SECTORAL PRESENTATION SECTORAL PRESENTATION WEDNESDAY JULY 15, 2009 - - PDF document

SECTORAL PRESENTATION SECTORAL PRESENTATION WEDNESDAY JULY 15, 2009 WEDNESDAY JULY 15, 2009

• HON. RUDYA
• HON. RUDYARD SPENCE

RD SPENCER, OD, MP. R, OD, MP. MINISTER OF HEALTH NISTER OF HEALTH TRANSFORMING HEALTH FOR NATIONAL DEVELOPMENT ___________________________________________ Acknowledgements

• Mr. Speaker:

I am honoured to once again stand in this Honourable House to report on the performance of the health sector over the last financial year and to share with the people of Jamaica some of the priority areas for this current financial year.

2 First of all, I would like to thank my Constituents who gave me the mandate to represent them in this Parliament. I thank them for their patience over the last year and a half as I try to balance the most challenging portfolio Ministry with my duties as Member of Parliament. I thank the Prime Minister for the confidence that he continues to repose in me in assigning me this portfolio and for the support that he continues to give to the health agenda. I thank Senator Aundre Franklin, Parliamentary Secretary in the Ministry on whose consistent support I rely to manage this challenging and complex portfolio.

• Mr. Speaker:

I must recognize the tremendous work of the staff in the public health sector. I thank the Permanent Secretary for her leadership of the public health sector through the most challenging decade in global health. Dr. Allen Young was appointed as Permanent Secretary in 2001 and has therefore been at the helm of the ship for the development and implementation of some of the most far-reaching policy interventions. I speak of the National Health Fund, the abolition of user fees for minors and the wholesale abolition of user fees last year. She was also the chief architect of the Jamaica Drugs for the Elderly Programme which was introduced in 1997 which has been an outstanding success.

• Dr. Allen Young will proceed on pre-retirement leave effective September 1, 2009. On behalf of

the health sector in Jamaica and this Honourable House, I wish her well and thank her on behalf

• f the people of Jamaica for her decades of service to the health sector in both the public and

private sector.

• Mr. Speaker, I thank the Chief Medical Officer, Dr. Sheila Campbell Forrester and the thousands
• f health workers who continue to go beyond the call of duty for the people of this country. I

recognize the work of the management and staff in all of our agencies and departments.

3 Our development partners continue to provide outstanding support to advance the health agenda

• f the country. I would like to mention:
• The Pan- American Health Organisation/World Health Organisation;
• The United Nations and its organs
• The United States Agency for International Development (USAID)
• The Caribbean Epidemiology Centre (CAREC)
• Various local and overseas based educational institutions
• The Caribbean Community (CARICOM)
• Individual governments such as the Governments of Cuba, Mexico, Spain and the

Republic of Korea

• Volunteer Missions, including members of the Jamaican Diaspora

I would also like to mention the many organizations in Jamaica in the private and non- governmental sectors that continue to work toward the achievement of the health agenda. Introduction

• Mr. Speaker:

Last year when I made my maiden presentation in the Sectoral Debate, I indicated to this Honourable House that I was doing so “at a time of great challenge and change in the global and local arenas”. That was true then, but nothing could have prepared us for what was to follow. Following on the fuel and food crises of last year, the world found itself in the grip of a recession that is the worst since the 1930s and the Influenza A H1N1 pandemic. I believe that these global threats are unprecedented and threaten to undermine the social fabric of countries and pose the most serious challenge to human security in the world.

• Mr. Speaker:

4 There should be no doubt in this Parliament about the strategic value of health to the transformation of the Jamaican society and the critical role that it must play in reconstructing the social landscape of our country. My presentation will be located within the context of the transformative agenda for health which will require the unrelenting commitment of this Parliament and a re-engagement of the people of Jamaica through a re-invigorated programme of health promotion. Grave Global Developments

• Mr. Speaker:

The Jamaican people need to be aware of the gravity of the global situation which is likely to impact negatively on health spending, health service delivery, health seeking behaviour and health outcomes. The working poor are expected to reach 1.4 billion according to the Global Employment Trend. Fifty million (50 million) people are projected to be added to the unemployment line and some 200 million people will be pushed into poverty. In addition, 40 million more people will suffer from malnutrition. The Economic Commission on Latin America and the Caribbean (ECLAC) projects growth of 1.9% for the Region after six years of consecutive growth averaging nearly 5%. Foreign Direct Investment to the Region is estimated to decline 35-45% this year. A Transformative Agenda

