Ernest Madu, MD, FACC and Paul Edwards, MD, FACC

Consultant Cardiologists

Heart Institute of the Caribbean (HIC) and HIC Heart Hospital

Correspondence to or call 876-906-2107


A holistic approach to health care delivery in Jamaica will require a comprehensive re-evaluation and transformation of our health systems, recognizing that we are experiencing an epidemiologic transition with significant impacts on human capital and national development. A vision for effective health care delivery in the new dispensation must include the following:

  1. Integration of inter- and multi-disciplinary teams of providers for cross-fertilization of ideas and cohesion in service delivery
  2. Acceptance of change as a necessary tool for growth and development- a more flexible system with better policy-research-provider collaboration is needed.
  3. Better use of research evidence in health care decision-making
  4. Improved understanding and more effective utilization of emerging technology in health care in both public and private sector health care delivery systems.
  5. Effective use of telemedicine to extend care to rural settings at affordable rates–this has been used effectively in many communities to extend care to rural locations.
  6. Remove regulatory barriers and bureaucratic bottlenecks to the acquisition of medical technology, equipment, and expertise or development of state-of-the-art facilities.
  7. Encourage deployment of appropriate health care technology that is culturally sensitive, affordable, durable, and adaptable to the local environment.

Concomitantly a greater emphasis must be placed on services across the full continuum of care by:

  • Focusing on the determinants of health from both the supply side and the consumption side.
  • Re-engineering health policy to encourage private-public sector partnerships in action and move away from slogans without implementation.
  • Adopting processes to quantify returns on investment for public health care spending using international standards of care and community health measures as effective tools.
  • Demanding greater accountability from health care providers, payors and regulators to ensure a more optimal and equitable healthcare delivery and outcomes for Jamaica.
  • Re-directing public health care spending from non-sustainable infrastructures to health promotion, preventive screening and treatment, medical equipment, technology, and expertise.
  • Appropriating resources to community-based care delivery tailored to specific needs unique to each Community.
  • More evidence based and rational deployment of public enlightenment campaigns, patient education and awareness

We must recognize that the global improvement in health care over the past 25 years has come as a direct result of the scientific and technological advances that have taken place over that time frame. These changes have occurred because of unrelenting research in the medical sciences. They have also come at significant costs, keeping much of that technological progress out of the reach of the less economically developed nations like ours. The result is that our patients are often denied the opportunity of newer and sometimes better and safer options that are routinely and commonly available to patients in many other countries. This is neither ideal nor acceptable. But we can change our story by embracing, rather than obstructing smarter and more creative approaches that allow us to optimize our health care delivery ecosystem in a cost-effective way to ensure more open access to care for all our citizens.

We must seek alternative ways of leveraging our limited resources to expand knowledge base as well as the quality of care for all Jamaicans.

We can no longer afford to look at things and accept them the way they are, reluctant, unwilling, or afraid to make them better. We must question the inefficient bureaucratic systems that impede our ability to provide the best possible health care to Jamaicans using the best evidence and technology. We must look for ways to extend the scientific breakthroughs in health care to all our citizens, demanding universal standards of care for ALL. We must change the existing order where 80% of modern health care technology and scientific advances are available only to 20% of the world population, an unfortunate paradigm that mirrors the uneven access to quality care in Jamaica.


In subsequent columns, we will address, with some degree of granularity, our prescriptions for immediate opportunities that can be capitalized on to enhance access to care for all Jamaicans by embracing smart and creative solutions that may be uniquely placed for Jamaica.



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