 Hello everyone and welcome to our special discussion with Prime Minister the Honourable Alan Chastney. It's part two of a special production looking back at 2019, the achievements and the challenges. And in this hour, we have the spotlight on health and tourism sector. The health sector, Mr. Prime Minister, is critical and to your own admission, and again, we go back to your budget address for 2019-2020. You said that dealing with the shortcomings has taken longer than desired, however, to your credit, you have remained resolute in trying to resolve what those issues are. But to the public's mind, the issues of health care are really boxed in into the commissioning or the non-commissioning of the St. Jude's Hospital and the OKEU, the Owen King EU Hospital. But it is as those perhaps who are very entrenched in what's going on, a more complex matter. So we'll get to expound on what those complications are. But first we'll review some of the highlights of the sector for 2019. Remaining a concern to both the government and citizens, health issues will and continue to be tackled by various interventions. The two main hospitals were in sharp focus throughout 2019. To ensure proper health care to citizens in the south, the government embarked on the construction of a new St. Jude Hospital. The 90-bed facility will cater for both inpatient and outpatient services. In the north, the phased transition from the Victoria Hospital to the OKEU continued in 2019 with the physiotherapy, dialysis and outpatient units along with the IT department and sections of the laboratory. Recognizing that the biggest deficiency in the nation's health care system is that tens of thousands of St. Lucians are unable to afford health care, the government has pushed forward with the National Health Insurance Program. This program aims to ensure that all St. Lucians have health insurance, with the government bearing the cost to cover the vulnerable, elderly and unemployed. The World Bank Health System strengthening project is well poised to push the primary health care agenda forward because this project is committed to the implementation of national health insurance while ensuring that our primary health care facilities are equipped to deliver services which will promote preventative care of the population. In 2019, the government also launched the health system strengthening project. The new system is aimed at improving health coverage to St. Lucians. The project is aimed at improving accessibility, efficiency and responsiveness of key health services and how do we aim to achieve that? For accessibility, the NHI will definitely address that in terms of our benefits package, given our population access to a specified benefits package. Efficiency will look at how we make our health care providers more accountable, how we treat our patients according to protocols. In an effort to reduce morbidity and mortality in terms of the number of persons in St. Lucia being stricken with certain diseases, the Ministry of Health embarked on an island-wide immunization drive to ensure all children at the age of 5 were assessed and vaccinated. The aim of this initiative was to reduce the need for hospitalization and medication and the cost that comes along with it. I look back there at some of the highlights in the health sector for 2019. We go straight into the big interest matters, St. Jude's Hospital. So much had been said on what was found, how it was going to be dealt with and then dealing with it. Now we have seen progress being made down at the site for St. Jude's Hospital. You are comforted that we are making strides in your own estimation. Absolutely. I mean, it was a very difficult process and one in which I think that we had to exercise the greatest amount of discipline in that given the amount of political pressure as well as public pressure would cause you maybe to do something that would not be to the benefit of the country in the long run. That was the tough part. Particularly when we met with the workers and the staff at the St. Jude's in the stadium. I mean, put yourself in these people's shoes that on the fire, moved into their miraculous job, were expecting that maximum a year it turned out to be then two years, then it turned out to be five years, then it turned out to be seven years, and now they are on the verge of making it to nine, possibly ten years. On more than one occasion, they were told, prepare yourself to move and to be disappointed. So I would say to you of all the people that we've met, their story was the most compelling. And I understand and when we were having to meet with them to go through the process that it wasn't as simple as looking at a building and saying, well, just fix up the building because it's better than the stadium, yes, it would have been. But we would have spent a tremendous amount of money where we have already spent money. So it's money on top of money. And we would not have built a facility that would have been able to facilitate and support the development that's taking place in the south. That's the reality. And yes, would it be better than what it is? Anything would be better than the stadium. But it was the strength, I think, that hopefully at some point people will look back and say, OK, my administration did do the right thing in what they did. So the problem was, first of all, we didn't expect to find the problem we had. We were told that the hospital was going to open up in July of 2016. It's when Minister Joseph and Minister Isaac went, they said, that's not happening. We then went and found that there was a letter that was written to the former prime minister in April of 2016 telling him it wasn't going to open in July. And they needed another $60 million. And possibly it would open at the end of 2016. So first of all, they already knew themselves they needed more money. And that there was still going to be time required to be able to finish off the thing. I then sent an independent auditor, physical auditor. And the person came back and said, boy, prime minister, there's a lot of deficiencies in this hospital. I mean, if you just walked into the emergency ward and compared it to OKEU, you could see automatically the difference. Things like the MRI machine and X-ray machine were being put on the ground floor. They were told not to do that. The ceiling was too low. So what did they do? They dug it down. So you actually go down on a ramp to make it to where those facilities are going to be. The ramp to take you upstairs, too steep and too