• Mr. Speaker:

5 The cumulative effects of the global recession, the influenza pandemic and the impacts of climate change require the development of the most farsighted and coherent health strategy and a convincing, rational and fully developed vision of any government in the postmodern era in Jamaica. We have decided to use the vehicle of transformation to reconstruct the bedrock foundation of Jamaica’s health sector, that is, the primary health care approach. This is the single most profound strategy that will simultaneously address those fundamental issues of equity, quality, access and community ownership, health promotion and social participation in health. The transformative agenda transcends a purely clinical response to the health needs of the Jamaican people and addresses the social determinants of health in the nation. The achievement

• f the Millennium Development Goals (MDGs) and Vision 2030 for Jamaica will depend on our

ability to transform the health sector. A critical plank of the transformation is the abolition of user fees, which, as we indicated to the Jamaican people we would use as the impetus to re-position the health sector. The other planks

• f the transformation agenda are:
• Renewal of primary health care; and the,
• Restructuring of the Ministry of Health and the RHAs

Abolition of User Fees

• Mr. Speaker:

This Honourable House will recall that this Government took the bold decision to abolish user fees at public health facilities on April 1, 2008 led to many criticisms. Today, I wish to bring to the attention of the Parliament of Jamaica irrefutable evidence in support of that policy intervention. Studies have shown that even where best practice conditions for implementation do not exist, as is the case of developing countries, patient utilisation increases especially among the poor.

6 This has been the situation in South Africa, Zambia, Uganda, Burundi, Madagascar, Zimbabwe and Jamaica both in respect of the free health care policy for children in 2007 and the subsequent wholesale removal of user fees last year. Furthermore, there is compelling evidence of a link between user fees and poverty. A study carried out in eleven low to middle income countries in Asia has shown that 78 million people were pushed below the international poverty line because of out of pocket payments. Separate studies conducted in Burundi, Ethiopia and Kenya have shown that user fees have reduced people’s asset base leading to what is being called the “medical poverty trap phenomenon”.

• Mr. Speaker, I am proud to announce that since the abolition of user fees policy last year, this

Government has saved the Jamaican people $2.214 billion dollars. In terms of patient utilization, the first year of abolition saw patient utilization increasing from 809,925 to 904,726 or 11.7% at Accident and Emergency Departments at public hospitals. Visits to the Accident and Emergency Department of KPH increased from 59,302 to 72,997 or just over 23% in the abolition year compared to the previous year. This compares to an 11.1% decline at the University Hospital of the West Indies where user fees were retained. Total admissions from Accident and Emergency increased from 166,684 to 173,703 in the abolition year, a 4.2% increase. Preliminary figures show health centre visits moved from over 1.48 million to more than 1.8 million representing a 17.4% increase in the abolition year. Pharmacy recorded the highest jump in utilization moving from 145,395 in 2007/08 when compared to 209,728 or an increase of over 44% in the first year of abolition.

• Mr. Speaker:

7 This House will recall that the University Hospital was exempt from the abolition of user fees policy.

• Mr. Speaker:

The Ministry is considering a proposal from the University Hospital of the West Indies to abolish user fees for children up to the age of 12 years old at that facility. This becomes necessary after careful study of the impact of the abolition of user fees policy on patient utilization at the hospital. While the Bustamante Hospital for Children experienced a 61% increase in visits to Accident and Emergency and over 17% increase in Admissions, the University Hospital Child Health Department experienced a decline of 16% for Admissions. Renewal of Primary Care

• Mr. Speaker:

The fundamental values of Primary Health Care include health as a right, solidarity and social

• justice. This approach is therefore seen by this Government as indispensable to re-orienting the

social and economic constructs of the country. Last year, a PAHO supported consultancy was undertaken to determine the strategic and action plans for the renewal of PHC. Based on the recommendations from the consultancy, we will be required to assess the scope of services that are delivered in Primary Health Care settings and to define, in detail, what these ought to be. We will need to improve the health information system and optimize the use of human resources working in primary health care.

