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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 St. Lucia , with a total land area of 238, 616
km2 is an island of the Caribbean. The majority of the population
inhabit the coastal areas and the less mountainous regions of the north and
south. It has a democratic system of government similar to the Westminster
model. St. Lucia is a member of the Commonwealth of Nations , the Organization
of Eastern Caribbean States (OECS) and the Caribbean Community (CARICOM).
Although the official language is English, a French patois is commonly used,
particularly among the rural population. Roman Catholicism is the dominant
religion. According to the 1991 census 86 % of the population is of African
descent, 2.6% are of East Indian descent and 9.6% are of mixed ancestry.
Demography: The population of St. Lucia
was estimated at 153,819 in 1999. The annual growth rate between 1980 and
1999 was 1.8%. Population is concentrated in the northern districts. About
39% live in the district of Castries, where the capital city of Castries is
located. The tourism and residential infrastructure of the northern district
of Gros Islet have developed significantly over the past decade, resulting
in continuous internal immigration. The establishment of industrial complexes
in the district of Vieux Fort in the south has impacted upon the geographic
redistribution of the population. A good network of roads link most communities
and villages to the main urban centers. Females account for 51% of the total
population, with women of child-bearing age (15-44 years) representing just
over 25%. About 32 % of the total population is below 15 years of age while
the elderly (60 years or older) only account for 7.9%. Persons in the economically
productive ages (15-64 years) comprise 62% of the total population. The dependency
ratio for 1999 was 62%. Between 1992-1995 and 1996-1999, live births fell
from 14,741 to 12,842 and the crude birth rate dropped from 26 to 21 per 1,000
population. With respect to high risk pregnancies, live births delivered by
females 10-14 years were 2,049 (16%), while live births delivered by women
35 years or older were 1,536 (12%), 1996-1999. The general fertility rate
was 85 per 1,000 females aged 15-44 and the total fertility rate 2.4 per woman,
1995-1999. Life expectancy at birth increased by two years for males (from
67 to 69 years) and for females (from 72 to 74 years) between 1996-1999. The
1991 census data suggests a net migration of 1,500 persons per year for the
1980 to 1991 period with a further decline of about 560 per year noted between
1992 to 1998.
Economy: St. Lucia grew steadily during
the early 1990s. GDP increased by an average 3.2% between 1988-1991, and by
3.9% for 1992-1995, grew by only 2.2% 1996-1999. Per capita GDP was $ US 2,785
in 1999. The last National Literacy Survey (which was conducted in 1990 and
only included persons 15-65 years) found that 54 % of the sample was literate,
27% illiterate and 19 % functionally illiterate. Illiteracy was highest in
the rural areas. About 70% of the illiterate population were females. Males
comprised 53% of employed population in the first half of 1999.
Mortality: Total deaths were 3,837 and the
crude death rate was 6.4 per 1,000 population, 1996-1999. Diseases of the
circulatory system were the principal cause of death (38%). Neoplasms and
external causes represented 16% and 9%. External causes of death are more
than three times greater for males than females; 1996-1999.The number of deaths
was higher for males for most broad causes.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (1-4 years):
En 1996-1999 there were 50 deaths among children 1-4 years of age: deaths
from congenital anomalies (10), accidents (9), intestinal infectious diseases
(6).
Schoolchildren (5-9 years): There
were 31 deaths among children 5-9 years of age, 1996-1999. Among these 11
deaths were from accidents.
Adolescents (10-14 and 15-19 years):There were 27 deaths for adolescents 10-14 years
of age, 1996-1999. Among these 10 deaths were from accidents of which 7 were
male. The number of deaths of adolescents 15-19 years of age was 47, 1996-1999.
In this group accidents contributed 21 deaths of which 20 were male and 50%
of male deaths were due to Land transport accidents. Seven deaths among all
adolescents were due to accidental drowning, 1996-1999.
Adults (20-59 years): Deaths
to adults was 975, 1996-1999. The 3 leading causes of death 1996-1999 were
malignant neoplasms (197) or 20% and accidents and adverse effects (125) and
heart disease (120), where the last two disease groups each contributed around
12% of adult deaths. Male deaths were 593: accidents (101), malignant neoplasms
(86) and heart disease (70). Female deaths were 382: malignant neoplasms (111),
heart diseases (50), and cerebrovascular disease (26) contributed 29%, 13%
and 7%.
