St Christopher and Nevis

1. St Christopher and Nevis Health Systems Strengthening Seminar Belize City May 30 �June 1, 2006

2. Background St Christopher and Nevis is an independent twin island federation that is located in the north eastern Caribbean. St Kitts spans 168km2 and Nevis 93km2 The combined population is 47,313 (2003 est.) The main stay of the economy is tourism with contributions from agricultural sector and export oriented manufacturing. Per capita GDP $8600 (2004 est.) Life expectancy at birth 69 years in males and 75 in females

3. Public Health System There are 2 General Hospitals (urban) that offer secondary care. Two rural district hospitals in St Kitts. 17 Health centers (11 in St Kitts and 6 in Nevis).

4. Organizational Structure

5. Health Sector Reform Since the late 1990�s, the health sector has undergone a series of reforms in an effort to improve efficiency, quality and sustainability. Discrete examples are illustrated in the following slides.

6. Establishment of Health Promotion Unit With the increasing prevalence of lifestyle related disorders, there was recognition of the importance of health promotion strategies and the need to emphasize prevention as part of the holistic approach to care. A Health Promotion Unit was established in 2000 to coordinate health promotion approaches across government departments and other sectors. It is staffed by a NCD Coordinator, Nutrition Surveillance Coordinator, Nutrition Officer, National AIDS Programme Coordinator and 2 health educators.

7. Upgrading of health facilities The main hospitals on both islands were upgraded. Several of the primary care facilities were also upgraded to accommodate the operationalisation of the primary health care approach to promote accessibility, community involvement and self reliance.

8. Human resource strategies Increased commitment to provide training opportunities for staff through: Scholarships In-service Education Department located at Joseph N France General Hospital Training of VCT counselors Training of Emergency Medical Technicians Continuous education for nurses and assistants

9. Restructuring of the Nursing Services Training programme for nurses and auxiliaries is now delivered through the Clarence Fitzroy Bryant College. Restructuring of nursing posts and responsibilities in an attempt to increase the autonomy of managers (the role of the Chief Nursing Officer has been de-emphasized as it relates to the general management of nursing).

10. Quality Initiatives There has been an effort to incorporate quality in all care processes. National Focal Point has been appointed to coordinate these efforts. Introduction of user satisfaction surveys. There has been some movement towards achieving accreditation of hospital (preliminary evaluation conducted in 2005)

11. Health Financing After almost thirty years, there was an evaluation of user charges in an effort to augment revenue collection (no follow up research to assess the impact on access). There is keen interest in implementation of a national health insurance scheme to ensure universal access to services.

12. Privatization There has been an increased willingness to engage the private sector entities to ensure provision of health services. CT scan available at Joseph N France through public private partnership. Plans to establish a haemodialysis unit at the same facility with collaboration from private sector.

13. Conclusion We have achieved some successes in our attempts to improve the performance of the health care system through health sector reform. We must build on these efforts and continue to sustain the momentum that has been created.

14. The End Thanks for your attention!