Commissioner Maria Buncamper-Molanus’s speech at the Case Management Conference on January 23rd 09

Case Management Conference

"As Strong As The Weakest Link"

Commissioner of Public Health: Maria Buncamper-Molanus

Friday, January 23rd and Saturday 24th

Honorable Lt. Governor Franklyn Richards, Leader of Government Commissioner Sarah Wescott-Williams, Director of Sector Health Care Affairs Jorien Wuitte, our special guests Drs. Leo Kliphuis and Dr. Javier Asin

I am honored to be present this evening for what I consider a vital conference which can produce results that can only be beneficial to the people of St. Maarten in terms of quality health care that’s safe, effective, efficient, timely, equitable, and patient-centered.

As everyone knows, the people of St. Maarten, voted on June 23, 2000 during the consultative referendum for the option of country status, which was confirmed and ratified in a unanimous motion of the Island Council of the Island Territory of St. Maarten on July 6, 2000.  

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It is only a matter of time when St. Maarten will receive the constitutional structure of country in free association with the Kingdom of the Netherlands. All tasks and authority will rest with the legal entity: the country of St. Maarten, becoming thus the third or fourth country within the kingdom.

A constitution encompassing binding provisions for the relationship between the government and its citizens;

A separation of powers based on clear-cut divisions between:

a. The Legislature;

b. An independent Judiciary;

c. The Government based on the rule of law and the principles of good governance.

A Bill of Rights that will form an integral part of the Constitution, and that guarantees the basic human rights and freedoms of the citizens.

A system of checks and balances that will guarantee political and financial accountability by the executive branch to the legislative branch as well as the guarantee of public accountability and transparency.

Our present healthcare system is fragmented and is contributing to an excessive level and unsustainable growth rate of healthcare expenditures. On one hand, there is an inconsistent synchronization and a lack of cooperation between healthcare providers which can put patients/clients at risk. On the other hand our health insurance system is complex and not accessible to everyone on the island.

The Island government recognizes the following policy accents that are reflected in the various policy documents such as the

1. Governing program,

2. The Slotverklaring Ronde tafel Conferentie

3. Building a healthy Island

4. Health care services St. Maarten

5. St. Maarten’s Strategic HIV/AIDS plan

6. The recently approved organization plan for the future Ministry of Public health and Labour & Social development[1].

– In this process of preparation for our new responsibilities there is the need to review, and develop public health and health care legislation for the Country St. Maarten due to the fact that all responsibilities with regards to the supervision, financing, policy & legislation and structure of public health and health care services, will be transferred to the island.

– The preparation process includes building capacity for the decentralization process and the future Ministry of Public health and Labour & Social development .

– The Island Government has established as a priority the development of a national health insurance plan, for all residents of St. Maarten, as a way to solve inefficiencies and find solutions to ensure the availability and access to health care services. This also in light of the many illegal immigrants.

– Developing integrated policies with other governmental sectors and/or future ministries such as ROB, Education, Sports, Economic Affairs and Social development are imperative. Certain public health areas can only be addressed effectively in collaboration with other policy sectors .

– The need to develop our public health infrastructure and health promotion to address and give improvement to health and environmental hygiene problems .

– Critical to our success as a country with responsibilities for health care on all levels, is the development of guidelines and policies, to maintain and improve the quality, establishment and accessibility of health care services.

– The achievement cost containment in health care through the introduction of a new financing system for health care, in addition to already existing needs to develop budgeting systems and Financial Overviews Health care (FOG).

– The already established prevention programs/activities will require further development aimed at health promotion and education pertaining to lifestyle, eating habits, overweight and exercise.

– In addition, we must recognize, that the promotion of primary health care and further development of multi-disciplinary cooperation between health care services and the introduction of accompanying managed care concepts, will lead to improved quality and contain costs in healthcare.

– Further strengthening will require Essential Public Health Functions, in order to improve areas such as epidemiology and surveillance, health information, food safety, quality of drinking water, youth health care, and medical relief in disasters. Especially health information and disaster management will be receive it’s die recognized and attention.

As a result of St. Maarten having full responsibility in the area of Public health policy-making and legislation, within a relatively short time, more is needed in health research to improve informed decision making in the near future. As a result of this, our budget 2009 continues to place more emphasis on the importance of health research. It is time for preparations to be made for a ‘new’ ‘How healthy is St. Maarten’ (10 years after execution in 1999).

With the availability of a new integrated facility for the fire department and ambulance services, we expect a improved professionalism and this will be reflected in the expansion of the ambulance shifts and the introduction of quality assurance programs and protocols as required in the Federal Ordinance for Health Care facilities.

We have long acknowledged public health initiatives for current concerns related to health promotion and environmental health and such is certainly reflected in our 2009 budget.

As was stated in the multi-annual health policy plan:

Building a Healthy Island (2003), there is a need for a transparent, accessible and affordable healthcare system on St. Maarten, which is clear, has effective policies and health-care services to the community and minimizes inequalities in the access to healthcare services on St. Maarten.

The Island Government has chosen as one of the areas of priorities in healthcare to promote and develop a collaborated multidisciplinary approach, with respect to treatments, preventive activities and the management of health problems. All healthcare providers as well as patients/clients need to participate in this approach.

The term used for this approach is case management, which is defined as a collaborative process of assessment, planning, facilitation and advocacy.

During this conference, several presentations will be given on case management: from the keynote speakers, Drs. Leo Kliphuis and

Dr. Javier Asin, as well as from local healthcare providers.

I would like to stress the importance of getting a better understanding of the benefits of case management, as an effective and efficient coordinated system of care. Ultimately, the aim of this conference is to establish case management in St. Maarten by defining realistic goals to achieve this system in 2009.

As I conclude, I would like to introduce to you the new General director of the Sint Maarten Laboratory Services NV: Drs. Hose Booi. Mr. Booi has been appointed by the shareholder

(Island Government) and will be responsible for the daily operations of laboratory. Mr. Booi welcome to Sint Maarten!

Finally I would like to thank you for attending, those of you who have registered and will be part of the one-an-a-half day conference.

This evening and tomorrow our keynote speakers will present and discuss

experiences in the Dutch Health Care system w.r.t. case management,

The Diabetes Mellitus Disease Management (DMDM),

case management and the patients/clients

Challenges for St. Maarten Health Care

The importance of collaboration in a health care system

Case management from a local perspective from several sectors within healthcare.

Ladies and Gentlemen:

The success for St. Maarten in achieving efficient, effective and a patient centered health care system will depend on our ability to use the tools required and acquired to make it work.

Indeed we are only as strong as the weakest link!!! So let’s commit to make that weakest link a strong one.

Good evening and thank you for your attention.