HEALTH OF OUR NATION

Annual Health Sector Performance Report 2019

Department of Health, Seychelles June 2020

Annual Health Sector Performance Report 2019 I - HEALTH OF OUR NATION OF OUR HEALTH from doing anything the license permits. doing anything from This is a publication of Department of Health, Seychelles. of Health, of Department This is a publication HEALTH SECTOR PERFORMANCE REPORT, 2019 REPORT, PERFORMANCE SECTOR HEALTH International License (https://creativecommons.org/licenses/by/4.0/). International must give appropriate credit to organization that created the document and provide a link to the li to the a link and provide the document created that organization to credit appropriate give must This document is licensed under a Creative Commons Attribution-Non-commercial-No Derivatives 4.0 Derivatives Attribution-Non-commercial-No Commons licensed under a Creative is This document Commons licence. You may not apply legal terms or technological measures that legally restrict others others restrict legally that measures or technological terms not apply legal may Commons licence. You Under the terms of this licence, you may copy and redistribute work for non-commercial purposes. You purposes. You non-commercial for work and redistribute copy may this licence, you of Under the terms cense. When sharing the document, you must license your work under the same or equivalent Creative Creative under the same or equivalent work your license must you cense. When sharing the document, II Annual Health Sector Performance Report 2019 Health Promotion Unit: Valentin. Reviewers: Rene. Key Contributors: Statistics Unit: Bharathi Viswanathan. Writing Team: Several peoplecontributed to thedevelopment ofthisreport. ACKNOWLEDGEMENTS Agnes Chetty, Sanjeev Pugazhendhi, Conrad Shamlaye, Shobanke DolapoAbidemi,Bernard AgnesChetty, JacquesFilez, Susan Fock Tave, EmelynShroff, Ituen-UmanahWilliams, JoachimDidon,Richard Ibrahim Husseini,Rosalie Isnard. Marie-JoseeDangkow, AnneFinesse,Georgette Furneau,BellaHenderson, Patricia David Marguerite. Annual Health Sector Performance Report 2019 III 33 33 34 35 31 31 37 38 39 40 47 48 49 50 51 III VI VIII IX X 1 3 4 6 6 7 7 8 9 12 16 17 19 20 21 24 25 26 28 ......

6.5 DENTAL LABORATORY SERVICES LABORATORY 6.5 DENTAL 6.3 SPECIALIST DENTAL SERVICES DENTAL 6.3 SPECIALIST SECTION PUBLIC HEALTH 6.4 DENTAL 6.1 INTRODUCTION SERVICES DENTAL 6.2 COMMUNITY 5.5 HEALTH INFORMATION 5.5 HEALTH 5.6 NEW DEVELOPMENTS 5.3 SERVICE DELIVERY 5.3 SERVICE MEDICINES 5.4 ESSENTIAL 5.1 FINANCING FOR HEALTH 5.1 FINANCING FOR WORKFORCE 5.2 HEALTH 4.2 PREVENTION OF NCDS 3.4. FERTILITY 4.1 NCD RISK FACTORS 3.2 MAIN CAUSES OF MORTALITY 3.2 MAIN CAUSES 3.3 MORBIDITY 3.1 VITAL STATISTICS 3.1 VITAL 2.3 SECTOR ACCOUNTABILITY 2.3 SECTOR CIVIL SOCIETY/COMMUNITY 2.4 EMPOWERED PARTICIPATION SECTOR 2.5 PRIVATE 2.1 HEALTH SECTOR STEWARDSHIP AND MANAGEMENT CAPACITY AND MANAGEMENT STEWARDSHIP SECTOR 2.1 HEALTH FRAMEWORK AND REGULATORY LEGAL 2.2 SECTOR TABLE OF CONTENT OF TABLE ANNEX 2. TREND IN MATERNAL MORTALITY, 1978-2019 MORTALITY, ANNEX 2. TREND IN MATERNAL WARDS) 2019 (SELECTED HOSPITAL, OF ADMISSIONS SEYCHELLES CAUSES ANNEX 3. LEADING LIMITATIONS RECOMMENDATIONS 2019 DISTRICT, BY ANNEX 1. MORTALITY ON SDG3 7. PROGRESS

SERVICES 6. ORAL HEALTH

SYSTEM 5. HEALTH HEALTH FOR 4. RISK FACTORS

3. HEALTH STATUS 3. HEALTH

1. INTRODUCTION AND LEADERSHIP 2. GOVERNANCE FOREWORD SUMMARY EXECUTIVE TABLE OF CONTENT TABLE ABBREVIATIONS ACRONYMS/ TABLE INDICATOR SUMMARY IV Annual Health Sector Performance Report 2019 FIGURE 3.3HALEANDLEAT BIRTH FIGURE 3.2COMPARISON OFLEAT BIRTH (INYEARS) FOR SELECTED COUNTRIES FIGURE 3.1LEAT BIRTH (INYEARS), 1980-2019 FIGURE 2.1HEALTH SECTOR STRUCTURE TABLE 7.2 PROGRESS ONSDG3,2019 TABLE 7.1 SCI,2019 TABLE 6.2 PILOT TOOTH BRUSHINGACTIVITY, SDS2019 TABLE 6.1 STAFFING INOHSD, 2019 TABLE 5.15PRESCRIPTIONS FILLEDINMOHFACILITIES, 2019 TABLE 5.14RADIOLOGICAL IMAGING, 2018AND2019 TABLE 5.13TESTS DONEINCLINICALLABORATORY, 2019 TABLE 5.12BEDOCCUPANCY LONGTERM CAREFACILITIES TABLE 5.11ATTENDANCE FOR REHABILITATIVE SERVICES, 2019 TABLE 5.10TOP SIXCAUSES OFATTENDANCE FOR OCCUPATIONAL THERAPY, 2019 TABLE 5.9OVERSEAS TREATMENT, 2017-2019 TABLE 5.8BEDOCCUPANCY SEYCHELLES HOSPITAL, 2019 TABLE 5.7OUTPATIENT DOCTOR CONSULTATION INPUBLICFACILITIES, 2019 TABLE 5.6NIHSSGRADUATES, 2017-2019 TABLE 5.5DISTRIBUTION OFPRACTISING DOCTORS ANDNURSES MOH,2019 TABLE 5.4ACTIVE DOCTOR STOCK, 2019 TABLE 5.3DONATIONS, 2019 TABLE 5.2NATIONAL HEALTH COUNCILS BUDGETBREAKDOWN, 2017-2019 TABLE 5.1MOHBUDGETBREAKDOWN, 2017-2019 TABLE 3.11REGISTERED LIVEBIRTHS TO TEENAGE GIRLS,2014-2019 TABLE 3.10ABORTIONS BY AGE GROUP, 2019 TABLE 3.9COMMON CAUSES OFADMISSIONS,2019 TABLE 3.8DEATHS DUETO DROWNING, 2017–2019 TABLE 3.7TOP 10BURDENOFDISEASE TABLE 3.6CEREBROVASCULAR ACCIDENTS (INCLUDING DEATHS), SEYCHELLES HOSPITAL 2019 TABLE 3.5MATERNAL ANDINFANT DEATHS, 2018-2019 TABLE 3.4ANNUAL DEATHS BY SELECTED DISTRICTS, 2019 TABLE 3.3ANNUAL DEATHS BY AGE GROUP ANDSEX,2019 TABLE 3.2ANNUAL DEATHS BY SEX,2015-2019 TABLE 3.1LIVEBIRTHS BY SEX,2015-2019 TABLE 2.1REGISTERED HEALTH CAREPROFESSIONALS, 2019 TABLES AND FIGURES ...... 12 11 11 4 45 43 39 36 33 32 32 32 31 31 30 29 29 27 27 26 26 25 25 18 17 17 16 14 13 10 10 9 9 9 7 Annual Health Sector Performance Report 2019 V 36 37 37 38 42 46 12 12 13 13 13 14 14 15 15 15 15 16 16 16 18 20 26 27 28 30 30 30 34 36 ...... FIGURE 7.1 DISTRIBUTION OF CHE BY INSTITUTIONS PROVIDING REVENUES FOR FINANCING SCHEMES FOR REVENUES PROVIDING INSTITUTIONS OF CHE BY FIGURE 7.1 DISTRIBUTION 2019 Q3 MPI, NATIONAL TO INDICATOR OF EACH CONTRIBUTION FIGURE 7.2 PERCENTAGE FIGURE 6.3 PREVENTIVE INTERVENTIONS PERFORMED BY SDS, 2019 BY PERFORMED FIGURE 6.3 PREVENTIVE INTERVENTIONS 2019 OF MAJOR SURGERIES, FIGURE 6.4 BREAKDOWN 2018 AND 2019 PER DISTRICT, PROGRAMME OF ANC DENTAL FIGURE 6.5 UPTAKE FIGURE 6.1 ORGANISATIONAL STRUCTURE OF ORAL HEALTH SERVICES DIVISION SERVICES OF ORAL HEALTH STRUCTURE FIGURE 6.1 ORGANISATIONAL CLINICS, 2019 DENTAL BY ATTENDANCE PATIENTS SERVICE DENTAL FIGURE 6.2 ADULT FIGURE 5.6 PATIENTS ON HAEMODIALYSIS, 2013-2019 ON HAEMODIALYSIS, FIGURE 5.6 PATIENTS 2019 SCORE, FIGURE 5.7 SEYCHELLES FIGURE 5.4 NUMBER OF SURGERIES BY SPECIALTY, 2019 SPECIALTY, BY FIGURE 5.4 NUMBER OF SURGERIES CLINICS, 2019 OUTPATIENT SPECIALIST TO FIGURE 5.5 ATTENDANCE FIGURE 5.1 DISTRIBUTION OF TOTAL HEALTH EXPENDITURE BY DISEASE CLASSIFICATION, 2016-2018 CLASSIFICATION, DISEASE BY EXPENDITURE HEALTH OF TOTAL FIGURE 5.1 DISTRIBUTION 2019 DENSITY (PER/ 1000 POPULATION), FIGURE 5.2 DOCTOR AND ANNEXES HOSPITAL FIGURE 5.3 SEYCHELLES FIGURE 3.18 TOTAL FERTILITY RATE TEENAGE, 1998-2019 TEENAGE, RATE FERTILITY FIGURE 3.18 TOTAL 1998-2018 IN STUDENTS, AND OBESITY OF OVERWEIGHT FIGURE 4.1 PREVALENCE FIGURE 3.16 DEATHS DUE TO ROAD TRAFFIC ACCIDENTS, 2015-2019 TRAFFIC ACCIDENTS, ROAD DUE TO FIGURE 3.16 DEATHS 2015-2019 /100,000 POPULATION, INTENTIONAL SELF-HARM AND SUICIDE RATE OF FIGURE 3.17 CASES FIGURE 3.13 AIDS-RELATED MORTALITY RATE, 2015-2019 RATE, MORTALITY FIGURE 3.13 AIDS-RELATED 2015-2019 OF HCV, FIGURE 3.14 NEW CASES 2000-2019 CO-INFECTION, FIGURE 3.15 HIV/TB FIGURE 3.11 NEWLY DETECTED CASES OF HIV, 2015-2019 OF HIV, CASES DETECTED FIGURE 3.11 NEWLY 2016-2019 OF HIV, CASES DETECTED AMONG NEWLY FIGURE 3.12 MODE OF TRANSMISSION FIGURE 3.9 PROPORTION OF NCDS DEATHS AMONG ALL DEATHS IN THE AGE-GROUP 30-70 YEARS IN THE AGE-GROUP AMONG ALL DEATHS OF NCDS DEATHS FIGURE 3.9 PROPORTION 2015-2019 DEATHS, FIGURE 3.10 PNEUMONIA FIGURE 3.7 CANCER DEATHS, 2019 DEATHS, FIGURE 3.7 CANCER 2019 SYSTEM, OF THE CIRCULATORY DISEASES DUE TO FIGURE 3.8 DEATHS FIGURE 3.4 FIVE LEADING CAUSES OF DEATH IN SEYCHELLES, 2015-2019 IN SEYCHELLES, OF DEATH CAUSES FIGURE 3.4 FIVE LEADING (N=428), 2019 NCD MORTALITY FIGURE 3.5 TOTAL OF CANCER, 2019 CASES FIGURE 3.6 NEW VI Annual Health Sector Performance Report 2019 WWP WHO UHC UCCPD TWG SNMC SMDC SDS SDG SCR SCI RMNCH PWID PLHIV PHA OHSD OECD NIHSS NHSP NHA NCD NBS NAC MTCT HPC HIS HCA DSRU MOH CVD CVA CRD CHE CARE ART APR APDAR ADS ACRONYMS/ ABBREVIATIONS

antiretroviral therapy cerebrovascular accident Seychelles Medical andDental Council noncommunicable disease technical working group World HealthOrganization Health Professionals Council national health strategic plan people whoinjectdrugs National Institute forHealthandSocialStudies mother-to-child transmission ofHIV national healthaccount service coverageservice index chronic respiratory diseases Seychelles Nurses andMidwives Council school dental services workplace wellbeing programme people livingwithHIV/AIDS Disease Surveillance andResponse Unit reproductive, maternal, new-born andchildhealth National Bureau ofStatistics Seychelles Rupees current healthexpenditure cardiovascular diseases adult dentaladult services Universal HealthCoverage Unit for Prevention andControl ofCardiovascular Diseases Campaign for Awareness, Resilience andEducation PublicHealthAuthority Agency for thePrevention ofDrugAbuseand Rehabilitation Organisation for Economic Co-operation and Development (OECD) Health Care Agency health information system Ministry ofHealth Oral Division HealthServices Annual HealthSector Performance Report National AidsCouncil Sustainable Development Goal Annual Health Sector Performance Report 2019 VII - -

Health-adjusted life expectancy (HALE) or healthy life expectancy is the number expectancy life (HALE) or healthy expectancy life Health-adjusted The probability of a child born in a specific year or period dying before reaching the age age the reaching before dying period or year specific a in born child a of probability The Number of core medical professionals, including physicians, non- physicians, clinicians, physicians, non- physicians, including professionals, medical core of Number The annual number of female deaths from any cause related to or aggravated by preg The to or annual aggravated number cause related any deaths of from female Probability that a child born in a specificyear or period will die during the 28 first com The number average of years that a new-born could expect to live if he or she were to Combined number of deaths of babies aged less than 7 days and the number of stillbirths stillbirths of number the and days 7 than less aged babies of deaths of number Combined The probability that a child born in a specific year or period will die before reaching the age age the reaching before die will period or year specific a in born child a that probability The GLOSSARY Health workforce density: workforce Health per 10,000 populations. and midwives nurses registered Perinatal Mortality rate: Mortality Perinatal births during the year. per 1,000 total in a year days days of termination irrespective of of pregnancy, the duration andsite expressedof the per pregnancy, 100 000 a specified time period. births, for live Maternal mortality ratio: Maternal 42 within or childbirth and pregnancy during causes) incidental or accidental (excluding management its or nancy Infant mortality rate: mortality Infant births. per 1000 live rate as a expressed period, of that rates mortality age-specific to if subject of 1 year, Under- five mortality rate: rate: mortality five Under- births per 1000 live expressed period, of that rates mortality age-specific if subject to of 5 years, Neonatal mortality Neonatal rate: births. per 1000 live expressed period, of that rates mortality age-specific to if subject life of days pleted Health adjusted life expectancy: expectancy: life Health adjusted disability. and mortality account into taking health, good in live to expect can age given a at person a that years of Life Life expectancy at birth: pass through life exposed to the and sex- age-specific deathratesat prevailing the time of hisor her birth, for a area. geographical or territory country, in a given year, specific VIII

Annual Health Sector Performance Report 2019 Achieved of heroin users, 2017; lence inthegeneral population, KAPB study 2013; get inNational NCDStrategic Plan; Notes: SUMMARY INDICATOR TABLE sion ofHIV Coverage ofPrevention ofmother-to- childtransmis % ofpatients on ART withviral suppression ART Coverage (Known PLHIV) Immunization Coverage (DPT3) ANCcoverage ceptives (6) % ofwomen ofchildbearingage onmodern contra CoverageService Hepatitis C prevalence (%)(5) HIV prevalence (%).(4) New cancer cases reported Viral Hepatitis C new cases STI newly diagnosedcases cases diagnosed HIV newly Leptospirosis case fatality rate (%)(3) AIDS mortality rate/100,000 population Intentional self-harm (numberof cases) Mortality from road traffic accidents (%) Mortality (30-70years) from diabetes (%) eases (%) Mortality (30-70years) from Chronic respiratory dis Mortality (30-70years) from cancer (%) (%) Mortality (30-70years) from cardiovascular diseases Under- five mortality rate (per1,000live births) Infant mortality rate (per1,000live births) Neonatal mortality rate (per1,000live births) Maternal mortality ratio (per100,000live births) Life expectancy at birth(years) Health Status Indicator (1) Nomaternal mortality inSeychelles in2019,oneregistered case happened overseas.

