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