Overcrowding in hospitals is a major problem across the world. In the
Caribbean island of Trinidad and Tobago, however, this situation is
deplorable and inhumane, affecting predominantly the sick, the elderly and
the poor. Through systematic empirical analysis, the hypothesis that
overcrowding would be resolved by increasing the number of beds was
tested at the San Fernando General Hospital (SFGH). Using two decades
of hospital utilisation reports, it was found that even when medical

With a history of relatively poor performance by its health system, Trinidad

and Tobago introduced radical reform under a new Decentralisation Act of

1994, which was intended to be patient-driven, bottom-up, flexible and

close to customers, as well provide effective management to achieve the

goals of the Ministry of Health (MOH). A critical analysis of the reform in

decentralisation and its performance is the subject of this article.

Essentially, we challenge through empirical field research the claims of the