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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 The Commonwealth of Dominica is situated in the Windward
Islands between Martinique and Guadeloupe . The island has a land area of 790
km˛. It has 8 active volcanoes, an abundance of rivers, and a rainforest covering
65% of the land. The population is concentrated in coastal towns and villages.
Dominica is divided into 10 parishes and the health services are organized into
7 health districts. Dominica is centrally administered with a parliamentary
type democracy. General elections are held every 5 years.
Demography: At the end of 1999, the population
was 76,069; (50.9% males; 49.1 % females). A third of the population is under
15; 12.5%, 60 years and over, and 71% urban. The Carib Indians, Dominica 's
indigenous population, number 4,500 persons, and are mainly concentrated on
a reservation of 15.3 km2. The Carib population is young; 70% under
30 and 40 % under 19 years old. Economic activity is mixed, mainly subsistence
farming, craft production and boat building. In 1999, women were the head of
37 % of households and in 1998, household size was 3.1. The fertility rate per
thousand females aged 15-44 continued a decline in 1996-1999 averaging 82.7.
In 1997-1998, the crude birth rate was 17 per 1,000 population . There was no
underregistration of births. There were 1,293 births in 1999. The crude death
rate 1996-1999 averaged 7.8 per 1,000 population and was 8 in 1998 and 1999.
In 1996-1999, infant mortality was 17.3 per 1,000 live births, 0.8 higher than
1992-1995. In 1999, it increased to 24. Life expectancy at birth, 1995-2000,
was 68.7 years (72.8 in females; 64.8 in males).
Economy: The economy in the 1990s experienced
sluggish growth and is in transition from relying on banana exports. The real
GDP rose from US$ 2,077 per capita in 1996 to US$ 2,177 in 1999. Socio-economic
conditions in the rural area have been negatively impacted by the decline of
the banana industry. A labor force survey in 1997 estimated unemployment at
23%. Among people 15-30 years, it was 34%; in women 27.1%, in men 19.6%, and
in some parishes, as high as 45.9%.
Education: The literacy rate in 1998 was 85%
(84% in females, 86% in males). Preschool education is provided to 3-4 year
olds in 82 schools. In 1999-2000, primary school enrollment was 99% and 88%
in secondary schools; 16% of secondary school students attend the Community
College.
Mortality: In 1996-1999, 2,333 deaths were
recorded (52.7% male). About 25% of all deaths occurred in those aged 15-44
years (67.1 % males), and 59% in those 70 years and over. Diseases of the circulatory
system accounted for 55% of all deaths, neoplasms 29%, external causes 9%, diseases
originating in the perinatal period 4%, communicable diseases 4% and deaths
from ill-defined causes 38%. Males accounted for 75% of all deaths and 65% of
deaths from neoplasms; 57% of deaths from diseases of the circulatory system
were female. Death certification by a medical doctor is mandatory and death
registration is complete.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years):Neonatal
health services at the main hospital are limited to basic secondary care; tertiary
care is not available on the island. More than 99% of all births are assisted
by a trained health care professional. From 1996-1999, 58 perinatal deaths occurred,
35 from slow fetal growth and fetal malnutrition. Of the 95 infant deaths 1996-1999,
59% were early neonatal deaths with prematurity the underlying cause in 64%
of these. In 1996-1999, 16 deaths occurred in the 1-4 age group, 25% from congenital
abnormalities. The immunization program routinely offers DPT, Polio, BCG, MMR
. In 1997, coverage with DPT and polio reached 92 and 97%, respectively. No
cases of vaccine preventable diseases were reported during 1997-2000. Normal
growth is reported for 89.8 percent of children in that age group, but 9.2%
were obese 1997-2000. In 1999, 10% of newborns had low birthweight. In 1999,
103 cases of gastroenteritis were reported. Diarrheal diseases caused 2 deaths
in 1997, one in 1998 and none in 1999. Only one death in 1999 was recorded from
acute respiratory infections.
Schoolchildren (5-9 years):At
age 5 all school entrants are screened in the school health program for vision,
hearing, anemia, growth and development and general physical health. In 1996-1999,
14 deaths in 5-9 years olds occurred -- 11 were males; 5 were accidental, 3
from motor vehicle accidents and one, homicide.
Adolescences (10-14, 15-19 years): Adolescents
represented 22% of the population in 1999; 3% were illiterate. Health risks
are alcohol use, other substance abuse, STIs including HIV, violence, accidents
and underemployment. During 1996-1998, 78 cases of suicide and attempted suicide
were reported -- more than half ( 53%) in adolescents under 18 years. Suicide
accounted for 3 deaths. During 1996-1999, 66 deaths were recorded in this age
group. The leading causes of death were transport accidents, injury due to violence,
other accidents, and epilepsy.