(6) n track On Nodata in2019. (3) Noverified data on total numberof cases ofleptospirosis;

Not ontrack (5) APDAR. Seychelles biological andbehavioural surveillance - - - 7 deaths M -69.7 F -78.4 62.3 (1) 99.8% 0.87% 2019 Data 17.4 16.8 16.4 24% 29% 83% 87% 81% 99% 262 662 109 8.7 1% 1% 1% 70 50 1 o all of <1% all of <40% /1600 Zero End -term deaths deaths Target M- 74 births NHSP 100% 100% 100% F -80 >95% <10% <134 <120 <100 0.5% 0.25 72% 70% 250 <60 <12 <10 (2) <5 Performance (2) (4) Different tar HIVpreva - -

Annual Health Sector Performance Report 2019 IX - - FOREWORD Principal Secretary Principal Secretary Bernard Valentin Bernard already already breathing new life into the disease prevention and health promotionfray and, indeed,into theway the see. to all want we that be the change upon all of us to It is incumbent operates. health sector risk factors and lifestyles that lead to many of the key causes of morbidity and mortality. causes of the key many lead to that and lifestyles risk factors They are joining are the health of services health new numbers professionals Seychellois year. every Encouraging Much stronger professional leadership, results-based management in services and programmes and relentless training will make the difference. Health promotion and community engagementmust intensify to address the Cancer, cardiovascular diseases, Cancer, chronic respiratory illnesses, diabetes, prevention, andHIV/AIDS diseases of in in these paradigm the shift really can that services and programmes need We attention. undivided our need fancy areas. While the country must both safeguard and improve on those achievements, our focus must especially be on the must our focus on those achievements, and improve both safeguard must While the country results. and see much better work do much more need to we where areas harm, Hepatitis coverageprevention,antenatalcare C coverage, antiretroviral and immunization continue to be does well. the sector where areas health sector does - in the especially in the communities. health sector health intentional of prevention mortality, Maternal report. the in progress visible of signs encouraging are There ysed statistics for a large part of their important work in 2019. The Family Health and Nutrition Directorate of the Directorate Nutrition and Health Family The 2019. in work important their of part a large for statistics ysed private the from Data report. the for time in sets data their of gamut whole the submit not did Agency Care Health portion the of what a large does not reflect therefore The report as desired. also not as forthcoming were sector and this in part due to the COVID-19 pandemic. the COVID-19 to and this in part due The Public Health Authority entirelystaff, immersedentirely in the COVID-19response, could notprovide anal clean, scrutinize and analyse the mountains of data received for the year 2019. for the received of data the mountains and analyse clean, scrutinize years in the previous that limitations more has, perhaps, Report Performance the Annual Health Sector This year, 2019. This is the third in a row. a row. in 2019. This is the third We thank the team of extremely dedicated senior health professionals who stopped at nothing to painstakingly Despite the COVID-19 pandemic, which resulted in the redeployment of countless key health personnel in the first first the in personnel health key countless of redeployment the in resulted which pandemic, COVID-19 the Despite half of 2020, and despite the restriction of movement during the entire month ofMay 2020, the Department of Health has been able to produce, in the month of June 2020, this Annual Health Sector Report Performance for X Annual Health Sector Performance Report 2019 1 needed to reach allnational andSDG targets. are ministries targets; other however,3 with synergy (SDG) strategic and directions newGoal Development able The country has reached several of the end-term NHSP targets and is on track to reach the majority of the Sustain the moment. measured routinely at not are services of Coveragehowever,quality (UHC); and like equity UHC of aspects some (80), coverageindex service high a achieved has Seychelles introduced duringtheyear. prescriptions were filled, and 81% of400,000 prescriptionsthan in PHCLaboratory.More wereClinical exemptedthe fromin anominalconducted prescriptiontests laboratoryfee recently 900,000 almost and hospital to sions All within services MOH reported high outputs in 2019: of primary, secondary free andtertiary services at thepoint ofdelivery. careservices; health to The MOH has the responsibility of transforming health resources into results. population is1.5/1000population. per doctors medical of number average globally, the while population, doctors/1000 2.6 is density doctor local 6%. to 2013 in 3.8% from increased Product Domestic Gross nominal of percent a as expenditure health total and sector health the to ed governmentThe invests considerable resources in health. new strategic plan. a of development the launched and interventions and policies its of review a conducted Unit Promotion Health lifestyles. The healthier promote to cigarettes; and and alcohol of sale and advertising products;food contentin sugar control to measures regulatory of number a implemented MOH 2019, In lifestyles. healthier promote to a implement severalinterventions and is units protectingkey investment MOH health Promoting and priority for NCDs, obesityanddiabetes show increasing trends inaseriesofpopulation surveys since 1989. 2018. in boys in 25% and girls in 32% reach to 1998 since steadily increased has Annual data from the School Health Programme reveals that the prevalence of overweight and obesity in children phasising that obese children are most likely to remain obese in adulthood with all ensuing health consequences. WHO describes childhood obesity as one of the most serious public health challenges of the 21st century1 2019, compared to 2018. in increaseslighttargets a NHSP reachdespitefailingto is birth atLifeexpectancy (LE) 2019. in deaths all of 15% the majority of deaths in 2019. and mortality and morbidity of cause prime mortality.infant for target term end- NHSP the reach to track on not is country however, the 2018; to compared rates mortality under-five and infant neonatal, in decreases were There were improvements in a few health status indicators in 2019, while some targets still remain elusive. Dialogue onQualityofCare. The MOH 2018 to procurement ofnew therapeutics. Some key questions on health were addressed in the National Assembly ranging from high infant mortality rate in the different actors in the health system. between collaboration effective and accountability transparency, as well as exist, frameworks the mandate,governance and leadershipcore its Under PerformanceAnnual The 2019. sectorperformancein Reporthealth providesthe 2019, the of glimpse(APR) of a EXECUTIVE SUMMARY https://www.who.int/dietphysicalactivity/childhood/en/ organized two major events in 2019: the Seychelles Primary Health Care Conference and a High-Level most live within easy reach of a health facility and can receive a comprehensivereceivecana package facilityand health a easyof reachwithin livemost The health sector employs adequate number of qualified health professionals health qualified of number adequate employs sector health The Several Acts and Regulations to promote and protect health came into force in 2019. Themainobjective ofboth events was to improve andhealthoutcomes. services Pneumonia is also an important cause of morbidity and mortality, contributing to diseases of the circulatory system (34%) and cancer (20%) caused (20%) cancer and (34%) systemcirculatory the of diseases more than 400,000 doctor consultations; 11, 000 admis Ministry of Health (MOH) ensures that strategicpolicy that ensures (MOH) Health of Ministry In 2019, 12% of totalof 2019, 12% In government budget was allocat a composite indicator to measure Universal Health Universal measure to indicator composite a Noncommunicable diseases (NCDs) is a is (NCDs) diseases Noncommunicable The population has excellent access Thetwo main risk factors for – the – There , em - - - - 1 INTRODUCTION

My Health, My Responsibility ‘Bouze’ Campaign 2 Annual Health Sector Performance Report 2019 4 gy_2019_2023_new.pdf nance.gov.sc/uploads/files/Seychelles_National_Development_Strate 3 2 the maingoals oftheNHSPare: gets. In line with the health sector’s vision and mission, tar health global and national key achieving for map the public and private health sectors. It provides a road within agencies the all of work the guiding framework lays out the health sector priorities and offers a unifying 2016-2020 (NHSP) Plan Strategic Health National The objectives related to health: 2019-2023 Strategy Development National the of goals the with aligned perfectly is This the pursuit ofsocialandeconomic development. in efforts all of centre the at family the and individual and in all. The health sector places the well-being of the all by all, for Health of principles the into translated is decisions about their health. The Health Sector mission environmentenabling an for citizens make to informed of the creation through all stakeholders, of ticipation par active the with Seychelles, in people all of dignity and life of quality and health the restore and protect promote, Torelentlessly Sector: Health the of Mission and steward ofthehealthsector. lead the as acts Health of Department The Seychelles. in people the toimproveof is health purpose the mary pri whose country in people and resources stitutions, in organisations, the all of consists sector health The with nature. harmony in living and health spiritual and mental cial, people in Seychelles of the highest level of physical, all so by attainment, The Seychelles: in Health of Vision ity ofthecitizen. responsibil the and provisioncare health Statefor the Seychelles. of Constitution the in enshrined is health to right The Seychelles National Development Strategy 2019-2023. http://www.fi 2019-2023. Strategy Development National Seychelles Constitution ofthe Republicof Seychelles, 1994. Ministry ofHealth,Seychelles National HealthStrategic Plan2016-2020. • • • - - services; and services; of healthprofessionals withtheexisting health increased level ofsatisfaction ofthe peopleand and communicable diseases; associated withprioritynon-communicable reduced incidence,prevalence andmortality increased expectation oflife with afocus onpeople-centred care. Build ahigh-qualityintegrated healthcare system responsibility for holistic health. empowerment andpersonal andsocietal Pursue effective health protection and promote 2 Article 29 underscores the commitment of commitment underscores the 29 Article 3 ht a to main two has that ------4 - -

practices and within theMOH: policies all guides values core of set A made inachieving SDG3targets. progress the of review and follow-up implementation, the for responsible is MOH the and (SDGs) Goals ment Develop Sustainable the to signatory is country The key strategic investment priorities were identified to: of number a mission, and vision health the Toachieve Statistics UnitandCancer Registry. (DSRU), Unit Response and Surveillance Disease the – reporting routine for units processing data MOH from led the process. The data used were compiled primarily Valentin,Bernard Dr SecretaryHealth, for Principal the uted to the development of this report and the Office of A group of people from all entities within MOH contrib Process Of Report Development remaining gaps. by the health sector, the achievements secured and the done work the about public the and legislatorsinform intendedtocare also providers.health is report all The and government of levels all makersat policy health al nation primarily is report this for audience target The Intended Audience ture implementation oftheNHSP. fu inform and SDGs e.g. commitments global also and targets NHSP set reaching towards made progress and mine and give an account of the work done during 2019 sectoratMOH the centrethe with sector;the of deter demonstratetoReportarehealth the accountabilityof Health Performance Annual the of objectives main The Objectives OfThe Report • • • • • • • • • • • • • • • • Productivity Partnership Excellence Development Caring coordination develop partnership, participation and promote research andinnovation; and strengthen governance andleadership; ensure sustainable financing for health; develop andsustain humanresources for health; strengthen integrated healthcare; promote andprotect health; Seychelles. improved overall wellbeing ofallpeoplein Reward andteam work Professionalism People

- - - - - GOVERNANCE AND 2 LEADERSHIP

High-Level Dialogue on Quality of Care, November 2019. 4 Annual Health Sector Performance Report 2019 7 after e president assumedthe healthportfolio in 2020. February 6 topics/stewardship/en/ 5 Social Studies and pre-service provides that entity academic an is (NIHSS) for Health Institute National The ership. respectivethe governing boards provide strategic lead Authority,Health while Public the of case the in sioner Commis Health Public or the Officers Executive Chief the with lies entities above the of Executive leadership health the MOHhave thefollowing mandates: of purview the under 2.1) (Fig. entities statutory The tion. coopera international and promotion health opment, devel resource human for responsible also is Ministry private sector responsible for health care provision. The and bodies pubic three the strategies by health of tion implementa the of coordination and oversight as well as evaluation; and monitoring planning; development; Ministry The Secretary. cipal The executive leadership of the MOH lies with the Prin 2019 against thematic areas asoutlinedinthe NHSP: during achievements key at looks chapter This promote andrestore health. protect, to is aim ultimate society.The civil and sector private the including system health formal the beyond sectors other with collaboration ensures governance Good system. health the in actors different the tween parency,accountability, be effective collaboration and trans is there that exist, frameworks policy strategic coverage.” objectives that arepolicy conducive universalto health health national achieve to seek they as makers cisions by governments/de out carried functions related ing rule-mak and steering rangeof wide “a as governance sector health defines Organization Health World The At the time of writing this report, the status of MOH had changed to DOH to changed had MOH of status the report, this writing of time the At HealthCare Agency Act2013,Section4(1) H-oenne eree fo https://www.who.int/healthsystems/ from retrieved WHO-Governance • • • • • • • • activities ona national level strategic guidanceandcoordination ofHIV The National AIDSCouncil(NAC): to provide health and provide protection of the population’s The PublicHealthAuthority(PHA):to regulate protect andrestore thehealthofpublic The HealthCare Agency (HCA):To promote, Private sector participation Empowered civilsociety/community Sector accountability Legal andregulatory framework Sector stewardship andmanagement capacity 5 edrhp n gvrac esrs that ensures governance and Leadership 6 is responsible for policy for responsible is 7 ------ment and implementation; detecting and correcting detecting implementation; and ment develop policy Itincludes of direction strategic the maintainingand demands. influences competing ing balanc involves that process political a is Stewardship and evolving Health Sector. implementation agenda a health within complex the of Much was done in 2019 to ensure efficient and effective board. NIHSS is now an independent entity with a director and providers. The care health education for in-service and AVANI Seychelles, Barbarons Resort andSpa 9 int/healthsystems/stewardship/en/ 8 yearssignificantlyhas improved and wellbe health the the system,overCare which Health Primary Seychelles therefore found it necessary to take a critical look at the Health Care for the 21st century and beyond. The MOH Primary to stimulus new a provides organisations and leadersDeclaration Astanaworld 2018 adopted by The The Seychelles HealthCare Primary Conference of new personnel. Corps. The Policy Analysis Unit also saw the recruitment rival of two statisticians from the Nigerian Technical Aid ar the Public by strengthened was 2018, in the Authority Health from Secretariat MOH the to transferred was which sector. Unit, Statistics afully health The functional place in put to efforts its continued MOH The Having afullyfunctionalhealth structure at least donotundermine-peoples’health. areas of government policy and legislation promote - or other that ensuring system,stewardshipmeans health formal the Beyond mechanisms. accountability fective establishing providers; care ef health and financiers to care health from - actors of range wide a of behaviour the articulating casefor nationalin development;health regulating the distortions; and trends undesirable FIGURE 2.1. HEALTH SECTOR STRUCTURE World Health Organization. Stewardship. Retrieved from https://www.who. Report of the Seychelles Primary Health Care Conference 11 – 13 July 2019, 2.1 HEALTH SECTOR STEWARDSHIP AND MANAGEMENT CAPACITY

8 9 - - - - - Annual Health Sector Performance Report 2019 5 - - - - empower and engage individuals, families, individuals, and engage empower of their health ownership take to communities co-providers. care health and be active Health. for Charter the Seychelles implement Build wider consensus, finalise and effectively and finalise consensus, Build wider Examine and put in place strategies to better to place strategies put in and Examine • • clear standards to measure quality, emphasis on con leadership fostering development, professional tinuous initiatives. of quality improvement and ownership The conference ended with the adoption of aresolu tionto improve PHC. The MOH has developed a draft roadmap for the ofimplementation theresolution and recommendations. Care Dialogue on Quality of High- Level In November 2019, the as MOH sector, private convened and public the both from experienced practitioners well as key nursing and allied health professionals and representatives of human resources and support ser vices to reflect on quality ofcare and make proposals for quality improvement initiatives. Theevent benefit ted greatly from the experience and wisdom of retired professionals. The event ended with a wrap up by the Health, Minister for who summarised the during the discussions, whichof included development various points raised Individual, families and community engagement engagement and community families Individual, - - improve staff performance. performance. staff improve roles of and tasks of the distribution Review workers. of cadres different and trainings based on training needs based on training and trainings mentoring/ the current Improving assessments. help can systems supervision supportive coaching Establish national staffing norms, in addition staffing national Establish development staff a structured having to updates continuous provides that programme of care. of care. marginalised populations. populations. marginalised and PHC between Assess interaction continuum ensure services to hospital-based health services as well as facility-based services health services as facility-based as well the of expectations and needs current with line in and to vulnerable attention paying community, of services to be delivered at different levels of levels different at be delivered of services to service delivery. the community-based Assess and re-organize Review and/or clearly define an essential package package essential an define clearly and/or Review programme, including making available programme, aspects all for protocols and guidelines standards, of service delivery. adequate funding adequate a of institutionalising the process Facilitate management/improvement quality national Identify mechanisms to mobilise additional to mobilise mechanisms Identify criteria MOH the current at and relook resources to ensure for PHC services allocation resource for coordination and integration of PHC with of and integration coordination programmes. other health related levels of services delivery to enhance effective enhance effective of services to delivery levels of PHC services.delivery better to ensure mechanisms Institute Put in place measures to strengthen the strengthen to Put in place measures all at structures management and leadership • • • • • • • • •

health for Human resources

Service Delivery

Governance and Leadership Governance ing challenges while safeguarding the gains. The confer The gains. the safeguarding while challenges ing recommendations: of key ence made a number invited invited key partners and to stakeholders reflect on the strengths and weaknesses of PHC in new and to emerg respond to up come with strategies Seychelles and PHC mechanisms have not evolved to adequately meet meet adequately to not evolved PHC mechanisms have emerging health needs and socioeconomic and other challenges faced by the nation. In July 2019, theMOH ing of the it Seychellois people. appears that However, 6 Annual Health Sector Performance Report 2019 2013 10 General: different stages of revision at the Office of the Attorney at currently are legislation of pieces Other scheduled. Mental Health Care Bill. The Second ofthe reading is yet to be first reading the heard Assembly National The 2019: in force into came Regulations and Acts following The Acts andotherStatutory Instruments Public Health Authority Act 2013 - Act 7 of 2013, gazetted 28th October 28th gazetted 2013, of 7 Act - 2013 Act Authority Health Public • • • • • • • 2.2 SECTOR LEGAL ANDREGULATORY process isend ofMay 2020. legislation. Theanticipated timeframe forthe the development of the new Bill and its subsidiary received technical assistance from theSADC for National Regulatory System. Seychelles has Benchmarking Tool (GBT) for evaluation of (AU) modelLaw aswell asWHOGlobal be basedontherequirements ofAfrican Union (consolidated to 30June2012).Thenew billshall and replace theexisting Pharmacy act1899 Medical Product andPharmacyBill–to repeal to Cabinet for approval. schedule have beenrevised andsubmitted Meanwhile fees that willform partofthe currently revising thedraft documents. comments. TheOfficeofthe Attorney General is Authority Act Regulations asprescribed by thePublicHealth Regulation of Health and Health Related Practices o Regulations, 2019) Excise Tax (ImpositionofSugar Tax onDrinks o Tobacco Control Act o o o Food Act2014: o o Health Professionals Act: promotion oradvertisement ofalcoholic drinks. to control manufacturing, production, saleand Alcoholic Drinks Control Act 2019 (Act 13 of 2019) 5g/100ml subjectto aSugar Tax5g/100ml ofSCR4/litre Packages and Single Cigarette) Regulations, 2019 Regulations, 2019 in food orfeed) Regulations, 2019 Pre-Packaged Foods) Regulations, 2019 of Schedules)Regulations, 2018 Regulations, 2018 All drinks withasugar content exceeding S.I. 30of2019Tobacco Control (Saleof S.I. 17of2019Food (ImportCertificate) S.I. 16of2019Food (Contaminant andtoxins S.I. 15of2019Food Act(Labellingof S.I. 2/2019HealthProfessionals (Amendment S.I. 1/2019HealthProfessionals (Fees) 10 FRAMEWORK , afirst draft wascirculated for sentation. Thequestions addressed some key issues: The Minister was asked over 20 questions after his pre bly to commemorate World AIDSDay 2019. MinisterThe for addressedNational Assem the Health Political Accountability Private Practice for nurses andmidwives. Part-time on Policy and Immunisation on Policy,Policy Transfusion Blood policies: three on ongoing is Work home, 3. 2. 1. • • Health Systems - - Health status - Governance andleadership legal drafting inprogress. Temperature Controls Regulations (Food Act)- (Revision) –legal drafting in progress. Seychelles Nurses andMidwives Act1985 ------2018 andearly2019 Hospital in2019,includinginfant mortality for Mortality andcauses ofdeath inSeychelles mortality in2018andearly2019 Trends andcauses ofmortality andinfant importation ofmedicines Regulation ofprivate pharmaciesand generations ofdrugs of donated equipment, procurement ofnewer Drugs andMedical products –qualitycontrol medical records Health information –Introduction ofelectronic hospital bedsfor patients being cared for at Quality ofcare –qualityofmeals,provision of Service access – wheelchair access to Eye Clinic incinerator for LaDigue unoccupied wingofNorthEast Point Hospital, English River HealthCentre, plansfor plans for oldBaieSte Anne,renovations at facilities at BaieSte, new facility at BaieLazare, Centre, hygiene at healthfacilities, laundry Infrastructure –improvement at Wellness congenital malformations detection of complications of pregnancy and Praslin andLaDigueduringthenight, early on Praslin, medical evacuation of patients from at Pointe Larue, rehabilitation of stroke patients delivery –provisionService ofbasicservices and doctors incentives for cadres otherthannurses conditions ofnursing assistants ,monetary Health workforce –improving working 2.3 SECTOR ACCOUNTABILITY - - Annual Health Sector Performance Report 2019 7 - - - - 74 477 951 321 708 2019 68 365 870 324 658 2018 61 323 811 328 583 2017 Total on register as at 31st December 31st as at on register Total 17 28 43 133 2019 2.5 PRIVATE SECTOR PARTICIPATION SECTOR 2.5 PRIVATE as an example of community engagement. Indeed, civ engaging a at aimed was conference the of part good il society and communities: therewere presentations by community members, civil society was represented among participants, and districtteam action plans had as components. engagement community private the of contribution the values sector health The the health and to improve sector wellbeing of the pop ulation, be it in the provision of healthcare and health or donations. services, contributions related care sector Private contributions or donations to the health sector in 2019 amounted to SCR2.5M, which SCR was 1.8M under of the Corporate Social Responsibility but 2018, in 0.4M SCR the than more was This Scheme. short of the SCR 2.3M in 2017. bodies: Seychelles bodies: Medical and Council Seychelles Dental (SMDC), Seychelles Nurses and Midwives Council (SNMC), and regis newly Among (HPC). Council Professionals Health Seychellois. were two in 2019, only nurses tered It is relevant to note the PHC Conference of July 2019 Table 2.1 shows Table the number of health care profession als registered with the three professional regulatory 19 66 19 138 2018 ------New Registrations New 0 64 87 16 31 2017 COMMUNITY 2.4 EMPOWERED CIVIL SOCIETY/ 2.4 EMPOWERED Midwives Allied Health Professionals Dentists Nurses Doctors whole family. Activities included screening hyper for tests. eye and HIV testing and diabetes, tension in collaboration with Drs4Drs and the MOH. This mass education health combined event screening and health and screening with health-related fun activities for the of the Oncology Unit; the annual beach walk at Beau Vallon Beach to raise awareness about breast cancer and the biggest event of the year, the Health-a-Thon events to raise awareness and improve the lives of can of lives the improve and awareness raise to events cer patients and theirfamilies – The Pink Linkto raise funds for cancer related activities, including upkeep Soroptimist International – Club of Victoria held three ness about the responsibility of patientstowards their health and the best way they should engage with the health system. Seychelles Seychelles Patients Association was visiblecommunities across Mahe in many Praslin,and raising aware raise awareness about Alzheimer’s disease and provide provide and disease Alzheimer’s about awareness raise local and overseas training and exposure to its mem bers. Association and many others. others. and many Association The Seychelles Alzheimer’s Foundation continued to tion,Seychelles Diabetes Society, Autismand neophytes Seychelles like Seychelles Stroke Foundation, Sey chelles Alzheimer’s Foundation, the Seychelles Patient The list of health sector non-governmental organisa tionsnow includes prominent organisations like Can cer Concern Association, HIV/AIDS Support Associa

