PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Barbados is the most easterly of the Caribbean
countries. It is has a land area of 430 km2 and the average temperature
is 270 Celsius with annual rainfall at approximately 1,524 mm.
It is divided into eleven parishes, and has an estimated population of 270,000
in 2000. The capital city, Bridgetown is the most densely populated area with
97,516 persons or 37% of the total population. The country has an excellent
network of roads with highways linking the airport, Bridgetown , the seaport,
the industrial estates and the tourist belts on the west and south coasts
and there is good public transportation. Barbados has a democratic government
with parliamentary elections every five years. Legislative power is vested
in Parliament, which comprises an elected House of Assembly of 28 members,
a Senate of 21 nominated members, and the Governor General who is the Head
of State. The Constitution provides for a Privy Council, and the Cabinet.
The Cabinet, which is comprised of Ministers, is the principal organ of policy
and is presided over by the Prime Minister.
Demography:In
1999, the mid-year population estimate was 267,400 persons, males (48%) and
females (52%). Population under 15 years was 22%, while those over 65 years
were 12%. The birth rate was 14.5 per thousand. Life expectancy at birth was
74.1 years for men and 79.1 years for women. The total labor force was approximately
135,500. At the end of 1999, the unemployment rate stood at 10.4%. The average
household size was 3.5 persons. Information also showed that 70,693 households
(94%) had potable water supplied inside their houses, while the remaining
6% had easy access to potable water supplies. In addition, more than 75% of
households had a telephone service and over 90% had electricity installed.
Economy:
Barbados achieved a record seventh consecutive year of economic growth in
1999. Gross domestic product grew from US $1,354.4 million in 1992 to US $2,068.9
million in 1999. During the period 1993-1999 the annual average rate of growth
was 2.8 percent. Per capita GDP increased from US $5,650 in 1992 to $7,750
in 1999. The main economic sectors were tourism, financial and business services,
manufacturing, agriculture and construction. The Government's fiscal position
was stable during the period 1997-1999. Current expenditure was US $834.2
million and capital expenditure US $128.4, 1999/2000.
Education:
Education in Barbados is compulsory for all children up to the age of 16 years.
The literacy rate is estimated at 97.4%. Information from the 1990 Barbados
Population and Housing Census indicated there were 75,170 households, approximately
44% headed by women.
Mortality:
During the period 1997-1999, the crude mortality rate declined from 9.3 to
8.3 per thousand population. By 1999 diseases of pulmonary circulation and
other forms of heart disease had moved into first position, replacing cerebrovascular
disease as the leading cause of death. Diabetes and ischaemic heart disease
remained in third and fourth places.
SPECIFIC HEALTH PROBLEMS Analysis by populations group Children (0-4 years):Live
births were 3,836 in 1999. Approximately 11% of newborns had a low birth weight.
Under-nutrition in children is uncommon and seldom a cause for hospital admission.
The neonatal death rate was 8.5 per thousand live births in 1999. The leading
causes of deaths in children under five years were due to conditions originating
in the perinatal period, followed by congenital anomalies. Approximately 75
% of all newborn babies were seen in the polyclinics and the remainder in the
private sector. More than 90% of children between 0-4 were immunized against
poliomyelitis, diphtheria, pertussis, tetanus, measles, mumps and rubella, 1997-1999.
All children must be immunized prior to entering primary school. In 1999 the
infant mortality rate was 12.8 per thousand live births.
Schoolchildren (5-9 years): Children
5-9 are 7.5% of population. Children are immunised with BCG at age 5 and over.
In 1999 deaths in the age group 5-14 were due mainly to cancer, diabetes, and
diseases of the digestive systems.
Adolescents (10-14 and 15-19 years): Among
the main causes of illness and death among those 15-24 years were road traffic
accidents, bronchitis, chronic and unspecified emphysema, asthma and HIV/AIDS.
Other health problems included mental health problems related to depression,
substance abuse, suicide and violence. Information from the Drug Rehabilitation
Unit at the Psychiatric Hospital indicates that marijuana and cocaine continued
to be the main substances abused by those under age of 20 adolescents. In 1999
a preliminary report suggested that 36% of students had experimented with cigarettes,
but only 1% were daily smokers.
Adults (20-59 years):Motor
vehicle accidents, violence and other injuries are a major cause of illness
and death among persons 25-44 years. Chronic non-communicable disease has increase
among those 45 years and over. In the age group 45 years to 64 years, heart
disease, diabetes, cerebrovascular disease, malignant neoplasms and HIV/AIDS
were the main causes of mortality. In 1997 there were two maternal deaths reported,
and no deaths in 1998 or 1999.