narrow. Look, I can go on forever. But the point was is that the amount of money that was going to require to be able to make that facility work became more and more difficult. And we went through the process of trying to say, OK, given the complexity of the situation, given the need to get into a better facility than the stadium, can we put a temporary facility? And the amount of money that that was going to cost made no sense for us to be able to do that. So eventually, once the decision was made that we would build a new facility, was to get the money, get the designs done, which we did. We've gotten planning approval and now work has begun. And we're trying to get into that facility before the end of this year is what the goal is we have. But in some quarters, the thought, the thinking is that really and truly your administration is just providing a sort of glorified polyclinic and not giving St. Lucian's a hospital. Oh, there's nothing further from the truth. You know, it's a 90 bed facility. In fact, I'm going to go on record in here and say to you that I think that the facility that we're building at St. Jude's is even better than what was built at OKU. And I'm on record saying that. And I think that when the facility is done, people will be able to physically go and look at the tube and make that decision. Now, why is that? When you look at the plan that we have for St. Lucia, we have said that in order to be able to double or triple the GDP, view for it has to come up, can't have this all this land and all this potential sitting there undeveloped. And so we're already starting to see it. So cruise ship facility coming in, new hotels coming in, industrial parks being expanded, new business parks coming in, secondary home market. So you need a proper hospital. Yes, for the view fortunes themselves, people from the South, people from my constituency, but also now if you're going to be able to be successful and competitive on a global basis and create an international city, you need a hospital that meets that standard. Most importantly, this sort of re-rehabitation, the expansion for here in our international as there are particular requirements for being able to have a health care facility within the vicinity. Absolutely. Absolutely. So I'm look, I'm very encouraged by what we're doing. I'm very proud of what we're achieving. I think that once it's completed, the people will be very proud. But sadly, many people are missing the point with health care in thinking that the success of health care is the commissioning of OKEU and Victoria. They are important elements of it, but by themselves are not the solution to the health care problems and solution. And quickly, the OKEU, the update on that. It's about consultancy in terms of being for management. We know that there has been these are transfer some of those services in there. So where are we at with that, with respect to how much closer are we to seeing the OKEU being commissioned? So again, I want to thank the Europeans for the gift in the first place. But sadly, the government was not ready. So you have a facility that's been finished for seven years. So we're having now to replace the air condition system because it wasn't was never turned on the MRI machine that never worked. Never once did one patient is now having to be replaced. Electrical systems, breakers, ventilation systems, drainage systems, all having to be redone. So every day I'm being presented with another bill to operationalize OKEU. But we're not daunted. We've come too far not to be able to complete this process. And what the problem was is that both for OKEU and St. Jude's given this size that they are and the cost of operating a hospital. OK, the cost of a running a bed at a hospital is about five hundred thousand US dollars a year. So you do not keep people in hospitals when it's unnecessary. So prepping people should be done in other facilities and post operation and recovery needs to be done in other facilities to just really come in for the operational procedure at the main hospital. And I don't mean get out, but we remove somewhere else to a less or costly facility. So that was the assumption and the ability to go from Victoria of 170 beds to OKU of 120 beds. I inherited that. Sadly, there was assumptions. The assumptions were that you would fix up the primary health care facilities. So right now it's no secret to solutions. If I fall sick or have an emergency, am I going to go to the hospital or am I going to one of my polyclinics first? I guarantee you the vast majority, if not all solutions, are rushing to the hospital. The emergency center can't cope with the numbers of people. And being people are being admitted into the hospital who don't need to be admitted to the hospital. So they're occupying now a very expensive bed. And the system to be able to pay for all these services has been input in place. You really believe that any semi-intelligent person can't go to Victoria Hospital and start pointing out the deficiencies. But they are very glaring, by the way. Glaring. So who in their right mind would want to have that? So the reason why it's that way is they don't have the money. That's the reality. So the state doesn't have the money either? The state doesn't have the money either. The state where it's been running deficits. All we do is we have money to pay salaries because that's the one in which if you don't pay that, then all hell breaks loose. But if there isn't enough medicine, if there is not the sheets, if there isn't enough food, if a piece of equipment's not replaced. Right? Then people don't make as big of an issue about those things. But they hold you and your government accountable when it's not available. But sadly, I mean, and look, I say this because sadly, people have become accustomed to that level of service. Not to say that they're happy with it, but we've become accustomed to it. There's an expectation of their right to be able to have access to health care and for the government to pay for it. I'm not justifying it. I'm just saying to you that that's what I inherited. I inherited, we inherited a grossly inadequate system in which mediocrity was what the order of the day was. So opening up a hospital doesn't resolve that problem. The thousands of people in this country that don't have access to health care because they don't have the money are terrified to go to the doctor because if the doctor gives them a prescription, they can't get it anyway. People who are on high blood pressure pills and only take the pill