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Health System of SURINAME Maltie Algoe Elly van Kanten Monitoring and Analyzing Health System Change and Health Reform, May 30 th June 1 st, 2006 - Belize

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2 Content: Health System Characteristics Health System Characteristics Health System Performance Health System Performance Health Status and Outcomes Health Status and Outcomes Relevant Trends and Interventions Relevant Trends and Interventions

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3 HS Characteristics Guiding principle: Health care is the right of every citizen (Constitution, art. 36, sub 2) Overall Goal: To achieve optimal health status for the majority of the population through provision of available, accessible and affordable health care

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Main responsibility of the MOH To promote Public Health through : 1. Improvement of living and working conditions 2. Health education Main tasks: Policy Development Policy Development Health Planning / Regulation Health Planning / Regulation Coordination / Supervision Coordination / Supervision Monitoring & Evaluation Monitoring & Evaluation Quality Assurance Quality Assurance

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Supply: MOH MOH Professionals Professionals NGOs NGOs Demand: Population Finance: MOF MOF MSA MSA State Health Ins. State Health Ins. Private Insurance Private Insurance Out-of-pocket Out-of-pocket

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6 Population (census 2004): 492 829 by ethnicity: 00-04 05-09 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 85-89 90-94 95-99 3000020000100000 2000030000 MalesFemales

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7 Organization & Management Planning division Legislation division Public Relations External relations Inspectorate NAP STI Clinic Dermatology services Foundations and Institutions PHC: - Regional Health Services - Medical Mission HOSPITALS Psychiatric Center Bureau of PUBLIC HEALTH General affairs: - Personnel - Finance - Maintenance - Expedition

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8 Structure of the MOH Main Office: Central Administration (incl. Planning and Legislation) Main Office: Central Administration (incl. Planning and Legislation) Inspectorate Inspectorate Bureau of Public Health Bureau of Public Health

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10 Primary Health Care Coastal area Coastal area - RHS (8 districts, 50 clinics, 100,000 clients) - Private GPs Interior Interior - MM (2 districts, 50 centers, 50,000 clients) Several NGOs providing: SRH services SRH services Health Promotion Health Promotion (Home) Care & Support (Home) Care & Support Research Research

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11 Secondary Health Care 5 General hospitals: 2 private (one with link to interior) 2 private (one with link to interior) 3 public (two with ER, one specialized in MCH) 3 public (two with ER, one specialized in MCH) 1 Mental hospital Total # of beds: 1318 # of beds per 1000 pop: 2.7 Occupancy rate: 70 %

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12 Human resources (2004) Number of Physicians400 Number of General Practitioners295 Number of Medical Specialists105 Number of Dentists42 Number of Non - university trained nursing personnel1 745 Number of registered nurses778 Number of midwifes57 Rates per 10,000 pop (2004) Physicians per 10,000 population8. 2 Dentists per 10,000 population0.9 Non university trained nursing personnel per 10,000 pop35.4 Number of registered nurses per 10,000 population15.8 Number of midwifes per 10,000 population1.2

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13 20002002 Gross Domestic Product (GDP)836.1 mln US $ 879.9 mln US $ GDP per capita1,915 US $1,925 US $ National Health Accounts Total Health Expenditure (THE)78,763,778 US $ THE per capita180.33 US $ THE as % of the GDP9.42% Public Health expenditure (PHE) 34.1 mln US $ 31.7 mln US $ PHE per capita78.1 US $69.4 US $ PHE as % of the GDP4.07%4,97% PHE as % of THE43.33%

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14 Distribution of spending by payer National Health Accounts, MSH, march 2002

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15 Distribution of spending by level of care National Health Accounts, MSH, march 2002

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16 Insurance coverage (Census 2004)

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17 Health Status and Outcomes Vital Statistics, 2004 Population492,829 Average Population growth rate1.4% Percent of urban population59.40% Total number of registered live births9,062 Total number of registered deaths3,289 Crude birth rate per 1 000 pop18.7 Crude mortality rate per 1 000 pop6.7 Life expectancy at birth (years)71.5 Total fertility rate2

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18 10 Leading causes of Hospitalization ( 2000) 1. Pregnancy, Childbirth and Puerperium 1. Pregnancy, Childbirth and Puerperium 2. Gastrointestinal diseases 2. Gastrointestinal diseases 3. Hypertension and Cardiovascular diseases 3. Hypertension and Cardiovascular diseases 4. Diseases of the respiratory system 4. Diseases of the respiratory system 5. External causes 5. External causes 6. Diseases originating in Perinatal period 6. Diseases originating in Perinatal period 7. Cerebrovascular diseases 7. Cerebrovascular diseases 8. Malign neoplasmata 8. Malign neoplasmata 9. Certain Vector-borne diseases 9. Certain Vector-borne diseases 10. Urogenital disorders 10. Urogenital disorders

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19 10 Leading causes of death, 2000 - 2004 1. 1. Cardiovascular diseases 2. External causes 2. External causes 3. Malign neoplasmata 3. Malign neoplasmata 4. 4. Diseases from the perinatal period 5. HIV / AIDS 5. HIV / AIDS 6. DM 6. DM 7. Respiratory disorders 7. Respiratory disorders 8. Gastro intestinal disorders 8. Gastro intestinal disorders 9. Diseases of tractus Urogenitalis 9. Diseases of tractus Urogenitalis 10. Intestinal disorders 10. Intestinal disorders

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20 Achievement of MDGs Immunization Coverage 85% PMR, IMR &