8 Work on PHC renewal this year will include a health information system policy, the physical upgrading of health centres and a continuation of the development of the Community Health Aide curriculum with a view to training and recruiting these workers. Restructuring of Ministry of Health

• Mr. Speaker:

The Ministry has developed a new vision and mission statement. The new vision is Healthy People, Healthy Environment and the mission is to ensure the provision of accessible, quality health services and to promote healthy lifestyles. We have re-defined our roles and functions to include the determination of health care services, programmes and technologies, holding RHAs accountable and the regulation of the private and public health sectors. We have also developed a new structure for the Ministry of Health that takes into consideration the essential public health functions and several recommendations that were made in numerous reports since the decentralization of the public health sector. The structure reflects certain underpinnings that are indispensable to the capacity of a modern policy ministry to formulate innovative policies, effectively monitor and evaluate their implementation and to provide strategic guidance and leadership in improving the health of the nation. The restructuring is in keeping with the modernizing policy of the government as outlined in Ministry Paper # 56 Government at your service: Public Sector Modernisation Vision and Strategy 2002-2012. The components of the restructuring are linked to those elements that have been identified in the Ministry Paper and the subsequent Medium Term Action Plan 2008-2012.

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• Mr. Speaker:

You will recall that the Government received the Health Task Force Report which looked into the operations of the Regional Health Authorities. The Ministry undertook its due diligence to determine the way forward. Two options are being put to the Cabinet for its consideration. The Submission will be made to the Cabinet before the end of July and will include the restructuring of the Ministry’s head office. Improving the Human, Physical and Technological Infrastructure

• Mr. Speaker:

The entire infrastructure of the public health sector needs to be modernized. As a result, we are undertaking work to improve the human, physical and technological infrastructure of the public health sector. The Human Infrastructure A significant part of strengthening our system of health care for Jamaica is the improvement of human resources in health. We are part of a collaborative effort in undertaking a human resources needs based study of the health sector in Jamaica. The partnership involves the University of the West Indies, Dalhousie University and PAHO/WHO. This focus on human resources in health was identified in the Toronto Call for Action for a Decade of Human Resources for Health in the Americas 2006-2015.

• Mr. Speaker:

10 I am pleased to announce that Jamaica has been selected as a Centre of Excellence for Health Workforce Planning. The Centre will be funded by PAHO and the International Affairs Directorate, Health Canada Biennial Work Plan. Jamaica’s Centre of Excellence is a place where country leaders, institutions, researchers, and policy makers from sectors of health, education, finance, and labor, come together with the common goal of providing quality health care to all people through a well-trained, well-placed, motivated workforce. The Centre is expected to be opened in February 2010.

• Mr. Speaker:

The needs based study that is being undertaken is not just about identifying gaps in existing categories or groups but also determining the present and future human resource needs of the health sector. It is the first step toward building a continued Observatory of Human Resources in health that is based on evidence and will facilitate needs-based planning and development. A report has been submitted based on the study which reveals shortages across the health workforce in general but more so in some professions and in some regions of the country. The data shows that in addition to a severe shortage of dentists in the public health sector, there is a significant shortage of rehabilitation specialists in speech and occupational therapy. The ageing population and the increased burden of chronic diseases require that a greater focus be brought to bear on these areas of specialty.

11 The challenge is that the training for most of these categories takes at least three years in addition to a period of internship. Our training institutions do not have the capacity to train at volumes that would allow us to fill the existing vacancies and replace based on attrition and migration. We will continue to utilize the $100m grant from the National Health Fund to undertake short- term training of Pharmacy Technicians, Lab Technician Assistants, Psychiatric Aides, Medical Records Technicians, and so on in order to free up our highly trained staff to focus on tasks that they cannot delegate. Starting September of this year, we will be undertaking training of 40 persons as Dialysis Technicians and Pharmacy Technicians at the Lionel Town Hospital. The Ministry has also entered into a public/private partnership with Radiation Oncology Centre

• f Jamaica to train radiation therapists.

The Physical Infrastructure

• Mr. Speaker:

Last year, we indicated to the country that we require in the region of about $2 billion to rehabilitate the physical infrastructure and re-equip the public health facilities. The state of the facilities is in large measure due to the dramatic decline in capital spending over the years. This year, the allocation for capital spending is $410M, moving from $56M in 2004/05. Over $150M of this amount will fund the commencement of works on a Block at the Cornwall Regional Hospital while $70M will be spent on the preparatory phase of the development of the National Identification System. We expect to commence registration for the System in 2010/2011.

