THE HEALTH OF OUR NATION Annual Health Sector Performance Report 2017 TABLE OF CONTENTS 1. INTRODUCTION 1 2. GOVERNANCE AND LEADERSHIP 3 2.1 Key achievements/Milestones during 2017 4 2.1.1 Health Sector Stewardship and management capacity 5 2.1.2 Sector Legal and Regulatory framework 5 2.1.3 Sector Accountability 6 2.1.4 Monitoring 8 2.2 Remaining gaps and Challenges 8 3. HEALTH STATUS 9 3.1 Vital Statistics and core mortality and morbidity indicators 9 3.1.1 Vital Statistics 10 3.1.2 RMNCH 11 3.1.3 NCD 13 3.1.4 Infectious Diseases 15 3.2 Mental Health 17 3.3 Risk factors impacting health status 18 3.4 Key achievements/MILESTONES DURING 2017 20 3.5 Remaining Gaps and challenges 20 4. SERVICE COVERAGE AND HEALTH SYSTEMS 21 4.1 Coverage of essential services 21 4.2 Improving access to health services 22 4.3 quality of care 27 4.3.1 Measuring quality of care 27 4.3.2. Perceived quality of care 28 4.3.3. Patient safety 29 4.3.4. Patient centered care 30 4.4 Key achievements/milestones during 2017 30 4.5 Remaining gaps and challenges 31 5. DELIVERING ON STRATEGIC INVESTMENT PRIORITIES 31 Priority 1: Strengthened integrated health care 31 Priority 2: Promoting and protecting health 33 Priority 3: Human resources for health 34 Priority 4: Sustainable financing for health 36 Priority 5: Research and innovation 38 Priority 6: Partnership and coordination 39 6. NEW THREATS 40 6.1 Infectious disease threats 40 6.2 Chemical threats 43 7. HEALTH IN ALL SDGS 44 7.1 Implementing the Health in All Policies agenda 45 7.2 Whole of Government Approach: Mobilizing ministries and partners 46 7.3 Achieving SDG 3: Ensure healthy lives and promote wellbeing for all at all ages 47 7.4 Remaining Gaps and challenges 50 ii 8. TAKING OWNERSHIP OF THE HEALTH AGENDA 51 8.1 Burden of Disease 51 8.2 Investing more heavily in prevention 52 8.3 Strengthening the Health System 52 8.4 Accountability 53 8.5 Progress made towards NHSP and global targets 54 8.6 Informing future implementation of the NHSP 54 8.7 The health sector perspective 54 8.8 Addressing equity gaps 55 8.9 Partnership 55 9.0 EPILOGUE 55 Annex 1. Calculation of UHC Service coverage index for 2017 57 Annex 2: Declaration on Health in All Policies 59 Figures Figure 1. The Health Sector ........................................................................................................................................... 4 Figure 2. Life expectancy at birth, 2010-2017 ............................................................................................................ 10 Figure 3. Neonatal, infant and under-five mortality rates, 2013-2017 ..................................................................... 12 Figure 4. Adolescent fertility rate, 2013-2017............................................................................................................ 12 Figure 5. Proportion of deaths due cardiovascular diseases in persons aged 30-70 years, 2013 – 2017 .............. 13 Figure 6. Cancer types among all cancer deaths in 2017 .......................................................................................... 14 Figure 7. Newly detected cases of HIV, 2013 – 2017 ................................................................................................. 16 Figure 8. Newly diagnosed cases of viral hepatitis C, 2008-2017 ............................................................................. 16 Figure 9. Reported cases of intentional self-harm, 2013-2017 ................................................................................. 18 Figure 10. CT and MRI-Scans done per 1000 population, 2011-2017 ...................................................................... 25 Figure 11. Cooperation doctors and dentists working in Seychelles in 2017 ........................................................... 39 Figure 12. Epidemic curve of suspected and confirmed plague cases by date of onset of symptoms, 2017 ........ 41 Figure 13. Epidemic curve of suspected dengue cases by week, 2015-2017 ........................................................... 42 Figure 14. The Sustainable Development Goals ......................................................................................................... 44 Tables Table 1. Assurances given in the National Assembly ................................................................................................... 7 Table 2. Registered health care professionals, 2017 ................................................................................................... 8 Table 3. RMNCH indicators, 2017 ............................................................................................................................... 11 iii Table 4. Age-specific death rate due to cardiovascular diseases in the age group 30-70 years, 2013-2017 ......... 