when they get a headache as if it was taken in an aspirin. So I'm hearing you saying that for Saint Lucian's, perhaps you believe that we've not been able to reconcile what the reality is. And I think the world over, if people were to do some reading, do some research in countries around the world, health care remains one of the most expensive sectors for any government. It is. But for any nation, because most governments don't get deeply involved in the health care sector. It is. But I'm saying to you is that the vast majority of people in Saint Lucia or a lot of people in Saint Lucia believe that the most important part of what we're trying to do in health care is the operationalization of OKEU and St. Jude's. But I think that's not because the buildings are so dilapidated or they're nonexistent. And I hear you and we're fixing them, but that's not the biggest problem. The biggest problem is the affordability of health care and putting a system in which it's going to be able to maintain the standards in order to give people quality health care. And so the most important thing that my administration is doing is health care insurance. That's going to be the greatest gift. And speaking about that, again, I want to remind you that during your budget presentation, what you said was that legislative and institutional changes would be required to facilitate the full establishment of the national health insurance scheme. So are we making headway where that is concerned? Making great headway. I mean, again, I want to thank the World Bank and their technical teams and PAHO and the Ministry of Health and NIC who have been working with us to get through this process. So basically what we're trying to do is introduce a health care insurance that will be managed by through NIC and which that once you have a job that you're going to be expected to make a contribution and your businesses make a contribution and it's going to become compulsory. So today it's not. And so on average, a thousand to $1,200 a year is what people would have to pay to get health care insurance. We're seeing if everybody participates, that number is going to come down significantly. So government will pay the premiums for the unemployed, the vulnerable and the elderly. Right. Everybody else who's working will make a contribution along with the employers. Anybody who currently has insurance can keep their insurance or they can come and join our insurance. So a small business who have not been providing it will get the benefit of coming into a very affordable insurance program. Our insurance program will cover basic stuff. So it'll cover private doctor visits. It'll provide basic operations. It will provide prescriptions. Right. But what you can do is you can top up that insurance if you want to now be able to be covered for bigger operations or more intrusive surgery. So that's a huge step in the right direction. Now what's the biggest benefit of this is we now can start tackling health care. In this country, we will know because everybody now will go to a doctor. So we don't have to guess what the state of health of our country is. We will know absolutely what the state of health, how many people have high blood pressure, how many people are pre-diabetic, how many people are advanced, etc. and everything else. It means that the Ministry of Health now can introduce preventive programs to address that. And because now we can continue getting checkups from everybody else, we can see that we're making progress. So what do we know? That some of the most costly diseases we have here are non-cunrical diseases, right? High blood pressure and diabetes. People because they can't afford to go to the doctors are waiting until they're almost a critical point. They have to either be amputated or go in the dialysis machine or have reached the point of high blood pressure. They're going to have to go off work or they almost borderline stroke or have had a stroke. So it means that the state now is getting them when they are in this critical position. It becomes a humanitarian cry. To give you an example, we've allocated $800,000 a year to be able to help people with their health care cost. For two years in a row, we've broken five and a half million dollars and their list of people wanting to get support still continues to come in. It's not doable and we're doing it because we all have a conscience. We're all sensitive and have a tremendous amount of empathy with the people who are coming in who just don't have the money. How many families have lost their homes? How many people have had to cash in their pensions simply either to help themselves or to help a family member of which now they've gotten sick? So this is destroying our country. So this health care insurance is actually the most important thing because now it allows people to go and get treated. It also means that we're dealing with things beforehand. We can have programs to prevent it. Now here's an amazing thing. As you now improve the health of your nation, the cost of health care comes down. Why? Because less people are getting sick and therefore the insurance has to cover less. So we're now having to deal with cancer dealing with car accidents and then therefore your insurance premiums will be able to come down. So when we came in, none of this was in place. None of the primary facilities were ready. No money had been allocated. 10 million EC dollars is what was allocated to move into OK EU. And as I said, that they weren't even finished with St. Jude's that already spent almost 130 million dollars at St. Jude's and it was even close to be finished. Now again, unlike what people are saying, whatever demolitions have to take place, there were some little buildings that had to be demolished because they were grossly unsafe and inadequate. But in the existing building, the one that they built, what we're saying, let's make that into a university. If we can get a medical university in that location will be the only island in the country in the region that has a medical university attached to a hospital. So for an internships and training purposes, that's a huge advantage. And we are in discussions with three companies looking at the possibility for them to be able to do that. I think that's going to be a huge win-win situation for all of us. Speaking about the strengthening of our primary health care sector, smart facilities, great program with funding from the UK government under its DFID program. So 20, 17 health centers will be upgraded as part of that