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Investing in Health – Building a Safer Future…1 Investing in Health – Building a Safer Future…1 The Health Situation Analysis (HSA), attempts to characterize, measure, and explain the health-disease profile and trends of the Dominican population, including illnesses, injuries and other health problems and their determinant factors, whether they are the responsibility of the health sector or of other sectors. It also facilitates the identification of needs and priorities in health, as well as the identification of interventions and appropriate programs and the evaluation of its impact on health. The situation analysis seeks to: define existing organization and management of health services and the health care delivery system and identify constraints which adversely impact health care delivery in the country. The main purpose of the HSA is primarily to inform the preparation of the 10-year National Strategic Plan for Health 2010- 2019. The importance of the Situation Analysis resides in contributing the information that the technical component requires for directing, management, and decision- making processes in health. The specific purposes of the HSA are: • Definition of the population health profile • Determination of health trends • Determination of unmet health needs • Identification of critical or vulnerable groups and populations • Measurement of health inequalities • Priority setting • Health impact assessment • Evaluation of health program effectiveness and performance • Identification of scenarios The analytical process used for identifying the health needs of the population is as follows: a) The Health Determinants framework The “Health Determinants” conceptual framework allows identifying the principal components of health and also allows identifying health issues and problems and the means and activities to address them. This framework stresses the need to consider health as a result of the interactions of many determinant factors well beyond the health care services. b) The political, social and economic context It is important to characterize the forces external to the health sector that shape the context under which health is analyzed. These forces exert important influences on the health of populations. They include the overall organization and policies of the government, the demographic characteristics and their change; certain social issues like education; and, economic factors (including the level and distribution of its wealth (and its antithesis, poverty) and its trends). Investing in Health – Building a Safer Future…2 c) Health status of the population The health of the population is analyzed from different perspectives: from the point of view of the populations being affected and from the specific diseases and health problems themselves. d) The response of the health systems The health system involves not only the structure and resources for health care, but also the way it is organized including the legislative aspects in response to health problems in the population. It includes different forms of response that society has developed to address its needs of promoting, protecting and recuperating health of individuals and populations. This response includes policies, resources, coverage levels and health services for the population, according to the main providers: public and private. Investing in Health – Building a Safer Future…3 TABLE OF CONTENTS INTRODUCTION 1. Social & Economic Context ……………………………………......... 1 . Social setting ………………………………………………………….……… 3 . The Economy ………………………………………………………….……… 6 2. Determinants of Health ………………………………….…………... 8 . Unemployment ……………………………………………………………….. 10 . Income & Social Status ………………………………………….………….. 11 . Social Support networks ……………………………………….……..…….. 12 . Education & Literacy ………………………………………………….……… 14 . Social Environments ………………………………………….……………… 15 . Personal Health Practices…………………………………….….…..……… 18 . Physical Environment ………………………………………………….…….. 22 . Housing ……………………………………………………………………….. 24 . Health & Social Care ………………………..………………………….……. 25 . Food Insecurity ……………………………………………………….………. 26 . Culture …………………………………………………………………………. 26 . Gender ………………………………………………………………….…...... 27 3. Health Systems & Health Profile ………………………………..…. 29 . Health Profile………………………………………………………….…..…… 30 . Employment & Economic Activity ………………………………….….……. 33 . Housing & Water Supply………………..………………………….………… 35 . Mortality………..…………………………………………………….………… 37 . Morbidity…… ……………………………………………………….………… 39 . Health Systems……………………………………………………….………. 48 . Organization & Management of service delivery………………….………. 49 . Capacity of the MoH to develop and execute health policy……….….….. 52 . Sectoral Regulation ……………………………………………..…….……... 53 . Health Sector Reform ……………………………………………..….