Elderly (60 years and older):Deaths
to adults 60 years of age and older was 2524: heart disease (731) malignant
neoplasms (553), 1996-1999. Among males, heart disease, malignant neoplasms
and cerebrovascular diseases contributed 372, 309 and 220 deaths. Among females,
heart disease, malignant neoplasms and cerebrovascular disease contributed
359, 244 and 233 deaths. Formal and informal social security systems are available
to the elderly. Many older persons are unable to access the health services
due to geographical location and/or transportation problems. Community Health
Aides visit elderly persons in their homes and communities on a regular basis.
Workers' health: The
Occupational Health and Safety Unit is responsible for monitoring the health
of workers in St. Lucia . Injuries accounted for 71 % of all claims submitted,
trauma or fracture on the job (11%), and burns (3%). The National Insurance
System covers about 60% of all workers.
The disabled:The
National Council of and for Persons with Disabilities (NCPD) provides services
to approximately 10,000 persons with disabilities.
Analysis by type of health problem Natural disasters: The
National Emergency Management Organization (NEMO) is responsible for disaster
preparedness. In 2000, The Disaster Preparedness and Response Act legalized
the actions of NEMO. Saint Lucia is a member state of The Caribbean Disaster
Emergency Response Agency (CDERA), an inter-governmental regional disaster
management organization established by CARICOM. Hurricane Lenny struck in
November 1999, causing an estimated at US $6.3 million damage.
Vector-borne diseases:
No cases of yellow fever, malaria [imported] (3) schistosomiasis (59), were
reported, 1996-1999.
Diseases preventable by immunization:
Immunizations given to children under 5 years of age are: diphtheria, whooping
cough, tetanus (DPT vaccine), poliomyelitis (OPV vaccine) measles, mumps,
rubella (MMR vaccine), and tuberculosis (BCG vaccine). No cases or deaths
were reported for these diseases among children under 5 years of age, 1996-1999.
Vaccination coverage rates between 88 % and 100% of children under 1 year
were maintained, 1990-1999, and there were no reported cases of vaccine preventable
diseases.
Intestinal infectious diseases: No
cases of cholera, cases of typhoid fever (3), salmonellosis (16) and shigellosis
(70) as well as 5,969 cases of diarrhea were reported, 1996-1999.
Chronic communicable diseases:
Tuberculosis TB increased from 82 to 93 between 1992-1995 and 1996-1999. Part
of this increase in cases is attributable to better reporting since 1999. The
M:Fratio was 1.7:1 in 1996-1999. Pulmonary cases comprised all cases in 1992-1995
and 92% of all cases for 1996-1999. The number of deaths have varied from 27,
1992-1995 to 13, from 1996-1999.
Leprosy:Cases
of leprosy were 37, 1996-1999.
Acute respiratory infections:A
total of 629 cases of influenza, 20% of all reported cases of ARIs, were reported
among children under 5 years of age, 1996-1999. In addition, ARIs were responsible
for 80 deaths, where pneumonia accounted for 79, 1996-1999.
Zoonoses:No
cases or deaths from rabies have been reported in St. Lucia for the past two
decades. Cases of leptospirosis were 40, 1996-1999. It is noted that an active
surveillance system for monitoring leptospirosis and other communicable diseases
was implemented in 1996, while two deaths from leptospirosis were reported
that year.
HIV/AIDS: There
were 254 cumulative cases of HIV infection since 1985. AIDS cases were 135
(78 males, 57 females), of which 116 persons (64 males, 52 females) - 86%
had died by the end of 1999. Over the period 1985-1999, the number of reported
cases of AIDS increased steadily for all ages. The number of cases doubled
for males and tripled for females, reducing the male-female ratio from 2.2:1
in 1985-1989.to 1.4:1 in 1995-1999.
Cardiovascular disease:
There were 731 deaths due to cardiovascular disease from 1996 to 1999, accounting
for 19% of all deaths and 53 % of deaths ratio of 5.8:1. Most (21 or 62%)
occurred in the 15-44 years age group, and had a male-female ratio of 9.5:1.
Cardiac arrest caused 268 cardiovascular deaths (37%), ischemic heart disease
174 (24%), pulmonary circulation and other forms of heart disease 134 (18%),
and heart failure 153 (21%). Females accounted for 359 (49%) of deaths due
to cardiovascular disease, and persons 60 years of age or older accounted
for 588 deaths (80%).
