ASHA KISSOON MISREPRESENTS FACTS BY GIVING INCOMPLETE INFORMATION

The Ministry of Health is aware that vast room for improvement in the public health sector presents us with real opportunities to serve our people and country better. Every day, we work to fix the weaknesses that exist, to reduce the challenges that health sectors around the world confront, and to improve the quality of care for our people. We are not oblivious to the fact that among the challenges we face are working conditions for health workers in Guyana. As part of working conditions, health workers’ salaries and benefits are a prime consideration.
During the debate over Budget 2024, MP Asha Kissoon, who serves also as the Deputy Speaker, highlighted this challenge. The Ministry of Health under the PPP Government has always been conscious that aggressive efforts must be made to improve working conditions for health workers, including the remuneration for doctors, nurses, and other allied health workers, for example, medical technologists, pharmacists, etc. While the PPP Government has always been at the forefront of improving salaries and working conditions, the PPP has made even more stringent efforts since August 2020, when President Ali and Minister Frank Anthony, the Minister of Health, were sworn-in.
MP Kissoon alleges that doctors work 16, 24 and 26 hours straight, without overtime. This statement can be confirmed if the Hansard is examined. MP Kissoon, by telling only part of the story, is clearly misrepresenting the facts, which we hope is an oversight.
Unless there is a specific kind of emergency, such as the unfortunate Mahdia incident, we are not aware that doctors work on a routine basis 16, 24 and 26 hours straight and are not paid overtime. While it is true that some doctors are assigned to cover periods that might extend to 16, 24 and 26 hours straight, doctors are not physically present in the clinics or in the wards for those numbers of hours in our hospitals. MP Kissoon is obviously referring to on-call assignments. In the case of GPHC, multiple doctors per department, often as many as 5 to 7, are assigned per department for on-call duties. In some regions, for logistical reasons, the doctors remain in the hospital compound but only respond to see a patient if called out. Because, in some settings, the doctor may live on campus, they are at home, and called if needed. At GPHC and several other hospitals, doctors are at home during on-calls.
On-call duties might be following a shift or on a doctor’s day-off. On-call means that doctors must make themselves available in case of an emergency need at the hospital. Doctors who are on call are paid a fixed sum, which presently is from $4,000 to $5,500 for an on-call assignment. This covers a period between 4.00 pm and 8.00 am. For most doctors on most of their on-call days, they are never called out. Even for a regular eight-hour shift, many doctors are away from their place of work. MP Kissoon’s address gave the impression that doctors are routinely requested to work beyond their shifts by physically being present and not being remunerated. This is not the case, and therefore MP Kissoon, who knows this as a fact, is deliberately misrepresenting the facts by not telling the whole story.
Where doctors must work with a physical presence beyond their shift, they are paid overtime at a rate of $2,000 per hour; or if it is in the ER department, between $2,700 to $4,500 per hour, depending on the level. Here, again, MP Kissoon is either unfamiliar with, or misrepresenting, the facts. It is true that, in some regions, the local administration might treat such physical presence for a whole or part shift, as multiple on-call assignments, or reduce the number of shifts a doctor does subsequently as compensation.
In 2023, overtime for clinical staff, including doctors, amounted to more than $25M per month at GPHC, compared to about $21M per month in 2022. In addition, for 2023, on-call payments averaged more than $23M per month. Ms. Kissoon should make herself familiar with the facts. If she needs such information, she can easily access such information. The annual report of GPHC is a public document.
MP Kissoon herself is a health worker and a Ministry of Health doctor working in a health centre. The MP must know that the dozens of doctors who work in the primary health care system in health centres do not work beyond the regular working hours of the health centres. Although health centres are intended to be open between 8 am and 4.00 pm, many do not complete the whole shift. MP Kissoon will face a major challenge to convince the Guyanese public that health centres work 24 and 26 hours straight. We would like evidence that any doctor who is assigned to work in health centres physically is present for more than 8 hours per day. They also do not work on weekends.
We challenge MP Kissoon to present us with evidence that a doctor working beyond regular hours is not remunerated either with on-call or overtime payment or with a local arrangement.
With regard to doctor migration, MP Kissoon clearly is not familiar with the facts. It would be totally dishonest and false were we to insist that there is no migration of doctors. But Guyana has a dispensation at this time that is very different from the 1970s, 1980s and the 1990s when migration of our doctors was above 90%. In those times, we depended almost entirely on a small band of Guyanese doctors supported by doctors from Cuba, the Philippines, and some other countries. Gradually, since 2000, the number of doctors migrating has reduced. While there are still doctors who resign from the MOH and GPHC, most of them remain in the country in the private sector. Our dependency on international doctors has become negligible, and mostly revolves around doctors for certain specialist areas only.
In terms of specialist doctors, Guyana’s retention rate over the last decade is more than 95%.
In 2023, the MOH employed in the health sector 50 new doctors; the number of doctors who resigned numbered 25. This in no way represents a mass exodus. The vast majority of doctors who resigned from the MOH were reemployed at GPHC or remained in the country in the private sector. Most of them resigned not because of salaries, but because they wanted to pursue post-graduate studies at GPHC/UG or embark on post-graduate studies abroad in Canada, China, Cuba, Brazil, Russia, the UK, UWI, and other countries; or did not want reassignment to a hinterland region. If we examine each region, the story will be similar. For example, in Region Six 20 doctors left the system in the last twenty months, with 8 being reassigned to other regions, one whose contract was not renewed, several on local or international post-graduate studies, with only 5 resignations, all of whom are presently working in the country.
MP Kissoon’s reference to health workers, especially doctors, migrating and indicating that salaries represent the main cause of migration is only giving part of the story. MP Kissoon did not say that Guyana is one of the countries, developing and developed, in which migration affects the health system. Every single developing country has this problem. Global health workers’ exodus to North America and Western Europe is a priority issue being addressed in forums at the UN and the WHO. The health workers’ exodus is especially chronic for nurses. Guyana has taken steps to address the nursing migration challenge. Meaningful steps, even if they are not yet enough, have been made in improving health workers’ working conditions.
MP Kissoon failed, for instance, to mention that there were no designations beyond GMOs in the public service. For that reason, senior doctors at the level of senior registrar and consultants were either employed by GPHC and assigned to the regional hospitals or were paid at GMO levels. These were adjusted in 2022, and now the MOH can employ doctors as registrars and consultants in the public health sector outside of GPHC with similar conditions as GPHC. Similar adjustments were made for nurses and other allied health workers. Further adjustments were made in 2023, and more are due in 2024. For doctors, the adjustments have led to salary increases between $71,000 (interns) and $172,000 (consultants) per month.
MP Kissoon, even if she wanted to argue more must be done, and the MOH concurs, failed to acknowledge these meaningful steps, which include salary adjustments for doctors. We urge MPs to be fair and to represent the facts, not alternative facts (deliberate falsehoods) when they speak in Parliament.

MINISTRY OF HEALTH