1. Country Presentation Saint Lucia

3. Caribbean Map

4. Macro-economic and Socio – Economic Profile - Summary MIDDLE INCOME OECS TERRITORY of 238 sq. miles GDP US$ 625.9 MILLION per capita GDP US$ 3928 5 % ON HEALTH - US$ 196 per capita (8%) 68% public and 32% private Steadily growing and aging population Rising unemployment (18%) Low incomes (25% below poverty Line) Large and growing informal sector

5. Overview of the Health and Social System Central Ministry of Health Professional bodies that structure and regulate the sector ( MDA, NA, PC. PHB) Health Providers and Health Professionals (Public, NGOs, Private) Financing Agents ( CF, PI, NIC, UHC) Community/local organisations Clients

6. Structure of the Health System Central Ministry of Health Eight Health regions 32 health centres 1 polyclinic 2 district Hospitals 2 general Hospitals and 1 Private hospital 1 Psychiatric Health facility 1 Drug rehabilitation facility Support services – located hospitals ( private) Universal Health Care – (NHI)

8. What is Affecting our Health ? Personal Behaviors, attitudes and Lifestyles Level of Education Environment in which we live and work Access to and availability of Health Services Attitude of Health care professionals Health conditions affecting the Global Economy

9. What are the Issues Affecting the Health System The ability of the economy to sustain the health system due to change in disease profile and increase health care cost Supply of Health Professionals and appropriate skill mix Technological changes Interaction of the health system with other sectors in the economy Fragmentation of Health System Inadequate Investment in Health Inefficient health information system

10. PRINCIPAL CAUSERankNo.Rate Diabetes Mellitus113381.9 Cerebrovascular Diseases211671.4 Ischemic heart diseases36137.8 Pulmonary heart Diseases, disease of pulmonary circulation 45131.4 Acute respiratory infections54225.9 Assault (homicide)63823.4 Malignant neoplasm of the digestive organs73722.8 Malignant neoplasm of prostate83622.2 Chronic Lower respiratory disease93219.7 Land Transport Accidents103018.5 10 Leading causes of death by rank for 2004

11. Trends in Mortality Indicators 1994 2004 Total deaths 950 1072 Crude death rate 6.6 6.5 Live expectancy at birth ( male) 68 71 Live expectancy at birth ( female) 72 77 Infant Mortality rate 12 16.2 Child (1-4 years ) mortality rate 5 4.1

12. 1. Accidents and adverse effects2,540 years 1. Accidents and adverse effects2,540 years 2. Perinatal conditions1,764 2. Perinatal conditions1,764 3. Malignant neoplasm1,421 3. Malignant neoplasm1,421 4. Heart disease1,110 4. Heart disease1,110 5. Homicide1,102 5. Homicide1,102 6. Congenital anomalies 797 6. Congenital anomalies 797 7. Diabetes Mellitus 520 7. Diabetes Mellitus 520 8. Cerebrovascular disease 369 8. Cerebrovascular disease 369 9. Suicide 369 9. Suicide 369 10. Chronic liver disease 195 10. Chronic liver disease 195 The top ten causes of death in terms of years of potential life lost (YPLL) p.a.

13. General Conclusions Morbidity & Mortality Neonatal deaths is a major contributor to infant mortality Injuries and accidents principal cause of deaths for children 1-4 years, adolescents and adults especially males Teenage pregnancies and low birth weight persistently high in spite of reduced fertility

14. General Conclusions (Cont) Diabetes is the principal cause of death and suffering among persons 45+ years; Malignant neoplasms is a major cause of death among adults and older persons (prostate, breast and cervix) HIV/AIDS - Increasing incidence, particularly among youth and adult females Improve environmental health through monitoring of food, water and environmental determinants of chronic and communicable diseases

15. Present Health Sector Response The Health System focuses on Disease Prevention and Management. Heavy emphasis on Disease Surveillance The system is reactive rather than proactive. Decisions made are not always evidenced based Limited Service integration Insufficient emphasis on client focused care HSR – NHSP, UHC, HMIS, HR and Training Plan

16. What do we want to achieve The Overall Goal : Producing a nation of productive people capable of Contributing to national wealth and development

17. Policy Guidelines Caribbean Cooperation in Health II MDG’s Primary- Based Health Care Model Caribbean Charter for Health Promotion

18. Main Objectives Improve the health care delivery system Reduce incidence of communicable and non-communicable diseases Enhance productivity Improve quality of life

19. Main Deliverables Increased access to quality health care Value for money Equity in health care

20. PRIORITY AREAS FOR ACTION AND CHANGE National Health Strategic Plan System Development Sustainable Financing Quality Improvement Networking

21. SYSTEM DEVELOPMENT Organisation of the Health Service Institutional Strengthening Physical Infrastructure and Outfitting

22. Health Service Organisation Convert health centers into health development units Establish Community Improvement committees ( PAHO healthy community initiative) Rationalisation of primary health care services Integrate levels of care and programmes ( mental health) Regional Health Team Approach

23. Institutional Strengthening Refocus and restructure MoH (leadership: policy development and planning, regulation, monitoring and evaluation) Development of National Health Information Systems Development of Human Resource Plan Improve management structures – central ministry, region and community

24. Proposed Relationships MOHNIC/UHC Hospitals Service Agreement Quality standardsFinancing Service quantitiesFinancial Audit Patient ServicesSupport to Regional PHC Services

25. Proposed Structures CMO Central MOH Programme Heads e.g. Gros Islet Polyclinic, Dennery Hospital, Soufriere Hospital, Nutrition, Env. Health, Dental, CDC N-CDC, Reproductive Health, etc. 9 Regional Health Teams Health Centres Hospitals PNO Policy, Standards, Monitoring

26. Improvements to Physical Infrastructure Refurbishment, rehabilitation and expansion of health centres ( CDB, BNTF, World Bank) Construction of New General Hospital (EU) Construction of Mental Health Facility (PRC)

27. SUSTAINABLE FINANCING Financial accountability of unit managers Develop National Health Insurance system – Universal Health System - Ensure access to an essential package of health care services

28. QUALITY IMPROVEMENTS Implement a quality improvement system Establish regulatory frameworks Develop appropriate legislation and update medical by-laws Adopt an evidenced-based approach to health care service delivery.

29. NETWORKING Strengthening community, regional, inter-ministerial and inter-sectoral collaboration Develop clear, objectives and policies Advocate for a healthy nation Regional Health Institutions International linkages

30. How will we facilitate change - Tools Integrated planning Intersectoral collaboration Health communication and marketing Community involvement/participation Quality Improvement System Lobbying and advocacy Health management and information system-monitor and measure health sector performance, health outcomes

31. Training Community Psychiatric Nursing Continuous Quality Improvement- Management and Administration- financial management and public health leadership Health Services Research Family Nurse Practitioners Public Health Nursing

32. Thank You SAINT LUCIA