Overview of Dominica's Health System and Governance

1. Dominicas Health System Ministry of Health & Social Security May, 2006

2. 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

3. Ministry of Health & Social Security Data source: Dominica 2001 Census

4. 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

5. Ministry of Health & Social Security Data source: Central Statistical Office

6. 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 Data source: Dominica 2001 Census

7. Ministry of Health & Social Security Data source: Health Information Unit

8. Ministry of Health & Social Security Data source: Registry of Births and Deaths

9. 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)

10. 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

11. 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)

12. 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

13. 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

14. 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

15. Ministry of Health & Social Security HIV Surveys Prison seroprevalence survey 2.6% (5/191) BSS Results outstanding

16. Ministry of Health & Social Security

17. Ministry of Health & Social Security Strategic Pandemic Influenza Plan Outline of strategic plan drafted Operational plans now need to be drafted PMH PHC Services

18. 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

19. Ministry of Health & Social Security Patient Administration System Computer network laid down Software purchased Heron Technology Corporation Training started and ongoing

20. 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

21. 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

22. Ministry of Health & Social Security NUTRITION EDUCATION/PHYSICAL ACTIVITIES

23. 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

24. 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

25. Ministry of Health & Social Security NON-COMMUNICABLE DISEASES POLICY DEVELOPMENT PREVENTION & MANAGEMENT PROGRAMME PUBLIC OFFICERS WELLNESS PROGRAMME COMMUNITY HYPERTENSION & DIABETES PREVENTION PROGRAMMES

26. Ministry of Health & Social Security HEALTH/CONTINUED EDUCATION

27. 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

28. 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

29. 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

30. Ministry of Health & Social Security Challenges/Issues (contd) 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. Ministry of Health & Social Security Thank You!