Elderly (60 years and older):Persons, over
65 years were 30,781 or 12% of the population, 1999, males (40%). In the age
group 65 years and over, the main causes of death were diseases of pulmonary
circulation and other forms of heart disease, cerebrovascular disease, diabetes
mellitus, acute myocardial infarction and pneumonia. Principal causes of medical
consultation were related to hypertension and cardiovascular diseases, respiratory
tract infections, osteoarthritis, diabetes mellitus, malignant neoplasms and
skin disorders. About 4% of the elderly live in institutions. The elderly have
access to primary care available at polyclinics and acute and secondary care
from hospitals. Five Geriatric and District Hospitals provide them with long
term inpatient care.
Worker's health: In 1999 the labor force was
about 135,500 persons. Statistics of the National Insurance Department showed
66,193 workers with sickness and 7,616 with injuries, 1999.
The disabled: There
were 2,197 persons registered with the Children Development Center around 1999.
To facilitate the integration of the physically and mentally challenged, issues
related to parking, seating on public transport, access to buildings and greater
opportunities for education were addressed.
Analysis by type of health problem Vector-borne diseases: Dengue
fever is endemic. There were 511 confirmed cases with five deaths in 1997; 237
cases with 6 deaths in 1998; 696 cases with four deaths in 1999; and 909 cases
with 4 deaths in 2000.
Diseases preventable by immunization: MOH
initiated a campaign to eradicate rubella-51% completed by 2000-immunizing all
men and women in the age group 21-35. Barbados has been free of poliomyelitis
since 1994. Since 1999, booster coverage was provided for children over 4 years.
No reported cases of diphtheria or whooping cough were reported, 1997-2000.
Since 1994 no cases of Tetanus have been reported. All children under five are
immunized against diphtheria, pertussis, tetanus poliomyelitis, measles, mumps,
rubella, and tuberculosis. In 2000, Barbados had achieved 97 % coverage for
DPT, 96% for polio, and 92% for Measles, Mumps and Rubella.
Intestinal infectious diseases: No cases of
cholera, hookworm, or trichuriasis were reported.
Chronic communicable diseases:No
cases of TB meningitis have been reported for more than ten years nor cases
of pulmonary TB in children under 15 years old. Although HIV/AIDS has increased,
there has been no corresponding increase in TB. The incidence rate of TB was
4.6 per 100,000, 1999.
Acute respiratory infections: In 1999, 11,447
asthma episodes were treated in the Queen Elizabeth Hospital . In 1999, the
incidence of broncho-pneumonia in under five year-olds was 96 per 100,000 population.
Health care workers have been trained and a pilot project was implemented in
the schools to train affected children with self-management of the disease.
Zoonoses: There
were no cases of rabies. But there were 6 cases of leptospirosis and one death
in 1999.
HIV/AIDS: As
of 2000 a cumulative total of 2,525 persons had tested positive for HIV - of
these, 1,242 cases of AIDS were reported. Adult population estimated with HIV/AIDS
is 2%, where the 15-49 year olds were 89 % of reported cases. There were 590
new cases of HIV/AIDS with 388 deaths, 1997-2000. The major mode of transmission
was heterosexual contact. The male to female ratio was 2:1. There were no deaths
from HIV/AIDS in the under one year olds in 1997 or 1998.
Sexually transmitted infections: First attendances
for both syphilis and gonorrhea were 6,878 in 1999. Sexually transmitted infections
are not notifiable by law.
Nutritional diseases: Malnutrition in children
under 5 years is not a major problem. There has been an increase in obesity
due to diet and sedentary lifestyles. Data shows that 58% of women and 29% of
men are overweight, while 30% of women are obese. By age 40 years, about 40%
of the population have high blood pressure and 18% have diabetes.
Cardiovascular diseases: In the adult population,
heart and cerebro-vascular disease are one of the leading causes of illness
and death. Discharge statistics for strokes showed 245 in 2000, occurring among
persons 65 and over.
Malignant tumors:Leading sites of cancer were
breast and cervical in women, and prostate in men. Between 1994 and 1998, there
were on average 71 new breast cancer cases per year, cancer of the cervix (33)
and cancer of the prostate (28). Cervical cancer screening is in place for women
in the child bearing age as part of the Family Health program.
