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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 Jamaica is the largest English-speaking island in
the Caribbean Sea . It is located 150 km south of Cuba and 160 km west of Haiti
and covers an area of 11,424 km˛. It is divided into 14 parishes. There are
two main cities - Kingston the capital and Montego Bay. The government is based
on the Westminster parliamentary model. The Governor-General represents the
Queen of England as the head of state. A cabinet of ministers, selected from
the bicameral legislature and headed by the Prime Minister, forms the executive
branch of government.
Demography:
In 2000, the population was estimated at 2.6 million. The annual rate of population
growth declined from 1.0% in 1996 to 0.6% in 1999. The crude birth rate declined
from 20.8 per 1,000 population in 1999 to 20.0 per 1,000 in 2000. Children age
0-14 years accounted for 31% of the total population in 2000. In 1998, life
expectancy at birth was estimated at 75 years (73 for males and 77 for females).
Approximately 86% of the population age 15 years and older are literate.
Economy:
The economy is open and import-dependent. Tourism, bauxite mining, and primary
agriculture exports, including sugar and bananas, are the traditional mainstays
of the economy. Private remittances from abroad continue to play an increasingly
important role in the economy. In 1999, GDP at current prices was estimated
at J$256.8 billion (approximately US$6.6 billion). The rate of inflation was
8.2%. Central government deficit was 5% of the GDP in the 1999-2000 period.
An estimated 16% of the population was below the poverty line in 1998.
Mortality: Infectious diseases, maternal and
infant mortality, and childhood diseases have decreased significantly. In 1999,
there were 15,372 certified deaths. There was an increase in the numbers of
homicides and accidents; these were among the leading causes of death in 1999.
Transport accidents comprised 85% of all accidents. The gender differential
in mortality was greatest for these two external causes. Young males accounted
for the most deaths from these two causes. Males had higher death rates than
females for malignant neoplasms, heart disease, and HIV/AIDS. The risk of dying
from cerebrovascular disease, hypertension, and diabetes was higher for females.
Diseases of the circulatory system accounted for 31% of all certified deaths.
Neoplasms accounted for 17%, and external causes for 13%. Conditions originating
in the perinatal period accounted for 4% and communicable diseases for 4% of
all certified deaths.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): The
infant mortality rate in 1999 was approximately 16 deaths per 1,000 live births,
which is generally regarded as an underestimate. There were 941 certified deaths
among children age 5 years and younger. Conditions originating in the perinatal
period were the most important cause of mortality for this age group (67% of
deaths). Congenital defects accounted for 9.1%, communicable diseases 5.0%,
external causes 2.8%, and HIV/AIDS 2.2%. Homicides (10 deaths) and transport
accidents (7 deaths) were the largest contributors to deaths due to external
causes. Other leading causes of death included influenza, pneumonia, and nutritional
deficiencies. Acute respiratory tract infections, poisoning, unintentional injuries,
gastroenteritis, and violence were among the leading hospital discharge diagnoses.
Schoolchildren (5-9 years): The
main problems among approximately 1,200 children seen in government-operated
child guidance clinics in 1999 include attention deficit, adjustment, and conduct
disorders. Data from the accident and emergency departments indicated that schoolchildren
accounted for 20% of accidental laceration, 14% of burns, and 10% of poisonings.
In 1999, this age group accounted for 11% of cases of sexual assault and 6%
of injuries inflicted with blunt objects. The number of children who lived on
the streets increased; most of these children are boys.
Adolescents (10-14 and 15-19 years): One
in every five Jamaican is an adolescent. They accounted for only 2% of deaths
in 1999. The major causes of hospitalization were injuries, respiratory diseases,
including asthma, and neoplasm. Adolescents accounted for 23% of intentional
injuries and 20% of accidental injuries treated at accident and emergency departments.
Injuries and respiratory diseases were also the main causes of deaths occurring
in hospitals. Among the 15-19 years age group, obstetrical conditions among
females and intentional injuries among males were the leading causes of hospital
admissions. Injuries, cardiovascular diseases (associated with rheumatic heart
disease) and HIV/AIDS were the leading causes of death. Adolescents age 10-19
years accounted for 53% of cases of sexual abuse seen in accident and emergency
departments. Rates of HIV infection were three times higher in adolescent girls
than boys, while AIDS was among the five leading causes of death in this age
group.
Adults (20-59 years): In
1999, the prevalence of hypertension and diabetes was high among women age 20-59
years. Diabetes accounted for one of every nine deaths, and the rate of diabetes
among women increased from 51.8 per 100,000 population in 1990 to 59.9 per 100,000
population in 1999. Breast and cervical cancers were leading causes of cancer
mortality in this group. The Women's Crisis Centre's profile of abused
women showed that sexual assault was reported by 59% of respondents and physical
assault with or without a weapon by 90%. Of those injured, only 26% reported
the incident to the police. In 2000, maternal mortality was estimated at 110
deaths per 100,000 live births. Complications such as hypertension in pregnancy
and postpartum hemorrhage were the main causes of maternal mortality. In 2000,
syphilis and hemoglobin testing were carried out on 75% and 74% of women attending
clinics at health centers, respectively. The level of syphilis in the prenatal
population declined from 6% in 1996 to 2 % in 2000. The prevalence of anemia
in pregnant and lactating women remained high at 15 % but these levels may also
reflect pre-pregnancy levels, as testing is done at the first prenatal visit.
