1. Health System of SURINAME Maltie Algoe Elly van Kanten Monitoring and Analyzing Health System Change and Health Reform, May 30 th – June 1 st, 2006 - Belize

2. 2 Content: Health System Characteristics Health System Characteristics Health System Performance Health System Performance Health Status and Outcomes Health Status and Outcomes Relevant Trends and Interventions Relevant Trends and Interventions

3. 3 HS Characteristics Guiding principle: Health care is the right of every citizen (Constitution, art. 36, sub 2) Overall Goal: To achieve optimal health status for the majority of the population through provision of available, accessible and affordable health care

4. Main responsibility of the MOH To promote Public Health through : 1. Improvement of living and working conditions 2. Health education Main tasks: Policy Development Policy Development Health Planning / Regulation Health Planning / Regulation Coordination / Supervision Coordination / Supervision Monitoring & Evaluation Monitoring & Evaluation Quality Assurance Quality Assurance

5. Supply: MOH MOH Professionals Professionals NGO’s NGO’s Demand: Population Finance: MOF MOF MSA MSA State Health Ins. State Health Ins. Private Insurance Private Insurance Out-of-pocket Out-of-pocket

6. 6 Population (census 2004): 492 829 by ethnicity: 00-04 05-09 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90-94 95-99 3000020000100000 2000030000 MalesFemales

7. 7 Organization & Management Planning division Legislation division Public Relations External relations Inspectorate NAP STI Clinic Dermatology services Foundations and Institutions PHC: - Regional Health Services - Medical Mission HOSPITALS Psychiatric Center Bureau of PUBLIC HEALTH General affairs: - Personnel - Finance - Maintenance - Expedition

8. 8 Structure of the MOH Main Office: Central Administration (incl. Planning and Legislation) Main Office: Central Administration (incl. Planning and Legislation) Inspectorate Inspectorate Bureau of Public Health Bureau of Public Health

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10. 10 Primary Health Care Coastal area Coastal area - RHS (8 districts, 50 clinics, 100,000 clients) - Private GP’s Interior Interior - MM (2 districts, 50 centers, 50,000 clients) Several NGO’s providing: SRH services SRH services Health Promotion Health Promotion (Home) Care & Support (Home) Care & Support Research Research

11. 11 Secondary Health Care 5 General hospitals: 2 private (one with link to interior) 2 private (one with link to interior) 3 public (two with ER, one specialized in MCH) 3 public (two with ER, one specialized in MCH) 1 Mental hospital Total # of beds: 1318 # of beds per 1000 pop: 2.7 Occupancy rate: 70 %

12. 12 Human resources (2004) Number of Physicians400 Number of General Practitioners295 Number of Medical Specialists105 Number of Dentists42 Number of Non - university trained nursing personnel1 745 Number of registered nurses778 Number of midwifes57 Rates per 10,000 pop (2004) Physicians per 10,000 population8. 2 Dentists per 10,000 population0.9 Non – university trained nursing personnel per 10,000 pop35.4 Number of registered nurses per 10,000 population15.8 Number of midwifes per 10,000 population1.2

13. 13 20002002 Gross Domestic Product (GDP)836.1 mln US $ 879.9 mln US $ GDP per capita1,915 US $1,925 US $ National Health Accounts Total Health Expenditure (THE)78,763,778 US $… THE per capita180.33 US $… THE as % of the GDP9.42%… Public Health expenditure (PHE) 34.1 mln US $ 31.7 mln US $ PHE per capita78.1 US $69.4 US $ PHE as % of the GDP4.07%4,97% PHE as % of THE43.33%…

14. 14 Distribution of spending by payer National Health Accounts, MSH, march 2002

15. 15 Distribution of spending by level of care National Health Accounts, MSH, march 2002

16. 16 Insurance coverage (Census 2004)

17. 17 Health Status and Outcomes Vital Statistics, 2004 Population492,829 Average Population growth rate1.4% Percent of urban population59.40% Total number of registered live births9,062 Total number of registered deaths3,289 Crude birth rate per 1 000 pop18.7 Crude mortality rate per 1 000 pop6.7 Life expectancy at birth (years)71.5 Total fertility rate2

18. 18 10 Leading causes of Hospitalization ( 2000) 1. Pregnancy, Childbirth and Puerperium 1. Pregnancy, Childbirth and Puerperium 2. Gastrointestinal diseases 2. Gastrointestinal diseases 3. Hypertension and Cardiovascular diseases 3. Hypertension and Cardiovascular diseases 4. Diseases of the respiratory system 4. Diseases of the respiratory system 5. External causes 5. External causes 6. Diseases originating in Perinatal period 6. Diseases originating in Perinatal period 7. Cerebrovascular diseases 7. Cerebrovascular diseases 8. Malign neoplasmata 8. Malign neoplasmata 9. Certain Vector-borne diseases 9. Certain Vector-borne diseases 10. Urogenital disorders 10. Urogenital disorders

