New perspectives in healthcare delivery

Public/private relationship has to continue as we need a healthy and happy population. The health care system functions better when they work hand in hand, with government understanding the realities on the field. The private sector should be given incentives to bring in new infrastructure and new equipment, the newest techniques, thus improving healthcare deliveries in the country.

Healthcare delivery in the last three years has been some countries have been much more affected than others, and each country, depending upon the circumstances, has followed a pattern of its own.

The Republic of Mauritius has used its own peculiarity based on its local implications and following the recommendations of World Health Organisation. Different stages of sanitary precautions, of segregation, lockdown, vaccination, changing drug therapy, booster doses and treatment of new cases have yielded their fruits. Certain countries like China and USA are still facing new challenges because of new variants and patients not responding to accepted norms of treatment. Mauritius has dealt with the pandemic quite satisfactorily. We have been affected economically, financially, morally, psychologically and our system of healthcare deliveries has undergone multiple adjustments. More doctors and nurses were recruited to contain the pandemic, so much so that it led to a scarcity of these types of professionals on the market.

We will not discuss about all the ways our country has been affected by the pandemic, but rather stick to the health sector. The COVID-19 pandemic has sent us a signal to prepare for the worst scenarios. Our health sector has shown its capacity to fight against difficult situations, but has shown our weaknesses. so that we are better prepared for future situations. The bulk of the pressure was on the public sector but, for the first time, the private sector contributed immensely, whether in taking part in vaccination, arranging for testing of patients and referring them to the hospitals, and ultimately treating COVID-19 positive patients in private clinics.

Scarcity of health professionals on the market has jolted us for a better preparation of capacity building. Many meetings were conducted at EDB and at the Ministry of Health and Wellness. More nurses are following courses in the private sector, aided partly by the HRDC, some more at Curtin Mauritius for a nursing global degree, some at MIH, and many more at Polytechnics Mauritius.

Formation of doctors is continuing at SSR Medical College, Anna Medical College and at the University of Mauritius. There are also courses in nursing for top-up and certain specialised courses. There is a need for doctors to be specialised in Mauritius, and this may become a reality with a Memorandum of Understanding (MOU) with foreign universities and the coming up of a teaching hospital in Flacq. Private clinics have also signed a Memorandum of Agreement with Polytechnics Mauritius for the formation of nurses.

The Ministry of Health and Wellness has also signed a MOU with the private clinics concerning medical and surgical treatment to patients who cannot be operated in the hospitals, provided the clinics have the infrastructure and personnel to do so. This will be of great benefit to patients and relatives who otherwise were asked to go abroad for same. Private clinics care coming up with innovations like supplying to patients facility to perform PET Scans, which is not yet available in the public sector.  With the approval of the Law, organ transplants are becoming a reality. Recently, some renal transplants were performed in the public sector, and private clinics will also offer their contribution. This will be of great help to patients undergoing renal dialysis. Corneal and liver transplants are other possibilities. Donation of organs may become a reality soon.

Public hospitals are re-organising their services to give a better healthcare delivery. Endoscopic examinations and diagnoses are being routinely done there. They are also thinking in terms of screening. The private sector has also developed fast in screening, examination, diagnosis and treatment of these cases. Laparoscopic operations are more and more practised in the private as well as the public sector. There are new developments in the treatment of Uro-genital cases, including renal stones, and laser treatment is already available in private clinics. Lasik operations are already available in the private clinics, so are PET Scans as mentioned earlier. Suffice it to point out that the private sector introduced the first CT-Scan, as well as the first renal dialysis.

There are seventeen private clinics in Mauritius at present, with a capacity of around eight hundred beds. Around 26% of the population attends private clinics for treatment, and one third of the deliveries of babies take place there. The out-of-pocket expenditure by the population in the private sector is more than the Budget of the Ministry of Health and Wellness (60% of the total). There are 5-6 new private clinics coming up this year - a general one at Curepipe Road, a cancer hospital at Coromandel, one at Reduit Triangle, one cancer hospital already functional at Rose Belle, one at Forbach in the North, one at Choisy and Tamarin, a new cancer clinic at Floreal) in addition to one in Africa. Medical Tourism may open new avenues, as well as new wellness and detoxification centres. Upgrading of existing clinics will help improve healthcare deliveries in Mauritius.

In the public sector, a patient cannot pick up a doctor of his choice - it will depend on who was the specialist on call when the patient was admitted. In the private sector, a patient and relatives can do so. The government is giving a facility to people who cannot afford such a service, to take a loan from some Banks, with no interest to be paid, A Memorandum of Understanding will soon be signed with the Ministry of Health and Wellness, under the patronage of the Ministry of Finance. Compared to fifteen years before, more and more persons are getting an insurance cover, by themselves or through companies where they work, and they have more access to private clinics. Government also visualises insuring people working in the public sector. We believe that soon fifty percent of mothers Mil be delivering their babies in the clinics.

The private clinics have to maneuver between a galloping inflation and the price for the treatment of uninsured patients, trying to maintain the prices so as not to overburden the items. The salaries by the people employed by the clinic increase with new laws like minimum salaries to be paid to them.

Private clinics try to balance the situation, more often in the interest of the patients. The healthcare system functions better when public and private sectors work hand in hand, the government understanding the realities on the field. In many countries like in India, a lot of incentives are given to the private sector to bring new infrastructure, new equipment, the newest techniques, and thus improve healthcare deliveries in the country.

Medical Tourism is another aspect where the government gains economically, providing more professional jobs, more jobs related to medical tourism, to hotels, to taxis, to facilitators and to other sectors of the population. The latest techniques, latest equipment, more skilled professionals, smiling faces, the sea, sand and sun are all usable assets to be tapped to improve medical tourism. Treating cancer patients in late stages on the island, with a tropical climate like ours, in the best surroundings will definitely attract patients and relatives.

The wish of any country is to have a healthy population. Non-communicable diseases need a better control, and the private sector participates in almost all organized health days, and work with many NGOs on a voluntary basis. My wish would be to offer better services to the population, especially in the private sector, with the latest technology at an affordable price. Public/private relationship has never been so understanding as now, and this has to continue in the interest of the population as, in the long run, we need a healthy and happy population.

Dr Dawood Oaris
Consultant ENT Surgeon
President, Private Clinics Association,
Professor Emeritus in ENT, SSR Medical College

Source : Discover & Invest Issue 23