smart project and I'll list them all in just a bit. The IMF again, I want to go back and refer there because it gives a good indication as to where we're at. That conclusion said that the government gets credit for its commitment to resilience, but it underscored that considered efforts are really needed to mobilize climate financing. So we get points for being able to recognize that we have to do more for the health care infrastructure and making it more resilient. But again, the money aspect, being able to mobilize for that. So first of all, primary health care services and making them green and the resilience part of it. So DERISO was a beneficiary of that. So the goal here was that we put in a water tank, we put in a backup generator, we put in LED lights, we put in cameras. So that if there was a hurricane, that they become self-sufficient for a period of time versus in the old days, they didn't have that. If they became isolated, they were closed down and there were actually no use to people and medicine that was in there would not be refrigerated. So it's not every primary health care service is going to do that, but it's being spread all around the country in order to make sure that there's diversity in that. And I really want to thank DFID and PAHO for that level of assistance. But in addition to that, we're fixing up over 33 facilities and adding equipment to them in order that people now feel more comfortable going there first. So in order to take that stress off of the main hospitals and to allow them to be able to work, two things will happen. One is that, for instance, if you go to the hospital and you have an operation and you get a bandage, you should be able to go back home and you don't have to go back to the hospital to be able to get the bandage changed. You can go now to your Divana Center or a polyclinic to be able to get that done. And that takes a tremendous one. It's easier for them, but that's the level of skills that we want to have in our nurses. In addition to that, the educational program will be done through those centers as well. So I mean, in my case, and there is so because things kept breaking in, nobody wanted to stay there alone. Right. So it just basically by putting the fencing up, putting the cameras around and strengthening it, it helps significantly in that in that regard. So I'm very excited about that. In terms of resilience, you're 100 percent right. It costs money. What we've been arguing on a global basis, and I'm very proud that Senlusha has been taking a lead. And I really want to thank Dr. Ribergert for the amount of traveling that she has done, the work that she's been doing behind the scenes in terms of really pushing this initiative, is how do we can get monies available to us to be able to build more resilience. And Senlusha has made a decision in our roads, in our facilities we're currently building, we're building that resilience in. Some of the other countries are in significantly more debt and don't have the capacity. So I'm fighting also for them. But there are some bigger issues. Let's take VG Beach as an example. When we did the modeling and if the water level rises by three feet, that VG Beach actually will go right across the runway and connect to Ganther's Bay and VG will become an island. So how do you resolve that problem? So what we think is we have to do is bring a maritime coastal team in, look at the possibility of creating a fake reef further out and reclaim some of the beach. So what will happen is when the heavy waves come, their fake reef helps cut the energy and helps stop now all the sand from coming apart and it pushes now the problem further back out. Cool the sack. Cool the sack is going to flood if the water level rises. You can already see that the sea level and the river level are parallel to each other. So the question is, how do you resolve that problem? Do you drain the area? Do you create better drains? Do you create a reservoir? So the fresh water comes down and you hold the reservoir and we then pump it out. So it means you build a wall like a dam down at the bottom. Those are the things that we're having to look at but once we've discovered what we're supposed to do, where's the money going to come from? And sadly, none of these things are going to improve the capacity of the country. What they do is help now prevent the country from damaging or if we have a major hurricane that the recovery isn't as bad as it would be if we had didn't have those things in place. And that's the challenge that we have on a global basis. So debt to GDP, access to OECD monies, how is that debt going to be treated and then how quickly can we get the money and also implement the projects? I mean, the different project that we have is money that was given by Prime Minister Cameron for the West Coast Road. And we were hoping to get it started in 2020. So it's taken almost eight years to be able to execute that program. You hear the complaint with CDB. I mean, CDB is a great agency and they're only following the rules that they have, but it's not the swiftest agency, particularly when you're dealing with climate change. Why? Every year there's a new hurricane season. So time is against us. And so this is why we're trying to push the envelope, do the advocacy that we're doing in terms of getting the world to change its mind or where the World Bank is helping us and maybe now creating a foundation. The we present a paper at the heads of government meeting in Caracom in February. We're hoping then we can get it approved by the multilateral agencies at the spring meeting. And then we have this year the Commonwealth meeting, which is taking place in Rwanda. While we're there because 34 CIDs, small island development states are members of the Commonwealth. We're hoping that we can all sign on now to this foundation and that now this becomes a vehicle to allow development agencies and countries to be able to provide funds to be able to help the CIDs resolve this climate change problem. Let me just list what these smart facilities are right here in St. Lucia. We have the Comfort Bay citizen, a senior citizen's home, the Leclerc Wellness Center, the VFO Wellness Center, the transit home, Derriso, Bellevue and Monterey Port, Saltibus, Moghuge, the Lafag Wellness Center, Baxon Library and Richfort Wellness Center, Morsi, Entryport, T-Rochet and the Castries Wellness Center. So of course the island there could see a broad spectrum of what's happening to make us more resilient, at least in the health care sector.