Adults (20 - 60 years):
During 1997-1999 , 98 % of births in health facilities occurred among females
aged 15-44 years. Antenatal services are used by 97% of women., averaging 5
visits per pregnancy. 20% of the admissions to the PMH was for Obstetric causes.
During 1996-1999 there were 2 maternal deaths. Oral contraceptives are most
frequently used and Pap Smears are examined in public and private laboratories.
Health among young men is challenged by violence, injury from external causes,
motor vehicle accidents, drug abuse and sexually transmitted infections.
Elderly (60 years and over):
The age group 60-79 years old represents 7% of the population with 3%, 80 and
over. Chronic non-communicable diseases greatly effect the morbidity and mortality
of this age group. During 1997-1999, 71% of deaths occurred in those 60 years
and older; 49% in the 60-79 age group and 51%, 80 years and over. Three community
day-care centers for the elderly were organized in the rural and urban areas
by community based organizations. Most of the elderly reside alone or with family
members; 1.8% are in institutional care. In 1999, a national policy on older
persons emphasized independence, participation, care, self-fulfillment and dignity.
Family Health A National Health and Family Life Education Committee, established
in 2000, has the responsibility for policy review and program redefinition.
Workers Health:Work
site conditions are monitored by the Labor Division and the Environmental Health
Department. In 1999, the Dominica Social Security received 114 claims for employment
injuries; 99 % from males. Of these injuries, 25% originated in the manufacturing
sector and 22% in the government sector. In 1999, of 4965 claims for sickness
benefits, 56% were from female workers.
Disabled: A
1999 school survey revealed that 233 children in the age group 5-9 years had
moderate to severe disabilities. Disabilities ranged from mental deficiencies,
sensory, physical and communication disorders. The Alpha Centre, an NGO, provides
education, parental skills training and parental support for 160 children. A
school for the hearing impaired has an enrollment of 26 children.
Indigenous Population:
In 2000, the Carib Affairs department was established for community development
and poverty alleviation. Changes in the socio-economic conditions and increased
access to health and education have improved the health status of the Caribs.
In 1999, the following health concerns were identified - lack of potable water,
solid waste disposal, violence, drug abuse including alcoholism, tuberculosis,
sexually transmitted infections, and helminthiasis. The Carib Territory is served
by two health centers.
Analysis by type of health problem Natural Disasters:The
country is vulnerable to natural hazards such as tropical storms and hurricanes.
Damage and rehabilitation costs from Hurrican Lenny in 1999 were estimated at
US$140 million and repairs are still on-going. In 1997, the Layou River landslide
and floodings caused great socio-economic impact to the country. A National
Volcanic Plan was produced in 1999. A seismic report concluded that a magmatic
eruption was probable within the next ten years.
Vector borne diseases:In
2000, the dengue virus serotype III was introduced for the first time. Serotypes
I and II circulate in the country. There was one death due to dengue hemorrhagic
fever. In 2000, the Aedes aegypti household index was 13% and the Breteau Index
29%. Malaria was eliminated on the island in 1962, but 6 cases were imported
during 1997-2000. The Anopheles mosquito is present in three localities. Yellow
fever vaccines are given to residents traveling to endemic countries. During
1997-2000, 35 persons were vaccinated.
Immune preventable diseases: There
were no cases of acute flaccid paralysis in the 1990's and no confirmed cases
of measles since 1991. All pregnant women receiving antenatal care in the public
sector are covered with tetanus vaccine. Haemophilus Influenza B vaccine is
only given to children in the private sector. In 2000, 21,026 persons aged 12-35
received MMR and 99% of children ages 1-5 years received their second dose.
During 1997-1999, 47 donors (1.5%) tested positive for Hepatitis B antigen;
98% of health care workers were immunized for Hepatitis B. In 1997-2000 there
was one adult death from tetanus.
Cholera and other intestinal infectious diseases:
In 2000, 6% of 3,752 stool samples were positive
for intestinal parasites. In 1998-2000, the most frequent were entamoeba coli,
followed by giardia lamblia, hookworm and strongyloides. There were 13 cases
of typhoid fever during 1997-1999.
Chronic communicable diseases: One
case of leprosy was reported in 1998 and 19 cases of tuberculosis 1997-1999.
There have been no reported cases of TB/HIV co-infection over the period.
Acute respiratory infections :
In 1999, 520 persons living with asthma registered in primary care clinics.
Common colds were the leading cause of illness at primary care facilities.
Zoonoses: No
cases of rabies were reported during 1997-1999.
