Hotel, Cascadia Hotel, Regent Star Hotel, Paria Suites and the Chancellor.

“These facilities are under the supervision of the Ministry of Health, as daily reports are provided as well as monitoring and surveillance through the County Medical Officer of Health.

“The bed allocation is a dynamic situation based on the clinical need for care and optimal resource allocation, and so is re-visited on a daily basis,” she said.

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