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It's a big breakthrough for most persons dealing with end stage renal failure. But, for some it is a disappointment. Today when the contracts were signed in Belmopan, we found out why:...

Jules Vasquez reporting
It may look like just another signing ceremony, but these agreements will save lives. This signatories are the Ministry of Health and the four hemo-dialysis providers: Dialysis Del Caribe, Belize Health care Partners, Loma Luz And the KHMH.

The government will be paying for two treatments weekly for all persons presently receiving dialysis treatments in country:

Hon. Pablo Marin, Minister of Health
"From the 30 patients we will be able to increase it to 88 patients."

But to get from 30 to 88 patients with only a modest increase in the budget - there was a tough trade off:

Hon. Pablo Marin, Minister of Health
"It is sad that we had so much patients out there and we weren't able to help them. I think the ministry, my CEO, my DHS we were working a along trying to find a solution on a way forward for us to be able to help all those patients that are not getting the dialysis service and I don't think it's fair and sometime people criticized. It is not fair for I or the ministry of for the government of Belize giving the 3 dialysis to only 30 patients and we have about 50 plus patients out there that are not getting the dialysis. We brought it up to cabinet, my cabinet colleagues agreed for us to expand it, but yet with the decision that we will have to remove one of the dialysis that we are giving to the patient, instead of being 3, to become 2 dialysis."

And this was the difficult decision two to three years in the making:

Hon. Pablo Marin, Minister of Health
"This is the hardest decision, because when we wanted to expand it, we had everybody say what happened with the persons that are already taking the dialysis and they cannot afford - how are you going to manage with that? And you know how people say, if somebody dies they will blame it on me, because the person didn't get the third dialysis - it is your fault. It will have to be on your conscience and I am sorry again and I apologized to those people who are taking dialysis out of Belize. I am apologizing to the people that I had to remove one of the dialysis that they are receiving. It's hard."

But now that the tough decision has been made, how can the Ministry ensure that value will be received for the 2.2 million dollar expenditure:

Reporter
"We have to now start looking at the quality of care. We know that there are no established standards for dialysis in Belize. We know also that all the units in use are refurbished machines, so the quality of care is not at a premium level. How do we ensure that what the ministry and what the tax payers are paying for is of an optimal quality and that dialysis patients would truly be served by it?"

Dr. Marvin Manzanero, Director of Health Services
"There are standards of care and I think we need to stress that, because one of the other questions that I think have been asked is how comes Karl Heusner and Loma Luz seems to paid more for a particular session, because its tied into that. The investment has been done in training personnel both at Karl Heusner and at Loma Luz. We try to scale up the quality care that they are giving."

Dr. Ramon Figueroa
"We have brought in specialists to do assessments and to give us an idea of what are some of the quality indicators that one needs to monitor. So that has been incorporated into our standards and guidelines, that's going to be shared and is part of the contract itself. The providers need to follow these standards. So there are standards, but we need to enforce it, we need to monitor it and having a contractual obligation with the providers, gives us that opportunity now. The issue of hemodialysis machines and their age is something that we are looking at. As DHS mentioned, one of the questions we had asked actually of the nephrologist that came to do the assessment was 'are the machines too old.' they said it already have that age, but if you do proper maintenance they can still continue to provide the service."

But, the bigger idea is to make sure people don't get to the stage where they need dialysis:

Hon. Pablo Marin, Minister of Health
"What we will be asking and what we will be doing, we will be doing a massive campaign. We believe that we need to educate our people not to reach to this point. The people of Belize needs to be conscious that this is really a serious situation. Not only with kidney failure, but diabetes which is one of the worse scenarios that brings you to this renal failure."

The contracts went live today - and so, all dialysis sessions taken at those four centers today were paid for by the Government.