HIV/AIDS:A
total of 69 persons tested positive for HIV. The male :female ratio ranged from
2:1 to 3:1. The predominant mode of transmission was male to male. The highest
percentage of HIV positives in 1997-2000 were aged 20-54 years; 10 children
under 4 and 9 adolescents tested positive. Eight blood donors tested positive
from 1997-2000; 4 in 2000. During 1997-1999, 26 people died of Aids.
Sexually transmitted infections: Data
1997-2000 from the public laboratory indicate that 50 blood donors (1.6%) tested
positive for venereal disease and 47 (1.5%) were positive for Hepatitis B antigen.
HTLV1 testing began in 1999 and 40 donors (2.3%) were positive. In 2000, 205
(6.5%) of samples were strongly VDRL reactive
Nutritional and metabolic diseases: In
1997, a micro-nutrient study in four health districts found Vitamin A deficiency
present only in the age group 1-4-years. No beta-carotene deficiency was found.
Anemia was found in 34% of children 1-4 years with no gender variation. Vitamin
E deficiency with no gender bias was noted in 8% of 1-4 years olds. Diabetes
is a major public health problem. As of December 1999, 2044 diabetics were registered
at primary health care clinics; 0.7% of the population. Diabetes is the second
most frequent cause of visits to a health clinics and was the fourth principal
cause of death each year 1997-2000.
Cardiovascular diseases: Hypertensive
heart disease and hypertensive disease have been among the three principal causes
of death since the 1990s. In 1999, there were 4,041 hypertensives registered
in primary care clinics -- 5.3% of the population.
Malignant Tumors:This
group was among the three leading causes of death 1996-1999. During 1997-2000,
333 malignancies were confirmed by histopathology. The main sites were breast
(17%), cervix (11%), skin (9%), stomach (7%), and prostate (6%). Pap Smear Screening
is available and breast self examinations promoted. Mammography is not available
on the island.
Accidents and violence: Accidents
and violence have increased 1997-2000. Transport accidents are among the ten
principal causes of death; an average of 10 persons died each year 1996-1999.
In 1996-1999, 52 deaths were due to violent injury. According to police reports,
crimes of a sexual nature have increased in frequency. Domestic violence, particularly
violence against women, is now a recognized problem.
Oral health: Oral
health services are provided at all 7 primary health care units, and in 5 private
facilities.
Mental health: In
1998, 58% of admissions to the Psychiatric Unit were male; 30 % were 20-30 years
old. More than 75% had a primary diagnosis of schizophrenia. In 1997-2000, police
reported a total of 27 suicides. Drug abuse, particularly cocaine and marijuana,
is on the increase. In 1997-2000, 66% of those arrested for drug offences were
males.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:
T he Health Sector policy is oriented towards reducing government subsidies,
increasing user fees and promoting greater private sector participation in health
services delivery. The MOH strategy focuses on Health Promotion, reorganization
of the Health Sector, Health Infrastructure, and Health Program Development.
Priority groups identified in the Corporate Plan 2000/2001 are - children under-5
years, pregnant and lactating mothers, women of childbearing age, adolescents,
the elderly and males in the reproductive age group.
Health sector reform: During
1997-2000, initiatives were focused on health care financing through the implementation
of a user fee system, cost containment, equity and quality of care. An evaluation
of the User Fee System in 2000 resulted in reduced fees and exemptions for certain
categories.
Institutional organization of the health system:
Health services are primarily government operated
and financed. Private services are limited to ambulatory care delivered by practitioners
and the DPPA, offering family planning services. Each health district has well
defined boundaries, staff, budget and the capacity to deliver primary health
care services. Primary health care services are decentralized and delivered
from 52 health clinics/centers, and two district hospitals. Secondary care services
are centralized, but specialist staff from the PMH conduct opthalmological and
psychiatric referral services in every health district. Private health insurance
is offered through several companies. Group insurance schemes are available
for all major employment categories.
Organization of regulatory actions:T he Environmental Health Services Act No . 8 of 1997
provides the basis for pollution control and waste management and the authority
to make food safety regulations. There is no monitoring of the quality or delivery
of health care in the private sector. The Medical Act (1944) allows monitoring
of the drug supply in private pharmacies. The Medical Board regulates, to a
degree, the practice of medicine, including registration. There is no requirement
for the registration of alternative medicine practitioners. The Nursing Council
regulates the practice of nursing.
Environmental protection: Environmental
impact assessments and hydro-geological studies are pre-requisites for the implementation
of all major projects, which must be formally approved by the National Physical
Planning Board. The Pesticides Control Board monitors the importation, use,
and impact of pesticides and chemicals. The Environmental Health Department,
MOH monitors water and food quality, and household and premises inspection.