Sources: Council databases Council Sources: TABLE 2.1. REGISTERED HEALTH CARE PROFESSIONALS, 2019 CARE PROFESSIONALS, HEALTH 2.1. REGISTERED TABLE scribed by the Medical Practitioners and Dentists Act 1994. The Seychelles Medical and Dental Council held elec tionsfor new Council members in 2019. The Minister for Health appointed the new Board members as pre Professional Councils in Health Councils Professional 3 HEALTH STATUS

Morning in Bel Ombre Annual Health Sector Performance Report 2019 9 - 8.0 438 325 762 2019) (2015- Average Average 8.1 437 358 795 2019 8.5 470 348 818 2018 7.8 426 322 748 2017

7.1 0.2 0.2 1.7 2.7 44.2 16.6 7.9 454 293 747 2016 /1000 population /1000 population 7.5 401 302 703 2015 Age-specific mortality rate rate mortality Age-specific 3.4 0.1 0.3 1.6 9.8 100 Males Females (Both Total sex) Crude death /1000 rate population 26.9 57.9 All deaths in the age group 15-24 years were among men, in fact, in the reproductive and productive in men than women. deaths more are age there groups, rate rate decreased slightly from 8.5/1000 population2018 to in 8.1/1000 population in 2019, but slight was ly higher than the for the average last fiveyears (Table 3.2). SEX, 2015-2019 BY DEATHS 2.2. ANNUAL TABLE NBS source: Data Males, (42 49 2019, in died who people 795 the Among 7 Females) were foreigners, representing 6% total of deaths. As shown in Table 3.3, 27 infant deaths were registered in 2019, representing 3.4 % oftotal deaths. Mortality by sex and age and age sex by Mortality In 2019, 795 deaths were recorded, the crude death

- 11 % of total deaths deaths % of total 835 794 17.0 1629 2019) (2015- Average Average 1 2 27 13 78 214 460 795 Total 813 792 16.4 1605 2019

12 0 2 0 832 818 13 24 74 17.1 1650 2018 245 358 Female 859 792 17.2 1651 2017 1 0 14 13 54 140 215 437 Male 857 788 17.4 1645 2016 814 778 3.1 VITAL STATISTICS 3.1 VITAL 17.0 1592 2015 National Bureau of Statistics. (2019).Statistical Bulletin: Population and Statistics, Vital Mid- Population Year Estimates. Catalogue Population Number: Preamble to the Constitution of WHO as adopted by the International Health Conference. New York, 19 June - 22 July 1946; signed on 22 July 1946. https:// 1946. 22 July on signed 1946; 22 July - 19 June York, New Conference. Health International the by adopted as WHO of Constitution the to Preamble 65 & + All Age-groups 25-44 45-64 1-4 5-14 15-24 <1 Age-group (years) Age-group Crude birth /1000 rate population Females (Both Total sex) Males 12 https://www.nbs.gov.sc/downloads/mid-2019-population-bulletin/download from Retrieved 2019/2. Seychelles. 11 www.who.int/about/who-we-are/constitution TABLE 3.3. ANNUAL DEATHS BY AGE GROUP AND SEX, 2019 AND SEX, GROUP AGE BY DEATHS 3.3. ANNUAL TABLE Data source: NBS source: Data TABLE 3.1. LIVE BIRTHS BY SEX, 2015-2019 BY 3.1. LIVE BIRTHS TABLE 2019 is 17/1000 population, it however, decreasedto 3.1). in 2019 (Table 16.4/1000 population There There were 1605 live births in 2019; for the years, last the five annual number of live births has remained below 1700. The average crude birth rate for 2015- 11% are aged 65 years and above. and above. 65 years aged 11% are births Live The mid-year estimated population annual an Females), 49% Males, (51% 97,625 was 2019 Seychelles of in population, total the Of 2018. over 0.9% of rate growth indicators indicators of health status: vital statistics, main causes morbidity and fertility. key of mortality, defined as the measurement of healthat a particular point in timeagainst identifiable standards indica or tors. In this we chapter, look at a number of different as “a state of complete physical, well-being, and mental not merely and the absence social of disease”. be can that concept multidimensional a is status Health The World Health Organisation (WHO) defines health 10 Annual Health Sector Performance Report 2019 TABLE 3.5.MATERNAL ANDINFANT DEATHS, 2018-2019 post-mortem. Thestillbirth rate of5.0/1000 total birthsin2019isthelowest recorded inthelast five years. on asphyxia as reported was death of cause their dead’; in brought ‘were condition healthy in home discharged and hospital in prematurity. born of complications were infants who and Five respiratoryto pneumonia distress, still not NHSP the reaching target live <10/1000 of Deaths births. neonates 14 of early, (5 late) 9 were mostly due is country the 2018, tocompared decrease a though 2019, in births live 16.8/1000 rateinfantwasmortality The indicators. (Table 3.5), but despite 2018 these decreases, to the country compared is rates still mortality not reaching perinatal NHSP end and - under-five term targets infant, neonatal, for somestillbirth, of these in decreases were There is increasing (Annex 2). 1978, the annual number of maternal deaths has varied widely, from zero to three; however, the five-year average registeredwasSince Seychelles.overseas occurredbut in death this – 2019 reportedin wasmaternaldeath One Note. Age structure ofpopulation indistrict not reported. *Data source- NBS. TABLE 3.4.ANNUAL MORTALITY BY SELECTED DISTRICTS, 2019 four districts (Table 3.4). except for 10 than less was 1) (Annex district each in population thousand rateper death The sea). at or abroad – country the outside occurred deaths (32 deaths total of 96% representing recorded were deaths 763 chelles, Sey of districts 26 the targeted In interventions. of development support help data can -national sub at Looking Mortality by Location 3.2.1 3.2.2 3.1.1 SDG Pointe Larue Plaisance Anse AuxPins St Louis District Still birth rate per1000 total births Perinatal mortality rate per 1000 total births births Under-five mortality rate per1000live Infant mortality rate per1000live births Neonatal mortality rate per1000live births births Maternal mortality ratio per100,000live Indicator Male 15 16 37 26 Female 3.1.1 MATERNAL ANDINFANT DEATHS 20 33 18 19 Deaths by Sex Total 35 49 55 45 [No. ofdeaths] % oftotal 2018 rates deaths 121.2 5% 6% 7% 6% 16.2 20.6 18.8 14.6 [14] [27] [34] [31] [24] 8.4 [2] Population indistricts* [No. ofdeaths] 2019 rates 3082 3974 4236 3241 17.4 16.8 62.3 [13] [28] [27] [14] 5.0 8.1 8.7 [8] [1] NHSP End-term target (rates) [zero deaths/1600 live births] Deaths /000Population No target No target < 12 <10 <5 0 11.4 12.3 13.0 13.9 - Annual Health Sector Performance Report 2019 11 -

13 3.1.2 LIFE EXPECTANCY 3.1.2 United Nations, Department of Economic and Social Affairs, Population Division (2019). World Mortality 2019: Data Booklet (ST/ ESA/SER.A/436). (ST/ Data Booklet 2019: World Mortality Division (2019). Population and Social Affairs, Economic of Department Nations, United 13

FIGURE 3.2. COMPARISON OF LE AT BIRTH (IN YEARS) FOR SELECTED COUNTRIES SELECTED FOR (IN YEARS) BIRTH OF LE AT FIGURE 3.2. COMPARISON LE in Seychelles is slightly higher than global average but lower than the LE in two neighbouring countries, Mauri countries, neighbouring two in LE the than lower but average global than higher slightly is Seychelles in LE (Fig. 3.2). countries and LE in high- income tius and Maldives

shows a gain of four years only in LE at birth in the last 39 years. in the last birth at only in LE years of four a gain shows 1980 -2019 (IN YEARS), BIRTH FIGURE 3.1. LE AT country country did the not reach the of NHSP males for 74 end-term Additionally, and target years females. for 80 years five-year (2015-2019)average LEat birthwas 70years for males and 79years 3.1 for Figure declined. females,since has but 2016, in both years 80.2 stillof peak a reached belowLE the women, the For target. end-term NHSP The life expectancy (LE) at birth for both sexes increased from 72.7 years in 2018 to 73.9 years in 2019 - an increase increase an - 2019 in years 73.9 to 2018 in years 72.7 from increased sexes both for birth at (LE) expectancy life The of more than For one males, year. LE at birth increased from 68.5 years in 2018 to 69.7 years in 2019, while for females it increased from 77.4 years in 2018 to 78.4 years in 2019. Despite increases in LE at birth in 2019, the 12 Annual Health Sector Performance Report 2019 Paris, https://doi.org/10.1787/4dd50c09-en 15 trieved from http://apps.who.int/gho/data/view.main.HALEXv?lang=en 14 mortality pattern issimilar to OECD countries. by cancer, which caused 19% of all deaths (Fig. 3.4). This in and system 2019 accounted for circulatory32% of all deaths; this was followed the of diseases is country the in death of cause leading The decade. last the for same the remained have mortality of causes main The for andsocialcare. healthservices implications has HALE and LE betweengap The health. determi socio-economic the factorsof health, of purview nants the arethatoutside by influenced highly are they indicators, health key are HALE and LE While (Fig 3.3). 1990 in women of HALE the than wasless 2016 in men for HALE the fact in sexes, the between HALE in gap year five- a about of gap a and women and men of LE There has been a gap of eight to ten years between the the Global BurdenofDisease Study 2017;390:1260–344 2016.Lancet for 195countries andterritories 1990–2016:asystematic analysis for (DALYs) for 333diseases andinjuries andhealthy lifeexpectancy (HALE) Source: Global, regional, andnational disability-adjusted life-years FIGURE 3.3.HALEANDLEAT BIRTH, SELECTED YEARS global average of63.3years. for both sexes was 65.7 years in 2016, slightly above the to LE. Based on global data, HALE at birth for Seychelles measurelife’ ‘qualityof a adds HALE health), poor and good in life of (years health of states different into LE dividing by because population a of status health the of measure good a is HALE health’. perfect than ‘less in lived years of number the by expectancy life overall adjusts It morbidity. and mortality account into takes which health, population of measure a is expectancy life healthy or (HALE) expectancy life Health-adjusted OECD (2019), Health at a Glance 2019: OECDIndicators,2019: Glance a atOECDPublishing, Health OECD(2019), data. Re (GHO) Observatory Health Global Organization. Health World 3.2 MAINCAUSES OFMORTALITY 14 15

- - abetes (Fig.3.5). di from eight and CRDs, from 12 neoplasms, from 151 CVDs, from were 257 deaths, NCD 428 the Of deaths. 209 Females) deaths in 2019, representing 54% of total Males, (219 428 with Seychelles in mortality of cause major the remain NCDs (CRDs). diseases respiratory ic chron and diabetes neoplasms, (CVDs), diseases cular cardiovas include (NCDs) diseases Noncommunicable CHELLES, 2015-2019 FIGURE 3.4.FIVELEADING CAUSES OFDEATH INSEY Paris, https://doi.org/10.1787/4dd50c09-en 16 men. in higher is dence this is different from OECD countries where cancer inci women; for population 302/100,000 and men for tion popula 274/100,000 was incidence cancer the 2019, In respectively). 30% and (27%, 2017 in reportedcases new 216 and 2018 reportedcasesin new 222 fromthe cancer were reported in 2019, representing an increase of cases new Females) 145 Males, (136 281 of total A Cancer incidenceandmortality death written ondeath certificates. towards of causes the diabetes in alwayscaptured not is mortality other of contribution that assumed is It FIGURE 3.5.TOTAL NCD MORTALITY (N=428),2019 OECD (2019), Health at a Glance 2019: OECDIndicators,2019: Glance a atOECDPublishing, Health OECD(2019), 3.2.1 TOTAL NCDMORTALITY 16 Prostate most the wascancer ------Annual Health Sector Performance Report 2019 13 - - - - 6 9 31 43 44 133 Total F 1 3 10 17 24 55 5 6 M 21 26 20 78 - - Description haemorrhage Subarachnoid haemorrhage Intracerebral intracra Other non-traumatic nial haemorrhage Infarction Cerebral not specified as haem Stroke, or infarction orrhage ICD 10 I60 I61 I62 I63 I64 Total Deaths due to diabetes and its complications are gener are complications its and diabetes to due Deaths Male, (1 deaths eight only 2019, in reported: under ally 7 Females) were reported with three occurring in the age-group 30-70 years. Diabetes in captured always not is contribute information this but mortality, to NCD of death. causes registered Diseases (CRDs) Respiratory Chronic deaths Twelve (9 Males, 3 Females) due to CRDs were in 2019, 30- in with deaths the two group reported age be CRD, of trend the on report to difficult is It years. 70 cause in these previous years deaths erroneously were with pneumonia deaths. grouped 133 cerebrovascular accidents (CVA), 10 more pared to com 2018 (Table 3.6). The majority (66%) this of and years 65 CVA than less aged persons in reported are age group accounted for half of all deaths caused by in 2019. CVA (INCLUDING ACCIDENTS 3.6. CEREBROVASCULAR TABLE 2019 HOSPITAL SEYCHELLES DEATHS), Diabetes In 2019, 27 (Males 20; Females 7) patients were admit were In 2019, 27 7) (Males patients 20; Females ted to hospital with myocardial infarction; there were

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17 Seychelles Cancer Registry Seychelles 17 RY SYSTEM, 2019 SYSTEM, RY males) representing 34% of all deaths (Fig. 3.8). 34% of all deaths males) representing OF THE CIRCULATO DISEASES DUE TO FIGURE 3.8. DEATHS Mortality from diseases of the circulatory system diseases of the circulatory from Mortality Diseases of the circulatory system was the main cause of death for 257 persons in 2019 (128 Males, 129 Fe

