Christopher Tufton | Bridging the gap on healthcare worker shortage

The global demand for healthcare workers is increasing, and with it, the need to enhance international collaboration in health, including through South-South cooperation.

My recent trip to India and the Philippines provided just such an opportunity as the Government of Jamaica progresses efforts to build out a more effective human resource plan for our healthcare system, making more healthcare workers available – in sufficient numbers and competencies – to serve the people of Jamaica.

The Government’s focus, from the outset, has been on completing a 10-year strategic plan for healthcare improvements. That plan recognises the chronic shortage of healthcare workers in critical areas of service delivery.

In nursing, these areas include critical care, neonatology, emergency, nephrology, midwifery and paediatrics, oncology, and cardiac care are also areas of urgent need, together with burn care, orthopaedics, ophthalmology, and rehabilitation.

Training is offered locally in some of these areas, but there is the challenge of a lack of specialist educators. There is currently a need for nurse educators for an in-service unit in the areas of nursing administration, psychiatric nursing, operating theatre, nephrology, neonatology, paediatric nursing, oncology nursing, and emergency nursing.

At the same time, while we continue to train and graduate nursing and midwifery personnel each year, the workforce is affected by attrition, especially due to resignations. More than 400 nurses and midwives separated from primary and secondary health care in 2024 alone.

The first response is, of course, to train more locals. However, the expansion of clinical training requires a few important inputs, including faculty to do the training and clinical rotation spaces in hospitals – both areas in which we are restricted as a small country. Our efforts to improve healthcare service offerings must, therefore, include enhancing our capacity to train more through partnerships.

There are also challenges with our doctors. For example, the country needs another 500 or so doctors across a range of speciality areas over a three-to five-year period for the first phase of implementation of the Secondary Care Model.

While there are specialists in training, there exists the need for the expansion of services now in order to take the pressure off the larger hospitals. Annotto Bay and Black River have recently been upgraded to Type B hospitals, but the ability to expand the service is limited by a lack of specialists.

At the same time, existing, Type B hospitals such as May Pen Hospital and Savanna-la-Mar Hospital have had difficulty attracting staff, and some services cannot meet the existing demand.

These hospitals are also looking to expand their services to the new set of services outlined in the Secondary Care Model such that there is also a demand for subspecialists.

In the regional hospitals, subspecialties like cardiology and nephrology are underdeveloped or not developed because of the inability to attract the subspecialists. Overall, there is need for more radiologists, anaesthetists, and pathologists to reduce backlogs and waiting times for investigations and procedures. Our healthcare plan must be sensitive to these realities.

GOVERNMENT’S PLAN

So far, more Jamaicans have been incentivised to choose a career in health through the career expo and employment fair, hosted in January,as well as the Barry Wint Memorial Scholarship.

We are also building out more hospitals, and through the Compensation Review, have offered increased salaries and made available more permanent posts than ever before – all as part of our retention strategy.

While these measures are forward-looking and will help, they are not enough to address the chronic shortages in some areas.

Two major challenges beset small island states like Jamaica. The first is a highly mobile labour market for healthcare workers supported by the lure of attractive incentives by health interests from our developed country neighbours.

The other is the seeming lack of sensitivity to the plight of this capital flight on our local healthcare system and no clear evidence of a willingness by our Western allies to coordinate in order to find new ways to collaborate around expanding training possibilities for all to benefit.

When low birth rate and high employment rate are added to this mix, Jamaica’s prospects for expanding our health workforce on our own efforts are highly doubtful in the short to medium term.

The reality is that Jamaica cannot depend solely on its own strengths for the pace of human capital development that is needed. As the evidence suggests, neither can we depend on the West to supply our needs.

SOUTH-SOUTH COOPERATION

Our best hope over many years continues to be our partnership with Cuba and the workers they provide. We must continue to embrace this partnership even as we further expand for new opportunities.

The Philippines and India are two countries that are geographically distant but, potentially, beneficial.

There are many reasons for this, including that both countries are English-speaking, with large populations, have a great reputation for training healthcare workers and the infrastructure to do so. Importantly, they also share the vision of collaboration rather than competition for healthcare labour mobility.

The Philippines trains some 10,000 nurses each year, has 87 public hospitals, and more than 300 additional facilities that are run privately or by the municipal authority.

India has a healthcare infrastructure that is supported by more than 239,000 health workers at their subcentres; 40,000-plus doctors at their primary health centres (PHCs); 26,000-plus specialists and medical officers at their community health centres (CHCs); and more than 45,000 doctors and specialists at their subdivisional and district hospitals. These are together with some 47,932 staff nurses at their PHCs, more than 51,000 at the CHCs, and 135,000-plus paramedical staff.

Also, both countries are major suppliers to the world for health workers, including Jamaica, in the past. We have a history we should capitalise on.

My visit was a recognition of our shared challenges as suppliers of healthcare workers to the world and to explore ways to partner around expanding training for the benefit of our respective peoples.

Jamaica’s interest is to engage these friendly countries in the joint training of our specialist nurses and doctors; train locals to become trainers to increase our faculty; and, where necessary and possible, source healthcare workers to fill critical gaps as we do with Cuba. The latter objective will be coordinated around our locals who are available to fill posts that exist. I had very good discussions in all areas.

I cannot help but think that our interests as a country, in this case for healthcare workers, are more likely to be found where common challenges and interests reside, not necessarily based on geographic proximity and typical expectations.

Jamaica will experience less than adequate growth if we do not have a more open mindset towards human-capital development, including inward mobility and collaboration around training. Leadership requires new thinking, and where necessary, embracing more decisively, old and new friends.

Dr Christopher Tufton is Jamaica’s minister of health and wellness and member of parliament for St Catherine West Central. Send feedback to cctufton@gmail.com or columns@gleanerjm.com.