Dominica’s Health System
Ministry of Health & Social Security
May, 2006
Ministry of Health & Social Security
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
Ministry of Health & Social Security
Employment in Week before Census by Area of Employment
05
101520253035
Ag
ricu
lture
,
Min
ing
&
Ma
nu
fact
uri
ng
Ele
ctri
city
,
Co
nst
ruct
ion
Wh
ole
sale
&
Ho
tels
&
Tra
nsp
ort
,
Fin
an
cia
l,
Pu
blic
Ed
uca
tion
He
alth
&
Co
mm
erc
e,
Oth
er
Pri
vate
Ext
ra -
Oth
er
No
t Sta
ted
Pe
rce
nta
ge
1991
2001
Data source: Dominica 2001 Census
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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.)
Ministry of Health & Social Security
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
Ministry of Health & Social Security
General Organization
•7 health districts
•7 district health teams
•52 health centre/clinics
•2 district hospitals
•Main hospital in Roseau (secondary care)
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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)
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
HIV Surveys
Prison seroprevalence survey• 2.6% (5/191)
BSS• Results
outstanding
Ministry of Health & Social Security
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
Ministry of Health & Social Security
Strategic Pandemic Influenza Plan
Outline of strategic plan drafted
Operational plans now need to be drafted• PMH
• PHC Services
Ministry of Health & Social Security
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
Ministry of Health & Social Security
Patient Administration System
Computer network laid down
Software purchased
• Heron Technology Corporation
• Training started and ongoing
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
NUTRITIONEDUCATION/PHYSICAL ACTIVITIES
Ministry of Health & Social Security
Healthy community Initiative
Dominica's Healthy community Initiative highlighting:
The processes Outputs of the approach Lessons Learnt Benefits Community ownership
Ministry of Health & Social Security
District Officers from four ministries meet quarterly to plan the implementation of health and social development intervention programmes
Coalition of inter-ministerial District
Officers
Ministry of Health & Social Security
NON-COMMUNICABLE DISEASES
POLICY DEVELOPMENT PREVENTION & MANAGEMENT
PROGRAMME PUBLIC OFFICERS WELLNESS
PROGRAMME COMMUNITY HYPERTENSION &
DIABETES PREVENTION PROGRAMMES
Ministry of Health & Social Security
HEALTH/CONTINUED EDUCATION
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
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
Ministry of Health & Social Security
Thank You!
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