Dominica’s Health System

1. Dominica’s Health System Ministry of Health & Social Security May, 2006

2. 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

3. Data source: Dominica 2001 Census

4. Demographic & Epidemiological Context 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

5. Data source: Central Statistical Office

6. 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 Data source: Dominica 2001 Census

7. Data source: Health Information Unit

8. Data source: Registry of Births and Deaths

9. General Organization • 7 health districts • 7 district health teams • 52 health centre/clinics • 2 district hospitals • Main hospital in Roseau (secondary care)

10. 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

11. 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)

12. 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

13. 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

14. 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

15. HIV Surveys • Prison seroprevalence survey • 2.6% (5/191) • BSS • Results outstanding

17. Strategic Pandemic Influenza Plan • Outline of strategic plan drafted • Operational plans now need to be drafted • PMH • PHC Services

18. 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

19. Patient Administration System • Computer network laid down • Software purchased • Heron Technology Corporation • Training started and ongoing

20. 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

21. 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

22. NUTRITIONEDUCATION/PHYSICAL ACTIVITIES

23. Healthy community Initiative • Dominica's Healthy community Initiative highlighting: • The processes • Outputs of the approach • Lessons Learnt • Benefits • Community ownership

24. Coalition of inter-ministerial District Officers District Officers from four ministries meet quarterly to plan the implementation of health and social development intervention programmes

25. NON-COMMUNICABLE DISEASES POLICY DEVELOPMENT • PREVENTION & MANAGEMENT PROGRAMME • PUBLIC OFFICERS WELLNESS PROGRAMME • COMMUNITY HYPERTENSION & DIABETES PREVENTION PROGRAMMES

26. HEALTH/CONTINUED EDUCATION

27. 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

28. 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

29. 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

30. 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

31. Thank You!