FIGURE 3.7. CANCER DEATHS, 2019 FIGURE 3.7. CANCER DEATHS, breast cancer, breast while cancer, in men, 30% (24/81) were due to (Fig. 3.7). cancer prostate Cancer was the second leading cause of mortality 2019 in with 151 deaths (81 Males, 70 Females). Among cancer deaths in women, 23% (16/70) were due to FIGURE 3.6. NEW CASES OF CANCER, 2019 OF CANCER, NEW CASES FIGURE 3.6. of 62.4/100,000 males, while breast cancer (47/145) was the most diagnosed in (Fig. 3.6). females 98.0/100,000 females – incidence of diagnosed diagnosed cancer in males (31/136 cases) – incidence 14 Annual Health Sector Performance Report 2019 non-communicable diseases 2016-2025. 20 development goals. Geneva: World HealthOrganization; 2019. 19 development goals. Geneva: World HealthOrganization; 2019. 18 portance inSeychelles. im of diseases are HIV/AIDS and pneumonia spirosis, lepto diseases, communicable and infectious Among suicides. mortality following road traffic accidents (RTA), falls and namely, interventions, better by avoided or prevented ture mortality were mainly deaths that prema could have been of causes Other NCDs. from mortality overall and Control of NCDs The target in the Seychelles Strategy for the Prevention DEATHS INTHEAGE-GROUP 30-70YEARS FIGURE 3.9.PROPORTION OFNCDSDEATHS AMONGALL Japan (8.4%). and (13.4%) Maldives for than higher but (22.6%) tius Mauri for than less slightly is this Seychelles, in 21.7% is years 70 and 30 age the between NCD any dy from ing of probability The 40%. of target NHSP the than higher is this – 3.9) (Fig. NCDs to due were 55% which, deaths years,group30-70 of age the in were2019 reportedin 359 Seychelles, In mortality. NCD premature women. for 15% and men for 21.6% was 70 of age the beforereaching NCD NCDs, while the risk of a 30-year old person dyingfrom to due were deaths all of (41M) 71% 2016, Globally,in Ministry of Health. Seychelles Strategy for the Prevention and Control of Control and Prevention the forStrategy Seychelles Health. of Ministry sustainable SDGs, the for health Monitoring statistics 2019: Worldhealth sustainable SDGs, the for health Monitoring statistics 2019: Worldhealth 3.2.3 MORTALITY FROM KEYCOMMUNICA 3.2.1 TOTAL NCDMORTALITY 19 BLE DISEASES 20 18 is a 25% relative reduction in the SDG 3.4 calls for a reduction in reduction a for calls 3.4 SDG ------of alldeaths were dueto pneumonia. in increase 15% 2019, In 3.10). an (Fig. 2015 since deaths pneumonia been with has There admissions 2019. in 363 pneumonia reported Hospital Seychelles TABLE 3.7.TOP 10BURDENOFDISEASE top 10burden ofdiseasefor Seychelles (Table 3.7). the among ranked is infections tractrespiratory Lower Pneumonia Disease Study2016.Lancet 2017;390:1260–344 of Burden Global the for analysis systematic A 1990–2016: territories and countries 195 for (HALE) expectancy life healthy and injuries and diseases 21 rosis diagnosedwas notavailable. accurate data for the total number of cases of leptospi as 2019, in calculated however,not wasthis, <10%; of rate fatality case a is mortality leptospirosis for target end-term NHSP The workers. migrant were tospirosis lep from died who personsseven the of Three males). (all withdeaths seven were there and 2019 tohospital in leptospirosis admitted were patients Sixty-three year. every mortality leptospirosis reports Seychelles Leptospirosis deaths oc curred inpersons aged 65years ofpneumonia andabove in2019. % 73 agent; causative the nor pneumonia of type the on information no is There FIGURE 3.10.PNEUMONIADEATHS, 2015-2019 10 9 8 7 6 5 4 3 2 1 Rank Global, regional, and national disability-adjustednational regional,and Global, life-years (DALYs) 333 for Road injuries Skin andsubcutaneous diseases Diadetes Sense organ diseases Chronic kidney disease Stroke Low backandneckpain Hypertensive HeartDisease Lower Respiratory Tract Infections Ischemic heartDisease Condition Group 21

- - - Annual Health Sector Performance Report 2019 15 - - - - -

cases cases (66 Males, 4 Females) were diagnosed – a signif icant reduction from the 87 and 186 newcases detect ed in 2018 and 2017 (Fig.respectively 3.14), and lower than the NHSP of end-term target 120. The majority of people diagnosed with HCV in 2019 are aged less than 35 years and 23 out the 70 cases are co-infected with HIV. The majority of cases of HCV CDCU, were Prison Clinic detected and facilities at that offer services to six people cases detect were who use drugs, however, Clinic. Force Defence People the Seychelles ed at were B (HBV) hepatitis viral of cases new (44) Forty-four (32 detected Males, 12 Females) in 2019, compared to 23 cases in 2018. HBV is a vaccine disease preventable and the country included HBV vaccine in its EPI sched ule in 1995. 2015-2019 OF HCV, FIGURE 3.14. NEW CASES in 2019. The CDCU reported 18 new AIDS cases (12 Females) Males, in 6 2019, representing a decreasefrom 23 cases the reported in 2018. There were 16 deaths (12 Males, 4 Females) from AIDS representing 2% of total deaths; higher than of the 0.5%. NHSP end-term target The AIDS mortality rate has more than doubled in the 2015 (Fig. 3.13). to compared years three last 2015-2019 RATE, MORTALITY FIGURE 3.13. AIDS-RELATED Hepatitis Viral The Clinical Laboratory did 13, 466 (HCV) tests in viral 2019; the hepatitisnumber of new C cases of HCV has decreased in the last two years. In 2019, 70 new programme. The country has recorded MTCT of HIV ev HIV of MTCT recorded has country The programme. reported case one with years three last the for eryyear

------HIV who were pregnant in 2019 followed the PMTCT testing attesting booking andat 36weeks of andgestation all interven PMTCT receive women pregnant HIV-infected women living with Only 19 of the 23 at the CDCU. tions (PMTCT) The MOH provides a package of interventionsto pre All pregnant women vent MTCT HIV are of offered HIV. lation groups. lation Prevention ofMother to Child Transmission of HIV In 2019, the Clinical Laboratory reported doing 16,653 HIV tests (ELISA and Rapid Tests); there is no data on the number HIV tests done among keydifferent popu HIV testing is done in PHC facilities, hospital, private clin private hospital, facilities, PHC in done is testing HIV ics and by some NGOs through outreach programmes. Source: Communicable Diseases Control Unit (CDCU). Control Diseases Communicable Source: FIGURE 3.12. MODE OF TRANSMISSION AMONG NEWLY AMONG NEWLY FIGURE 3.12. MODE OF TRANSMISSION 2016-2019 OF HIV, CASES DETECTED in 2019, 53% were and heterosexuals 31% PWIDs (Fig. 3.12). tions, namely, people injectwho drugs (PWID); men who have sex with men (MSM); and female sex work among the newly diagnosed cases ers However, (FSW). The HIV epidemic is concentrated among key popula FIGURE 3.11. NEWLY DETECTED CASES OF HIV, 2015-2019 OF HIV, CASES DETECTED FIGURE 3.11. NEWLY the 120 and 112 new cases diagnosed in 2018 and 2017 2017 and 2018 in diagnosed cases new 112 and 120 the respectively (Fig. 3.11). The majority of newcases are < 35 years). people (aged in young detected The NHSP end-term target for annual new HIV infections infections HIV new annual for target end-term NHSP The is < 60 cases. There were 109 (74 Males, 35 Females) newly diagnosed cases of HIV in 2019; a from decrease HIV/AIDS 16 Annual Health Sector Performance Report 2019 2015-2019 FIGURE 3.16.DEATHS DUETO ROAD TRAFFICACCIDENTS, than 1%. in deaths end-termtargetNHSP than slightlyhigher less 2019, of all of 1.4% for responsible was RTA 3.16). (Fig. population 11.3/100,000 to 2019 in increased but the death 2018 and 2017 in decreased RTAratefrom3.6.1] [SDG in2016, apeak From groups. age ductive pro and reproductive the in young, RTAare following dying people 2019; RTAsin from Females) 2 Males, (9 deaths 11 were There men. were RTA; (87%) following majority died the people 63 years, five last the In RTA not available. is information complete but place, work hap the in deaths pened these of some that appears It years. 65 than more aged one and years 45-64 age-group the in women two years, 45-64 age-group the in men eight years, 25-44 age-group the in men three falls; to due Females) 3 Males, (11 deaths 14 were there 2019, In Falls Data source: CDCU FIGURE 3.15.HIV/TB CO-INFECTION, 2000-2019 since 2015. recorded death TB first the it making 2019, in ported years)rewas55-64 group age the in male (a death TB Six cases of TB were diagnosed among expatriates. One 3.15). (Fig. HIV with co-infected were three cases, 13 pulmonary TB and one extra-pulmonary TB case. Of the 12 2019: in CDCU by reported were cases TB Thirteen Tuberculosis (TB) 3.2.4 OTHER CAUSES OFMORTALITY

- - -

-harm since 2016 (Fig. 3.17). There were 50 reported 50 were There 3.17). (Fig. 2016 since -harm Theredecreasea is reported in cases intentionalof self Intentional self-harm [SDG 16.1.1],bothwere men. ing a homicide mortality rate of 2.0/100,000 population There were twodeaths homicide reported in 2019, giv Homicide TABLE 3.8.DEATHS DUETO DROWNING, 2017 –2019 were female. Seychellois two the while males, were drowning from died foreignerswho nine (Table All deaths 3.8). ported re the of majority the up foreignersmaking with 2019 in 11 to 2018 and 2017 in cidentalsubmersionfrom16 There was a reduction in deaths due to drowning or ac Drowning lected wards (Annex 2for more data). se on admissions of causes common some shows 3.9 Table diabetes. to related are wards medical on sions admis all of 9% Only wards. surgical for common are cancerwards,medical and on whereasinjuries mission ad for causes common are pneumonia and CVD 2019. There were 11,339 atadmissions Seychelles Hospital in SUICIDE RATE, 2015-2019 FIGURE 3.17.CASES OFINTENTIONALSELF-HARMAND tive substances. psychoacof use/abuse to due wereyear lastreported men young in deaths 10 deaths, suicide to addition In below 10/100,000for thelast five years. remained ratehas suicide the 2018, forExcept girl. old 12-year- a was which among suicides, six and 2019 in self-harm intentional of Females) 20 Males, (30 cases Total Seychellois Foreigners Nationality 3.3 MORBIDITY 2017 16 11 5 2018 16 10 6 2019 11 2 9 ------Annual Health Sector Performance Report 2019 17 ------1 73 43 39 29 29 21 10 431 186 Total 0 0 0 6 3 1 1 0 0 1 45-49 , which is the TFR at 22 2 0 0 4 2 7 0 1 27 11 40-44 2 3 1 5 7 5 7 67 25 12 3.4. FERTILITY 35-39

3 2 0 8 7 9 9 23 82 31 13 30-34 Age-group 5 1 0 9 6 7 92 41 13 10 which a populationreplaces itself fromgeneration to assuminggeneration no migration. The NHSP targets a TFR of 3.0. The number of recorded abortions in 2019was 431, a med 73 were There (502). 2018 to compared reduction ical termination of pregnancies (TOP) and 186 incom 3.10). abortions (Table plete cases of STI attest to unsafe sexual practices. practices. sexual to unsafe attest of STI cases The number of gonorrhoea cases diagnosed in (190) 2019 is higher than cases reported in both 2018 (186) for alarming is antibiotics to Resistance (117). 2017 and Cipro to resistant are cases gonorrhoea: 60% of tested resistant 24% and Ceftriaxone to resistant 16% floxacin, Cefixime. to com 2019 in detected were Chlamydia of cases 35 Only pared to 219 and 230 cases in 2018 and 2017 respec The decreasetively. in number of chlamydiacases was kits during 2019. of testing unavailability due to The fertilityrate is determinedby births inrelation to The population. female the of structure age and size the a children of number total the is (TFR) rate fertility total woman is expected to have in her lifetime and iscom puted as the sum of age-specificfertility rates divided compared decrease a 2019, in 2.3 was TFR The 1000. by replacement average the above still is this (2.4) 2018 to offertility 2.05 births perwoman er, in the er, last fiveyearsreported cases ofSTI has been consistently much higher. The high number of annual 25-29 - 8 6 8 2 5 2 0 90 57 96 63 87 45 11 363 335 342 189 133 Total 85 20-24 9 3 1 2 4 2 0 6 64 27 16 56 96 20 82 40 19 55 199 165 15-19 Female 0 0 0 0 0 0 0 6 3 3 34 37 56 66 78 57 10-14 164 239 177 107 Male Institute for Health Metrics and Evaluation (IHME). Findings from the Global Burden of Disease Study 2017. Seattle, WA: IHME, 2018 WA: IHME, of Disease Study 2017. Seattle, from the Global Burden (IHME). Findings Evaluation and Metrics for Health Institute Plan 2016-2020 Health Strategic National of Health, Seychelles Ministry TOTAL Septic abortion Septic Molar pregnancy Anembryonic gestation Anembryonic abortion Inevitable Missed abortion pregnancy Ectopic TOP abortion Complete Incomplete abortion Incomplete TYPE Fractures Acute lower respiratory respiratory lower Acute infections tract diseases Pneumonia Pulmonary Embolism Cerebrovascular Diabetes Mellitus Diabetes Hypertension Neoplasms Leptospirosis Leptospirosis Dengue

22 23 TABLE 3.10. ABORTIONS BY AGE GROUP, 2019 GROUP, AGE BY 3.10. ABORTIONS TABLE The NHSP end-term target for STIs is 250 cases; howev cases; 250 is STIs for target end-term NHSP The these cases were not captured by the Statistics Unit. The CDCU 662 reported (284 Males, 378 Females) new cases of STIs in 2019, compared to 891 cases in 2018. Cases of STI are reported only by the CDCU. It is believed believed is It CDCU. the by only reported are STI of Cases primary in managed also are STI with people some that health care and private health facilities, but currently, Sexually Transmitted Infections (STI) Infections Transmitted Sexually and reported by the DSRU. by and reported OF ADMISSIONS CAUSES 3.9. COMMON TABLE Data Data on notifiable diseases and outbreaks is collected 18 Annual Health Sector Performance Report 2019 March 2020. 26 development goals. Geneva: World HealthOrganization; 2019 25 Paris. https://doi.org/10.1787/4dd50c09-en. 24 age inyoung groups. years three last the in migration net in Statistics of Bureau tional has been modifiedage (excluding groups out-migration) by the Na the given in girls of population the cause be is this 80/1000, above were reports health annual countries neighbouring countries OECD in rate the than higher 15-19 much is this (Fig.3.18), aged2019 in girls 69/1000 yearswas girls for (ABR) rate birth adolescent The 2014-2019 TABLE 3.11.REGISTERED LIVEBIRTHS TO TEENAGE GIRLS, yrs. 15-19 yrs. 10-14 Statistical Bulletin .Population and Vital Statistics December 2019. NBS, December Statistics and Vital .Population Bulletin Statistical sustainable SDGs, the for health monitoring statistics 2019: Worldhealth OECDIndicators,2019: Glance a atOECDPublishing, Health OECD(2019), 2014 183 5 2015 187 5 25 . The ABR reported in previous 2016 26 206 3 which recorded a decrease a recorded which 2017 201 3 2018 212 24 5 and some and 2019 228 9 - - FIGURE 3.18.TOTAL FERTILITY RATE TEENAGE, 1998-2019 Source: NBS RISK FACTORS FOR 4 HEALTH

Physical activity, school children. 20 Annual Health Sector Performance Report 2019 Report.pdf 2015.http://www.who.int/chp/steps/Seychelles_2013_STEPS_ : Seychelles findings. main and methods IV): Study Heart (Seychelles 2013-2014 chelles 29 al Burden ofDiseaseStudy 2017.Seattle, WA: IHME,2018. 28 27 boys in2018(Fig.4.1). 1998 and 2018 and reached 32.2% in girls and 25.0% in dren aged 9-16 years increased monotonically between chil in obesity and overweight of prevalence the that shows Programme Health School from available Data adult population aged 25-64showed the following: veys sur NCD national four The surveys. periodic through assessed are factors risk NCD level, population the At important social andeconomic impact. take.resultNCDs largea in burden has and disability of in alcohol excess and diet, activity,physical unhealthy insufficient behaviours: smoking, risk modifiable major four with associated largely themselves are which tes diabe and lipids blood elevated pressure, blood high four overweight, to namely factors attributable risk largely main “physiological” is NCDs of burden The high bloodsugar. and pressure blood high smoking, were disability and Globally, in 2017, the leading risk factors for early death likelihood ofdeveloping adiseaseorinjury’. the increases that individual an of exposure or teristic es. WHO defines a risk factor as ‘…any attribute charac diseas non-communicable and communicable both of Several behavioural risk factors increase disease burden Ministry of Health. National Survey of Non-Communicable Diseases in Sey Institute for Health Metrics and Evaluation (IHME). Findings from the Glob RiskFactors. https://www.who.int/topics/risk_factors/en/ - - - 29 and highbloodcholesterol; and FCTC measures); (due to thestrict implementation oftheWHO marked upward trends for diabetes andobesity. slightly downward trends for highbloodpressure a marked 25-year downward trend for smoking conducted in 1989, 1994, 2004, and 2013 for the 4.1 NCDRISKFACTORS 28 27 ------ment in Seychelles. Thisincludemeasures to: environobesogenic the of causes societal the address health measures both in schools and in other sectors to public strong programmes, education health to dition ad in implement, to need the emphasizes weight cess ex of prevalence increasing persistently and high The 2019. 1996 and2018.PHA, between obesity pro and overweight screening of prevalence the School of update P. gramme: Bovet B, Viswanathan G, Mangroo Source: IN STUDENTS, 1998-2018 FIGURE 4.1.PREVALENCE OFOVERWEIGHT ANDOBESITY

------Ensure that healthy meals(withplenty of healthy behaviours andnutrition. to perform screening andrelated counselling on ensuring that schoolnurses have sufficient time Strengthen theSchoolScreening Program by water; and water, asamain,safe andinexpensive source of media to promote water includingtap drinking, Conduct awareness programmes onthemass that bottled water is affordable; Implement fiscal andother measures to ensure youth; junk foods andsugar beverages seenby the Ban orlimitadvertisement andpromotion of curriculum; activity per week aspartoftheschool Ensure that allchildren have 3hours ofphysical promote theiruse; schools, sportpremises andpublicsettings, and Ensure that water fountains are present inall vegetables) are available in allschoolcanteens; - - - - Annual Health Sector Performance Report 2019 21 ------complies with the measures 33

It includes several measures such as: a 34 of cigarettes. The total excise is currently 60% and 60% currently is excise total The cigarettes. of From January 2019, a 10% increase on excise tax tax on excise January 2019, a 10% increase From This implemented. was products on all tobacco price 70% of the retail over to tax brings the total A Regulation on food content labelling for labelling content food on A Regulation was tax sugar of implementation effective in 2019 Gazette in the Official published to on the SSB sessions sensitization Several on item news including; stakeholders various continuous and tax Radio on SSB TV and National depicting posters of A2 size dissemination of sugar and dangers intake of water importance and public places. workplaces schools, to intake grams of sugar per 100 ml came into force on 1st 1st on force into ml came per 100 sugar of grams 2019 April • • • Seychelles Tobacco Control Act, 2009. https://seylii.org/sc/legislation/ World Health Organization. Framework Convention on Tobacco Control. 33 act/2009/14 34 WHO; 2005. Geneva: bill 2019 was developed and approved by the National December 2019. on 23rd Assembly and gazetted Control Tobacco Control The Act Tobacco Control Tobacco on Convention Framework WHO the of (WHOFCTC). total ban on smoking in selected public places and in manda all places enclosed and work public transports; displayed be to matters and other health warnings tory on packets;cigarette atotal ban on direct and indirect tobacco advertising, promotion and sponsorship; to a tal ban of sales of tobacco products to and by minors; and the setting up of Tobacco a multisectoral National Control Board (the executive secretary is the manager other measures. of UPCCD); and several In 2019, Tobaccothe Control BoardNational discussed the implementation of severalregulations and the de This includes: regulations. of new velopment and sale advertising of alcohol Regulation In order to tackle the growing alcohol advertisement, the National NCD Committee memorandum with recommendations since 2017. This submitted cabinet a included bans on alcohol advertising in all national ra dio/TV in programmes, all national newspapers includ ing the government and private newspapers, posters and billboards in all public events when a portion large of pro participants likely is under-age to be community Kreol,fairs, FestivalRegatta, sports events, (e.g. etc.). A high-level committee chairedby the President was set up in 2019 with members including the Public Health Commissioner (also chair of the NCD drinks alcoholic An commit stakeholders. other and APDAR tee),