The Veterinary Division issues importation licenses and inspects meats and fish.
There is no mechanism in place for the evaluation of medical technology.
Health promotion: In
1999, the MOH instituted a Health Promotion Resource Center and trained staff
in health promotion and health education. Renewed emphasis has been placed on
the healthy community, healthy school approach.
Epidemiological surveillance:A
need exists to identify and control risk factors for chronic non-communicable
diseases. Active epidemiological surveillance exists mainly for communicable
diseases. However, there is no systematic process for collection, analysis,
and dissemination of information. The seven Type III health centers have been
designated sentinel stations. One public and one private health laboratory provide
services for the island.
Drinking water/liquid and solid waste:
In rural areas, 90% of the population has access to potable water supply and
100% in urban areas. Water is chlorinated in 98 % percent of the systems. Deforestation
and agricultural activities are major problems negatively affecting drinking
water resources. Access to adequate excreta disposal facilities is available
to 85% of the population -- a 20 % increase over 1996. In some areas, particularly
the West Coast, the coverage is as low as 60%. In rural areas, the pit latrine
is the most common mode of disposal.
Solid waste:The
Solid Waste Management Corporation has responsibility for the collection, storage
and disposal of solid waste. The Environmental Health Department of the MOH
monitors and controls the system. Only 60% of the population has access to all
services offered by the Corporation. The remaining 40% utilize composting, reuse,
burning and burying. Hospital and health facilities solid wastes are incinerated
on the premises.
Air pollution: There
is no program for the monitoring or prevention of air pollution.
Protection and control of food: The
Ministry of Agriculture, which issues licenses, is responsible for the approval
of the importation of meats. The Bureau of Standards regulates food importation
and safety. The Environmental Health Department has a system of inspections
at the port, warehouses, food stores, food production and vending facilities
and through health education. All food establishments and vendors must be registered.
Surveillance of food-borne illnesses is inadequate.
Organization of individual health care services:Primary
health care services are delivered through seven health districts each with
a peripheral network of type I clinics and one type III health center per district.
Each Type I clinic serves a maximum 3000 persons within a five mile radius and
services delivered include child and reproductive health, nutrition, health
education, medical care, community action and emergency services. A Type III
center functions as the administrative headquarters for each district and is
equipped with a dental unit, one or two beds for deliveries of pregnant mothers
and provides a comprehensive range of services and health education. In addition,
two small district hospitals have facilities for inpatient care. Secondary care
services are provided at the Princess Margaret Hospital , with a capacity of
225 beds. The facility provides inpatient services, ambulatory specialist clinics,
emergency service and diagnostic services. Tertiary care is available in neighboring
islands, financed mainly from private sources. There is one private laboratory
on the island. There are no private inpatient care facilities.
Essential drugs and medical supplies: The
country participates in the regional pharmaceutical procurement system for the
Eastern Caribbean . There is a national formulary and a well-defined process
for the rationalization and update of drug availability and use. The budget
for drugs and medical supplies is about 8% of the national health budget. During
1997-2000, an annual average of US$ 890,000 was spent for drugs and medical
supplies.
Human resources: Health personnel have been
secured through assistance programs from the governments of France , Cuba and
Nigeria . Two Dominican institutions train health care professionals; the government
run School of Nursing and the privately owned USA offshore medical school. Continuous
education for nurses is delivered through the nursing school. The medical school
trains doctors primarily for the US market and very few locals attend. Local
physicians receive training at The University of The West Indies and outside
the region.
Health sector financing: The
government expenditure on health averaged 13.9% of the total recurrent budget
1997-2000; in fiscal year 1999/2000 it was US$ 11,148,500. The MOH is the third
largest consumer of government resources. Over the last four years, the secondary
hospital has received an annual average of 48.7% of funds compared to 22.5%
for primary health care services. The level of private resources spent for health
is unknown.
External health technical cooperation and financing: In
1997-2000, bilateral international partnerships for health continued with the
government of France , Cuba , Nigeria , Taiwan, and Japan . Cuba provided training
and supplied specialists. Nigeria provided technical assistance in the field
of medicine, nursing and laboratory technology. France provided funding for
the new operating theatre at PMH, in addition to technical assistance and training
of health care professionals. Some funding for health facilities development
and equipment was obtained from the European Union. Dominica has also collaborated
with and benefited from regional initiatives, organizations and international
organizations. The Brenda Strafford Foundation funded the construction of a
Type I health center in 1999/2000; continues to meet the operating cost of four
health centers, and contributed substantially to opthalmological services.