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• Mr. Speaker:

Last year, we completed work on the Toll Gate, May Pen, Lucea, Parks Road and Windward Road health centres through the Jamaica Social and Investment Fund (JSIF). Works on the Yallahs and Greater Portmore Health Centres were also completed through projects funded by the United States Government. The Spanish Agency for International Development completed work on the King of Spain Wing at the Spanish Town Hospital. Works are in progress at the Jeffery Town, Falmouth and Stony Hill health centres. This year, we will move ahead with the NHF supported $300m rehabilitation of health centres in keeping with our stated priority to renew primary health care. We experienced some delays in getting the project off the ground last year and took a decision to move the responsibility for the management of the project from the Ministry to the National Health Fund. We are at varying stages of tendering, contracting and pre-construction works for the Islington, Retreat, Gayle, Denham Town, Dallas, Darlow, Halse Hall, Milk River, Santa Cruz, Black River, Porus and Betel Town health centres and the Clarendon Health Department. The Technological Infrastructure

• Mr. Speaker:

Among the Ministry’s priorities this year is the development of a policy for health information system (HIS) and improving the HIS of the public health sector. The Ministry of Health relies on six stand-alone databases. We are moving toward a unified system with online connectivity.

13 The Government of the Republic of Korea has been providing technical support to the tune of US$1.5 million to develop Jamaica’s National Health Information System. The current system being developed by the Koreans will be installed and ready for testing by October 2009. They have also committed to assist us with training of our personnel and maintenance of the system for two years. Expansion of critical Services

• Mr. Speaker:

There are some important services that we are expanding to meet the needs of the population. Two of these services are the pharmaceutical services and renal dialysis. Pharmaceutical Services The abolition of user fees has brought into sharp focus the increasing demand for pharmaceutical services and the need for the public health sector to re-think the entire chain of operations involved in providing these services. We made some promises to the Jamaican people and we have made good on those promises. We committed to revising the vital, essential and necessary (VEN) drugs list. We did, and added 142 items to bring the full List to 738. We have included more drugs for conditions such as cancer, cardiovascular diseases and diabetes. We also told the Jamaican people that in light of the shortage of Pharmacists and our inability to attract staff from the private sector, we would train Pharmacy Technicians and these would free up our highly trained Pharmacists from doing some tasks. We commenced the training of Pharmacy Technicians and so far, we trained two cohorts comprising thirty persons. A third cohort will begin training in September.

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• Mr. Speaker:

The Ministry is collaborating with PAHO to undertake a pharmaceutical survey among individual and community households to determine the effectiveness of the service. We will also complete the development of a pharmaceutical policy this year.

• Mr. Speaker:

Parliament will recall that the Prime Minister announced the intention of the Government to make some changes to the operations of Health Corporation Limited with a view to improving the procurement and supply of drugs to the public health sector. We undertook the necessary due diligence and some decisions have been taken. The Ministry of Health, through the National Health Fund, will partner with private pharmacies to dispense drugs on behalf of the government. The Submission is before the Cabinet for its consideration. In light of the difficult financial climate, this initiative is to be implemented on a phased basis

• ver a three-year period, 2009/10 - 2011/12.
• Mr. Speaker:

The preliminary cost of implementing and operating the proposal is approximately $2.34 billion for the first phase (2009/10). The first year cost of the initiative is already accounted for in the 2009/10 budget for $2.24 billion and a $300.0 million grant from the National Health Fund. For year two (2010/11), an additional $416.13 million will be required and only an incremental amount of $131.06 million for year three 2011/12. Renal Dialysis

• Mr. Speaker:

15 This House will recall that I spoke about expanding the renal dialysis services in the public health sector. Less than one month ago, we purchased 17 new dialysis units for the Kingston Public Hospital which cost some US$386,000. We intend to continue to expand the services at the University Hospital of the West Indies and the Cornwall Regional Hospital. Millennium Development Goals

• Mr. Speaker:

I now turn my attention to Jamaica’s performance in the health related Millennium Development Goals (MDGs). In June of this year, Jamaica hosted two important meetings. One was a Special Council for Human and Social Development of Ministers of Health and Education in the Caribbean Region. That meeting was held under the theme, Winds of change: Education and Health Collaborating to Advance Human and Social Development. The other was the Latin America and Caribbean Regional Ministerial Meeting which was held in support of the 2009 Annual Ministerial Review of the United Nations Economic and Social Council (ECOSOC). I had the honour of presenting the report on the outcome of the second meeting at the Annual Ministerial Review at the UN office in Geneva last week. In the Ministerial Declaration, adopted by consensus, the Council, calls for, among other things, political leadership, empowerment of communities and the engagement of all stakeholders for attaining the MDGs. I also presented Jamaica’s country report to that Annual Ministerial Meeting. The report outlined

• ur progress toward the achievement of the health related MDGs and provided information on a

unique policy innovation in the form of the National Health Fund.