- - - - - 32 . The strategy 30 adopts the nine national 31 ogies and essential medicines, including ogies and essential 4.2 PREVENTION OF NCDS OF PREVENTION 4.2 cal inactivity cal apy and counselling to prevent heart attack heart attack prevent to and counselling apy A sugar tax of SCR 4 per litre on all sugar- of SCR 4 per litre tax A sugar sweetened beverages (SSB) with more than five than five (SSB) with more beverages sweetened public and private facilities. public and private At least 80% availability of the affordable 80% availability least At and stroke and stroke NCDs on both major treat to required generics, 0% increase in obesity and diabetes 0% increase drug 50% of eligible people receiving least At 30% reduction in mean population salt intake intake salt in mean population 30% reduction use tobacco of in the prevalence 30% reduction of high blood in the prevalence 25% reduction 10% reduction in prevalence of insufficient in prevalence 10% reduction 10% reduction in alcohol use in alcohol 10% reduction physi pressure 25% reduction of NCDs 25% reduction • 9. 7. 8. 4. 5. 6. 3. 2. 1. Ministry of Health. Seychelles Strategy for the Prevention and Control of Global strategy for the prevention andcontrol of noncommunicable dis Ministry of Health. Seychelles Strategy for the Prevention and Control of eases. Resolution (WHA 53.14) was adopted by the World Health Assembly. World Health Assembly. eases. (WHAbywasResolution 53.14) the adopted https://www.who.int/nmh/publications/wha_resolution53_14/en/ non-communicable diseases 2016-2025. diseases non-communicable 31 2016-2025. diseases non-communicable 32 30

measures were implemented in 2019: implemented were measures tax Sugar prevention of NCDs involving principal secretaries and guide to 2016 November in MOH the by up set was CEO the The following ofimplementation the NCDstrategy. A high-level national multisectoral committee for the technol ther

voluntary targets agreed by the WHO member states: by agreed targets voluntary use of alcohol. The National NCD Strategy es, cancer, chronic respiratory diseases and tobac – factors risk diabetes behavioural common four their and co use, unhealthy diet, physical inactivity and harmful the National NCDStrategy 2016-2025 is in line with the WHO recommendations andfocuses mainly on the four main NCDs – cardiovascular diseas education,programs and policy formulation. In 2019, UPCCD led the implementation ofkey interventions of Diseases (UPCCD) provides leadership, expertise and capacity at the national levelfor the surveillance, pre vention andcontrol of CVD/NCD through surveillance, Within the MOH, several units NCDs. and prevent healthier lifestyles implement to promote tions interven The Unit for Prevention and Controlof Cardiovascular ‘Promotingand protecting health’ is onestrategic investment priorities the five of identified in NHSP. the 22 Annual Health Sector Performance Report 2019 primary school children to basic information on tobac on information basic to children school primary all exposingat aimed is project The 2018. since project campaign lifestyles healthy a of implementation the in Resilience andEducation (CARE) collaboratedUPCCD forCampaign the with Awareness, Partnership withkey stakeholders released in2020. be will report the and participated media the and sale of point offices, private and governmental selected ly Seychelles for a period of two months and 829 random in conducted was WHO the by developedsurvey, The Legislation. Control Tobacco Seychelles the of part as Tobaccoin ban sponsorship PromotionAdvertising and the and transports public and places public indoor in survey monitors the complianceof the ban onsmoking on tobacco advertising promotion and sponsorship. The ban smoke the implementation the and free law the of assess to survey compliance a on countries other five with along project pilot WHO a in part took Seychelles • • • in to force on1st April2020. Seychelles ratification tothe protocol will come deposited to UN.Asconfirmed by UN, the the President, andrelated documents were the protocol on29thOctober 2019,assented by National Assemblyapproved the ratification of by theTobacco Control Board in2018.The European Unionand11from theAfrican Region. countries have ratified the protocol, includingthe and enablinginternational cooperation. So far, 50 of aninternational tracking andtracing system tobacco products, includingtheestablishment illicit trade by securingthesupplychainof products. Itprovides legal tools for preventing eliminate allforms ofillicittrade intobacco to ratify theprotocol. Theprotocol aims to Following theadoption, parties were requested parties to theConvention including Seychelles. illicit trade oftobacco products was adopted by fine for anyone who fails to comply. sale ofcigars. Theregulation alsoincludesaspot cigarettes. The regulations shallnotapply forthe than 10sticks andabanonthesaleofindividual mandatory sale of cigarettes by packets of not less from 1st ofJuly2019.Theregulation includes gazette on20thMay 2019andimplemented as Individual Cigarette was drafted bytheBoard and Control Act,aregulation onSaleof Packages and than 65%oftheexcise tax ontobacco products. WHO isrecommending countries to adopt more The Cabinet approved amemorandum submitted As partoftheWHOFCTC, aprotocol to eliminate (g) ofthe and As persection27(f) Tobacco - - and those with high risks such as those with diabetes, with those as such risks high with those and adults and children obese women, pregnant including groups various targeting services inpatient and tient outpa provides also Unit The formulation. policy and programmes education, through diseases related tion of the promotion for healthy lifestyles in order to reduce the burden level of nutri national the at expertise and leadership provides and cycle life the across being well nutritional promotes Programme Nutrition The Nutrition Programme students participated intheproject, whichincluded: two primary schools (Port Glaud and Grand Anse Mahe) 2019, During lifetips. co,as wellskills substance as use During 2019, an impact assessment of the Cancer Pro Cancer the of assessment impact an 2019, During vides regular update to theministry andpolicymakers. pro and basis regular a on cases cancer all register to order in 2008, in up set apopula was registry, which tion-based is Registry Cancer National Seychelles The Seychelles. in mortality and incidence cancer reduce order to in ofcancer and treatment prevention tion, detec early promotesProgramme Control Cancer The Cancer Control set up. was policy nutrition national the of development the same will be finalized in 2020. A steering committee for imple the mentation of the Nutrient Profile Model support (NPM) and the to children to beverages coholic ported by WHOtoadvertisingban of non-al and foods programmeThe formulationthe led policy,also of sup Eau andEnglishRiver primary secondary schools. Bel of students among conducted was children aged school- by eaten food of types and patterns eating ing identify of aim the with Study Pilot Nutrition School A 2019(115) compared to 2015(59). in doubled almost clinic nutrition the ing children attend obese of number total the addition, In therapy. nutritional receiving inpatients of number the and session nutrition prenatal attending women nant preg of number the in increase an was there 2019, In hypertension etc. • • • • promoting healthy lifestyles at home schoolchildrenprimary ontheimportance of A half-day sessionorganized for parents ofthe book onsugar-sweetened beverages Dissemination ofIEC materials includingaguide to healthy lifestyles including healthy eating habits order to equip them with various life skills related A half-day training for teachers ofbothschoolsin UPCCD andCAREmembers attended by 714 physical activity conducted by boththe staff of Activities on heart health, substance use, diet and ------Annual Health Sector Performance Report 2019 23 - - - of health promotion interventions in the countryand following a consensus building workshop developed a promotion. policy on health draft A Workplace Wellbeing launched in Programme 2018 under (WWP) the movement aimed Health at building was Of in-organisation capacity Our Nation for workplace health promotion and disease preven tion. WWPfocuses on building knowledge on relevant aspects of health promotion and disease prevention, infrastruc relevant setting-up in organisations assisting for NCDs. health and Five promotion for screening ture training workshops have been held since September 2018, and 112 participants from 15organisa different tions trained. In 2019, the WWPwas launched in the MOH. The programme is evolving, still and new, based are platforms delivery service and content feedback, on regularly; there reviewed are plans in future to include and screening. prevention on cancer content more Additionally, in 2019, Healththe Promotion partnership with WHO Unit, in conducted a situation analysis ------MOH Facebook page (103 postings) page MOH Facebook Radio Programmes (50 presentations on K- Radio, K- Radio, on presentations (50 Radio Programmes (53 postings) MOH Webpage TV Programmes ( 52 presentations on Bonzour ( 52 presentations TV Programmes Sesel and 13 on Alo Dokter) 30 on SBC AM Radio) - - - -

stance stance abuse. In 2019, the Health Promotion Unit pro media following the and materials IEC numerous duced programmes: the Health Promotion Unit. They are typically targeted at priority diseases and risk factors for health, namely, NCDs, sexual reproductive health, HIV/AIDS, and sub sibilities of healthprofessionals across all programmes within health, as well as other sectors. Health promo tion activities are coordinated at the national level by Health Promotion Health Promotion Health promotion activities Seychellesin tralised, and are decen are carried out as part of routinerespon and work has started to develop a con cancerdevelop to national and has work started strategy. trol gramme was conducted in Seychelles by the WH0-IAEA WH0-IAEA the by in Seychelles conducted was gramme 5 HEALTH SYSTEM

Pharmaceutical Analyst, National Drug Quality Control Laboratory. Annual Health Sector Performance Report 2019 25

- - 37 . 100% 100% 7.59% 6.13% 0.39% 37.80% 27.40% 30.92% 85.90% 39 % of total. % of total. 2019 2019 Budget 978,150 Budget 1,349,330 1,103,922 3,570,020 3,957,522 77,613,576 62,674,403 878,858,596 1,023,104,097 100% 35.31% 30.07% 34.62% 100% 8.35% 6.52% 0.61% 84.52% % of total. % of total. , while globally, in , while 2016, the globally, mean proportion of 2018 38 2018 a percentage of nominal Gross Domestic Product (GDP) Product Domestic Gross nominal of percentage a 3.8% from in increased 2013 6% to in 2019; the NHSP Seychelles health. spent GDP of 4% > is target end-term is spending less on health than OECD countries which spent an average of 8.8% of GDP 2018 on health care in total government expenditure from domestic sources 10.6% (< 2% - > 20%) health was to devoted Budget allocation to the health grow sector every continues year. to In 2019, 12% budget of was allocated to the total health and sector, for the government first time in the history ofSeychelles, thehealth bud get was above one billion Seychelles rupees (SCR) or $746.79 per capita. There was 12% increase (SCR 110, 854,607) in the 2018. to 2019 health compared budget Most of the health budget was to allocated HCA (Table 5.1). While MOH secretariat and PHA also saw a slight increase in their budget, the 2019 budget for NAC de 29%. by creased and services are provided free of charge at the point of the point at of charge free and provided services are as expenditure health Total sector. public the in delivery Budget - - - - 969,300 1,138,050 1,115,696 3,223,046 Budget 5,575,000 76,157,520 59,496,390 771,020,580 912,249,490 Health 35 MOH Budget Breakdown, 2017-2019 Breakdown, MOH Budget 100% 37.91% 25.99% 36.10% 100% % of total. 4.70% 0.40% 5.47% 89.43% health-financing, % of total. 36 National Health Councils Budget Breakdown, 2017-2019 Breakdown, Health Councils Budget National 2017 2017 Budget 751,800 1,096,680 1,044,149 2,892,629 Budget 3,562,840 49,012,050 42,071,000 800,934,410 895,580,300 5.1 FINANCING FOR HEALTH 5.1 FINANCING FOR responding to people’s expectations; and expectations; people’s to responding costs the against protection financial providing of ill-health improving the health of the population they serve; serve; they population the of health the improving • • • Ministry of Health. Seychelles National Health Strategic Plan 2016-2020. Health Strategic National of Health. Seychelles Ministry https://doi.org/10.1787/4dd50c09-en. Publishing, OECD Paris. Indicators, a Glance 2019: OECD (2019), Health at OECD 2018. Organization; World Health goals. Geneva: development for the SDGs, sustainable health 2019: monitoring health statistics World WHO. Health System Strengthening Glossary.https://www.who.int/healthsystems/hss_glossary/en/index5.html Strengthening Health System WHO. Health World (WHO).Organization Monitoring the building blocks of healthsystems: a handbook of and indicators their measurement HPC Total SNMC SMDC Health Councils NAC Total HCA PHA MOH 38 39 35 36 2010. WHO, Switzerland: Geneva, strategies. 37 TABLE 5.2. NATIONAL HEALTH COUNCILS BUDGET BREAKDOWN, 2017-2019 BUDGET BREAKDOWN, COUNCILS HEALTH 5.2. NATIONAL TABLE The government The also government funds the three health professional councils to support implementation and monitoring of with years previous the two to compared increased councils professional in to 2019, work; the budget regulatory 5.2). the SNMC (Table to going share the largest The government invests considerable inputs in health 2017-2019 5.1. MOH BUDGET BREAKDOWN, TABLE to to essential medicines, financing, and leadership/gov 2). in chapter ernance (addressed mance of the health system is done according to the WHO building blocks framework: access system, information service workforce, delivery, are are being achieved and the extent to which progress can be toattributed the alonehealth system or to oth er factors. For this report, assessment of the perfor While the main goals of a are clearly health de system fined, it is more difficult to assesswhether these goals

whose whose primary purpose is to improve health. objectives: fundamental three thus, have systems Health Health systems consist of all the people and actions 26 Annual Health Sector Performance Report 2019 40 TABLE 5.4.ACTIVE DOCTOR STOCK, 2019 lined in the NHSP is partnership and coordination with out priorities investment strategic seven the of One tively. respec 23.2% and 23.8% 25.3%, was 2018, and 2017 sharecurrentof expenditurehealth for yearsthe 2016, a as expenditure health Non-governmental increasing. also is health on spending pocket of out that evidence is there and rapidly expanding is sector health private the that shown has years three last the over NHA The Source: NHA Report 2018. TURE BY DISEASE CLASSIFICATION, 2016-2018 FIGURE 5.1.DISTRIBUTION OFTOTAL HEALTH EXPENDI prevention. not known how is much is spent on it health however,promotion and 5.1); (Fig. deaths of causes leading the burden aretwoconditions wheredisease these chelles Sey reflection of actual an is This diovascular diseases. car and neoplasms towards distribution higher with expendituretowardsgoeshealth NCDs of majority The dard WHOtools. years with capacity building of staff and the use of the stan over improved has exercise NHA The penditures. ex health private and public total measuring for work undertaking of the MOH since 2009, providing a frame major a been has (NHA) Account Health National The formance indicators. per key to linked allocations with programmes, PPBB specific to according allocated is budget sector health andthe in 2018 (PPBB) Budgeting Based Programme The Seychelles Government moved to full Performance Total Public Private Donor Ministry ofHealth,Seychelles National HealthStrategic Plan2016-2020. Practising 223 183 40 Professionally active ------14 14 0 metabolism. errorsforinborn projectscreenbabies toforof a 1.3M was donor donatedSCR Resortswho Hotel and Constance Ephelia local biggest The 521,825). (SCR 2018 to considerable increase a compared 2.4M, SCR dona was tions local total of value the 2019, in MOH to funds Several local companies donated a variety of goods and projects. programme2018-2019 the der activity of number a for since assistanceSeychellesreceivedun WHO 2019, in 1980; health in partner important an been has WHO TABLE 5.3.DONATIONS, 2019 2019 (Table 5.3). in donations several received and partners ternational collaboratesgoals,MOH in localand of number a with NHSP the Toachieve beyond. and sector health the in six strategic investment priorities in the NHSP. the in priorities investment strategic six the of one as identified is health for resources Human in thepublicsector. employed all are categories two latter The (Table5.4). training postgraduate on are (6.3%) 16 and care; tient pa in involved directly not are they i.e. active, aresionally profes 14 (5.5%) doctors; practising are (88.1%) 223 doctors: active 253 revealed count Head doctors. practising resident 40 and specialists werevisiting nine registered health facilities reported private 49 doctors, while of doctors, which 213 employs sector public The and equitably distributed healthworkforce. motivated highly-competent, adequate, with staffed is sector health the that ensure to place in mechanisms hasinstitutional MOH the that to ensure is objective Local WHO Donor 5.2.1 WORKFORCE DENSITY 5.2 HEALTH WORKFORCE On post- graduate Training 16 16 0 SCR. 2,488,387.19(US$178,571) SCR. USD 542,680 Amount Total 253 213 40 40 The - - - - - Annual Health Sector Performance Report 2019 27 - - - 2 0 5 6 0 19 21 12 23 17 17 1 5 0 3 0 2019 0 0 0 0 0 0 0 10 14 24 24 6 0 0 1 3 11 2018 0 0 0 0 0 8 0 0 0 19 0 0 8 14 11 2017 5.2.2 HEALTH WORKFORCE PRODUCTION WORKFORCE HEALTH 5.2.2 Programme of service Programme Therapy Bachelor of Dental Natal with KwaZulu (In partnership South Africa) University, Bachelor of Science in Nursing with Chamberlain (In partnership USA) University, International Paediatric Post Graduate Graduate Post Paediatric International Certificate Children’s with Sydney (In partnership Australia) Network, Hospital Master of Science in Nursing Master with Chamberlain (In partnership USA) University, Advanced Diploma in Midwifery Advanced Diploma in Nursing Diploma in Nursing Sciences Diploma in Biomedical Diploma in Pharmaceutical Sciences Diploma in Pharmaceutical Care Medical Diploma in Emergency Diploma in Dental Hygiene Hygiene Diploma in Dental Diploma in Physiotherapy Diploma in Physiotherapy Diploma in Social Work Diploma in Environmental Health Diploma in Environmental Sciences Oral Health in Certificate Advanced Care Certificate in Health Care in Health Care Certificate Certificate in Health Care in Health Care Certificate The NationalInstitute of Health and Social Science (NI HSS) is an independent entity within the MOH, which provides pre and in-service training. The led institute by is a director and has an executive provides board, which oversight. NIHSS is fully Seychelles accredited Qualifications Authority and by it offers the quali ty training and education in health and social studies at tertiary level. In 2019, therewas an increase in the number of graduates for both pre and in-service train ing for some courses, for however, diploma in nursing 5.6) (Table graduated only five 2017-2019 GRADUATES, 5.6. NIHSS TABLE Source: NIHSS Source: ------Our 41 53 61 187 Community

43 60 303 144 Hospital Note that statistics formost countries include 42 World health World 2019:statistics monitoring health for the SDGs, sustainable National Bureau of StatisticsStatistical Bulletin, Catalogue Number: Pop on (Accessed 10.1787/4355e1ec-en doi: (indicator). Doctors (2020), OECD Midwives Doctors Cadre Nurses 43 2019. Health Organization; World Geneva: goals. development 41 2019/2 ulation 42 30 January 2020) TABLE 5.5. DISTRIBUTION OF PRACTISING DOCTORS AND DOCTORS OF PRACTISING 5.5. DISTRIBUTION TABLE MOH, 2019 NURSES Among health care professionals in the public sector, there is a ofconcentration doctors and nursesworking care. health primary to compared 5.5) (Table hospital in There are 951 nursing professionals currently registered registered currently professionals nursing 951 are There in the country, of which, 640 are currently practising. ployed ployed in the public The sector. dental field, with 114 employees makes up the largest group of allied health professionals. There There are more than 700 registered allied health pro fessionals in the country and 78% of them are em fewer than fewer 10 medical doctors per 10 000 people, and the average global density of medical doctors in 2017 15 per 10 000 people. was The doctor density in Seychelles is well above global figures; according WHO,to 40% of countries all have

