Turks and Caicos Islands Hospitals

The challenge

In 2006, the Government of the Turks and Caicos Islands carried out an international tender to select a private partner who would carry out an infrastructure based healthcare renewal program designed to:

  • Replace an aging Islands healthcare system suffering from a lack of continuous improvement and unable to fulfil the aspirations of its population
  • Reduce and largely eliminate dependency on a treatment abroad programme funded by the Government to compensate for the lack of acceptable healthcare facilities within the Island. The cost of this treatment programme was rapidly becoming unsustainable by the Islands’ economy.

In July 2006, InterHealth Canada was selected as a preferred private partner.

The people first approach

InterHealth Canada financed, designed, constructed and now operates and manages the only government hospitals located within Turks and Caicos Islands.

The Islanders now have a high quality international standard healthcare service available to all and the clinical service plan has reduced the existing treatment abroad program by 75%.

The islands became more attractive to foreign tourists who perceive that they are able to obtain healthcare to the highest standards. This in turn boosted the tourism economy.

The spin off establishment of a National Health Insurance Plan ensures the long-term sustainability of the project.

The hospitals opened on time and to budget despite both suffering damage from Hurricanes Hannah and Ike during construction phase. Both centres are certified as storm proof to Hurricane Category 5.

Won the prestigious “Latin American PPP Deal of 2008” award from Project Finance Magazine. Picked by KPMG and the Infrastructure Journal’s Infrastructure 100 as one of the world’s most interesting projects.

Improving the Quality of Life of Communities

Since commissioning services in April 2010 InterHealth Canada has introduced efficiencies in health care delivery as evidenced by compliance with key performance indicators and improved health care outcomes.

The health information management system captures important health indicators and epidemiological data that has provided the local government information to inform decision making on resource allocation and public health interventions. The population now enjoys greater access to diagnostic equipment by providing the first government owned CT scan and MRI machines. Previously patients either accessed these services privately or overseas at significant costs to either the patient or government. There are several services that are being delivered on island which now affords patients to receive care on island supported by family instead of traveling overseas.

Promoting Health and Well-Being

InterHealth Canada has a robust platform of public education using seminars, workshops and educational materials on social and local media platforms. The health care team volunteer services within the community to organise health fairs and fitness challenges. The hospital restaurants have a wide selection of items that promote healthy nutrition. The hospital engages in various staff welfare activities such as subsidised memberships in local gyms and walk, run and cycle activities.

Local and Sustainable Jobs

InterHealth Canada is committed to being the employer of choice. We have a dedicated training and development department that delivers several strategic training and development initiatives on site and in accordance with our strategic goals. Our medical and clinical staff have access to renowned international conferences that provide invaluable opportunities to new and emerging trends in health care. We have increased local capacity through primary and secondary school educational programs meant to sensitize young people towards careers in health care. We have a targeted recruitment process to capture highly skilled and innovative local individuals via a collaboration with the local government and proactive succession planning. We deliver observational programs for local persons who are enrolled in tertiary institutions studying fields in all aspects of health care.
Influx of roughly 150 new healthcare professionals who raised the standards of the healthcare system and provided boost to the local economy.

Better Services at Affordable Prices

As a UK overseas territory, social medicine concepts underpin the financing of health care in the Turks and Caicos Islands. The services of the hospital are largely funded by a National Health Insurance Plan which his operated by the National Health Insurance Board. Beneficiaries of the plan access care via an affordable $10.00 co-pay. InterHealth Canada exercises sound financial management and ensures our pricing structure provides value for money and services affordable to the local government and the National Health Insurance Board.

Since opening in 2010, additional services have been introduced and InterHealth Canada remains eager to bring more services on island to lower the cost of sending patients overseas for treatment.

Scope of work

Integrated Healthcare Public Private Partnership and healthcare renewal program funded by InterHealth Canada and designed to:

  • Work with Turks and Caicos Island Government to establish the National Health Insurance Board required to fund the healthcare system.
  • Provide two full-service hospitals built to the best international standards within 24 months.
  • Deliver a total of 60 beds over 2 sites.
  • Services to include primary, secondary and specific level tertiary acute care.
  • Conduct a full assessment and training of all existing staff.
  • Recruitment of further staff regionally and internationally to fulfil service delivery requirements.
  • Achieve international accreditation by Accreditation Canada within 2 years of operations and to be maintained throughout the concession period.
  • Transfer ownership of the facilities back to the Turks and Caicos Island Government at the end of the concession period to an agreed exit plan and pre-set building condition.

Partnership structure

InterHealth Canada continuously works with the Turks and Caicos Government to ensure high-quality care of services which meet the clinical needs of the population in a financially sustainable method.

The Health Regulatory Authority

The Service Review Board is responsible for reviewing complaints, potential or existing litigations and key performance indicators with a clinical view. The board meets quarterly and consists of eight senior healthcare representatives from Turks and Caicos Government, Interhealth Canada TCI Ltd and an independent clinical chairperson.

The Contract Management Committee

The Contract Management Committee works collaboratively with Interhealth Canada to review performance and discuss strategic initiatives related to any changes in good clinical practice or good industry practice. The committee also reviews trends, new technology and relevant innovations in the health care Industry along with key performance indicators.

Under the Project Agreement, changes made to existing clinical services must undergo a Change Request Procedure seeking pre-approval from government.

Change enquiries are submitted to TCI government once patient volumes and patient demands reach the necessary levels to create a sustainable service model.

The Contract Management Committee

The National Health Insurance Board (NHIB) is the entity responsible for the management of all activities involving the TCI’s National Health Insurance Plan ( NHIP). TCI Hospital, managed by Interhealth Canada, is an entirely independent organization. It provides patient care to NHIP beneficiaries as the National Insurance Board’s preferred provider. TCI Hospital is not responsible for determining copay fees. These fees are dictated solely by the National Health Insurance Board. The Hospital collects co-pay fees on behalf of NHIB.

The model of delivery chosen by the Government of Turks and Caicos Island is based on the United Kingdom’s Independent Sector Treatment Centres programme with two significant differences:

  1. There is no sovereign guarantee from the Government; and
  2. The concession period is significantly longer; 25 years verses 5 years in the United Kingdom

Lending institutions were cautious to lend into a project where the infrastructure and clinical components were not ring-fenced. Clinical risk is generally not something banks wish to lend into.

To overcome this challenge, InterHealth Canada set up a twin SPV structure with an infrastructure arm which would design, build and operate non- clinical components (INFRA C°) and a clinical arm which would deliver clinical services (CLIN C°).

This effectively provided a one-point interface with the Public Partner.