One of the COVID-19 isolation units at the Scarborough General Hospital, Tobago.

The revelation that having spent $70 million on a Cardiac Catheterization Laboratory for the Tobago General Hospital, the lab remains shut to nationals, is another example of the fundamental challenge facing the country, that of a lack of planning, execution and accountability.

Not only has the money been spend on plant and equipment but the lack of access for the people of Tobago means simply, if you get a heart attack you are more likely to die than if this lab was functional.

Do not take it from me, but rather from cardiologist Dr Ronald Henry, who in an interview with my colleague Kyron Regis noted that the old way of doing things, where medicine is given to patients with heart attacks and the outcome is awaited, contributes to the loss of lives and ultimately the loss of productive members of the labour force.

He said as a result of this type of treatment, people do not only stay away from work longer, but many of them never return to work, because even if they survive they have parts that are weakened permanently.

The cardiologist argued that a properly managed Primary PCI (Percutaneous Coronary Intervention) referred to as PPCI Program would assist in avoiding these circumstances. The Cath Lab is crucial for this to happen.

The truth is that the Cath Lab was built and equipped but never staffed and remains a proverbial white elephant.

This, in a country where the Ministry of Health identifies Ischemic Heart Disease as the leading cause of death.

Quite often the challenge facing T&T is not one of money but of planning and seriousness.

How else do you explain a situation where we are paving roads every five years and literally within weeks it is being dug up or potholes develop? Look at the Western Main Road from Westmorings to Chagaramas. It was repaved at a cost to taxpayers and great inconvenience to residents. This was done within the last four years. Today, when you drive on it you are seeking to avoid huge potholes. The Diego Martin Main Road was paved on the eve of the general elections and already is developing potholes. So when the Minister of Finance comes and talks about the budgetary shortfall bear in mind that his government and those that preceded it had no interest in the structural change that will ensure the country gets value for money and a population seeming powerless or not interested in protecting its tax dollars.

The Minister of Health Terrence Deyalsingh and Prime Minister Dr Keith Rowley boasted on the campaign trail that the country had a world class health care system, second to none. That they could have said that with a straight face when Minister Deyalsingh knows that the Port of Spain General Hospital can only do chest xrays and emergency CT scans have to be sent to Eric Williams Medical Sciences Complex and non-emergencies to Sangre Grande Regional Hospital while there in no MRI machine at POSGH is astounding.

Surely the Minister of Health knows the horror stories of the health sector from people waiting days for a bed to consultants who visit the hospital at best for a couple hours a week. Yet the Minister and the Prime Minister could still feel emboldened to tell the country that we have a world class health system.

For sure we spend a lot of money on health care but its a lack of systems, a lack of accountability and a lack of planning including maintenance of equipment that allows us to be in a constant state of under-performance.

Since the general election I have spent time in this column arguing that the country lacks sufficient focus to achieve its full potential and at all levels we are prepared to get by, knowing that the next energy boom is around the corner and it will allow us to have another cycle of the good times.

Well that energy boom is unlikely and with the global focus on climate change, the main source of revenue for the country comes from a sunset industry.

As I have said time and again, that does not mean we should not work hard on getting things right in the sector but we must view it as a bridge to a new future and not in and of itself the future.

The white elephant in Tobago, the constant spending on paving roads that do not last, the poor governance and scandals at CEEPEP are all linked to a country that continues to waste resources and not see that if it is to achieve its potential it has to change course.

When Minister Imbert takes to floor in just under a month, no one should expect anything transformative. He has already signalled that it will a budget talking about transactional issues. For example, the decision to remove VAT and other taxes on computers, as welcomed as it is, what is the strategy behind it? It is to become a more digital society? How does that relate to broadband and internet capacity? Is there a 5G strategy? Are we talking about the use of data and big data and the adoption of technology. How does that relate to the ease of doing business and the digitisation thrust and how will digitisation impact health care, where we still have records that are written and lost?

So yes, remove the taxes, but let us hear what the vision is, communicate that vision to the country and get buy-in.

Much has been made about spending $500 million on agriculture but what is this going to be linked to? Is it that we are trying to be self sufficient or is it that we are trying to make an industry out of it? What role will digitisation play? How will we get a tourism sector that can take produce from farmers and give them another sustainable market. How do we ensure that local produce is linked to school feeding programmes? In other words where is the planning?

For far too long governments have only talked about projects, so building new hospital or highway or paving a road are all projects. Little is said about the real changes needed. Reform is hard work but if we don’t do it, if we don’t plan beyond building a Cath Lab we will end up having spent money and be no better off for it.