School children's health sacrificed to save money

Privatization of school medical services left program shrunken and ineffective, say MKs.

The once-admired School Health Service (SHS), in which every school had a nurse who treated illnesses, monitored pupils' growth, hearing and posture, educated them about healthful behaviors and lent an ear to their troubles - was shrunken and turned ineffective by privatization at the Treasury's initiative and with the Health Ministry's implementation.
The major failures of the two ministries for giving cost-saving the highest priority over pupils' welfare is the target of major criticism by the state comptroller in his chapter on the Health Ministry.
The findings caused the National Council for the Child and MKs to issue severe criticisms and demand that the Health Ministry regain control of the service by cancelling the privatization scheme.
Council head Dr. Yitzhak Kadman called on the government to bring back the institution of school nurses, "cancel the wild, failed and irresponsible" transfer of responsibility to private contractors, try in court those responsible for the "failed and dangerous" privatization and provide the SHS with enough funds to ensure pupils' health.
MK Haim Oron, who heads the Knesset's public health caucus, said that SHS has been run during the last three years only with an eye for profits rather than promoting health and preventing disease. He called for an urgent discussion of the issue in the Knesset State Control Committee.
MK Dov Henin said that handing over responsibility to the for-profit Association for Public Health Services, headed by a former Health Ministry official and without it being selected by a public tender, was a disaster.
The National Council for the Child charged that the Treasury had developed a well-honed tool to save money while disregarding the public good.
Targeting a public institution or service that it wants to privatize, it severely cuts funding for it, waits a while until the level of performance drops and then declares that it is so bad, it has to be transferred to a private entrepreneur who places the lowest bid. The technique has been utilized against the Israel Employment Service and other public institutions, and attempted against well-baby stations (tipat halav) as well.
Kadman declared that while an experimental eye salve, for example, cannot be marketed until tested on a small group of children after approval by a Helsinki Committee on Human Experimentation, the government "gambled on the health of 1.5 million children without receiving Helsinki approval."
His council demanded that "those forces that obsessively pushed the negligent and rash process of privatization at all cost" be investigated and punished if found guilty.
The chapter in the Comptroller's Report was indeed one of the fiercest and most critical on the Health Ministry in years. Until 1997, the SHS was run by private suppliers hired by the local authorities or by the Health Ministry. Then, the National Health Insurance Law was amended to require the ministry to provide it alone, with their own employees. The ministry hired nurses and doctors to be present in the schools and provide ongoing services, but the Treasury then squeezed the service, cutting back the budget. When the level of services declined, it commissioned the for-profit contractor to do the job with a minimal budget, claiming that it would save NIS 7 million a year.
The comptroller found that not only was the service in the schools absolutely inadequate, but the ministry had to hire Magen David Adom to provide mobile first aid when a pupil was injured; this cost an addition NIS 20 million a year, rather than saving money. The annual cost to the government for the privatized service was NIS 84m. instead of the original NIS 64m.
In the "good old days," nearly every school had its own nurse, who was a "mother figure" always available to a pupil in need and even made home visits to children in problematic surroundings and families. But this was abandoned. With budget cuts, a smaller number of nurses travelled among schools.
The Health Ministry told the comptroller that there should be one nurse for every 1,500 pupils, but this declined to one for 2,480 five years ago and has since been further reduced.
Under privatization, nurses hired for relatively low pay and mostly to give vaccinations were brought in by the association. But even this function was not carried out well, the comptroller wrote, noting that some nurses took vaccines home - possibly losing their efficacy - because of the lack of refrigeration facilities. The number of nurses declined as the school population increased; tens of thousands of children did not receive on time the shots they were supposed to get.
Seventy pupils were even injected with useless water (which should have been mixed with vaccine powder) rather than vaccines; when the error was discovered the children had to face the needle again.
The Israel Medical Association filed suit in the High Court of Justice against the Health Ministry's privatization of its services. The association's contract was supposed to end this month, the comptroller noted, but this has been postponed by six months - with the association still in charge of the SHS - until a public tender chooses another private agency to provide services.
The comptroller charged that before privatization, the two ministries failed to conduct a professional survey of how school health services are run successfully abroad. Cost-benefit analyses were not conducted - and the government's "only consideration was saving money."
When the for-profit association was hired, it filled only 63 percent of the stipulated job slots, apparently to cut its expenditures. The Health Ministry's supervision of the SHS was inadequate, the comptroller charged, and the Education Ministry was - except for one short meeting - not consulted about the change to privatization.
The comptroller concluded that the privatization decision must be returned to the ministerial level to set a new policy.
Asked to comment, Health Ministry associate director-general Dr. Boaz Lev told The Jerusalem Post on Wednesday that he agreed the SHS should be the responsibility of the state and provided by his ministry.
Children in the school are "a captive audience," he said. They have no choice of getting it from somewhere else, unlike tipat halav services, which the Treasury also tried to privatize but which are are now provided by municipalities and health funds, as well as the Health Ministry.
"The problem with the School Health Service was that the Finance Ministry did not supply the needed funding. The service declined before it was privatized. It takes some time to set up a proper service. It was the best among bad choices. Having a nurse in every school is, of course, preferable, but it became impossible."
Lev said his ministry tried to persuade the Treasury against privatization but was not successful. It did not try to lobby through MKs and make it a public issue because that would not be the proper way of doing things, he said.
While Lev said he preferred that the ministry regain responsibility for SHS, he doubted that it will happen.