……… 57 . Technology, Supplies & Equipment ..………………………………...……. 58 . Health & the Environment …..……………………………………….……… 59 . Impact of Human Resources on the Health system ………………...…… 61 . Labour markets …………………………………………….………..….……. 63 . Millennium Development Goals …………………………………….….…… 64 . Environmental Coordinating Unit ……………………………………..….... 66 . Essential Public Health Functions ……………………………………...….. 66 . National Health Accounts ………………………………………….…….…. 67 4. Health Services & Response Capacity …………….……….…..… 70 • Primary Health Care ……………………………………………………….… 71 • Ocular Health …………………………………………………………….…… 82 • Mental Health Services ……………………………………………….…….. 90 • Diagnostic Centre …………………………………………………….……… 94 • Laboratory …………………………………………………………….….…… 95 • Pharmacy …………………………………………………………..…….…… 97 • Environmental Health including Solid Waste …………………….…….…. 99 • Dental ……………………………………………………………..……….….. 108 • Health Promotion Resource Centre & Nutrition…………………..…….… 110 • Drug Abuse Prevention ……………………………………………………... 116 • HIV&AIDS …………………………………………………………..………… 118 o Private health services …………………………………………………..….. 124 • Secondary Health Care ……………………………………………………… 126 Investing in Health – Building a Safer Future…4 5. Resources for Health ………………………………..………...……… 139 . Health Care Financing …………………………………….……………….… 140 . Human Resources …………………………………………….……………… 149 . Physical Resources ……………………………………………….…….……. 161 . Health Information Systems ………………………………………….……… 180 Appendix I Ministry of Health Organizational Chart …………….……..… 186 Appendix II Princess Margaret Hospital Organizational Chart ….…...… 187 Appendix III Primary Health Care Organizational Chart ………………..… 188 List of Figures & Tables ……………………………………………………..….. 189 List of Abbreviations ………………………………………………….……..….. 191 References …………………………………………………………….………….. 193 Investing in Health – Building a Safer Future…5 Investing in Health – Building a Safer Future…6 1. Social and Economic Context Geography Dominica is the largest and most northern of the Windward Islands. Situated between Latitude15 20 minutes North and Longitude 61 22 minutes West, it covers 289 square miles and has approximately 91 miles of coastline. Only 29 miles long 16 miles wide, the island is situated on the inner volcanic arc of the Lesser Antilles. The island’s topography is very rugged with steep luxuriant rain forest mountains, deep river incised valleys and tree –covered hills that produce and sustain pristine rivers, perennial streams and tumbling mountain waterfalls. The northern half is dominated by the cone of its highest mountain, Morne Diablotin (4,747 ft). Four of Dominica’s mountains rise over 4,000 feet. A chain of seven other mountains extends from the island’s center to the south. The Morne Trois Pitons National Park (incorporating the central mountain range) is inscribed on the United Nations World Heritage List since 1998, based on criteria of Outstanding Universal Value to Mankind, its natural aesthetic, rich bio-diversity and irreplaceable contribution to the understanding of science and natural landscape. Flatter areas are restricted to the coastal areas of the north east and center of the island. The geology of Dominica is similar to the other volcanic islands in the Lesser Antillean Archipelago. Volcanic activity is present in regions of the Valley of Desolation and Boiling Lake, Wotten Waven and the Soufriere. Coral limestone areas are almost nonexistent and are restricted to small outcrops and uplifted areas on the west coast. Dominica’s relatively undisturbed and rugged landscape, extensive forest, pristine fresh and sea water and overall ecological system have contributed to the island being acclaimed as the “Nature Island of the Caribbean”. This label has impacted favourably in positioning Dominica’s global choices as a tourist destination for nature lovers and environmental adventure seekers. landscape Dominica boasts of a variety of natural attractions including numerous rivers and streams, deep river gorges, waterfalls, fumaroles, a boiling lake (considered the world’s largest) and four cold freshwater lakes, two situated more than 2,500 feet above sea level. Dominica’s rivers and lakes provide the island’s water supply as well as leisure attractions for local and international tourists. The climate is humid tropical marine. It is characterized by little seasonal variation in temperatures and strong, steady trade winds. The island is among the wettest in the Caribbean. The amount of rainfall is seasonal with the wettest months generally occurring between June and November. Dominica’s relatively high range of altitude, coupled with its rainfall, has given rise to a wide variety of vegetation. The undisturbed forests have been Investing in Health – Building a Safer Future…7 described as the most extensive in the Lesser
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