The
Development Planning Unit
Government of the British Virgin Islands

NATIONAL INTEGRATED DEVELOPMENT STRATEGY

Health Sector
(continued)

CHAPTER 6 
RESOURCES

Human Resources

The quality of health care is directly proportional to the level of skill, training and sensitivity of health care staff. A range of skills is required for the tasks of health promotion and illness prevention, long-term ambulatory care, geriatric care, public health management, and coping with the increasing burden of accidents and injury

In 1997, a Human Resources Advisor (HRA) was appointed to the Health Department. The function of the HRA is to plan, develop and advise in the management of the human resources in order to achieve the strategic plans of the Health Department. The role profile is also to advise/develop methods of assuring accountability.

The British Virgin Islands suffers from shortages of skilled personnel, and mainly recruits from other Caribbean countries. In a 1995 review of community nursing services, 67% of nursing personnel and 33% of assistant nurses in the community health nursing service came from outside the territory. Foreign nationals are given 2-year contracts and some of them leave at the end of this period, resulting in a rapid turnover of nursing personnel.

In 1996, the territory had 28 doctors (16 in government services, 9 in private practice), 72 registered nurses, 22 nursing assistants, 4 pharmacists (2 public, 2 private), 6 environmental health officers, and 2 solid waste managers. There was one clinical psychologist, one mental health counselor, and two mental health officers in the mental health services. There were 9 positions filled in health service administration, of which four were in medical records (two trained persons and two assistants).

Currently, manpower and development training comes from several sources. Government sources include courses at the Government's training Division for employees already in the service and through the granting of scholarships for those who wish to be trained in the health sciences. A significant amount of training is done in the Caribbean, U.S.A. and to a lesser extent, in Canada and the UK. Manpower development is also delivered through regional and international training opportunities provided by organizations such as PAHO/WHO, ODA and the Hocking programme. Additionally, the organization of local training events through PAHO, visiting specialists and the UWI provide opportunities for further manpower development. This is particularly important for clinical updating and in priority areas for service development.

Issues/concerns in health manpower development:

1. Absence of formal training programmes for health professions locally,
2. Inability of the health sector to compete with more lucrative sectors for scare human resource (school leavers).
3. Absence of bridging programme to facilitate upgrading of certificate and diploma trained personnel to degrees, to allow access to postgraduate training programmes.
4. Limited opportunities for continuing education (renewal).
5. Under utilization of available technologies for professional updates and continuing education (e.g. Internet, CD-ROM, A/V materials).
6. Absence of a legal requirement for continuing education.
7. Cost of short term training overseas prohibitive.
8. Absence of local or regional professional accreditation bodies.
9. Culture of linking continuing education and training to financial reward.
10. Professional isolation.

Attention must be given to planning the human resource capability for sustaining the reformed health systems. Manpower planning capability must be based on systematic demands, which are in turn related to health profiles.

Financial Resources

The Government is the major provider and financier of health services in the British Virgin Islands. Health services are almost entirely financed (95%) from the consolidated fund. In 1990, the budget allocation for community health services (primary health care) was separated from that for hospital services. In 1995, the actual recurrent expenditure for health was $5,820,828 excluding local funding for capital projects. This represents 7.78 % of the National Actual recurrent expenditure, which was $74,770,791 with hospital services accounting for 68.2 % and primary health care 31.8 % (see appendix 1).

A portion of the health expenditures is met through cost recovery sources of revenue from the health sector include inpatient and outpatient hospital fees; dental, X-ray, and laboratory fees; and prescription drug sales. In 1995, the percentage of the health department actual recurrent expenditure that was met by actual revenue was approximately eight percent (8 %). Other sources of revenue include the Social Security Board and donations from external agencies.

Financial analysis of health sector carried out by Keele University estimated that in 1993, the government accounted for approximately 51% of the health-related expenditure in the territory. No estimates were made of the amount spent by the population purchasing health care off-island. (McNaught, A. & Lee, K., 1994). The remainder of the health care expenditure was estimated to be distributed as follows:

• Health insurance premiums paid by employers, including the government, parastatals and private sector employers (21%).
• Direct payments to practitioners (9%)
• Medicines, dental and optical appliances (12%)
• Fees paid to traditional practitioners (1%)
• Health fees paid to Government providers (2%)

The area of health insurance is a growing area of health expenditure. All government and parastatal employees are eligible to join group schemes. Additionally, private organizations may offer this as a benefit. In 1993, parastatal and private sector employers paid an estimated $81,000 and $1.2m respectively for schemes for their employees (Min of health & welfare, 1995). Since the premium: claim ratio is approximately 4:1 for government and parastatal schemes, these payments represent a large financial outflow while doing little to enhance local services.

In his 1991 annual report, the then director of primary health care observes that "although 12% of the total Government budget is allocated to health services, 60% of consultations (up to 95% in some specialties) actually take place in the private sector. At the same time, only a small percentage of fees charged by the Government is actually collected. The only public hospital is underutilized as occupancy levels average about 40%, and this is perhaps because of the virtual absence of private wards and the propensity for residents to seek treatment in the United States Virgin Islands and Puerto Rico.

As previously mentioned, under the current financing scheme, the health sector is unable to keep pace with public and professional expectations for high quality service and for further significant development and expansion of the health sector. As the health sector is only one of the many sectors competing for limited government funds and it is not likely that the sector will receive further increases to its share of government expenditure, it is crucial that alternative means ways of financing be examined. Some strategies that could adequately address this problem include:

1. The promotion of Value for Money and cost effectiveness in the provision of health service in the public as well as private sector.
2. The creation of other sources of financing including a National Health Insurance Scheme and more realistic levels of user fees.
3. The improvement of the quality, scope and marketing of services to motivate the expending of more health dollars locally.
4. The pursuit of a strategy for rationalizing and allocating existing resources.

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