19. 19 10 Leading causes of death, 2000 - 2004 1. 1. Cardiovascular diseases 2. External causes 2. External causes 3. Malign neoplasmata 3. Malign neoplasmata 4. 4. Diseases from the perinatal period 5. HIV / AIDS 5. HIV / AIDS 6. DM 6. DM 7. Respiratory disorders 7. Respiratory disorders 8. Gastro – intestinal disorders 8. Gastro – intestinal disorders 9. Diseases of tractus Urogenitalis 9. Diseases of tractus Urogenitalis 10. Intestinal disorders 10. Intestinal disorders

20. 20 Achievement of MDG’s Immunization Coverage 85% PMR, IMR & <5 MR per 1000 of LB

21. 21 Maternal Mortality Rate Deliveries by skilled personnel 90%

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24. 24 Performance: Strengths & Opportunities Performance: Strengths & Opportunities Demand: Strong NGO involvement Strong NGO involvement Increasing awareness for health rights Increasing awareness for health rightsSupply: Independent financing and provision of health care Independent financing and provision of health careFinancing: Subsidized health care for the poor Subsidized health care for the poor Social health insurance for civil servants Social health insurance for civil servants Global Fund for HIV/AIDS, TB and Malaria Global Fund for HIV/AIDS, TB and Malaria

25. 25 Performance: Weaknesses & Threats Demand: HIV/AIDS (increasing infections) HIV/AIDS (increasing infections) Illegal abortions (est. 10,000 /year) Illegal abortions (est. 10,000 /year)Supply: Weak MOH Weak MOH Structural migration of nurses Structural migration of nurses Unequal access to health care Unequal access to health care Insufficient focus on cross cutting issues : Gender, Environment, Youth Insufficient focus on cross cutting issues : Gender, Environment, YouthFinancing: No correlation between health expenses of 9,4% of GDP and quality of care No correlation between health expenses of 9,4% of GDP and quality of care

26. 26 HSR “Support for HSR” (1st project) (1998 – 2003) Series of studies on: Household Budget Survey Household Budget Survey National Health Expenditures (NHA) National Health Expenditures (NHA) Performance of PHC Performance of PHC Actuarial model for the State Health Insurance Actuarial model for the State Health Insurance Drug Procurement Drug Procurement Integration of SHI and MSA Integration of SHI and MSA Payment Systems Payment Systems Distribution of medical cards Distribution of medical cards Quality Assurance Quality Assurance

27. 27 HSR “Support for implementation of HSR” (2 nd project) (2004 – 2008) Project Components: Improve performance of preventive and primary health care services Improve performance of preventive and primary health care services Improve access to medicines Improve access to medicines Reduce costs and improve efficiency Reduce costs and improve efficiency Improve equity Improve equity Strengthen MOH Strengthen MOH

28. 28 Health Sector Plan (2004 – 2008) Strategies 1. Strengthening primary care and prevention 2. Improving both efficiency and quality of hospital care 3. Promoting the financial accessibility of health care services 4. Health care cost control 5. Strengthening support systems (procurement, logistics, communication, NHIS) 6. HRD (quality, quantity, motivation) 7. Improving and safeguarding quality

29. 29 Multi-annual Development Plan (2005-2010) & MOH policy note (2006 – 2007) Planned interventions (Policy Framework): National health costs insurance and financing National health costs insurance and financing Improve infrastructure Improve infrastructure Basic health care package (focused on prevention) Basic health care package (focused on prevention) Improve management (QA, data acquisition) Improve management (QA, data acquisition) HRD and HRM HRD and HRM Critical review of health- and environmental legislation; Critical review of health- and environmental legislation;

30. 30 Relevant Trends / Interventions Strengthen PHC: Special attention for deprived areas and vulnerable groups; Special attention for deprived areas and vulnerable groups; Community Participation Community Participation Addressing chronic diseases Addressing chronic diseases Integration of preventive components in PHC Integration of preventive components in PHC Emphasis on prevention (  health education), early detection (  screening) and secondary prevention (  multidisciplinary treatment) Emphasis on prevention (  health education), early detection (  screening) and secondary prevention (  multidisciplinary treatment)

31. 31 Relevant Trends / Interventions Intersectoral approach: Recognition of intersectoral influences on health (by agriculture, labor, education, housing etc) Recognition of intersectoral influences on health (by agriculture, labor, education, housing etc) Need for intersectoral cooperation (e.g. in HIV/AIDS) Need for intersectoral cooperation (e.g. in HIV/AIDS) International commitments: MDG’s (demanding specific attention) MDG’s (demanding specific attention) Global Fund (demanding coordinating mechanism) Global Fund (demanding coordinating mechanism)

32. Thank you