Oral Health: The national Oral Health Survey
of children indicated the combined efforts of the private and public sector
dental care was insufficient to meet the needs and demands for services.
RESPONSE OF THE HEALTH SYSTEM
National health policies and plans:The Ministry
of Health (MOH) is both a provider of health care services, and regulator of
the sector. Primary care and health promotion, education and occupational health
are priorities. In 1999, a National Employees Assistance Program aimed at providing
counseling and referrals was introduced. Essential drugs are free to patients
seen in government institutions. Drugs of the Barbados Drug Formulary are provided
free at private participating pharmacies to children under 16, persons with
some chronic non-communicable disease and those 65 years and older. Antenatal
care for pregnant mothers before the twelfth week of gestation and health services
for adolescents are provided at public polyclinics. MOH regulates and monitors
development projects and commercial and industrial activities with respect to
their impact on drinking water and, solid and liquid waste management, hazardous
waste management, air and noise pollution. A drainage-control program was initiated.
Hurricane preparedness exercises were held each year.
Health sector reform: In
the 1990's, health sector reform was seen as critical to improve quality
of care, equity, efficiency, and effectiveness for the long run. Initiatives
undertaken include mental health reform, continuous quality improvement and
accreditation, care of the elderly, care of disabled, and reform of the Queen
Elizabeth Hospital . Mental health care is based upon institutionalized care,
but a strategy to re-orient mental health services away from institutionalized
care towards a community-based model with linkages to the private sector for
treatment and rehabilitation services is envisioned. A policy for a collaborative
arrangement with private sector providers to for long term care of the elderly
was approved. An Advisory Commission of Enquiry was set up in 1998 to review
QEH management.
Institutional organization: The
MOH is the executing agency for the delivery of health care in the public sector.
The health care delivery system includes the publicly funded QEH. It provides
acute, secondary and tertiary care. A network of five district hospitals provides
long term care for the elderly, a mental health hospital and a half-way house,
a long term care facility and a rehabilitation center for the physically and
mentally challenged, and a hostel for homeless persons with AIDS. In 1999, QEH
had 501 beds, more than 90% of the acute beds in the country. The School of
Clinical Medicine and Research of the UWI is based at the QEH using it for teaching
and research. Services at 8 polyclinics are strategically located within easy
access of catchment areas served. Health care services at government facilities
are free of cost. The private health care market, comprised of more than 100
general practitioners and consultants , is growing. There are also private sector
laboratory radiological and diagnostic services. The private Bayview Hospital
provides 30 acute-care beds while 37 private nursing and senior citizens' homes
provide long-term care for the elderly. The polyclinics are supplied with necessary
equipment for the delivery of quality health care. There is a referral system
between clinics, hospitals, the private sector and other support services. Public
health services include family health, such as maternal and child health; adolescent
health; community mental health; dental health; nutrition; general practice
clinics; and environmental health services such as food hygiene, mosquito and
rodent control. The Environmental Engineering Division is responsible for construction
control, and monitoring air and water quality. The Sanitation Service Authority
is responsible for refuse collection, management of the landfill, the maintenance
of cemeteries, and the cleaning of city streets. The Barbados Drug Service,
a WHO Collaborating Center , manages the provision of essential drugs in the
country, ensuring that Barbadians receive affordable quality drugs and pharmaceuticals.
Insurance companies market health insurance packages specifically to credit
unions, trade unions and large organizations. Estimates of private health insurance
coverage in 1995 and 1996 ranged between 18 and 20% of the population.
Regulatory actions: Public
Health Nurses maintain surveillance and investigate notifiable diseases. The
safety and effectiveness of drugs, the operations of pharmacies and pharmaceutical
manufacturing plants are regulated. In 1999, legislation was introduced to regulate
and monitor the operations of private hospitals, nursing and senior citizens'
homes. The professional practice of doctors, nurses, pharmacists, dentists and
para-professionals are regulated by Medical, Nursing, Dental, Pharmacy and Paramedical
Councils. In 1997, the Paramedical Professions Act was amended to include other
professional areas such as dietetics, and nutrition, osteopathy, cardiac technology,
speech language pathology, counseling and educational psychology, acupuncture,
reflexology and nuclear medicine technology. In 1999, legislation to strengthen
control of imported foods imported was introduced.