Malignant neoplasms: Malignant
neoplasms accounted for 553, 14% of all deaths, 1996-1999; of these 56% were
males. The three most common sites among males were prostate (95), stomach
(32) and trachea/bronchus/lung 2)
Vector-borne Diseases There
were 18 cases and one death from dengue fever, 1996-2000. In 1999, there was
one imported case of malaria. No cases of yellow fever, Chagas' disease, plague,
or schistosomiasis were recorded, 1996-2000. 3 ) For women, the important
sites were breast (44), cervix uteri (43) and stomach (19), 1996-1999. The
M:F death ratio was 7.7:1, 1996-1999. Cancer of the genital organs was the
leading contributor to cancer deaths for both sexes 1996-1999; digestive organs
were second. Cancer of the breast contributed 17% of all cancer deaths and
respiratory organs (13%).
Accidents and violence:Accidents
and violence were responsible for 337 deaths, 9% of total deaths, 1996-1999.
Of these 235 deaths were due to accidents and homicides. The M:F ratio from
external causes for all ages was 3.7:1, Also, deaths from accidents represented
70% of all external causes of death, 1996-1999. Deaths from Motor vehicle
accidents (98), 42% of this category, 1996-1999; the M:F ratio 5.1:1. Deaths
from accidental drowning accounted for 37 deaths or 16 % of deaths due to
accidents, 1996-1999. The majority of drowning fatalities were males (32).
Homicide with 61 deaths was the second most frequent external cause, 1996-1999.
The M:F ratio was 5.1:1. There were 34 suicides where the M:Fratio was 5.8:1,
1996-1999.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans: The
main objective of the National Health Policy of the Ministry of Health (MOH)
for June 1993 to July 2003 is to maintain and upgrade the number of human
resources present and future. The National Health Policy covers health personnel,
revenue collection, technology use, population growth, vulnerable and at-risk
groups, substance abuse, workers' health, environmental issues, HIV/AIDS,
community participation.
Health sector reform: A
Health Sector Reform Committee appointed in 1997. The main issues for health
sector reform included decentralization of management and functions, integration
of different levels of care, improved financing and quality assurance. It
is guided by the following principles: community participation, decentralization,
intersectoral collaboration, evidence-based decision-making, quality care
assessment, and institutional strengthening and sustainability. The Planning
Unit within the MOH adjusted the implementation plan, and developed a communication
plan and strategy jointly with the Bureau of Health Education; funds were
approved for its implementation in the 2001/2002 budget.
Organization of the health sector: Various
departments within the MOH are responsible for the implementation of health
programs such as health education, environmental health, preventive services,
hospital and curative services. Primary health care services are mainly provided
at the 34 health centers and two (2) district hospitals. In addition to routine
general medicine clinics, special services are offered in obstetrics/gynecology,
pediatrics, surgery, sexually transmitted infections and mental health. Special
clinics and basic services are offered to diabetic and hypertensive clients
at the primary care facilities. Secondary and specialized care and services
are provided at the three general hospitals and the psychiatric hospital.
Although clients may seek care at any facility, the administration and management
of health facilities are based on the catchment population.
Private participation in the health system: Many
medical and dental practitioners work in both the public and private sector.
Nurses have recently been employed in the hotel industry and in private home
nursing care.
Health insurance:The
main types of health insurance are private health insurance for individuals
and groups, and coverage by the National Insurance Scheme (NIS). The NIS pays
an annual contribution to the MOH to cover in-patient hospital expenses for
employees who contribute to the NIS.
Certification and professional health: The
Medical and Nursing Councils are responsible for the registration and monitoring
of doctors and nurses, and the Medical Board for dentists, pharmacists and optometrists.
Drugs: The
use of prescription drugs is monitored by the Chief Pharmacist of the MOH.
Quality of the environmental: The
monitoring of water quality is the responsibility of the Environmental Health
Branch. The Pesticide Control Board is responsible for the registration and
licensing of pesticides. The Ministry of Planning is response for physical development
and the environment.
Health promotion:
Within the MOH, the portfolio of health education and promotion falls with
the Bureau of Health Education. Other ministries and non-governmental agencies
are also involved in health promotion and education.
Disease prevention and control:
Disease prevention programs exist for TB, leprosy, HIV/AIDS, dengue fever,
measles and (STIs). Activities include surveillance, management and treatment
of cases, and special clinics (STIs). A National Tuberculosis Register was
established in 1996 and a cancer registry was established in 1995. The Expanded
Programme on Immunization (EPI) has maintained high vaccination coverage for
many years; and the incidence of vaccine preventable diseases is very low.
