Challenging the health process, fixing the hurts in St Vincent and the Grenadines (A) 2006-58.1

When Mrs Verlene Saunders, Permanent Secretary in the Ministry of Health, opened the memo on 26 November 2006, she was dumbfounded. Nothing in her outstanding public service career had surprised her more than the note indicating that the Cabinet had decided to proceed with health sector reform by January 2005, and within three months, required a plan of action. Milton Cato Memorial Hospital was to be organised as a quasi-commercial operation, run by a separate Hospital Authority, as a first step in the reform process. As Mrs Saunders contemplated her options, she pondered on the many issues that must be addressed. She became very despondent as she thought about what was required to successfully transform the operations. The plan would require commitment from a number of stakeholders but how could a workable win-win solution be reached?

This case introduces a number of public policy challenges including the reconciliation of public and private health interests, and the management of powerful stakeholders. It can also be used to discuss priority-setting for a complex task with a tight time-frame.

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• Part B (sequel)