FIGURE 5.2. DOCTOR DENSITY (PER/ 1000 POPULATION), DENSITY (PER/ 1000 POPULATION), FIGURE 5.2. DOCTOR 2019 working working in the health sector as managers, educators, etc. researchers, (Canada, France, the Netherlands, Slovakia and Turkey), Turkey), and Slovakia Netherlands, the France, (Canada, correspond figures the data, comparable of lack to due ing to “professionally active” doctors, includes doctors compared to selected countries according to OECD sta OECD to according countries selected to compared tistics. only practising doctors. However, for some countries doctors and 65% of dentists). and 65% of dentists). doctors Fig. 5.2 shows Seychelles ranking for physician density based on the 2019 mid-year population of 97 625. 97 of population mid-year 2019 the on based den and doctors foreign on dependent is system health tists, with about two thirds of theworkforce (66% of The active Doctor Densityis 2.59 per 1000 population 28 Annual Health Sector Performance Report 2019 FIGURE 5.3.SEYCHELLES HOSPITAL ANDANNEXES were profiles/description job new and analysed were job description existing evaluation, the During tions. well as ensuring alignment of their structures and func as other each to relationship their determine and HCA ercisereviewedevaluated in technicaland positions all evaluation exercise for all the cadres ofjob services. Thea ex conducted WHO of in support the workers,with HCA health 2019, of capacity build to and strength workforce health the understand better to effort an In both doctors andnurses have beenrevised. for service of schemes the years, three last the in als; ular revision of scheme of service for health profession Councils and professional associations advocate for reg edition was data qualityanduse. 2019 the for theme the symposiums; annual organize professionals health allied The cadres. professional all for organized is development professional Continuous on postgraduate training. currently are dentists and doctors Eighteen Australasia. and America Latin Asia, Europe, in countries 12 in institutions training nine at training undergraduatein students 56 were there 2019, in and countries, of number a overseasin trainedareDoctors 5.2.3 HEALTH WORKFORCE REMUNERATION AND RETENTION - - - - minutes of a health facility, additionally; services are services additionally; facility, health a of to30 minutes 15 within living population the of majority the with good very is services to Access 5.3). (Fig. Hospital health care facilities and one main hospital – Seychelles primary 17 of network a is There care. tertiary and ary second primary, comprehensive provides MOH The Access Health Care Conference heldin2019. delivery was also a key recommendation of the Primary with their expectations. Improving all aspects of service line in well-being holistic for care quality receive ents cli ensuring services integrated provide to is aim the Improving service delivery is a key priority for the MOH; source production. re human strengthen to mechanisms for need urgent an showed also capacity HR of Assessment structure. pay gradeand a exercisedesigned The developed.also free at thepoint ofdelivery. 5.3.1 ACCESS TO ANDUTILISATION OFSER 5.3 SERVICE DELIVERY VICES - - - - Annual Health Sector Performance Report 2019 29 - - 44 Total 46,750 73,552 302,216 422,518 16.56 72.29 48.33 65.17 45.29 44.42 52.92 26.80 66.69 10.30 Throughput* N/A 23,757 57,683 81,440 working Hrs. working After normal After 5.66 5.31 5.07 2.50 3.64 4.24 6.17 7.15 19.14 13.95 22,993 73,552 244,533 341,078 of stay (days) of stay working Hrs. working Average length Average During normal Casualty PHC SOPD Total Grand admissions to giving acute wards a bed occupancy rate 5.8). of 67% (Table seven seven consultations per person peryear, utilisation of services appear less in the Seychelles, Statis however, facilities only. public from data reports tics Unit Data capture in the MOH is still mostlyand only paper-based aggregate data is submittedto the Statistics Unit. There is often no information on thesex andage does Unit Statistics MOH services.The using persons of not capture the number of doctor consultations in the sector. private IN PUB CONSULTATION DOCTOR 5.7. OUTPATIENT TABLE 2019 LIC FACILITIES, Seychelles Hospital provides acute care and also long- term and palliativecare. In 2019, therewere 11, 339 the NHSP end-term target of <5/capita. Compared to OECD countries where there is an average of almost 87% 75% 66% 62% 50% 53% 66% 39% 76% 89% Rate Rate ------Bed Occupancy 6 18 43 14 41 26 10 30 26 30 # of beds OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en Publishing, OECD Paris, Indicators, a Glance 2019: OECD (2019), Health at OECD I.C.U. Psychiatric Female Surgical Surgical Female Gynaecology Maternity Male Surgical N.I.C.U. Female medical Female Paediatric Ward Male Medical *Cases per bed per month *Cases 44 TABLE 5.8. BED OCCUPANCY SEYCHELLES HOSPITAL, 2019 HOSPITAL, SEYCHELLES 5.8. BED OCCUPANCY TABLE imately imately four doctor consultation/per capita, meeting tient consultations are done in regional PHC facilities. regional PHC are done in consultations tient During 2019, more than 400,000 doctor consultations were recorded by the MOH (Table 5.7) giving approx disabled patients at home. Traditionally, specialist out specialist Traditionally, at home. disabled patients patient serviceswere providedat Seychelles Hospital, outpa specialty some years, three last the for however, Utilisation of servicesUtilisation facil PHC in provided is consultation doctor Outpatient for some elderly and and departments ities, outpatient ral from PHC and waiting time for elective surgery. for elective time PHC and waiting from ral At the moment, MOH is not measuring some important important some measuring not is MOH moment, the At to access understand to further help can that indicators refer after a specialist to see time waiting services like new modules to assess health facilities further; this will this further; facilities health assess to modules new include a module on and quality a mod second of care and finance. ule on management A service readiness assessment was done in 2017 and a assessment repeat is planned 2020. for The new har monized health facility assessment will include two to to review the objective,components andreach of PHC programmes. rative andrehabilitative services. Fifteen programmes con national a following level; PHC the at services offer ference on PHC in July 2019, a task force was set up MOH offers a comprehensive package of preventive, cu preventive, of package comprehensive a offers MOH 30 Annual Health Sector Performance Report 2019 as partofpost-natal care. disorders metabolic inborn for screening and services clinic eye the of part as surgery eye posterior cluded in This HCA. deliveredby services of lists the to added were that services specialist new were there 2019, In CLINICS, 2019 FIGURE 5.5.ATTENDANCE TO SPECIALIST OUTPATIENT were newly referred patients (Fig.5.5). consultations all of 37% only and reported, were tions after discharge from hospital. In 2019, 73,552 consulta their PHC provider, private clinics or as part of through follow up services to these referred are patients basis; outpatient an on services offer specialists of number A FIGURE 5.4.NUMBEROFSURGERIES BY SPECIALTY, 2019 stetrics/gynaecology (Fig.5.4). ob and surgery general in majority the with 2019, in totalsurgicalHospital.A 4242 of operations were done operating room and two procedural rooms in Seychelles There are three main operating theatres, one maternity Ward. Surgical Female to admitted were patients some 2019, in Medical Ward stay.Female the renovation of During averagelongestof Psychiatric lengththe Wardthe had like in previous years was on Male Medical Ward, while occupancy bed highest The 2019. in renovation under was mostly in admissions to medical wards, which were 2019, a 10% decrease compared to 2018. The decrease There were 11,338 admissions to Seychelles Hospital in 5.3.2 SPECIALIST OUTPATIENT SERVICES - - - TABLE 5.9.OVERSEAS TREATMENT, 2017-2019 derwent corrective surgical procedures. congenitalmalformationsgery, un infantswith 12 and sur cardiac had patients of 12% treatment, overseas requiring (44%) disease common most the was Cancer cent of the 2019 cohort were aged 65 years and above. (TableTwenty-one2017 5.9). tocompared per 18% of decrease a once); than more travelled patients (some overseas treatment for travelled (165 children) patients 209 adults/44 2019, In locally. available not that are interventions diagnostic and treatment cialized proval of a medical board for ap patients who require spe the with treatment, overseas provides MOH The Overseas Treatment women withbreast cancer. patients chemotherapy,started new were 236 majority the consultations; 4918 reported Unit Oncology the cialized 2019, patients. In cancer outpatientto services spe provide nurses and doctors of team dedicated A Oncology Unit Source: AMSA. LTFU-Lost to follow -up. FIGURE 5.6,PATIENTS ONHAEMODIALYSIS, 2013-2019 only. five was dialysis chronic on patients of number the in increasehowever, net (22,624), the 2018 to compared (25,008) reportedwere sessions dialysis more 2019, In ysis (Fig.5.6)mostly because oflossvascular access. dial discontinue to decided 11 and died 19 dialysis, ed patients 177 were of newpatientschronic35 on 2019; dialysisin start total A Praslin. and Mahe on use, of MOH provides haemodialysis services, free at the point Haemodialysis Services Number ofpatients Cost (SCR)M 2017 43.9 255 2018 40.9 211 2019 42.8 209 ------Annual Health Sector Performance Report 2019 31 ------322 262 641 439 Total 1075 4799 26 49 RC 232 164 148 2070 Female 3 8 2 47 13 35 NP of health and care activities to support continued continued support to activities care and health of home. living at Aiders. as First registered Aid and were 129 home carers were trained in several aspects in several trained were 129 home carers Aid in basic First trained were 56 home carers First in training refresher followed carers home 45 • • • to to allow them to remain in their home and community settings. MOH provides inpatientcare in two main institutions 5.12); (Table Hospice provides end- of- life care mostly to cancer patients, whereas NorthEast Point Hospital care. rehabilitative in need of admits patients extended extended period on assistance with Activities of Daily Living. Full-time and part-time careproviders alongside com munity health nurses, Occupational Physiotherapists deliver therapists the programme. and The profes sional home health services provided include wound care, pain management, medication and disease edu cation and management, physical, speech and occupa tional therapies. MOH supported capacity building of home care 2019: pro in services, the ‘professionalise’ to order in viders programmes Training are ongoing and will continueto equip all home carers with the necessary skills to sup port elderly persons and those living with disabilities RC - - - 773 109 225 461 375 2661 17 Male Total 2700 2691 Consultations 8 24 13 33 23 36 NP 5.3.3 REHABILITATIVE SERVICES SERVICES REHABILITATIVE 5.3.3 11 2534 Repeat Consultations 6 166 New Referrals 5.3.4 LONG TERM AND PALLIATIVE CARE TERM AND PALLIATIVE 5.3.4 LONG services Audiology Podiatric Acupuncture Autism Disorders Mental Polyneuropathy Disorders Developmental Fractures Diagnosis Accident Vascular Cerebral cognitive and who areconsequently dependentfor an Long-term Long-term care can be received in institutions and at with persons enabling and assisting on focuses It home. a reduced degree of functionalcapacity – physical or Seychelles. doms and The human Home dignity. Care Programme/ System Protection social the of element key a as Service is the largest programme providing long-term care in able older people who experience significant declines in capacity to receive the care and support of others consistent with their basic rights, fundamental free The WHO defines long-termcare assystems that en 2019 atric services and audiology (Table 5.11). services and audiology (Table atric SERVICES, REHABILITATIVE FOR 5.11. ATTENDANCE TABLE Notes: NP- New Patient; RC- Repeat consultations Repeat RC- Patient; New NP- Notes: podi acupuncture, include services rehabilitative Other TABLE 5.10. TOP SIX CAUSES OF ATTENDANCE FOR OCCUPATIONAL THERAPY, 2019 THERAPY, OCCUPATIONAL FOR OF ATTENDANCE SIX CAUSES 5.10. TOP TABLE 64, 000 physiotherapy sessions, mostly for backache, inflammatory joint pain and for rehabilitation following inju following rehabilitation for and pain joint inflammatory backache, for mostly sessions, physiotherapy 000 64, and disorders mental with patients with mostly worked unit therapy occupational the whereas, fractures, and ries 5.10). (Table accidents cerebrovascular The MOH rehabilitationoffers several services at PHClevel and in special institutions, in someinstances, care is audiology; occupational therapy; physiotherapy; atavailable: following domiciliary services The level. are offered orthotic/prosthetic services; and acupuncture. In 2019, thePhysiotherapy Unit reported conductingmore than 32 Annual Health Sector Performance Report 2019 country is still falling short of the NHSP target of 15,000. however,the 2018, to compared 60% of increase an – formed. An extra 307 mammograms were done in 2019 (TableX-rayswith 5.14) per diagnostic test highest the year previous the from increase 10% a 2019, in tests 59,476 performed Centre Diagnostic Radiological The Radiological imaging TABLE 5.13.TESTS DONEINCLINICALLABORATORY, 2019 now donelocally. is test PCR DNA using HIV of ally,infantdiagnosis early addition guidance, testing HIV national new on based 2019 in adopted was test, Blot discon Western of use tinuing HIV diagnosis, of confirmation for algorithm new A 5.13). (Table analysis biochemistry were tests these of 68% 2018; to compared increase 17% a 2019, during tests 838,829 performedlaboratory clinical The Clinical Laboratory TABLE 5.12.BEDOCCUPANCY LONGTERM CAREFACILITIES North East Point Hospital Hospice Total Surgical Pathology Microbiology Blood transfusion Unit Haematology Biochemistry Unit 5.3.5 DIAGNOSTIC SERVICES Number oftests 838,829 159,356 573,246 34,858 61,833 9,536 # ofbeds 28 6 19.00 68.34 1.14 4.16 7.37 100 % Number ofAd missions 175 22 - - - TABLE 5.14.RADIOLOGICAL IMAGING, 2018AND2019 ume I. Washington (DC): National Academies Press; 1990 (https://doi. 1990 Press; Academies ) org/10.17226/1547 National (DC): Washington I. ume 45 provide to areas certain in weaknesses are there that showed results countries, OECD against benchmarking and care of indicatorsforquality selectedfor assessing when However, years. previous to compared services an increase in the patients’ satisfaction with health care needs. tient topa responsive and effective clinically appropriate, safe, are that services as defined is quality care Health easy storage andretrieval ofdata. for allows now upgrade This Centre. Diagnostic Khalifa Sheik the in located facility imaging the for ware hard and Communication Systems (PACs) software as well as Archiving Picture the of upgrade an was there 2019, In Ultrasound X-Ray C.T. Scan MRI Type ofexamination Total Mammogram Special Screening Institute of Medicine. Medicare: A strategy for quality assurance, vol assurance, forquality A strategy Medicare: Medicine. of Institute - bed-nights Occupied 7267 2061 45 5.3.6 QUALITY OFCARE In 2017, a survey found that there was there that found survey a 2017, In Average length 41.5 days 93.7 days of stay 573,246 53,948 12,015 32,555 6834 1759 2018 511 274 Bed occupancy 59,476 12,508 37,167 71% 94% rate 68.34 6792 1930 2019 818 261 - - Annual Health Sector Performance Report 2019 33 ------5.5 HEALTH INFORMATION HEALTH 5.5 Survey population and health risks and health risks population Survey of death and causes births, deaths Count health service data Optimize and performance progress Review policy and action use for Enable data - - - - - tem (eHIS) has been on the agenda of the MOH for over over for MOH the of agenda the on been has (eHIS) tem a decade. In 2019, a contract was signed between the HCA and Manomara Software Companyfor the intro duction of an eHIS andwork is plannedto start soon. Several sessions to sensitize healthworkers on the in troduction andexpectations of newa HIS system were the HCA. by organized An independent assessment of the health data maturity system was done by WHO of based on avail the able data; this was done and capacity to moni systems data country strengthen as part of an including SDGs, health-related the towards exercise progress tor to UHC, and other national and sub-national health prior ities andtargets. The assessment (SCORE) looksat five interventions: different The MOH collects a lot of routine data, butat the mo ment, data capture is mostly paper–based. Data col lation and processing is done mainly by the Statistics Unit, the Diseases Surveillance (DSRU) and and the National Cancer Response Registry. These units Unit are based in entitiesdifferent and agencies and do not system. information part a unified health form The Statistics Unit collects vitalstatistics and a variety of data from community health facilities; Hospital Seychelles (wards, laboratories, department, radiology, pharmacies); one outpatient private clinic and one NGO health In facility. 2019, two statisticiansfrom Ni geria joined the unit pro under cooperation a bilateral gramme. The DSRU reports notifiable diseases from clinical services, all public laboratories and some private clinics. In 2019, DSRU developed new Integrated Disease Sur veillance and Response (IDSR) guidelines to help build the country’s capacity to prevent, detect, and respond public health emergencies. to Transitioning to an electronic health information sys ------52, 519 332, 559 101, 953 487, 031 Number of prescriptions filled Number of prescriptions 5.4 ESSENTIAL MEDICINES 5.4 ESSENTIAL Mechanisms to recognise and reward and recognise Mechanisms to quality in care improvement and practices of workflows Revision Training and continuous professional and continuous Training of health workers development making - based decision Evidence • • • • Hospital Hospital Total Inner Islands Primary Health Care Facilities more than 30 pharmacies. more patient information leaflets for several products. several for leaflets information patient The MOH does not collect data on the number of pre scriptions filled in privatethe sector where there are Among key achievements in 2019, the Pharmaceutical Services developed standards for pharmacy staff and TABLE 5.15. PRESCRIPTIONS FILLED IN MOH FACILITIES, FILLED IN MOH FACILITIES, 5.15. PRESCRIPTIONS TABLE 2019 are exempted. Analysis of from filledprescriptions PHC exempted. are were prescriptions of 81% that shows Mahe on facilities the fee. from exempted scriptions were filled 2019 in (Table 5.15). A nominal prescription fee was introduced in 2019; the elderly, children and patients with chronic medicalconditions 480 medicines (unique molecules) including formula updat regularly is list the children; for tions specifically ed to include new products. More than 400,000 pre The MOH has a National Essential Medicines List with fection control, patient safety and communication. and safety patient control, fection Following the High- Level Dialogue, the Paediatric Ward Ward Paediatric the Dialogue, Level High- the Following started a quality improvement project focusing on in

in November 2019. During his opening Minister address, for the health pointed out several areas quality of care: improve is needed to work more where facilities providing health services donot routinely re Dialogue High-level A indicators. care of quality on port held was institutions post-primary in Care of Quality on quality quality services and standard of care. At the moment, 34 Annual Health Sector Performance Report 2019 chelles Performance Monitoring andEvaluation Policy, 2018. 46 compliance, policy health Assessing e.g. diversetopics on surveys mostly submitted, proposals The approval. before amendments needed four and approved were seven which of 2019 in Committee Ethics and search Re Health the to submitted were proposals research well as a Health Research and Ethics Committee. Eleven as Unit Research dedicated a is there PHA, the Under Research progress beyond the development of a PM&E roadmap. and use. Unfortunately, in 2019, work on PM&E did not availability, data quality to relating weakness and severalgaps identified assessment readiness The system. PM&E results-based a strengthening and/or building for place in wereprerequisites the whether determine to assessment readiness a conducted that committee Policy Evaluation and 2018, in line with the National Performance Monitoring In diseases. and programmes different for conducted is however,monitoring MOH; the in unit PM&E dedi cated no is There government. the by adopted ment manage results-based of pillars four of one is PM&E Performance Monitoring and evaluation (PM& and to inform policy. accountability for data of use and data service health of quality and availability in especially areas five all in weaknesses and gaps are there that showed and 2019 in WHO shared by was 5.7) (Fig. SCORE Seychellesfinal Source: WHO FIGURE 5.7.SEYCHELLES SCORE, 2019 Department of Public Administration Government of Seychelles. Sey of Seychelles. Government Administration Public of Department 46 , MOH set up a PM&E steering PM&E a up set MOH , E) - - - - file report to theWHOAFRO HealthObservatory. Seychelles developed and submitted its first health pro WHO AFRO HealthObservatory in November. toHealth” Ocean “From conference international an held Standards of Bureau Seychelles the and tistics Sta of Bureau National the Department, Environment the and Innovation, Technology Science for National Institute the Seychelles, of University the Authority, Fishing Seychelles the with collaboration in Authority, Health The Public of Standards. Bureau National the among with collaboration in knowledge children, school fish and households on study a conducted team ber of scientific papers through the year. The Seychelles active international an collaboration and published anum remains Study Development Child Seychelles The ers for developmental outcomes. mark biological testing for as such projects science sic health behaviours. Additionally, risky there are also for moreseveral ba behaviours and attitude knowledge, vices to menonceinaweek. ser dedicated offers clinic The Clinic. Pins Aux Anse at launched was men for specifically clinic haviour,new a be health-seeking influence and issues, health several on awareness their increase men, reach to effort an In Men’s Clinic lot sites. pi after of informationreview the key 2020 from in up scaled be will SEY-PEN of implementation that pected ex is It hypertension. and mellitus diabetes of control the of improvement and management; clinical fective of cost-ef up scale detection; early objectives: main the following has and care primary for interventions Disease Non-communicable the Essential of Package from WHO adapted is tool PEN SEY- The Vallon. Beau and Pins Aux Anse namely, Mahe, of island main the November carecentres 29th twoprimary health in on pilots with 2019, on launched was pilot SEY-PEN The SEY-PEN Project 5.6 NEWDEVELOPMENTS