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• Mr. Speaker:

Overall, the country has experienced mixed results in the achievement of the health related MDGs. Jamaica is on track to achieve universal access to reproductive health, halt/reverse the spread of HIV/AIDS, malaria and TB. However, we are slipping in the reduction of child mortality and maternal mortality.

• Mr. Speaker, Jamaica has comparatively low child and maternal mortality rates. This explains

why the targets of reducing by 2/3 and ¾ respectively are difficult to achieve. Shortage in midwife cadre, which stands at 47%, has impacted negatively on our efforts. The Ministry of Health covers the tuition cost for the midwifery training and we are encouraging persons to take advantage of this opportunity. A major area of success for Jamaica is in our efforts to address the HIV/AIDS pandemic. We have maintained HIV prevalence at 1.5% for more than a decade. However, last year generalized HIV prevalence increased marginally to 1.6%. We have challenges relating to high risk behaviour. A study conducted last year showed an HIV prevalence of 31.8% among men who have sex with men. However, persons with no obvious high risk behaviour are also at risk of contracting the virus as 20% of persons reported with AIDS between 1982 and 2008 had no obvious high risk behaviour. While there is room for improvement in tackling stigma and discrimination, significant inroads have been made in increasing access to anti-retroviral drugs resulting in significant reduction in mother to child transmission and deaths due to AIDS.

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• Mr. Speaker:

We are confident that with the successful implementation of some critical policies such as the abolition of user fees and the renewal of primary health care, we can meet the health related MDGs. Since the historic UN Millennium Declaration, the prevalence of chronic non-communicable diseases has presented new challenges to public health. Jamaica recommended that ECOSOC place before the UN General Assembly a new Goal relating to halving the incidence of chronic NCDs by 2015 and a new target pertaining to the prevalence of chronic non-communicable diseases by sex and age. Jamaica also recommended that more health related development aid should be made available to those countries that are heavily indebted and are likely to flounder and fail in meeting the MDGs especially in light of the global recession.

• Mr. Speaker, Jamaica received support for its recommendations from several countries including

Barbados, Namibia, Canada and Brazil. National Health Fund/JADEP

• Mr. Speaker:

As I indicated earlier, Jamaica was asked to make a presentation to the 2009 Annual Ministerial Review last week on the National Health Fund which is regarded as an innovative policy intervention. This year, enrolment in the Fund reached 404,615 beneficiaries, representing a 16% increase

• ver the previous year’s figure. There were 35,947 new beneficiaries for the NHF Card and

18,364 for the JADEP Card.

18 NHF Card beneficiaries are now enrolled for 546,285 cases of illness. This is an average of 2.62 cases per individual. Hypertension remains the condition with the highest enrolment with just

• ver a quarter (26%) of the total number of cases.

The other leading conditions were arthritis – 16%, diabetes – 14% and high cholesterol 12%. Benefits Distribution

• Mr. Speaker:

Thirteen new Active Pharmaceutical Ingredients (API) were added to the NHF Drug list bringing the total number to 201. Overall, the total number of items on the NHF Drug list reached 1,288. The overall number of claims satisfied for NHF and JADEP during the year increased by 18% to reach over 2.6 million prescriptions. NHFCard beneficiaries received on average a 56% subsidy from more than 1.88 million prescriptions filled. The total value of their prescriptions was $3.038 billion and the NHF paid $1.692 billion in

• subsidies. For the JADEP Card 713,990 prescriptions were provided to the elderly beneficiaries.

This reflects an increase of 16% over the previous year.

• Mr. Speaker:

In regard to providers, twenty-two (22) new pharmacies signed contracts with the NHF to provide NHFCard benefits bringing the total number of NHFCard Providers to 422. JADEP Providers also increased to 344 up from 318, last year. Institutional Benefits The NHF continues to support the health sector. Over the last financial year, the National Health Fund approved funding for projects to the tune of over $842 million including fifteen projects for

19 NGOs totaling approximately $134.34 million. Funds in excess of $670.46 million were disbursed over the last financial year. The projects include construction and infrastructure, health promotion, research and the purchase

• f equipment.

Influenza A H1N1 Virus

• Mr. Speaker:

I now turn my attention to the most pressing public health concern that is facing Jamaica at this

• time. I speak of the Infuenza A H1N1 virus. Jamaica has institutionlised planning for an

Influenza Pandemic since 2005 and a MOH Influenza Pandemic Preparedness and Response Plan since 2006. This was revised in 2007. The plan was written in keeping with the six pandemic phases of the WHO with specific actions for each phase. It is the authoritative guide for the health sector and encompasses all actions to be taken to effectively and efficiently deal with the medical and health aspects of the influenza pandemic exposure, individual cases and epidemic measures.

