Recently the Cuban trained new Minister of Health, Dr. Kenneth Darroux, toured the seven (7) health districts on the island to assess health services. But the Labour MP from Petite Savanne has assured Dominica that he will be laser focus in addressing some of the shortfalls he personally witnessed in these facilities. I am sure the Minister is also studying the country's 'National Strategic Plan for Health 2010–2019'. This policy document and road map was launched by the government in November 2010 and it identifies key health priority areas. They include: training and development of staff in critical clinical and administrative areas; reorienting delivery models to achieve greater efficiency and effectiveness; improving capacity for planning, monitoring, and evaluation; and developing an efficient, automated health information system.

According to the Washington DC based Pan American Health Foundation (PAHO), Dominica's performance in essential public health functions was assessed in 2010. PAHO which was founded in 1902 and is an international public health agency working to improve health and living standards of the people of the America. It serves as the Regional Office for the Americas of the World Health Organization and works closely with the countries of Latin America and the Caribbean in dealing with priority health issues. Dominica's very own Dr. Carissa F. Etienne was elected Director of PAHO by the Member States of the Organization on September 1, 2012 and began her five-year term on February 1, 2013.

The assessment said that the island performed within the "optimal" range in health promotion. Performance was "above average" for monitoring, evaluation, and analysis of health status; surveillance, research, and control of risks and threats to public health; social participation in health; development of policies and institutional capacity for planning and management in public health; and reducing the impact of emergencies and disasters on health. Two functions achieved "average" range: strengthening institutional capacity for regulation and enforcement in public health and evaluation and promotion of equitable access to necessary health services. Performance was within the "minimum" range for three functions: human resources development and training in public health, quality assurance in personal and population–based health services, and research in public health.

Was the quality of the ambulance service in the rural areas one of the functions which received a minimum grade? What about the quality of physical plants of the existing health centers which were built in the 70s? Does he need a much bigger budget to address these issues in the PAHO report which received minimum grades? Dr. Darroux will have to answer and fix some of these vexing questions.

Does existing health legislation need to be revised, amended or enacted to ensure that rural folks have proper adequate ambulances and health services? Does health expenditure and financing allocations need to be revised? According the Ministry of Finance, the total Government budget in 2006 was $321.60 million, with the health budget accounting for 10.6% or $ 34,036million. The health budget decreased to 9% of the total budget for 2007–2009, and then increased to 10%, or $52.742 million, in 2010. In 2008, the total annual expenditure on health was $60.3 million or 8.2% of the total budget, representing 6.3% of GDP. The total annual per capita expenditure on health was $ 894.88.

In July 2014, the PM who is also the Minister of Finance delivered the 2014-15 Budget address under the theme 'Toward expansion of the economy'. Skerrit said, 'his vision and goal is to provide first century quality care to Dominicans'. Out of the Budget of $552.4 million, only 4.03 % or $7,006,924 is allocated to the Ministry of Health. Did anyone advise this PM that expanding the economy also means expanding the health ministry's budget allocation because a healthy population is a wealthy population? Skerrit lamented during the Budget address that 'a current surplus of $77.2 million dollars is anticipated for this current fiscal year'.

This writer hopes that Minister Darroux's fresh assessment of the health districts provided the insight which is needed to lead and improve Dominica's capacity to effectively finance, manage, and sustain the delivery of quality health services. Important to the country's capacity to fulfill these roles is a profound understanding, analysis and catalyzing of the urgent need for better health services for rural and poor populations must be a priority. While the functioning of the broader health system was probably the Minister's focus during his assessment tour, I hope he took note that particular attention is needed to sustain Dominica's HIV and infectious disease response among the other pressing issues.