Some debts are measured in pesos and others in appointments that never happened. The one just uncovered at the Departmental Hospital of San Andrés, Providencia and Santa Catalina is both. On November 8, the special intervening agent, Marjorie Englehard Archbold, said in a statement that the funds assigned to the Basic Health Teams programme "are not available in the hospital's accounts in the amount required to meet pending obligations." Semana, El Espectador, El Nuevo Siglo, Diario La Libertad and San Andrés Hoy reported it.

In plain neighbourhood terms: the doctors, nurses, dentists and psychologists who knocked on doors in the island's most remote sectors did the work, filed their invoices, and the money meant to back those payments is not fully in the account.

What we know and what we don't

Precision matters, because on this island rumours move faster than transfers. The intervening agent has not said anyone stole that money, and neither does this column. She said the financial review found the funds fall short, that the obligations predate the intervention ordered by the National Health Superintendency on October 16, and that the case has been reported to the Superintendency and to the Ministry of Health, which assigned those funds by resolution. She also said anything requiring further action will go to the oversight bodies.

What we don't know matters most. None of the published reports gives a figure for the shortfall. Nobody has explained how much the Ministry transferred, how much was spent, how much was paid and to whom, or what the difference was used for, if the money went to other hospital expenses. That is, word for word, the task the intervention says it is doing: establishing "the resources received, the amounts executed, the payments made and the outstanding balances for each obligation."

Why this hurts more here

Basic Health Teams are not an administrative luxury. They are primary care that comes to your door: general medicine, nursing, dentistry, psychology, in sectors where people cannot afford a taxi to the hospital. If those teams stop going out because nobody pays them, the bill is not paid by the contractor. It is paid by the diabetic grandfather in La Loma, the teenage mother in San Luis, the fisherman who never had a check-up.

And it comes on top of everything else. In September, during Health Minister Ana María Vesga's visit, 13 of the hospital's 59 licensed services were found not to be working, El Nuevo Siglo recalled: 22% of services switched off, surgical waiting lists over a year long, 3,676 radiology exams awaiting reading, a single general surgeon covering several areas, and repeated payroll delays. A hospital in that state has no room for its prevention money to go missing from the books too, since prevention is exactly what keeps people from arriving at the emergency room in serious condition.

What the islands have a right to demand

The intervening agent was right not to promise payments without backing. "We will not offer payments without the funds to back them: the responsible thing is to establish clearly what happened and how it is resolved," she said. That is sensible. But good sense has to come with a timetable and documents. At a minimum, the Archipelago should know, and soon:

  • How much did the Ministry of Health assign to the programme for San Andrés, under which resolutions, and when was it transferred?
  • How much was spent, how much was paid to contractors, and what is the exact amount that now has no backing?
  • If part of those funds was used for other hospital expenses, who authorised it and on what legal basis?
  • What came out of the Monday, November 9 meeting with the programme coordinators, and when will workers know if they will be paid?
  • Which findings will be referred to the Comptroller, the Procuraduría or the Prosecutor's Office, and when?

I do not raise these questions to point at anyone. There is no published ruling, charge or fiscal finding that would allow it, and getting ahead of one would be irresponsible. I raise them because silence in public health is also a decision, and the same people almost always end up paying for it.

At the time of writing I found no published agreement with a payment date. The intervention has a chance to do something rare on this island: open the books before the judges ask for them. It should. And the Ministry, which put up the money, should also say what oversight it exercised while it was being spent.

Armando Archbold, journalist from Universidad Externado with a master’s in politics, editor of WiNyuuz

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