• Mr. Speaker:

Jamaica was alerted on April 26th. 2009, by WHO which determined that the cases of Influenza A(H1N1) in Mexico and the USA constituted a Public Health Emergency of International Concern, under the International Health Regulations (2005). Jamaica responded in keeping with the recommendations of the WHO. We heightened surveillance for unusual outbreaks of influenza-like illnesses and severe pneumonia. One day later, April 27, 2009, the Ministry activated its National Emergency Operations Centre in keeping with the WHO moving the Pandemic level from Phase 3 to Phase 4. We alerted the

20 National Disaster Mechanism, all partners and stakeholders, all members of the health sector in the public and private sector and the general public. When the WHO moved to Pandemic Alert Phase 5 on April 29, Jamaica had already implemented the WHO Effective and Essential Measures for this Phase including heightened surveillance, early detection and treatment and infection control in all facilities. Jamaica had its first confirmed case on May 29, 2009. As of July 13, there were 39 confirmed

• cases. Based on our surveillance, Jamaica started experiencing local transmission of the virus on

June 22. Unfortunately, we recorded our first related death on July 6, 2009 and have since recorded a second death. In these two cases, there were underlying health conditions which compromised their immune system.

• Mr. Speaker:

Jamaica has distinguished itself as a success in the management of outbreaks and epidemics. We have our best team involved in the day-to-day management of this influenza pandemic. I must commend Dr. Marion Bullock DuCasse for the splendid work that she has been doing in managing the situation. I salute our health workers across the length and breadth of Jamaica who are at the fore front of providing service to our people in the midst of this public health threat.

• Mr. Speaker:

21 I would like to urge the Shadow Minister for Health to be more responsible in his public utterances about the situation. If he had taken the time to speak with the former Ministers of Health on that side of the House, one of whom is still a serving Member, they would have enlightened him about the protocol involved in confirming and announcing cases. The protocol is based on the international health standards regulations. Jamaica must declare a confirmed case to the international community within 24 hours. No one, no one, can question the integrity of the public health team in the management of this public health threat.

• Mr. Speaker:

The Shadow Minister should do the decent thing and apologise to our public health team for casting doubt on their integrity.

• Mr. Speaker:

Jamaica undertook six main strategies in dealing with the pandemic.

• 1. Heightened surveillance at health facilities and our ports (including informal ports);
• 2. Early detection, diagnosis and treatment;
• 3. Infection control in health facilities;
• 4. Intersectoral Collaboration with key entities.

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• 5. Public Awareness, Information and Education; and,
• 6. International Cooperation with regional and international health institutions.
• Mr. Speaker:

The World Health Organisation considers this as a mild strain of influenza and there is no need for people to panic. We urge the public to follow the precautions that our public health officials have been giving even before we had our first case. We are advising persons who have existing health conditions such as chronic diseases, HIV/AIDS, or any other illness that compromises the immune system to seek medical attention at the first onset of flu like symptoms. We cannot predict the course that this pandemic will take but we can continue to take the necessary precautions to protect ourselves. At this time, we are not disrupting social or economic activities because there is no scientific basis to do so. We maintain, if you have flu like symptoms stay home and take your flu medicine, drink lost of fluids and rest. If the symptoms persist, visit your doctor. This latest pandemic has once again demonstrated the profound shift that has taken place on the epidemiological landscape. We now face the double burden with communicable and non- communicable diseases. This shift requires an effective health promotion agenda with a supportive legislative framework.

23 We will continue to implement the Healthy Lifestyle Policy which provides the framework for action and a quality improvement project sponsored by PAHO. We are placing emphasis on a nutrition and food security policy. In addition, we will be amending the Public Health Act to provide for further measures to regulate and control tobacco use. Conclusion

• Mr. Speaker:

Even as Jamaica positions itself to address the severe and wide-ranging impact of a global recession, climate change and the likely effects of the H1N1 virus, this Government is committed to advancing the health agenda that will give us a sustainable strategic advantage in an increasingly dynamic and competitive global marketplace. The transformation of the health sector provides the best guarantee to reach, mobilize and influence a significant portion of our population to advance the country’s human and social development as we work to secure the social capital of Jamaica land we love. God Bless our Parliament and God Bless Jamaica. I thank you.