------6 ORAL HEALTH SERVICES

Raising oral health awareness in the community. 36 Annual Health Sector Performance Report 2019 TABLE 6.1.STAFFING INOHSD, 2019 partment onaparttimebasis. De Prison the to services dental provides also OHSD centres. health community the in located are but ities, stand-alonefacilnot are dental clinics community The Oral healthfacilities: HEALTH SERVICES DIVISION FIGURE 6.1.ORGANISATIONAL STRUCTURE OFORAL 6.1). (Fig. Unit Laboratory Dental the by supported Health, Public Dental and Services Dental Specialist Services, Dental Community organisedin is and Director a by ed head is division The population. the to services dental the preventive, providesrestorative within rehabilitative HCA and (OHSD) Division Services Health Oral The Dental laboratory assistants Dental laboratory technicians Dental technologists Dental hygienists Dental therapists Dental surgery technicians Dental specialists Dental officers Cadres . . . .

Roof Buildingat theSeychelles Hospital Montagne Posee Prison One centrally located dental clinicintheYellow 11 school-baseddental clinics 10 community dental clinics 6.1 INTRODUCTION Number 16 14 23 63 8 2 4 1 - - - promotion interventions. providesdentaland oral22 health clinics all childrenin DentalprovideCommunity Services care for and adults were notkept, compared to 23%in2018. 2019 in appointments all of 25% that noted also OSHD tributed to reduced School Dental attendance.Services at mainly is reduction This 2018. to compared duction re 5% a 2019, in attendances 79,405 recorded OHSD Uptake ofdental services Dental Therapy withtheUniversity ofKwaZulu- Natal. in Degree Bachelor their completed therapists dental Eighteen training. overseas on technicians dental two and dentists general five were Health there Lazare2019, In Baie Centre. the at services dental adult vide pro and months three every rotate dentists The tion. Associa Dentist German the and Seychelles of ment Govern the between understanding of memorandum volun a longstanding a of dentist the teerterms German under by complemented is 6.1) (Table dental The DANCE BY DENTAL CLINICS,2019 FIGURE 6.2.ADULT DENTAL SERVICE PATIENTS ATTEN followed by AnseRoyale andAnseBoileau. facility,busiest the Centreis Health River English 2019; in facility by attendance shows 6.2 Fig. check-ups. tal den i.e. care, preventive clinical forwere visits of 13% Only appointments. their kept 68% appointments, en giv were or booked who patients the Of visits. all of 76% of 60% for 2019, accounting females with walk-ins,were which in attendances 37,478 recorded ADS UptakeService services. Digue and at the Yellow Roof Seychelles Hospital deliver La and Praslin Mahe, on centres health community at 10 officers dental Fifteen from Services. referrals Dental with School the deals also and above and years sixteen aged persons to care dental rehabilitative and ADS provides community-based preventive, restorative 6.2.1 ADULT DENTAL SERVICES (ADS) 6.2 COMMUNITY DENTAL SERVICES ------Annual Health Sector Performance Report 2019 37 ------6.3.2 ORTHODONTIC SERVICES SERVICES 6.3.2 ORTHODONTIC 6.3.1 ORAL AND MAXILLOFACIAL SERVICES SERVICES AND MAXILLOFACIAL ORAL 6.3.1 cerned with facial growth, development of the denti tion and occlusion. It includesmonitoring opment devel the of teeth and providing interceptive measures with The appliances majority appropriate. where of or andworkcarried fixed is outthodontic removable with appliances. Orthodontic care alsoencompasses provision of advice and educationto the patients, caregiv ers of minors and other health-care professionals such and ENT surgeon. as speech pathologist FIGURE 6.4. BREAKDOWN OF MAJOR SURGERIES, 2019 OF MAJOR SURGERIES, FIGURE 6.4. BREAKDOWN activi surgical all of 96% for accounted surgeries Minor Four extraction. tooth or invasive surgical for mostly ty, patients were diagnosed with cancer eight and cases were under follow up. No patients were referred for specialised treatment. overseas Orthodontics is a specialized branch of dentistry con Oral Oral and Maxillofacial Services (OMFS) offers hospital based and community-based treatment to the public on basis. a In referral 2019, the Unit comprised of four managing surgeons a wide of range cases the involving and neck. jaws face, cranium, attendance clinic Outpatient Dental Roof Yellow the at primarily offered Servicesare cas new were 1616 which of attendances, (6,536 Clinic es). Clinics were also held Anse at Royale English River, Health River English and Royale Anse Anne. Ste Baie and re attendances 547 and 354 of total a recorded Centres Inspectively. 2019, a pilotwas conducted at Anse Boi further with decentralize the aim to leau Health Centre two only after discontinued this was services, however, clinics because of very poor utilisation - only cas three seen. es were Activities Surgical OMFS performed 1302 surgical interventions in 2019, 55 (4%) of which were major surgeries, of which the majority was for trauma (Fig. 6.4); other pathologies included benign and malignant lesions (soft and hard region. and neck tissue) of the craniofacial ------6.3 SPECIALIST DENTAL SERVICES DENTAL 6.3 SPECIALIST 6.2.2 SCHOOL DENTAL SERVICES (SDS) SERVICES 6.2.2 SCHOOL DENTAL Specialist Specialist dental services include dentistry. oral and paediatric orthodontics surgery, dental /maxillofacial, officers. hort completing their Bachelor’s Almost Therapy. 600 adults were Degree seen under this pro Dental in dental of supervision the under done was this gramme, While dental therapists are primarily engaged in SDS, management of adults was a requirement for the co SDS, 2019 ments in 2019. ments BY PERFORMED FIGURE 6.3. PREVENTIVE INTERVENTIONS A number of preventiveinterventions as were ‘check-up’ first the represents ‘NEW’ 6.3); (Fig. 2019, done in of appoint 2019 are and ‘check-up’ follow-up ‘RECALL’ dents dents can be called in from the classroom where the the school premises. on SDS has a facility where most contacts are walk-ins, attendance is mostly mostly is attendance walk-ins, are contacts most where not did children of 26% 2019, In (55%). appointment by keep their appointments. For preventive services,stu Service uptake atten with 2019 during attendances 18,293 were There dance slightly higher for girls (53%). Contrary to ADS, the oral health and status the quality of life of children run the service. therapists Dental in Seychelles. SDS provides Oral Health Care services targeting the population under years 16 of age. oral and to health care therapeutic improve preventive The provides SDS after hours (1%) refused treatment last year. year. last treatment refused (1%) hours after Mahe in 2019. Almost half of all attendanceswere for dento-alveolar and/or maxillofacial trauma. It is inter estingto note that a minority of patients who consult during weekends and on public holidays. On-call service On-call holidays. public on and weekends during on Mahe and Praslin. is offered A total of 156 cases were registered after hours on The dental on-call or after-hoursservice caters for pa tients with emergency dentalconditions and isavail hours 24 and days week on 8am and 4pm between able After Hours Dental Service Dental Hours After 38 Annual Health Sector Performance Report 2019 to all PublicSchoolsin2020. participationand threeschools rate was excellent The programme 6.2). (Table for Crèche beextended 2 will Year IECD,of re-introduced crèchemodified a programme tooth-brushing project The schools. piloted public in was in support the with Services, Oral Health the programschools, effort crèche in tooth-brushing re-vampan to the In Tooth brushing Programme Crèche Year 2 BSA: BaieLazare; Ste Anne:GA:Grand AnsePraslin, Digue LD: La Baie BL: Boileau; Anse Royale;AB: Anse AR: Pins; Aux Anse AAP: Mamelles; Les LM: Clinic; YellowRoof YR: River; BV-BeauEnglish Notes:Vallon; ER: FIGURE 6.5.UPTAKE OFANCDENTAL PROGRAMME PERDISTRICT, 2018AND2019 oraland vices promotionhealth has Unit The activities. ser hygiene dental clinical providing Section Health lic Pub Dental the of unit a is Unit Hygienist Dental The and tion, monitoring, evaluation. preven on focuses Section Health Public Dental The patients andchildren withbehavioural problems. the dental rehabilitation ofspecialneeds children, cleft School severalDentalwith Services children)casesas (34 such the helping been has specialist dental diatric pae the 2019, July Since dentist. general a as ployed OHSD has one paediatric dental specialist currently em Paediatric Dental Services are yet to be fully developed. and 141fixed appliances. appliances functional removable 490 prescribed Unit The 2018. since services orthodontic for list waiting a cases. The Unit screened the 447 patients who were on new were 699 which of attendances, 7029 were There 6.4 DENTAL PUBLICHEALTH SECTION 6.3.3 PAEDIATRIC DENTAL SERVICES 6.4.1 DENTAL HYGIENIST UNIT - - - - - maternal and child oral health. Fig. 6.5 shows uptake by improving of aim the with women, pregnant targeting program prevention a is programme dental ANC The ANC Dental Programme long-term care facilities. in or wards the on home, the in seen also other with individuals special needs. Some patients are and diabetes with patients haemodialysis, on patients dental facilitiesoutside and targeted pregnant women, these sessions held were sessions Some of basis. one one-to a on were majority The sessions. education health oral conducted also Unit Hygienist Dental The management ofplaque-inducedgingivitis. of all appointments given and 82% of visits were for the representsthis 66% male) (40% were2019 recorded in attendances 9477 only; appointment by is Attendance uptakeService dent onavailability ofdental surgery space 14 dental hygienists; however, delivery of care is depen to theaverage numberofpregnancies annually(1600). compared low very is (197) seen women pregnant of number the 2018, to compared uptake in increase an reportedfacilities Although 2019. and 2018 for district 6.4.2 ORALHEALTH PROGRAMMES - Annual Health Sector Performance Report 2019 39 - - - 96 100 100 98.9% % participation 48 24 24 96 Crèche Number of children Per Per children Number of 6.5 DENTAL LABORATORY SERVICES LABORATORY 6.5 DENTAL 48 24 25 97 Total and repair of removable prostheses (dentures), construction and of orthodontic appliances splints. In occlusal and 2019, 672 new removable prostheses were constructed, representing an 80%increase from the 374 produced in 2018. Orthodontic laboratory was work completed for 405 patientscompared to the 247 in 2018. recorded In 2019, there was a plan prosthe to ceramic and dentures chrome-cobalt transition to acrylic from plastic/ ses. from from private and public-sector organisations who also provided support in kind for these activities. Addition ally, to assist with oral health promotion efforts, the unit a created number of IEC materials and media pro grammes. The dental laboratory is responsible for the fabrication - - - 18 13 56 25 Girls Number of Participants Number of 6 12 41 23 Boys PROMOTION ACTIVITIES ACTIVITIES PROMOTION 6.4.3 COMMUNITY-BASED ORAL HEALTH ORAL HEALTH 6.4.3 COMMUNITY-BASED Total Grand Anse Mahe Grand Au Cap Bel Ombre Schools activities and Toothactivities Brushing and amongst Demonstrations others. Other activitieswere organized request on Oral Oral Health Day, Cancer Awareness Week, and World Diabetes Day. These included oral health exhibitions, oral health screening, talks, Dental Plaque Disclosing A total of 65 oral health promotion/education activi tieswere organized in 2019 and most of the activities were centred on specific themes such as World the approach of public health. The committee works in col in works committee publicof The health. approach laborations with to otherstakeholders better integrate activities. health promotion general health into oral mittee (OHPC) is empower to and enable the people of Seychelles to better their oral health. The activities implemented are in line with the common risk factor The primary purpose of the Oral Health Promotion Com Promotion Health Oral the of purpose primary The TABLE 6.2. PILOT TOOTH BRUSHING ACTIVITY, SDS 2019 SDS ACTIVITY, BRUSHING TOOTH PILOT 6.2. TABLE 7 PROGRESS ON SDG3

Sustainable Development Goals. Annual Health Sector Performance Report 2019 41 ------

. Fig 7.1 shows distribution of current 50 mental health services mental Inpatient care (Acute Psychiatric Unit) Psychiatric (Acute care Inpatient community children) and (adult clinics Outpatient Domiciliary care • • • National Health Accounts Report, 2016-2017. Health Accounts National out of pocket spending at a time whengovernment is on health. spending more 50 gists, gists, Social Worker and Nursing Assistants) of health care works delivers the following mental health vices: ser Among key achievements in 2019, the Mental Health Services introduced a to tracking system trace patients ensure to appointments scheduled miss they as soon as continuity ofcare, there increased was utilisation services re-admission and inreduction psycho-geriatric of rates. SDG 3.8.2: Financial Protection All health services at public facilities are free; howev er, out of pocket spending appears substantial in the last three years health expenditure (CHE) for 2016-2018 with house holds contributing more than 20%.no It assumed household that faces catastrophic health expenses Seychelles, but there is a in need to understand the high proaches to further improve care. further improve to proaches approximately with high services is health of Utilisation four doctor consultations percapita in 2019 (Chapter 5). All deliveries are institutional and the country has re corded high coverage (>95%) of childhood immuniza tion for many years. Sexual reproductive and services health are available free of charge at the PHC level and also in some and private NGO clinics; there are no recent surveys of contraceptiveprevalence, but assumed to it is be less than the NHSP end-term target of 55%. The Cancer Programme in partnership with developing WHO a is national cancer strategy new that approaches will to cancer give prevention andscreening. In 2019, the number of both mammograms (818) and pap smears (6170) done increased compared to 2018, and (1500 targets end-term NHSP the of short were but 15,000 respectively). A multidisciplinary team (Doctors,Nurses, Psycholo view view the content of the package of health services at ap delivery service innovative identify to and level PHC - - - - -

- -

47 (SDG 3.8) means 48 SDG indicator Coverage 3.8.1: of essential health services 3.8.2: SDG indicator Financial protection designed to promote better health prevent illness and to provide treatment, rehabilita tion and palliative care of sufficientwhile at the same time quality, ensuring that the use of these services does not expose the user to financial hardship. Universal Health Cov Health Universal erage that all people receive they services health the services including need, - - - - 49 WHO. Universal Health Coverage Key Facts. https://www.who.int/news- https://sustainabledevelopment.un.org/post2015/transformingourworld of Goal 3 in 2019. https://sustainabledevelopment.un.org/sdg3 Progress room/fact-sheets/detail/universal-health-coverage-(uhc) 46 47 48 Conference in 2019, Conference the MOH set up a to re task force child health, as well as rehabilitative care needs. care as rehabilitative child health, as well made at recommendations Following the National PHC tertiary healthcare and 15 programmes offer services across the life course addressing communicable, non communicable diseases, reproductivematernal and to to a package of comprehensive health services, includ ing oral health services, free at the point of delivery. Services are organized into primary, secondary and SDG 3.8.1: Coverage of essential health services of essential SDG 3.8.1: Coverage In Seychelles, physical and financial accessaccess easy have residents all – guaranteed are services to health and for innovations such health. as digital the demographic and ep idemiological challenges facing most countries, es with those for women and health children’s and both addressing for NCDs, form form for integratingpre viously separate services diseas communicable for and way cost-effective to achieve UHC around the world. It provides a plat According According to the WHO, PHC is the most efficient quality health need other they SDG that services be reached. can 3 targets is through ensuring that all people have access to UHC underpins all other SDG the 3 targets – it maternal maternal and child mortality is decreasing; however, more effortsare needed to achieve universal NCDs. (UHC) and address coverage health SDG 3, good health and well-being is associated with 13 targets and 27 indicators. Globally, there has been some progress in SDG 3: life expectancy is increasing; erty, protecting the planetprotecting and ensuring that all people erty, 2030. by prosperity peace and enjoy Member Member States, committedto the2030 Agenda of the Sustainable Development Goals (SDGs) – 17 Develop pov ending of aim the with targets 169 and Goals ment In 2015, Seychelles, together with other United Nations Nations United other with together Seychelles, 2015, In 42 Annual Health Sector Performance Report 2019 56 55 54 53 52 51 on efficiency, quality andequity. working recommends WHO hardship, financial low coverageand service high with Seychelles,like countries For can bedeveloped andimplemented. ‘who is left behind’. There is therefore an urgent need to understand “who is left behind” so that targeted services quality of care and due to data gaps (mostly lack of granular data), we cannot reliably report on equity and identify There are several challenges in measuring all aspects of UHC; the MOH does not routinely measure and report on calculations ofSCIinthe2017and2018APR. for Mauritius it was 64 (TableAccording7.1). Worldtothe StatisticsHealth 2015, in SCI for the Seychelles 2019, whereas Report 68, was 2017 in 70 was SCI the Seychelles, For age SCIwas 64,andinhigh-income countries SCIwas 80 andabove. Globally, many countries are making progress and the SCI improved from 2000 to 2017. 100 andisbasedon16tracer indicators infour categories: To measure progress in UHC, WHO recommends using a service coverage index (SCI) which ranges between 0 and Source: NHA2017,2018 FIGURE 7.1.DISTRIBUTION OFCHEBY INSTITUTIONS PROVIDING REVENUES FOR FINANCINGSCHEMES Primary HealthCare Primary ontheRoad to Universal Health Coverage 2019GLOBAL MONITORING REPORT. Geneva, Switzerland: WHO, 2019. World healthstatistics 2019: monitoring health fortheSDGs,sustainable development goals. Geneva: WorldHealth Organization; 2019 AnnualHealthPerformance Report, 2018. AnnualHealthPerformance Report, 2017. World healthstatistics 2019:monitoring health fortheSDGs,sustainable development goals.Geneva: WorldHealth Organization; 2019. HealthCare Primary ontheRoad to Universal HealthCoverage 2019GLOBAL MONITORING REPORT. Geneva, Switzerland: WHO, 2019 • • • • Service capacity andaccesshealthsecurity Service NCDs Infectious diseases health (RMNCH) Reproductive, maternal, newborn andchild 55 ; these calculations are based on comparable estimates, while primary data was used for 56

