Government Modernizes Remuneration Framework for Health Services Authority Board

Cabinet has approved a modernised remuneration structure for the Health Services Authority (HSA) Board of Directors, replacing the previous per-meeting payment model with fixed monthly stipends. This strategic change is designed to enhance transparency, strengthen governance standards, and ensure responsible management of public resources.

The HSA was established on 1 July 2002 under the Health Services Authority Act to provide healthcare services in accordance with the Government’s National Health Policy and Strategic Plan. Under section 8(1) of the Act, the Board is responsible for the policy direction and oversight of the Authority’s operations, a mandate that requires sustained time, expertise, and informed decision-making.

Board remuneration is governed by section 13 of the Public Authorities Act. Remuneration and allowances are determined by Cabinet, must remain within limits set by the Deputy Governor under the Public Service Management Act, must be published, and must be clearly stated in appointment letters. All such costs are borne by the Authority.

In February 2021, Cabinet approved a remuneration structure based on payment per meeting:

·         Chair: CI$750 per meeting

·         Deputy Chair: CI$600 per meeting

·         Members: CI$500 per meeting

Between January 2022 and June 2023, the Board held 190 meetings at a total cost of CI$490,850, compared to 13 meetings costing CI$23,700 during the 2016–17 period.

Reports from the Office of the Auditor General highlighted concerns regarding the number and categorisation of meetings counted for payment, instances where board remuneration exceeded the earnings of full-time medical professionals, and inconsistencies in remuneration practices across statutory boards. The per-meeting model did not regulate meeting frequency, allowing costs to escalate without a corresponding increase in accountability or value for money.

Effective 1 December 2025, remuneration for the HSA Board of Directors has moved to a fixed monthly structure:

·         Chair: CI$3,360 per month

·         Deputy Chair: CI$2,760 per month

·         Other members (non-civil servants): CI$2,400 per month

This revised framework establishes a clear monthly cap on payments, improves cost predictability, and removes incentives linked to meeting volume. The structure aligns more closely with remuneration practices across other statutory authorities and reflects established public-sector governance benchmarks, while recognising the significant responsibilities of Board members.

Minister of Health, Environment and Sustainability, Hon. Katherine Ebanks-Wilks, said, “Transparency, accountability and strong governance standards must guide the stewardship of public resources. This revised remuneration framework responds directly to concerns raised by residents and oversight bodies, ensures better value for money, and reinforces the principles that underpin effective public-sector governance.”

The Minister noted that the issues surrounding board remuneration have affected public confidence in the HSA and have had an impact on staff morale.

Further measures under consideration include a review of the HSA Act to assess whether additional accountability mechanisms are required for very senior management where performance does not meet acceptable standards, as well as steps to improve transparency in board operations. This includes examining how board decisions and minutes can be made more accessible to the public through clearer and more consistent publication on the HSA website, alongside existing statutory requirements.

The Ministry is also reviewing board appointment processes to strengthen transparency and public confidence, including consideration of publicly advertising board vacancies and formalising clearer criteria to demonstrate that prospective directors meet statutory requirements relating to integrity, skills, experience and the management of conflicts of interest.

The introduction of a revised remuneration structure for the HSA Board forms part of a broader programme to uphold governance standards, ensure responsible use of public funds, and support effective long-term oversight of the healthcare system. By moving to a transparent, capped and sustainable payment model, the Ministry and the HSA reaffirm their commitment to accountability, effective leadership, and the delivery of safe, high-quality healthcare services for the people of the Cayman Islands.