Suggestions for Health Sector Reform in Trinidad and Tobago

Health reform refers to the changes in health administration, health planning and, health research that places significant emphasis on local health challenges aimed at improving health administration, health planning and healthcare. They will combine to produce an efficient model of healthcare delivery capable of increasing patient physical, medical and psychological safety. Health reform should be driven by empirical data, best practice and evidence based practice. A variety of health statistics; such as mortality, manpower needs, technology functioning and patient satisfaction; should be analyzed and employed in strengthening health systems.In Trinidad and Tobago the current system of healthcare is highly centralized. The Ministry of Health maintains operational oversight of five regional health authorities. These are the North West Regional, North Central Regional, Eastern Regional, South West Regional and Tobago Regional. South West, North West and North Central are the largest regions; each catering for the healthcare needs of more than three hundred thousand people.A significant reform should be the specialization of the Ministry of Health in fewer functions aimed to improve healthcare efficiency. For example, it can concentrate on data compilation and analysis. It should be staffed with expert health researchers tasked with analyzing changes in epidemiology, and trends in morbidity and mortality. Furthermore, the Ministry of Health should have the power to instruct regional authorities to make systemic and resource changes based on the statistics collected and analyzed. Regional bodies should be mandated to provide health based statistics to the Ministry of Health quarterly. The Ministry of Health must maintain general oversight of regional authorities. It should produce annual reports based on self- monitoring and evaluation of the systems, performances and challenges in each region. Financial statements and audits should be submitted annually to the Ministry of Health and factors accounting for variance should be justified. Recommendations should be made for improvements and incidences of white-collar crime prosecuted.


One major reform that should be implemented is granting absolute autonomy to regional health authorities for the delivery of healthcare. They should be able to generate their own funds by charging fees for their services. This would eliminate dependency on the state or Ministry of Finance for funding. Each regional health authority should be able to invest in the stock market or undertake other income generating measures it deems feasible. Its funds should be spent in accordance with the health needs of the population it serves. Regional authorities should be responsible for primary, secondary and tertiary healthcare. In addition, they should be given oversight of private hospitals and health facilities in their geographic regions. Private facilities should be subject to price controls to avoid exorbitant charges and should be required to pay at least ten percent of their annual profit to the regional authority.In addition, regional authorities should have the power to ensure that all health institutions and providers adhere to national accreditation standards. The Ministry of Health should be charged with responsibility for developing national accreditation standards in all aspects of the operations of health institutions. These should include hospitals, pharmacies, private practice. Also conventional and alternative medicines should be subject to accreditation standards. Everything and every health based institution should be subject to accreditation standards comparable with those of more developed countries such as Canada and the United States.It is palpable that the boundaries of each regional authority be redefined so that they are of almost equal population size. At this time South West Regional is responsible for slightly over one half million people. Therefore given its limited resources, it cannot be expected to perform with greatest efficiency. Given the fact that the better health facilities are situated in urban centers, this would be a challenge that must be overcome judiciously. To accommodate this reform, regional authorities should induce joint public and private partnerships in the provision of healthcare centers in rural and other districts less accessible to major hospitals and health centers.To make the health system efficient, a centralized electronic health record system should be developed and implemented. This would ensure that patients could access care in any region. Thus it would make it easy to access health records from any healthcare facility owned and administered within any regional authority. It is expected that the Ministry of Health should take a leading role in this enterprise. Records of patients in private hospitals should be accessible to regional authorities given that they may be moved to a public hospital if the care they require cannot be attained there. Sometimes for financial reasons such as exorbitant cost, patients may be moved to a public hospital.


Employment policies should enable the free movement of skills and expertise across regions. In some instances, highly specialized surgeons and caregivers should be made available to patients in other regions on a needs basis. In other words, one region can pay another for the services of its skilled human or physical resources demanded.Regional bodies can collaborate in health planning. They can develop their strategic, business and budget plans cooperatively. Afterwards they can tweak their plans to fit their population needs. The main advantages of centralized planning will be greater transparency, accountability and inter-operational functionality. Inter-planning can reduce competition between regions and ensure that scare resources are used efficiently. In effect, the Ministry of Health can compare operational effectiveness and best practice across all regions and provide opportunities to strength operational or institutional efficiency.The health system should be reformed so that it is able to provide high quality care for patients. Patients should be well-educated to take advantage of a competent, highly organized and skillfully administered healthcare system. Finally reform must involve all stakeholders; government, private practitioners and citizenry. A convergent bottom up and top down model should be adopted so that there is universal buy-in to health reform capable of contributing to economic and social development of the country’s human capital.

Alternative Sources of Business Growth Finance: There Is More Than One Way to Fund Growth

Talk to any business owner or read the business section of any newspaper and you’re likely to come across stories of struggles to access sufficient finance to grow or maintain their business. But we are beginning to witness a change in how business owners access finance with many now actively seeking out alternative sources.

A survey carried out by the UK’s Forum of Private Business found that 26% of businesses were hunting out alternative financial products, with 21% seeking them outside of the traditional main High Street lenders. In fact, in another survey undertaken by the Federation of Small Businesses, it was discovered that only 35% of respondents used a traditional overdraft facility in 2011.