Of the 1,925 prenatal attendees, 1.2 % tested positive for HIV. The highest
number of positive cases (36%) was in the age group 20-24 years. The Constabulary
Statistical Department reported that 100 women were victims of homicide. 50%
of women of reproductive age were current users of a family planning method.
In 1999, cardiovascular diseases and diabetes mellitus were among the leading
causes of hospital admission and death among adult males. Injuries were the
leading causes of morbidity among men age 20-44 years. Men accounted for over
60% of all intentional injuries seen at accident and emergency departments.
Cancer of the prostate, trachea, bronchus and lung, and stomach were the five
most common causes of cancer death among males. Accidental injuries and motor
vehicle accidents were also more common in men.
Elderly (60 years and older): In
1999, cardiovascular disease were the leading cause of admission among persons
60 and older, followed by diabetes mellitus. The leading cause of hospital deaths
in 1999 was cardiovascular disease, followed by diseases of the respiratory
system. In 2000, persons age 60 years and older accounted for 9.7 % of the population.
The main non communicable diseases affecting the elderly were hypertension,
arthritis, overweight, and diabetes.
Workers Health: In
1999, the Ministry of Labor monitored factories whose workers comprised 5% of
the employed labor force. The Ministry reported 223 accidents from these factories,
for an accident rate of 4.8 per 1,000 workers. The case fatality rate among
these workers was 2.2 deaths per 100,000 in 1999.
The Disabled:Almost
10% of the population was disabled with physical disability ranking as the highest
type (29%). Persons with visual disability accounted for 12%, multiple disabilities
14%, mental illness 8%, and mental retardation 5%.
Analysis by type of health problem
Natural Disasters: Between 1996 and 2000, the
major disasters in Jamaica were floods in the parishes of Portland and St. Mary.
Vector-borne diseases: An
outbreak of dengue occurred in 1998 with 1,509 reported cases. In 2000, there
were 25 cases. No indigenous cases of malaria were reported; however, there
were 7 imported cases.
Diseases preventable by immunization: Immunization
coverage in 2000 was 94% for BCG, 86% for DPT, 86% for polio, and 88% for MMR.
During 1996-2000, there were 15 cases of congenital rubella. There were 36 laboratory-confirmed
cases of hepatitis B infection in 1996 and 174 in 2000.
Respiratory diseases: Respiratory
tract infections accounted for 12% of all visit to accident and emergency departments
of hospitals in 1999, with asthma accounting for 49% of these visits.
Zoonoses: In
2000, 24% of samples were seropositive for Leptospira, compared to a seropositivity
rate of 51% in 1998.
HIV/AIDS: The
national incidence of AIDS in 2000 was 352 per 1,000,000 population. The main
mode of transmission was heterosexual (61% of cases). The cumulative number
of AIDS cases from 1982-2000 was 5,099 for a male to female ratio of 1.6:1.
The case fatality rate was 61%. There were 414 cases in children with a case
fatality rate of 54%.
Sexually transmitted infections: There
were 17 cases of congenital syphilis in 1999 compared to 36 cases in 1996.
Cardiovascular diseases: In
1999, cardiovascular disease was the second leading cause of death for a rate
of 84.6 per 100,000 population. It was the leading cause of death among hospital
inpatients, accounting for 33% of deaths.
Malignant neoplasms: There were 2,407 deaths
due to malignant neoplasms in 1999 (93.2 per 100,000). Among males, prostate
cancer caused 30% of cancer deaths, lung 17%, and stomach 9% with death rates
of 28.9, 15.9, and 9.1 per 100,000 respectively. Among females, breast cancer
caused 18% of deaths, cervix uteri and other unspecified uteri 14%, colon and
rectum 8%, with death rates of 15.8, 12.9, and 7.1 per 100,000 population respectively.
Accident and violence:
In 1999, three surveyed hospitals documented more than 12,000 injuries in a
6-month period. Injuries accounted for 17% of hospital discharge diagnoses (excluding
obstetrics) in 1999. Violence related injuries accounted for 49% of injury visits
at accident and emergency departments. 3 % of all visits to the accident and
emergency departments were for accidental injuries and 2% for motor vehicle
accidents.
Emerging and re-emerging diseases: There
were 17 cases of Haemophilus influenzae meningitis during 1999-2000, 75% of
the cases were children between the ages of 6 months and 5 years.
Mental Health: In
2000, schizophrenia accounted for 49% of patients seen at mental health clinics.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:The Ministry of Health revised its health policy in
1997 and identified major health policy goals and operational objectives. Three-year
corporate plans and annual operational plans were developed with the involvement
of stakeholders.