14 Table 5. Age-specific death rate due to cancer in the age group 30-70 years, 2013-2017 ..................................... 14 Table 6. Reported cases of tuberculosis, 2013-2017 ................................................................................................. 17 Table 7. Coverage of key services, 2017 ..................................................................................................................... 21 Table 8. Service capacity and access ........................................................................................................................... 23 Table 9. Doctor consultations in the public sector, 2013-2017................................................................................. 24 Table 10. Number of patients on haemodialysis, 2013-2017 .................................................................................... 25 Table 11.Number of prescriptions filled, 2016 and 2017 .......................................................................................... 26 Table 12. Comparison of quality of care, Seychelles and OECD countries ............................................................... 27 Table 13. Patients’ perception of quality of care ....................................................................................................... 29 Table 14. Assessment of patient safety ...................................................................................................................... 29 Table 15. Workforce demographics in the HCA, 2017 ............................................................................................... 35 Table 16. MOH funding, 2017 ..................................................................................................................................... 37 Table 17. Visiting specialists in 2017 ........................................................................................................................... 39 Table 18. Promoting health and promoting sustainable development: health in all SDGs ..................................... 46 Table 19. Achieving SDG 3 targets: issues and suggestions ....................................................................................... 48 iv Acronyms AF aflatoxins AIDS Acquired Immuno-Deficiency Syndrome ANC antenatal care ANHRD Agency for National Human Resource Development ART antiretroviral therapy BP blood pressure CEO chief executive officer CVD cardiovascular disease COPD chronic obstructive pulmonary disease DPT3 3 doses of diphtheria-pertussis-tetanus vaccine DSRU disease surveillance and response unit EPSS epidemiology and statistics section FP family planning FTCT framework for convention on tobacco control HCA health care agency CHF congestive heart failure HIS health information system HIV human immunodeficiency virus HPC Health Professionals’ Council IDSR integrated disease surveillance and response IHR international health regulations IOM Institute of Medicine MDG Millennium Development Goals M&E monitoring and evaluation MI myocardial infarction MOH ministry of health MMR maternal mortality ratio MRSA Methicillin- Resistant Staphylococcus Aureus infections MTCT mother-to-child transmission of HIV v NAC National Aids Council NBS national bureau of statistics NCD non-communicable disease NHSP National Health Strategic Plan NIHSS National Institute for Health and Social Studies OECD Organization for Economic Co-operation and Development (OECD) PHA Public Health Authority PLHIV people living with HIV PWID people who inject drugs RMNCH reproductive, maternal, new-born and child health SARA service availability and readiness assessment SCR Seychelles Rupees SDG Sustainable Development Goal SDH Social Determinants of Health SMDC Seychelles Medical and Dental Council SNMC Seychelles Nurses and Midwives Council TB tuberculosis TRIPS Trade Related aspects of Intellectual Property Rights UCCPD Unit for Prevention and Control of Cardiovascular Diseases UHC Universal Health Coverage WASH Water, Sanitation and Hygiene WHO World Health Organization WTO World Trade Organization vi Glossary Life expectancy at birth: The average number of years that a new-born could expect to live if he or she were to pass through life exposed to the sex- and age-specific death rates prevailing at the time of his or her birth, for a specific year, in a given country, territory or geographical area. Neonatal mortality rate: Probability that a child born in a specific year or period will die during the first 28 completed days of life if subject to age-specific mortality rates of that period, expressed per 1000 live births. Under- five mortality rate: The probability of a child born in a specific year or period dying before