by Dr Ishma Harford

A new hospital, a health financing scheme, or any major capacity-building initiative is the work of years, sometimes even decades. Real health reform is a marathon, while political cycles run in sprints.

That mismatch is the quiet reason so much of it never materialises.

Any administration courageous enough to begin a major project must first find the resources, and commit to financing, often through debt. It then absorbs the criticism, because every dollar must be justified to a public being asked to wait for a benefit it cannot yet see. Stakeholders must be kept engaged, conflicts of interest managed, and difficult decisions made and defended at every turn. And then, before the ribbons are cut, the electoral term ends.

What the incoming administration inherits is a project it likely spent the previous term scrutinising. The handover is rarely seamless, and momentum stalls. Perhaps its completion is judged no longer a priority. Perhaps the resources vanish. Perhaps, ideologically, it is no longer one they are willing to defend. Whatever the reason, the project sits half-built, serving no one.

But who is left to foot the bill?

You are. The patient who could be benefitting from that project ends up waiting or travelling for care that should have been available at home. The taxpayer services a debt for something not yet earning its keep. And a little more of our already thin trust in the system drains away.

For the administration that dared to start, a stalled project is wounded legacy, and a gamble on whether it will see another term at all. So, the safer bet, term after term, is not to start.

Perhaps, then, we need not ask for courage, but consensus.

Courage is a great deal to ask when human nature tends to self-preservation. A system that only works when brave people happen to hold power is not really a system. It is wishful thinking.

Selwyn Ryan, writing about Caribbean democracy in Winner Takes All, named the trap plainly. In a winner-take-all culture, he argued, too much of national affairs is treated as territory to be captured and lost with each election. And the opposition’s role, by design, is to oppose and hasten the government’s fall, not to help it succeed. To help a rival finish a landmark project is only to strengthen his claim to the next term. Consensus is not merely hard. It is punished. His answer was that some concerns are simply too important to be left to that fate.

They should be treated, in his words, as “borderless or cross-party rather than partisan issues,” settled by agreement no matter who holds office. He was discussing the energy sector and national assets. He could as easily have meant health.

This is what a middle-of-the-road approach would ask. Not that parties don’t disagree or debate, for this is the foundation of democracy. But that regardless of disagreement, one line will never be crossed: undoing sound work simply because the other side began it. No lip service or backpedalling, but the honesty that public health is an end in itself, and not a political pawn.

Consensus is harder than courage. It asks a government to start what it may not be there to finish, and an opposition to continue and even finish what it did not begin. It asks both to value the nation’s health more than political advantage.

The question is not whether consensus is the answer, but how we place health in the middle of the road and overcome the contention our political systems encourage.

Dr Ishma Harford is a medical doctor and a Commonwealth Scholar completing a master’s degree in Health Analysis, Policy and Management. The Health Imperative is an educational, politically neutral column about health, the system that delivers it, and all the implications in between.

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