1. HEALTH SYSTEM CONTEXT Working Group #1 Questions 1, 2, and 9

2. Working Group Members Vishwa Mahadeo GUY Ann De Roche SAV Samuel Deane BAR Serge Lafond Health Canada Marjorie Parks BEL Bonne Richardon Lake ANG Elly Van Kanten SUR Marilyn Entwistle PAHO TRT

3. Demographic Trends Data No Urban/Rural distinction in Anguilla and Barbados Collected data in the census but not available for all years requested in Table 1 (5 year periods) Additional distinction for some countries is remote/hinterland e.g. Guyana and Surinam

4. Demographic Trends Data Data on Urban/Rural distinction is not applicable to Anguilla & Barbados Data is available for indicators but there is not the capacity in some countries to analyse data by gender (SAV); however, it is available in other countries

5. Demographic Trends Data Within last 5 years, countries have done censuses – beforehand, estimates Data on migratory balance unavailable – difficult to assess magnitude of illegal immigrants When providing data for rates, important to also provide absolute numbers if population is small

6. Demographic Trends Data Difficulty in providing information on prevalence of exclusive breastfeeding - data would not be reliable Clarification needed if data unavailable for all the years within the time frame – is the reported figure an average of data available

7. Demographic Trends Data If data is not disaggregated then how should data be presented e.g. data only available on a national level How should data be handled when only syndromic cases are reported & not confirmed

8. Demographic Trends Data Data on incidence of positive sputum- smears microscopy now available with introduction of DOTS – however data not available back to 1990 Annual incidence of HIV/AIDS – should be explicit in stating confirmed cases – should it be annual incidence of HIV & annual incidence of AIDS?

9. Demographic Trends Data Could we introduce another indicator asking for incidence of HIV-TB co- infected persons? Mortality Rate Data – for some countries, data on ethic groups is unavailable Mortality Rate Data – if urban/rural, then should also include remote/hinterland

10. Demographic Trends Data Mortality Rate Data – need to define “other” External causes – Needs to be Defined Nutritional deficiencies as a cause of infant mortality limited to malnutrition

11. Process of Data Collection Reliance on stakeholders Difficulty in accessing information from private sector and reliability of data is questionable National Conferences of Regional Health officers in Guyana to discuss the data over periods

12. Table 9 Constraints/Enabling Factors Data on prevalence of depression unavailable – constraint is under- reporting (only for mental health) or not reported at all Data on domestic violence is under- reported Child labour rate – BEL has official info – not known/collected for other countries

13. Table 9 Constraints/Enabling Factors Disaggregated data (i.e. by gender, by geographic area, by ethnic group) not available for all indicators Data could be presented on a 10 year basis related to the census not on the 5 year interval

14. THANK YOU !!!! Questions?? Comments Pls !!!