Dominica’s Health System

Dominica’s Health System

Ministry of Health & Social Security

May, 2006


General 790 sq. kilometers Mountainous – 8

active volcanoes Government centrally

administered with Parliamentary type democracy

System of local Government- Councils

Tourism now the main foreign exchange earner


Employment in Week before Census by Area of Employment

05

101520253035

Ag

ricu

lture

,

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ing

&

Ma

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fact

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ng

Ele

ctri

city

,

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ion

Wh

ole

sale

&

Ho

tels

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ort

,

Fin

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cia

l,

Pu

blic

Ed

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tion

He

alth

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Oth

er

Pri

vate

Ext

ra -

Oth

er

No

t Sta

ted

Pe

rce

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ge

1991

2001

Data source: Dominica 2001 Census


Life expectancy at Birth All sexes – 73 (72-74) years• Males 71.0 (70-71) years• Females 76 (74-77) years

2002 Poverty Assessment Findings:• 29% of households and 39% of population at or

below poverty line• Poverty more heavily concentrated in rural areas• Poverty severe amongst the Caribs – 70% poor

and almost 50% indigent

Demographic & Epidemiological Context


POPULATION GROWTH, 1960 - 2001 CENSUSES

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

7th April,1960

7th April,1970

7th April,1981

12th May,1991

12th May,2001

Census

Po

pu

latio

n

Data source: Central Statistical Office


Population structure Total population =

68,635 (2001 census)• Males = 50.3%

• Population <5 = 8.9%

• Population <25 years = 45.4%

• Population >60 years = 13.4%

Migration and declining birth rates - negative population growth

Population Age Structure, Dominica 2001

0500

1000150020002500300035004000

0 -

4

5 -

9

10 -

14

15 -

19

20 -

24

25 -

29

30 -

34

35 -

39

40 -

44

45 -

49

50 -

54

55 -

59

60 -

64

65 -

69

70 -

74

75 -

79

80 -

84

85+

Male

Female

Data source: Dominica 2001 Census


Data source: Health Information Unit

Trends in Vital Statistics

0

5

10

15

20

25

1999 2000 2001 2002 2003 2004

Rate

Crude birth rate (per1,000 pop.)

Crude death rate (per1,000 pop.)

Total fertillity rate

Infant mortality rate (per1,000 L.B.)

Under 5 years mortalityrate (per 1,000 L.B.)


Trends in Mortality, Dominica 1998 - 2003

0

50

100

150

200

250

1998 1999 2000 2001 2002 2003

Nu

mb

er

of

Death

s

Communicable Diseases

Malignant Neoplasm

Diseases of the Circulatory system

Conditions Originating in Perinatalperiod

External Causes

All Other Diseases

Symptoms & ill-defined Conditions

Data source: Registry of Births and Deaths


General Organization

•7 health districts

•7 district health teams

•52 health centre/clinics

•2 district hospitals

•Main hospital in Roseau (secondary care)


Type 3 Health centres – 1 per health district. Serves as admin headquarters of the district

Staffing: DMO, FNP, EHO, Pharmacist, CHN, RN/midwife, dental therapist and support staff

Type 1 clinic (45) Staffed by a nurse/midwife and serves a

population of 500- 2000 persons Secondary care level = Princess Margaret

hospital Tertiary services- neighbouring islands or

visiting specialists


Private Institutions

Services limited to ambulatory care provided by practitioners

90% of private services located in capital 1 small hospital 1 laboratory Pharmacies Family planning (Dominica Planned

Parenthood Association)


Human Resources

All available health staff are employed Loss of human capital related to

migration particularly among nurses. Over 90 vacant nursing positions Deficit exists in most specialist areas

such as anesthesia, radiology, internal medicine, pathology, and surgery

Assistance through the TAC programme with Cuba, Nigeria and Japan


Most doctors are Cuban trained A new nurse training programme with a

capacity of 100, began this year utilizing Tutors from Cuba.

Nursing School and Hostel refurbished with assistance from Cuba.

Environmental Health Officers and Community Health Nurses trained with funding from PAHO

2 radiographers trained with funds from PAHEF


Plans to address nursing shortage include • Immediate increase in training

• Cuban technical assistance

• Overseas recruitment

• Implementation of recommendations of Cabinet appointed Task Force to examine issues germane to the recruitment, retention, recognition and reward of nursing professionals

Succession plan for all departments being encouraged


HIV Surveys

Prison seroprevalence survey• 2.6% (5/191)

BSS• Results

outstanding


05

101520

Number of Cases19

8719

8819

8919

9019

9119

9219

9319

9419

9519

9619

9719

9819

9920

0020

0120

0220

0320

0420

05

HIV Positive by Year and Gender Dominica

Male Female Unknown


Strategic Pandemic Influenza Plan

Outline of strategic plan drafted

Operational plans now need to be drafted• PMH

• PHC Services


Policy Directions Essential Public Health Functions

Reviewed this year. Findings are being utilized in updating of the health situation analysis, in preparation for the development of a new National Strategic Plan for health for the next five years.

Review of CCHII. Priority Areas for CCHIII


Patient Administration System

Computer network laid down

Software purchased

• Heron Technology Corporation

• Training started and ongoing


HEALTH PROMOTION

Health promotion the new approach that strengthens the capacity of individuals and communities to control, improve and maintain physical, emotional, mental, social, and spiritual well-being is the key strategy the Ministry of health applies to all intervention programs


Key Programme Areas

HEALTH AND SOCIAL COMMUNICATION

Continued used of the print and electronic media and community meetings to disseminate health information

to simulate

healthy practices


NUTRITIONEDUCATION/PHYSICAL ACTIVITIES


Healthy community Initiative

Dominica's Healthy community Initiative highlighting:

The processes Outputs of the approach Lessons Learnt Benefits Community ownership


District Officers from four ministries meet quarterly to plan the implementation of health and social development intervention programmes

Coalition of inter-ministerial District

Officers


NON-COMMUNICABLE DISEASES

POLICY DEVELOPMENT PREVENTION & MANAGEMENT

PROGRAMME PUBLIC OFFICERS WELLNESS

PROGRAMME COMMUNITY HYPERTENSION &

DIABETES PREVENTION PROGRAMMES


HEALTH/CONTINUED EDUCATION


As the ministry of Health focuses increasingly on the social determinants of illnesses, disabilities and death among the populace it has become clearer that health promotion agenda incorporates in public health practices will provide sustainable results for improved quality of life


Health Priorities

NCDs – Cardiovascular diseases, Diabetes and cancer

Communicable diseases – HIV/AIDS, dengue, FBDs, vaccine preventable diseases and IHR

Accidents and violence Mental health and substance abuse Obesity, nutrition and physical activity


Health Priorities

Family health including child development, youth health, healthy ageing, and gender aspects of health

Natural and other disasters management Environmental protection, development

and sustainability Health systems development


Challenges/Issues (cont’d) Health care financing - NHS Communicable diseases with epidemic

potential• Pandemic influenza

• West Nile

• Dengue HIV/AIDS

• Universal access to prevention, care, treatment and support

• Mainstreaming the response


Thank You!

Dominica’s Health System

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