Health sector reform: The
main elements of the reform process are decentralization and integration of
services; restructuring the Ministry of Health at the central level; promotion
of quality assurance standards; broadening financing options; and creating partnerships
with the private sectors.
Development of legislation: Several
acts were passed in 1997: the National Health Services Act, the Decentralization
of Management of Health Care Act, and the Mental Health Act. With respect to
quality assurance, there were amendments to acts governing the health care practice
of various professionals and requiring registration of additional groups. Promotion
of individual responsibility for health was supported by the Seat Belt Law (1999).
Three new regulations under the Public Health Act were enacted in 2000, including
food establishment and facility regulations impacting on tourism.
Decentralization of health services:The Ministry of Health is divided into two broad areas--administrative
and technical services. The Permanent Secretary is responsible for the administrative
services while the Chief Medical Officer is responsible for the technical services.
Decentralization of the health sector began in 1996 with the creation of Regional
Health Authorities. Thus, decision-making capacity was removed from individual
hospitals and parishes and vested in the Authorities. Some central level functions
were devolved to the Authorities.
Private participation in the health system:Private
health care is provided by general physicians and specialists, and by private
laboratories, pharmacies, and hospitals. Non-governmental organizations also
provide ambulatory health care, targeting the poorer segments of the population.
Modalities of health insurance and their respective
coverage:There is only one specialized health
insurance provider that offers individual and group plans. Life insurance carriers
also provide group health plans. Difference by consumption quintile exist, ranging
from almost no coverage for the poorest quintile (0.4%) but steadily increasing
with each successive quintile, to a high of 33% coverage in the wealthiest quintile.
Persons age 60 years and older had significantly lower levels of health insurance
coverage compared with younger individuals.
Organization of regulatory actions: The
Ministry of Health established the Standards and Regulation Division in 1999.
The Division developed standards for maternity centers and nursing home staff;
protocol for the management of chronic diseases were developed and a criterion-based
clinical audit was introduced to survey the competence of health professionals
in the management of major obstetrical emergencies. The Government chemist is
responsible for testing drugs and other chemicals and the Bureau of Standards
is responsible for monitoring food standards and safety. The Environmental Control
Division conforms with international chemical and biological standards for food
safety, water, and sewage. Management of municipal solid waste falls under the
jurisdiction of the Ministry of Local Government. The Pesticide Control Authority
is responsible for minimizing the adverse effects of pesticides on the environment
and human health.
Organization of public health care services:The health promotion strategy focuses on changing
lifestyles. The HIV/STI program focuses on surveillance, STI control, behavior
change communication, laboratory testing, research, monitoring and evaluation.
Health analysis, epidemiological surveillance
and public health laboratory systems: Communicable
disease surveillance was conducted using both active and passive systems. In
1999, the Jamaica Injury Surveillance System was established in hospitals with
computerized information systems. Special projects include the physician-based
sentinel surveillance system and the survey for Invasive Bacterial Meningitis,
Septicemia, and Pneumonia in Children. Public health laboratories, including
the National Public Health Laboratory, provide testing services in public hospitals.
Organization of individual health care services:
The health system offers primary, secondary,
and tertiary care. Ambulatory care at the community level is delivered through
a network of 343 health centers. Secondary and tertiary care are offered via
23 government hospitals and the teaching hospital of the University of the West
Indies , with a combined capacity of 4,802 beds. Approximately 38% of the population
utilize the public sector for ambulatory care, 57% use the private sector, and
5 % use both sectors. Private sector health services are provided through an
extensive network of professionals offering specialist services, and by family
doctors throughout the island. A number of non-governmental organizations provide
health services for a nominal fee. The blood bank receives blood from 12 blood
collection centers. All blood is screened for HIV, HTLV, HbsAg, HCV, and VDRL.
Rehabilitation services in the public sector include physiotherapy, social work,
speech pathology, and occupational therapy. Non-governmental organizations provide
specialty support for the disabled.
Health supplies: Jamaica
has a national formulary; a vital, essential, and necessary drug list, and policies
relating to the use of generic drugs.
Human resources: Training
programs have not been able to meet the demand for health personnel except in
the area of medical doctors, dental nurses, and community health aides. Shortages
are compounded by the continual loss of public sector personnel to the private
sector, and by migration of personnel to other countries.
Health research and technology: The use of
evidence-based data to guide program development has been merged with the concept
of Essential National Health Research with linkages with the University of the
West Indies and other national, regional, and international organizations. Advances
in health technology and the purchase of new diagnostic equipment have increased
service delivery options and contributed to decreased morbidity and length of
stay for many surgical conditions.
Health sector expenditure and financing: The
Ministry of Health's budget grew from US$118.2 million in 1995-96 to US$188.2
million in 1999-2000. The Ministry's budget as a percentage of the Government
budget was 7.0 % in 1997-1998 but fell to 4.7% in 1999-2000.
External technical cooperation and financing:
Technical cooperation and financial support
are received from regional institutions, intergovernmental organizations and
international organizations, as well as through bilateral and multinational
agreements.
