National Consultations for Healthcare Transformation


Healthcare Sector Reform is an integral part of the efforts of the Government of the Republic of Trinidad and Tobago (GoRTT) to modernize the public health service, making it more patient-centric, responsive and efficient.

In the National 2030 Vision the desired goal of a sustainable modern health system has its foundation in up-to-date evidence-based public health principles and practices as well as services supported by regional and national institutions.

The public health system, in the short term must provide higher standards of care to patients as well as greater and more equitable access to healthcare services. To achieve this future state of 2030 healthcare, a mechanism must be established to sustainably provide quality services to citizens now and in the future.

Overall Goals of the Trinidad and Tobago Healthcare Service

  • Efficiency: GoRTT is determined to improve the quality of health services
  • Effectiveness: Only by working together, with a shared approach, can we improve healthcare in T&T
  • Access: Increasing access to quality health services and addressing disparities in health care provision across the country is a key priority for GoRTT
  • Equity: GoRTT is committed to providing affordable health care for all

The Government of the Republic of Trinidad and Tobago recognizes that one of the key features in establishing a modern health care system is the development of “objective standards of care”.

In light of this, a seven member Cabinet approved Committee led by Dr. Winston Welch, was established in November 2015 with the responsibility to review the healthcare system.

Objectives of the Welch Committee

i. To audit the current manner of operation of the Regional Health Authorities and its ability to provide quality health care.

ii. To rationalise the system(s) and framework governing doctors who pursue private practice while employed in a public institution.

The Welch Report

After extensive consultation via meetings with personnel in the health sector, written submissions by the public and online reviews, the Committee’s First Report, termed The Welch Report 1 was submitted on August 29, 2016. It focuses in the main on the review of the level of health care delivery by the Regional Health Authorities and highlights some fundamental transformational initiatives geared at improving the health sector.

The Welch Report 1 included 38 recommendations aimed at addressing the challenges in the healthcare sector that are negatively impacting in the levels of efficiency in the delivery of healthcare services in Trinidad and Tobago.

The Welch Committee Report 1B focuses on the rationalization of the system of public sector doctors in private practice.

Recommendations from the Welch Reports

Welch Report 1 Recommendations

The Recommendations have been grouped into 9 areas of action

1. Leadership and Governance /Organisation and Management:

  • retain the RHAs
  • revisit their organization and management systems to improve service delivery
  • strengthen the Ministry's leadership and governance role.

2. Health Infrastructure and Technology:

  • Improve and modernise the Primary (health centers), Secondary and Tertiary (hospitals) health facilities
  • Improve medical technology and services e.g. Laboratories

3. Human Resources for Health:

  • Address adequate human resource capacity for the country’s needs at all levels of administration, service delivery, including specialists
  • Invest in training to building HR capacity and quality

4. Quality and Monitoring:

  • Improve and monitor quality of services offered

5. Policy and Legislation:

  • Develop, revise and enforce legislative , policy and guiding documents e.g. Standard operating procedures, manuals and guidelines, etc

6. Operational Issues impacting care: (7 key areas for urgent attention)

  • Pharmaceuticals
  • Oncology
  • Radiology
  • Mental Health
  • Maternal /Child Health
  • Dental

7. Health Promotion and Communication:

  • Greater emphasis on health promotion and communication including increased health education initiatives

8. Health Financing:

  • Pursue a suitable financing model aimed towards the provision of equitable and affordable healthcare

9. Health Information Communication and Technology:

  • Strengthen and modernise Health Information Management Systems including the roll out of Electronic Medical Records

In this regard, the under mentioned 38 recommendations and points for consideration are presented.

There is need for:

  1. Improved functional relationships of the various bodies that contribute to primary care delivery. Resolving challenges in primary care relative to staffing, reporting, service delivery with guaranteed medical presence.
  2. Follow up clinics in health centres with guaranteed medical presence for hospital discharges. This should help to reduce the burden on hospitals and support the primary care initiatives.
  3. Detailed attention to and monitoring of patient service delivery areas.
  4. Details of responsibilities for Senior Medical Officers.
  5. Major infrastructure needs of various hospitals/institutions.
  6. Institutional Staffing: allied professionals, nursing, certain medical specialties.
  7. An advocate for streamlining of vertical services. Utilization of the RHAs in staffing and other supports, Ministry of Health to determine policy.
  8. Review the executive structures of the RHAs — numbers and roles of executives. Authority of the Medical Director. Emphasis on product delivery.
  9. Development of synergies across RHAs.
  10. HR - Management.
  11. Financial Management.
  12. Data collection and utilization.
  13. Strengthening of the Office of the Chief Medical Officer: technical/medical support.
  14. Review of Ministry of Health to meet changed circumstances.
  15. Review and consolidation of pharmaceutical procurement.
  16. Development of cardiac services.
  17. Development of C40 storage and distribution.
  18. Oncology service - linear accelerator for St. James.
  19. Psychiatry - continued repair of St. Ann’s Hospital, revitalization of community facilities.
  20. Emphasis on certain specialties in certain regions.
  21. Proper arrangement for Sangre Grande and Tobago in accessing specialist services in other regions.
  22. The appointment of specialists and the development of specialist services.
  23. The need to facilitate transfer of patients.
  24. The need to facilitate staff transfers, even if temporarily.
  25. Listing of the major projects, likely costs and need for prioritization.
  26. Hospital rationalization.
  27. Eric Williams Medical Sciences Complex – a public service, secondary institution.
  28. The matter of individual responsibility.
  29. Simple education/health news programme.
  30. The University and its occupation and output.
  31. Other teaching facilities.
  32. Whither RHA.
  33. Specialist Medical Officer Appointment.
  34. Dental Services adjustments.
  35. Ambulance Services adjustments.
  36. Nursing Services Enhancement.
  37. Recording of the options for the Couva Hospital.
  38. Roles of representatives, professional bodies, non-governmental organizations, interested individuals.

Welch Report 1:

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Welch Report 1B:

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