High-risk pregnancies are monitored and iron supplements and counseling provided.
Screening programs are offered for cervical, breast and prostate cancer. Preventive
services are free except for contraceptives and vaccinations required for
college entry, and yellow fever.
Epidemiological surveillance systems: Sources
of data for the Communicable Disease Surveillance System are: routine medical
clinics held at the 34 health centers and two district hospitals. The system
captures information on notifiable diseases, HIV infection and AIDS, measles,
rash and fever illness, as well as acute flaccid paralysis on a weekly basis,
suspected cases of fever, diarrhea and dengue, TB. The Food Unit of the Environmental
Health Department bears responsibility for food protection, control and safety.
Inspections of food service establishments and wholesalers are conducted at
least three times per year. Food handlers are monitored.
Organization and function of health care
services of populations: The Environmental
Health Branch is a department within the MOH responsible for the delivery
of environmental health services including food and water safety, vector control
and sanitation services. The Water and Sewerage Authority is responsible for
the collection, storage and distribution of potable water.
Ambulatory, emergency and in-patient services:
There are six hospitals (5 public, 1 private),
three acute general hospitals, two district hospitals, and one psychiatric
hospital. Some primary care is provided to out-patients at medical clinics
and at the accident and emergency departments of the general hospitals. The
two district hospitals provide primary care as well as in-patient care for
minor medical, surgical and pediatric problems, as well as maternity units
for low-risk deliveries. The psychiatric hospital provides in-patient and
some primary care to out-patients through community psychiatric clinics at
the hospital and in seven other districts. There is a drug and alcohol detoxification
center.
Primary care services: Out-patient
services for general morbidity are provided at medical clinics at the health
centers and at district hospitals and through the casualty or emergency departments
of acute general hospitals. Medical and pharmaceutical services are made available
at health centers and district hospitals. Maternal and child health (MCH)
services offered at MCH clinics include antenatal and postnatal care, as well
as immunizations of children.
Health supplies: Drugs are provided through
the Organization of East Caribbean States (OECS). All vaccines used in the
public sector are procured through PAHO's Revolving Fund. A National Procurement
Committee is in place to coordinate the procurement of biomedical equipment.
Human resources:
Personnel employed by the health (public-sector) increased between 1985 and
1999. Between 1989 and 1999 the ratio of physicians, trained nurses and dentists
per 10,000 population increased from 4.3 to 5.3, from 19 to 20, and from 0.76
to 0.85 respectively.
Training: The
Sir Arthur Community College is the local institution that trains health personnel.
Community Health Aides are trained by the Community Nursing Department. Training
of other categories of health personnel are not provided locally. In-service
training for health professionals is frequently organized by the MOH and other
health related organizations. Cuba provides scholarships for training in medicine
and other health related areas. The UWI offers training in medicine, environmental
health, health education and other related areas.
Labor markets for health personnel:Most of the available health personnel are employed
in the public sector. Traditionally, doctors, dentists and pharmacists are
the majority of health professionals employed in the private sector but private
companies offering diagnostic services and optical care are now available.
Health sector expenditure and financing:Primary sources of funding for Government recurrent
expenditure comprise taxes and user fees. The National Insurance Scheme makes
an annual contribution to the consolidated fund to cover in-patient hospital
expenses. The execution of many major capital projects has relied heavily
on international aid. The per capita budget on health for 1999 was about US$
120 and the health budget as a proportion of GDP was 4.3%.
External technical cooperation and financing:
The health sector of Saint Lucia received
technical and financial assistance from several external agencies and governments,
1996-1999. The European Development Fund provided US $741 thousand for the
rehabilitation and reconstruction of the Victoria hospital. The European Union
funded several projects: Major repairs to public facilities, construction
of a shelter for victims of abuse, furniture and equipment, Integrated Child
Protection and Development Programme, and Care for the Elderly; funds amounted
to US $1,290,370. The Department for International Development (DFID) funded
a project proposal for a new Women's Support Center . The French Government
provided funding for the construction of the new maternity wing and equipment
for the Victoria hospital; computer software, hardware, and the services of
a French epidemiologist for the Epidemiology Unit of the MOH. The Cuban government
provided US $92,593 to cover the cost of a feasibility study for the construction
of a new psychiatric hospital. The Chinese government donated US $14,815 to
the 'Golden Fund' which was established by the Minister of Health to raise
funds for the construction of the new psychiatric hospital.