So, if banks are continually reluctant to lend to all but the lowest risk businesses, how can the remainder of the UK’s business population finance growth? Here are some of the increasingly popular alternative sources of finance to investigate.

Better Management of Working Capital

This may appear to be an odd source of finance but very often businesses are sitting on undiscovered cash reserves which can be used to finance growth. A report issued by Deloitte in 2011 revealed that the UK’s largest businesses were sitting on £60 billion of unproductive working capital. Inefficiencies in how working capital (debtors, stock and creditors) is handled can unnecessarily tie up your cash. Cash can be unlocked and released back in to the system thereby allowing self-financed growth plans by taking a close look at credit procedures, how credit terms are granted and how outstanding payments are chased.

Ensuring that stock is kept at an optimum level via better inventory management is another area where cash can be released to support and finance growth. Take a good look at your inventory management process and identify areas where cash is trapped.

Good management of working capital is not just about better control of debtors and stock, it is also about maximising the terms given by creditors. Are you too eager to maintain a first class relationship with your suppliers by paying well before the due date? You can positively impact your cash position by taking full advantage of terms offered by your suppliers. Have you fully leveraged your position by seeking an extensive of terms from say 30 days to 45 days?

Being more efficient in how working capital is managed can release sufficient funds to self-finance growth plans.

Personal Resources

With traditional avenues of funding being more difficult to access business owners are now looking to their personal resources to fund growth. Whether it be drawing on cash savings, using personal credit cards or taking additional mortgages on residential properties, such sources are an instant solution. A survey by the Federation of Small Businesses found that 33% of respondents had utilised their savings to fund growth. As well as being more immediately accessible using personal resources is often a cheaper source of finance.

Family and Friends

Sometimes referred to as the three F’s – family, friends and fools – this can appear to be a less stressful way of raising finance. In some ways it can but it can also be a journey fraught with danger. Tapping into their personal network business owners source finance by either seeking a loan and offering to pay an interest rate higher than that on offer on a High Street savings account, or offering a slice of equity in the business in return for investment.

Raising finance in this way can be relatively easy because the request and fulfilment is very much based on personal trust. Typically a Business Plan would be presented highlighting both the investment opportunity and the risks but at the end of the day success is down to the depth of the relationship and level of trust.

The danger in raising funds this way is that the nature of the relationship will change from that of a personal nature to a business transaction. Failure to regularly pay as per agreed terms, or even total failure to pay, can irreparably damage the relationship so tread with care.

Asset Finance

The Asset Finance industry is based on the concept of either preserving cash or speeding up access to it. Asset finance, which consists of invoice discounting, factoring and funding of asset purchases, has been available as a source of finance for many years, yet it’s only now gaining more recognition. Figures released by the Asset Based Finance Association, a trade association representing the industry, show that to the third quarter of 2011 the amount financed by the Association’s members increased by 9% compared to the same period in the previous year. Whilst the increase may not seem significant it is against the backdrop of a fall in traditional bank lending.

In a world where ‘cash is king’ asset financiers help preserve cash by financing the purchase of assets such as vehicles, machinery and equipment. Because the financier is looking to the underlying asset as security there is usually no requirement for additional collateral. According to the Asset Finance and Leasing Association one in three UK businesses that have external finance now utilise asset finance.

Asset financiers can help speed up the flow of cash within a business by allowing quicker access to cash tied up in the debtor book. An invoice discounting and factoring facility gives businesses the ability to immediately access up to 80% of an invoice instead of waiting for the agreed credit terms to run their course. Such finance facilities will speed up the velocity of cash within the business thereby allowing the business to fund a high rate of growth.

New players such as Market Invoice are entering the market to allow businesses to raise finance against selected invoices. Tapping into high net worth individuals and funds Market Invoice acts as an auction house with funders ‘bidding’ to advance against certain invoices.

Crowfunding and Peer-to-Peer

A relatively new phenomenon is the concept of raising finance by tapping into the power of the crowd. The historically low rates of interest payable on savings have led to depositors seeking out new ways to increase their returns. With business owners struggling to raise the funding they need it’s only natural that a market would be created to bring these two parties together.

CrowdCube entered the market in 2010 to match private investors seeking to be Dragons with those businesses looking to raise capital. Once a business passes the initial review stage their proposal is posted on the site and potential investors indicate the level of investment they wish to make with the minimum amount being as low as £10.

Businesses looking for a more traditional loan should consider Funding Circle. Established in 2010 Funding Circle also matches individual investors looking for a better return with those businesses seeking additional finance. Businesses can apply for funding between £5,000 and £250,000 for a period of 1, 3 or 5 years. As a minimum the business has to have submitted two years Accounts with Companies House and be assessed in order to arrive at a risk rating which guides potential investors.

As the crowd sourcing concept matures we are likely to see more players enter this market to capitalise on the need for better investor returns and easier access to business finance.

There is More Than One Way to Fund Growth

Accessing finance to fund growth plans does not have to be difficult if you are prepared to seek out alternative providers. Funding growth is now no longer the exclusive preserve of the traditional High Street bank and it’s now down to business owners to seek out the alternative routes.