Health of our Nation Annual Health Sector Performance Report, 2018 April 2019 MINISTRY OF HEALTH, SEYCHELLES 0 TABLE OF CONTENTS Acronyms and abbreviations .................................................................................................................... v Summary Indicator Table .......................................................................................................................viii Foreword ................................................................................................................................................ ix Executive summary ................................................................................................................................. xi 1. Introduction ..................................................................................................................................... 1 2. Governance and Leadership ................................................................................................................. 3 2.1 Key achievements/Milestones during 2018 .................................................................................. 5 2.1.1 Sector Legal and Regulatory framework ................................................................................. 5 2.1.2 Sector accountability .............................................................................................................. 6 2.1.3 Empowered civil society/community ..................................................................................... 9 2.1.4 Private sector contribution ..................................................................................................... 9 2.2 Remaining agenda ....................................................................................................................... 10 3. Health Status ...................................................................................................................................... 12 3.1 Vital Statistics ............................................................................................................................. 13 3.1.1 Live Births ............................................................................................................................. 13 3.1.2 Mortality by age and sex ...................................................................................................... 13 3.1.3 Maternal and Infant deaths .................................................................................................. 14 3.1.4 Life Expectancy ..................................................................................................................... 15 3.2 Mortality by cause ....................................................................................................................... 17 3.2.1 Non-communicable (NCD) mortality .................................................................................... 18 3.2.2 Other causes of Death .......................................................................................................... 20 3.3 Morbidity .................................................................................................................................... 22 3.3.1 HIV/AIDS ............................................................................................................................... 23 3.3.2 Viral Hepatitis ....................................................................................................................... 24 3.3.3 Sexually Transmitted Infections (STI) .................................................................................... 25 3.3.4 Tuberculosis ......................................................................................................................... 26 3.3.5 Pneumonia ........................................................................................................................... 26 3.4 Fertility ........................................................................................................................................ 28 4. Public Health ...................................................................................................................................... 30 4.1 Disease Surveillance ................................................................................................................... 31 4.2 IHR monitoring and evaluation ................................................................................................... 34 4.3 IDSR implementation ................................................................................................................. 35 4.4 Health Protection ........................................................................................................................ 35 i 5. Risk Factors .................................................................................................................................... 37 5.1 Non-Communicable Diseases (NCD) Risk Factors .................................................................... 38 5.2 Prevention of NCDs .................................................................................................................... 39 5.3 HIV and HCV risk factors .......................................................................................................... 43 5.4 Prevention of HIV and HCV ....................................................................................................... 43 6. Achieving Universal Health Coverage ............................................................................................. 44 6.1 Introduction ................................................................................................................................. 45 6.2 Service Coverage ........................................................................................................................ 45 6.2.1 Reproductive, Maternal, New-born and Child Health (RMNCH) .......................................... 46 6.2.2 Infectious Diseases ............................................................................................................... 47 6.2.3 Non-Communicable Diseases ............................................................................................... 48 6.3 Challenges of Measuring UHC ................................................................................................... 50 7. Health system strengthening ............................................................................................................. 52 7.1 Human Resources ....................................................................................................................... 53 7.2 Health Financing ......................................................................................................................... 54 7.3 Health Information ...................................................................................................................... 55 7.4 Service delivery .......................................................................................................................... 57 7.4.1 Access and Utilization ........................................................................................................... 57 7.4.2 Specialized Care .................................................................................................................... 61 7.6 Key Developments in Hospital Services ..................................................................................... 64 7.7 Key Developments in Primary Health Care Services ................................................................. 65 8. Achieving Health-related SDGs ........................................................................................................... 66 Limitations ............................................................................................................................................. 70 Epilogue ................................................................................................................................................. 71 Annex 1. Analysis of Infant Mortality, 2018 ............................................................................................ 73 Annex 2. WHO IDSR recommendations .................................................................................................. 77 Annex 3. National EPI Schedule, 2018 .................................................................................................... 79 Annex 4. Attendance by region .............................................................................................................. 80 Tables and Figures TABLE 1.REGISTERED HEALTH CARE PROFESSIONALS, 2017 AND 2018 .......................................................................................... 8 TABLE 2. NUMBER OF REGISTERED NURSES, 2013-2018 ............................................................................................................... 8 TABLE 3. CORPORATE SOCIAL RESPONSIBILITY DONATIONS, 2018............................................................................................... 10 TABLE 4. LIVE BIRTHS BY SEX, 2013- 2018 .................................................................................................................................. 13 TABLE 5. ANNUAL DEATHS BY SEX, 2013- 2018 ..........................................................................................................................