Menu

Rattan Gujadhur

[Rattan Gujadhur] Reflection and Questions: The spectre of spiraling health care costs in Mauritius


Rédigé par Rattan Gujadhur le Vendredi 24 Juin 2022

There seems to be a gulf between reality on the ground within healthcare in Mauritius, versus what we generally read in bulky country reports, by the WCO (WHO local country office).



There seems to be a gulf between reality on the ground within healthcare in Mauritius, versus what we generally read in bulky country reports, by the WCO (WHO local country office). In 2016/2017, the country report had showered great accolades on the government, on their 'successes', in areas they call, the 'six strategic areas' i.e., Communicable Diseases Control; Non-Communicable Diseases Control; Promoting Health through the Life-Course; Strengthening Health Systems; Emergency Preparedness, Surveillance and Response; and Corporate Services and enabling functions. Yes, there have been some localized progress, as one cannot be one-sided in this analysis, but the health statistics on the population seems to point towards something deeply sinister, already happening in the health sector. A society, in the very throes, of a major health care crisis. A crisis right at our door. Country health datasimply jumps out at anyone doing basic preliminary research. 
 
The 2015 heath statistics report of the combined Mauritius and Rodrigues islands had earlier shown a dismal, and high level of mortality, for the five major killers on the islands:

➢ Diabetes Mellitis (24.1%)
➢ Heart Diseases (19.1 %)
➢ Cancers and Tumors (13.1%)
➢ Diseases of respiratory functions (9.2%)
➢ Cerebrovascular diseases (8.6%)

Since 2015, and with sad regret, the data has taken a downward negative spin. The society has verily become a very 'sick one', if one focuses only on these five NCO categories. The data looks dismal. Add to this, the specter of an increased incidence of Alzheimer's in Mauritius. The recent report by Sorefan, Goorah and Dorkhy mentions about 14,000 people with Alzheimer's disease on the island, all showing very modest improvements with pharmacological therapies.

So, one may humbly ask, what did the local WHO office actually congratulate the government for? Clearly not for an increasingly sickened society? Surely not ! Closer reading of the country report, shows that it was simply an accolade for good 'communication'. Well, Well done, government ! To quote the report....

'...We recognize and congratulate the Government of Mauritius for the measures taken to set up a multi-sectoral NCD steering committee as well as sustaining the inter-sectoral mechanism to ensure an integrated and coordinated response for the prevention and control of non-communicable diseases. In addition, we applaud the Government of Mauritius for prioritizing the health sector in the national budget allocation as well as in the implementation of regional and global health commitments...'
 

To break this 'congratulatory note' further down, and uncover the meaning of these words, they simply mean, the government had, kind of, 'tried' to connect divisions under their own MOHQOL (Ministry of Health and Quality of Life), and attempted to address the expanded cases of NCOs, and then so called 'prioritized' health care in the budget (which all countries normally do, its basic stuff). Hence the WHO office, played high politics, by just only scouring the surface without really calling out the elephant in the room, i.e a severely declining population health.

Moreover, the recent budget address of 2021-2022, makes a bold statement, we are now stronger, said the Minister! We are investing another $ 325 M this year versus $ 290 M in the last budget. 

The investment allocated here is mostly focused on hospital network extensions, community health center expansions. These are obviously much needed and a blessing for the country. Specialized cancer divisions, specialized equipment, and enlarged community health centers can only do better for the country. Some key questions must however be asked if these new enlarged funds will actually address the downward health spin,  and turn the situation in the country around. Coupled with all this is the massive economic challenge, as recently well summarized by economist Mr S. Kushiram, '...high inflation...will aggravate domestic and external imbalances and also undermine growth prospects. Short of fiscal consolidation, the current size of fiscal deficits is too large to ensure medium term public debt sustainability, to control inflation, and to stop the drain in foreign exchange reserves...'. Faced with these grave economic challenges, a few questions can be fielded on the population to enhance better understanding of what is truly at stake, what is the truth behind the recent budget health care statements and, finally, whether the proposed planned actions will  indeed, and urgently, safeguard the health and wellness of the island in the next few years.

• The health metrics of the island comparing 2015 to 2021, data shows a worsening of health statistics/state of the population for both Mauritius and Rodrigues, yet we see in that same very period, a drive towards expansion of infrastructure around the island, a mushrooming of private hospitals. Are these new schemes and networks offering cost effective and efficient services to the population, or are these just major private business endeavors, shrewdly geared mainly for profiting private large groups, and much less for addressing the health crisis at hand? If they are here to abate and help, why are things worsening on the island?
 
• With regards to the mushrooming of private clinics on the island, and how do their costs compare to that of' government' hospital cost structures? A quick comparison of, for example, the costs structure of private vs. government hospitals, for example, angiography, shows at least 10-20 x of the costs offered to the public. Who ends up paying for these enlarged premia, if not finally the public? Who controls these private costs structures for services and why do they keep increasing with decreasing population health? Is this not going to aggravate debts on the island, as the public 'borrows' to meet these taxingexpensive private hospital costs?
 
• Finally, with regards to the recent budget address, are the $ 325 M injected into health care this year, not simply a ruse and distraction, or mainly a revamping of the 'hardware', and not the 'software'? Is the government doing enough when it comes to 'competency', 'training', 'resource capacity building' on the island of our healthcare workforce. Private and governmental customer services are well known, through anecdotal records, to be very poor on the island. In brief, are we ready on the island to truly turnaround the dismal health statistics and revert downwards the increasing mortality on the island as a result of the 'big five' NCOs?
  

References:
1) WHO Mauritius Biennium report, 2016-2017
2) Heath Statistics Report, Ministry of Health and Quality of Life, 2015
3) 2022-2023 Budget, Closer to the Brink, Sushil Kushiram, L’express, 17 Jun 2022
4) A triangulated study on non-pharmacological management of Alzheimer’s disease in Mauritius, Dookhy, Goorah and Sorefan. Source: https://doi.org/10.1101/2021.04.27.21255997

 

A propos de l'auteur : Rattan Gujadhur      left Mauritius for higher studies in the US in 1999. He has practiced in the Pharma and Biotech world for over 29 years and is a Dr in Chemistry. He remains deeply in love with Mauritius and has published reminiscences of Mauritius via a poetry collection and a novel.

Vendredi 24 Juin 2022