Management of health services in the Commonwealth Caribbean

Putting aside the very substantial gains made in recent years by health services of the Commonwealth Caribbean, this article reviews the administrative problems faced by those services at the present time. For the most part, these problems appear to have two main sources: weakness of the colonial heritage, and greatly increased popular demands following the attainment of associated or independent status. In general terms, there are a great many current needs. In many cases, for example, it would help to give more attention to identification and delineation of specific health problems, to make more extensive use of planning, to update existing legislation, to establish a better information system, to revise the budget classification system and loosen budgetary controls, to improve supply management, to more thoroughly define areas of official responsibility, to reassert individual responsibility for decision-making, and to streamline administrative channels. All in all, the problems faced by the health services make it imperative to reexamine the possibilities for implementing administrative reforms. It is felt, however, that besides being addressed to current problems, such reforms should be designed to help the health service cope with any new situations that may arise - before such situations can threaten its vital contribution to social and economic well-being.