Health promotion services: The National Consultation
on Health Promotion in 1997 brought government and private organizations together
to discuss approaches for establishing partnerships for improving community
health. The introduction of Health and Family Life Education within the curriculum
of primary and secondary schools has been a major achievement. Legislation to
strengthen management and care for the elderly in nursing homes and senior citizens
homes was provided and a public-private partnership in 2000 was implemented
for this purpose.
Surveillance:The
surveillance of communicable diseases is the responsibility of a team led by
the national epidemiologist and integrated by environmental health officers
and public health nurses working in collaboration with public health and private
laboratories and the Leptosopira Laboratory. The leptospirosis laboratory is
the only one in the sub-region, and performs diagnostic analyses for other Caribbean
territories. Law requires notification of all cases of communicable diseases
listed in the Health Services Regulations to the MOH.
Potable water and sewage disposal: The
Barbados Water Authority provides potable water to households throughout the
country. About 99% of households have direct connections to potable water. The
City of Bridgetown is connected to a sewerage system and one on the south coast
of the country is near completion.
Solid Waste Services: Refuse collection services
are provided twice per week in densely populated districts, once per week in
rural areas, and daily in the City of Bridgetown .
Food protection and control:Surveillance
of food catering establishments licensed under the Health Services Act is ongoing.
Each year, th e MOH provides training courses for food service personnel. The
MOH continued to collaborate with the Ministry of Agriculture and the private
sector in an effort to control the rodent population.
Food assistance:
Most primary school students are provided affordable meals. The Welfare Board,
the Barbados Red Cross Society, church-based organizations and other NGOs provide
food for the needy. In the public sector home-helpers prepare meals and take
care of the elderly. The National Advisory Committee on AIDS facilitates a food
bank program for persons living with HIV/AIDS.
Ambulatory Services, Hospitals and Emergency Services: There
are both public and private ambulatory health care services. Outpatient clinic
attendances at the QEH for the major causes of chronic illnesses - diabetes,
hypertension, cardio-vascular diseases, ophthalmology and nephrology - numbered
110,194. In 1999 the private sector provided about 55% of ambulatory care visits
for primary and specialist care services and 87% of ambulatory visits for dental
services. These services are financed by consumers or private health insurance.
The polyclinics also provide a significant share of ambulatory care that includes
attendances for maternal and child health services, dental services and general
practitioner visits.
Health supplies: Supplies
for medical and other health care purposes are obtained for the public sector
through a government central purchasing agency. Most supplies are imported.
Immunobiological and reagents:Vaccines are
purchased through the PAHO/WHO revolving fund and reagents for laboratory use
and diagnostic procedures through the main medical laboratory at the QEH. Bacteriological
testing is also done in collaboration with CAREC. Barbados is in the process
of setting up MRI services with public/private sector collaboration. CT Scan,
ultrasound, mammograms, angiograms, and regular X-rays are available at the
QEH.
Human resources: In
1997 Caribbean Health Ministers addressed the issue of movement of professional
between countries. This included accreditation of training institutions; registration
of professionals and identification of human resources needs, and establishment
of training priorities. QEH is a teaching hospital used by UWI Faculty of Clinical
Medicine and Research. In the 1990s there was an out migration of professionals
causing nursing shortages. Thus, 120 nurses are being trained per year at the
Barbados Community College (BCC). BCC also trains environmental health officers,
medical records clerks, laboratory technicians, pharmacists, registered nurses,
nursing assistants and rehabilitation therapy technicians. Also, MOH provides
continuous education programs for health personnel.
Sectoral expenditure and financing:Health care services are financed through Government
expenditure on publicly provided services, out-of-pocket payments, by private
health insurance. Government allocation to MOH accounts for about 16% of total
government expenditure. In 1999/2000 the expenditure of the MOH was US$ 148
million of which 22% was allocated to family health, environmental health services,
dental health and health promotion. Expenditure on the South Coast Sewerage
Project and the Integrated Solid Waste Management Program was 16% of the MOH
budget, 1999/2000. Allocation of expenditures to secondary and tertiary care
services was about 39%, care of the elderly, 8% and provision of pharmaceuticals
10%.
External health technical cooperation and financing: PAHO,
Caribbean Regional Drug Testing Laboratory, Caribbean Food and Nutrition Institute,
Caribbean Epidemiology Center, Caribbean Environmental Health Institute Caribbean
Health Research Council and the Inter American Development Bank provided technical
and financial assistance mainly in the areas of environmental health, public
health, human resources development, research methodology and health promotion.
This cooperation has mainly comprised training programs, technical assistance,
development and use of information systems and the improvement of laboratory
testing.