53 and 80 in 2018 in 80 and 54 but due to missing data was not calculated in 2019 in calculated not was data missing to due but 52

51 In 2015, the global aver - Annual Health Sector Performance Report 2019 43 - - ND 100 100 77% 79% 88% 99% 99% 81% 70% 93% 2019 63.5% - - 80 100 100 77% 79% 88% 99% 72% 83% 93% 2018 95.83 63.5% 38.1% 99.1% 72.04% 82.22% 72.83% population) Year and Source Year 2018/2019, EPI Data 2018/2019, CDCU Data 2018/2019, CDCU Data improved sanitation 97%. sanitation improved (72.04*82.22*72.83*95.83) 2017, Joint External Evaluation. External 2017, Joint 2013, Seychelles Heart Study IV. 2013, Seychelles Heart Study IV. 2013, Seychelles Heart Study IV. 2013, Seychelles 2018/2019, Maternity Ward Data Ward 2018/2019, Maternity Not Applicable to Seychelles Context Seychelles to Not Applicable surgeons and >1 psychiatrist per 100,000 population) per 100,000 and >1 psychiatrist surgeons reported, as percentage of total women aged 15-49 years. 15-49 aged women of total as percentage reported, 2018, 2019 MOH. (WHO recommendation of >18 beds/10,000 2018, 2019 MOH. (WHO recommendation 2010, Population census, NBS Access to treated water 93% and water to treated census, NBS Access 2010, Population Not measured. All children with pneumonia treated in hospital. with pneumonia treated All children Not measured. 2018, 2019 MOH (WHO recommendations of >90 physicians, >14 of >90 physicians, 2018, 2019 MOH (WHO recommendations 2018, Sexual and Reproductive Health Programme Data; based on # Data; Health Programme and Reproductive 2018, Sexual IHR Core Capacity Index IHR Core UHC Index Overall Health Workers Density Health Workers Service Capacity Access Hospital Prevalence of Tobacco of Tobacco Prevalence Non-Smoking Blood Pressure of normal Prevalence Plasma Glucose Fasting NCDs of normal Prevalence Sanitation and Hygiene) Sanitation Malaria Prevention Tuberculosis Treatment Treatment Tuberculosis Access, (Water WASH Infectious Diseases Diseases Infectious (of known Coverage ART PLHIV) Pneumonia in children Pneumonia in children <5years. Immunisation Coverage Coverage Immunisation (DPT3) for Seeking Care Family Planning coverage Planning Family (4+ Coverage Antenatal Visits) RMNCH UHC Components ND- No data; EPI: Expanded Programme of Immunization; PLHIV- People living with HIV. People PLHIV- Immunization; of Programme EPI: Expanded ND- No data; Note: done Calculations based on guidance from tracking universal 2017 coverage: health global Organization World monitoring Health report. 2017. Bank; / World and Development Reconstruction for Bank and International TABLE 7.1. SCI, 2019 7.1. TABLE 44 Annual Health Sector Performance Report 2019 the following indicators iscurrently notavailable: for Data 7.2). (Table mortality NCD premature ducing however,NCH); stagnatingis it a for few targets e.g. re (RM 3 SDG several achieve to track on is country The ties for real-time monitoring ofmany goals. opportuni present technologies Modern data. al-time re including data, SDG granular and quality timely, in resources more invest to need Seychelles that agreed ministries all workshop, consensus-building a During Planning. Economic and Investment Trade Finance of Ministry the exercisetargets,by this SDG led was all to report taking stock of where the country was in relation SDG baseline national a developed Seychelles 2019, In • • 3.3.4 Hepatitis Bincidenceper100,000 o population 3.3.1 NumberofHIVinfections/1000 uninfected increasing inlast four years No recent surveys butdiagnosedcases - - - -

• • • o (per 100,000population) household air andpollution ambient air pollution Age-standardized death rate attributable to o planning sati, satisfied withmodern methods (aged 15-49 years) who have their need for family 3.7.1 Proportion of women of reproductive age o substance usedisorders 3..5.1 Coverage oftreatment interventions for o population No data, butpresumed to bevery low available. women attending is family planningservices No survey data. For 2019,onlynumberof of drugaddiction the prevention, treatment and rehabilitation Data withAPDAR, theagency responsible for increasing inyoung adults vaccination inchildren butdiagnosed cases No recent surveys, highcoverage ofHBV Annual Health Sector Performance Report 2019 45 Comments Global target not specified. Global target 5 last for trend Decreasing years but average than 5 yr. Lower higher 2018 value trends. Increasing in 2018 (APR UHC calculated 2018). in in 2019, one death No deaths 2018. women, for slowly Increasing men for in gains slowdown On track for SDG target but SDG target for On track yrs. five last trend increasing deliver women all Traditionally, before birth few Very in hospital. arrival not SDG but still for On track NHSP target achieving not SDG but still for On track NHSP target achieving is based on known Denominator of HIV cases yrs. four TB incidence in last higher than 2015 baseline. 55% of all to NCDs contributed aged among persons deaths 30-70 yrs.              Trend Rating worsening trend. trend. worsening 69 80 6.1 0.0 8.7 81% 11.3 65.3 62.3 17.4 13.3 21.2 2019  Value 98.8% - Source – maintaining achieved or target on track to achieving SDG target;  Observatory NBS unit, Statistics DOH unit, Statistics DOH Global Health CDCU, PHA CDCU, SDG Africa and Dash index boards unit, Statistics DOH unit, Statistics DOH Statistics unit, Statistics DOH unit, Statistics DOH unit, Statistics DOH PHA CDCU, Statistics unit, Statistics DOH

unintentional poisoning unintentional birth (years) at life-expectancy Healthy Coverage of essential health services of essential Coverage (0-100)) Index ( Service Coverage to attributed rate Mortality Deaths due to road traffic injuries traffic road due to Deaths (births per 1,000 birth rate Adolescent 15-19) aged women Mortality rate attributed to attributed rate Mortality disease, cancer, cardiovascular respiratory or chronic diabetes 30-70. aged disease in populations rate Suicide mortality PLHIV receiving ART PLHIV receiving Incidence of Tuberculosis (per 100,000 population) Under-5 mortality rate (per 1,000 live live (per 1,000 rate mortality Under-5 births) 1,000 live (per Rate Mortality Neonatal births) live births) live skilled health by Births attended (%) personnel SDG 3 Good Health and Well-being Health and Well-being SDG 3 Good Indicators 100,000 (per Rate Mortality Maternal

* 3.9.3 3.8.1 3.7.2 3.7.2 3.6.1 3.6.1 3.4.2 3.4.1 3.3.2 * 3.2.2 3.2.1 3.1.2 3.1.1 SDG - improving moderately, but will fall short of SDG targets; short of SDG targets; but will fall moderately, - improving io/2019AfricaIndex/2019_africa_index_indicator_profiles.pdf  Network (2019): Profile. SDG Solutions Africa Centre Development SDG for Africa * Index in and Included Africa Notes: Sustainable Index Indicator and Dashboards Report 2019. Kigali and New York: SDG Centre for Africa and Sustainable Development Solutions Networkhttps://sdsna.github. Rating based on globalTrends: thresholds. Table 7.2. PROGRESS ON SDG 3, 2019 ON SDG 7.2. PROGRESS Table 46 Annual Health Sector Performance Report 2019 May 2020. 58 Sustainable and Development Solutions Network (SDSN). Stiftung Bertelsmann York: New 2019. Report Development tainable 57 ing inovercrowded householdsetc. (Fig.7.2). are level of education attained, lack of employment, liv poverty multidimensional overall to most the tributing con Deprivations indicators. all in deprived were ple totaldeprivations peo all that be if experienced would sionally poor people in Seychelles experience 4% of the multidimen that meaning – 0.040 was (H*A) A and H tensity (A) was 33.26%. The MPI which is the product of averagein the and 11.88%, was (H) incidence poverty dex (MPI) In Poverty Multidimensional on publication latest The health andwell-being. of determinants social address and behaviourshealthy 3, 4, 5, 8, 10 to build synergy and ensure UHC, promote tegratedstrategy 2, groupinterventions 1, and SDG for SDG 3, For goals. SDG achieve to required interventions the across trade-offs and synergies major address should behind’ one no ‘leaving of principle the by derpinned goals. 2030 to achieve to order in transformations Report, deep needs world Development the 2019, Sustainable the to According National Bureau of Statistics. Multidimensional Poverty Index, 2019. NBS, 2019. Statistics. MultidimensionalIndex, of Poverty Bureau National Sus Fuller,(2019): G., Lafortune,Schmidt-Traub,G. J.,C., Kroll,Sachs, G., Health and Well-being 58 shows that inthethird quarter of 2019, the 57 The transformations, un transformations, The , therea needfor is in an ------concerted implementation or follow-up actionsince. or formal limited been has There polices. all in health PolicyAll in DeclarationHealth mainstream pledging to comes, all members of the Cabinet of Ministers signed a terminants of health on disease burden and health out of all the SDGs and the influence of socio-economic de interconnectedness the recognizing 2017, In solutions. terconnected and therefore call for joint and integrated in and integrated consequently are challenges implementation and the goals, SDG The equitable outcomes. toensure health needed are interventions what and behind’ left is ‘who understand to important is It TOR TO NATIONAL MPI,2019Q3 FIGURE 7.2.PERCENTAGE CONTRIBUTION OFEACH INDICA - - - - Annual Health Sector Performance Report 2019 47

LIMITATIONS/CHALLENGES around data for core health indicators. indicators. health core for data around reporting. of death quality of cause with the challenges several are There Unfortunately, a Unfortunately, data verification workshoporganized in February 2020 was cancelled, the objectiveswere and to and present 2019 share all from units;data; shared processing to data build data to review/verify consensus The statistics UnitThe doesfromstatistics datanot health the capture sector; private this report is rather largely a MOH, than report. a health sector Information from the PHA and several programmes is not included in this report as many health care workers were were workers care health many as report this in included not is programmes several and PHA the from Information annual their submit not could and response Covid-19 national the support to 2020 of beginning the at redeployed reports. 48 Annual Health Sector Performance Report 2019 for discussionandconsideration. success, understand gaps and decide on remedial actions. The writing team proposes a few key recommendations acknowledge implementersto and leadership with discussed be will sector health the of performance 2019 The • • • • Governance • • ------Progress onSDG3 Risk factors for health HealthStatus ------Oral healthservices ------Health System - address highnumberofSTI Sexual reproductive healthprogramme andHealthPromotion Unit to develop interventions to Occupational HealthUnit to review deaths due to ‘falls’ inthe workplace Allocate more resources for healthpromotion and prevention Create acommunity ofpractice to address NCDs need vaccination) Understand theincrease inHBV cases ,relook at HBV vaccination policy(which at riskgroups Set upatechnical working group (TWG) to review highpneumoniamorbidityandmortality Develop joint programme withothersectors to supporthealthy ageing to increase HALE - - - in RadiologyDepartment. CMEonresponsible useofdiagnostics PS to revitalize theHiaP pledge TWG to review UHCandwhois‘left behind’ by eachprogramme Programmes to submitcoverage data ontime Develop initiatives to reducemissedappointments Report attendance data to Statistics Unit Improve uptake ofANCdental programme The Chief Medical Officer toimplement measures toimprove qualityof causeofdeath data. Improve qualityofdata. Develop formal mechanismsfor improved collaboration amongStatistics Unit,DSRUandCancer Registry Accelerate implementation ofeHIS AMSA to develop andmaintain acomprehensive renal register Assess implementation ofnew initiatives –Diabetic Passport,SEYPEN Allunitsto work onQIinitiatives learning from the Paediatric Ward experience Sensitize doctors aboutincreased numberoflab tests inClinical Labandincreased investigations Address low numberofnurses graduating from NIHSS Address increasing obesityamongschoolchildren asapublichealthemergency Use data to inform decisions Develop accountability framework Set upformal mechanismsto improve communication withinandacross agencies

RECOMMENDATIONS

Annual Health Sector Performance Report 2019 49 9.2 5.2 2.4 8.5 6.6 7.9 9.7 0.0 6.5 6.5 7.0 7.6 5.5 7.7 5.1 7.1 7.5 5.7 5.8 8.4 6.7 9.0 7.8 12.3 11.4 13.9 13.0 10.2 Deaths per 1000 per Deaths Population in District Population 574 3568 3876 4586 2926 2720 3169 3419 3974 3082 3215 2905 3241 2850 4236 4093 4935 4665 4312 3951 4786 4020 2963 3996 3810 3737 4016 97,625 districts *Population in *Population 4% 3% 1% 3% 2% 3% 4% 0% 6% 5% 3% 2% 6% 3% 7% 4% 4% 5% 3% 4% 5% 5% 2% 3% 4% 3% 5% 100% deaths % of total % of total 0 45 20 18 25 33 49 35 21 19 23 32 25 36 33 20 11 25 31 27 36 22 28 36 41 17 55 763 Total Deaths by Sex by Deaths 7 0 8 7 9 4 19 10 10 16 33 20 10 11 12 16 10 15 12 14 16 10 17 15 15 16 18 350 Female ANNEX 1. MORTALITY BY DISTRICT, 2019 DISTRICT, BY MORTALITY 1. ANNEX 0 8 4 26 10 11 15 17 16 15 11 11 16 15 21 21 12 11 15 17 19 13 13 21 25 13 37 413 Male District Takamaka Total Roche Caiman Roche St Louis Pointe Larue Pointe Glaud Port Other Islands Plaisance Mont Buxton Mont Fleuri Mont La Digue Les Mamelles Grand Anse Praslin Grand Ile Perseverance Glacis Anse Mahe Grand Cascade English River Bel Air Belombre Baie Ste Anne Baie Ste Beau Vallon Au Cap Baie Lazare Anse Etoile Anse Royale Anse Aux Pins Anse Boileau 50 Annual Health Sector Performance Report 2019 ANNEX 2.TRENDINMATERNAL MORTALITY, 1978-2019 Annual Health Sector Performance Report 2019 51 10 10 70 64 19 16 35 91 90 236 153 118 109 208 126 Number of Number of Number of Number of admissions admissions admissions - - 1734 1734 Cause Cause Cause System System Diabetes adenoids Fractures Neoplasms Neoplasms Leptospirosis nal infections specified sites Bronchial Asthma Asthma Bronchial Intracranial injury Intracranial furuncle and carbuncle Diseases of the Circulatory Diseases of the Circulatory Diseases of the Circulatory Diseases of the Circulatory presumed infectious origin infectious presumed Total Admissions in 2019 = Total = Admissions in 2019 Total Chronic respiratory diseases respiratory Chronic Acute upper respiratory tract tract upper respiratory Acute Cellulitis, Cutaneous abscess, abscess, Cellulitis, Cutaneous infections of multiple and un infections Chronic diseases of tonsils and diseases of tonsils Chronic Total Admissions in 2019 = 290 Total Viral and other specified intesti Viral Diarrhoea and gastroenteritis of Diarrhoea and gastroenteritis E10-E14 A27 J45 A09 J06 J35 A08 ICD-10 codes I00-I99 S06 C00-D48 ICD-10 codes I00-I99 C00-D48 J40-J47 S01-S96 L02-L03 ICD-10 codes Leading causes of admission in ICU, 2019 of admission in ICU, Leading causes Leading causes of admission in Female surgical ward, 2019 Note: In 2019, some medical were patients admitted on Female Surgical Ward 2019 Ward, of admission in Paediatrics Leading causes 62 61 44 43 45 31 86 52) 312 107 212 150 121 115 180 Number of Number of Number of Number of admissions admissions admissions 73* (Asthma 73* (Asthma 2019 (SELECTED WARDS) 2019 (SELECTED 1857 1376 Cause Cause Cause System System Diabetes Diabetes Neoplasms Neoplasms Neoplasms Pneumonia Pneumonia Appendicitis ventral, etc.) ventral, Leptospirosis furuncle and carbuncle Diseases of the Circulatory Diseases of the Circulatory Diseases of the Circulatory Diseases of the Circulatory Hernia (inguinal, umbilical, Hernia (inguinal, umbilical, Total Admissions in 2019 = Total Total Admissions in 2019 = Total Chronic respiratory diseases respiratory Chronic Cellulitis, Cutaneous abscess, abscess, Cellulitis, Cutaneous Total Admissions in 2019 = 804 Admissions in 2019 Total Fractures (Rib, neck, femur, etc.) (Rib, neck, femur, Fractures ANNEX 3. LEADING CAUSES OF ADMISSIONS SEYCHELLES HOSPITAL, SEYCHELLES ADMISSIONS OF CAUSES LEADING 3. ANNEX K35-K38 C00-D48 K40-K56 L02-L03 S01-S96 ICD-10 codes C00-D48 E10-E14 J12-J18 I00-I99 J40-J47 ICD-10 codes A27 E10-E14 J12-J18 C00-D48 I00-I99 ICD-10 codes Leading causes of admission in Male 2019 Surgical Ward, 2019 Leading causes of admissions in Female Medical Ward, Leading causes of admissions in Male Medical Ward, 2019

This is a publication of the Department of Health Seychelles, June 2020.

For queries email [email protected].