Official Name: Barbados
Capital City: Bridgetown
Official Language: English
Surface: 430 km 2
PAHO Subregion: Non-Latin Caribbean
UN 2 digits Code: BB
UN 3 digits Code: BRB
UN Country Code: 52


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.

    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.

    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.

    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.