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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 Montserrat is a tiny island of approximately 102 km˛,
situated in the volcanic island chain that stretches from Saint Kitts in the
north to Grenada in the south. In 1989, Hurricane Hugo had virtually destroyed
Montserrat and the island was still recovering from its effects, when after
lying dormant for nearly 400 years, the Soufriere Hills volcano erupted in July
1995 and devastated Montserrat , altering the lives of its residents forever.
Most of the population fled the island as soon as the volcano erupted. The southern
two-third of the island was declared unsafe and the population moved to the
north, a sparsely populated and poorly developed part of the island. Much work
had to be done in the north for this area to support life and allow the population
to survive. Over a relatively short period of time, two-thirds of the population
left Montserrat and settled either in the U.K. , the U.S.A, or other neighboring
Eastern Caribbean islands. Montserrat is a British dependency that has its own
system of Government, with a Chief Minister and three other Ministers duly elected
by the people, as well as a Governor who represents the British Government.
The volcano totally destroyed the former capital, Plymouth, and a new center
in the north, at Brades, has since been developed and functions as the Government
headquarters. Elections were held in 1996 but no party won a clear majority
and a coalition government was formed.
Demography:
Mid-year population estimates show a drop from 10,608 in 1995, to 6,094 in 1997,
and to 3,595 in 1998. In 1999, as the situation stabilized, people began to
return to the island, including many migrant laborers. Consequently, the mid-year
population estimate increased, to 4,771 in 1999 and to 4,938 in 2000. These
migrants, both male and female, continue to enter Montserrat because of the
building boom and the availability of certain jobs. They come mainly from Dominica,
but also as far away as Guyana and Jamaica. In 1999, there were 2,536 males
and 2,235 females in Montserrat. There were 35 live births in 1998, 45 in 1999,
and 48 in 2000. The general fertility rate, generally considered low, was 43.1
per 1,000 women of childbearing age in 1999. The male-female ratio was 1.1:1
in 1999. The dependency ratio decreased from a high of 83 in 1997 to 70 in 1999.
Economy:
Prior to the volcanic eruption in 1995, Montserrat's tourism-based economy was
relatively stable, with a GDP in 1995 of US$ 51.5 million. The economy is no
longer self-sustaining and the country is overwhelming dependent on outside
assistance (US$ 35 million in 1999). Montserrat is heavily dependent on the
British Government and its Department for International Development (DFID).
The Government employs 48% of the labor force. Mortality:
The crude death rate was 15.9 per 1,000 in 1998, 12.4 per 1,000 in 1999, and
9.1 per 1,000 in 2000. There were 57 deaths in 1998, 59 in 1999, and 52 in 2000.
The leading causes of death in 1998 were diseases of the circulatory system,
diseases of the respiratory system, diseases of the nervous system, and malignant
neoplasms. There were no deaths from communicable diseases, except for one in
1999 from AIDS, and no deaths occurred in the perinatal period.
SPECIFIC HEALTH PROBLEMS
Analysis by population group Children: There
were no infant deaths during 1997-2000. There were 251 cases of acute respiratory
infections among children under 5 years in 1998, 300 in 1999, and 240 in 2000.
There were 27 cases of gastroenteritis in this age group in 1998, 8 in 1999,
and 16 in 2000. There were 56 cases of gastroenteritis among children age 5-9
in 1998, 28 in 1999, and 33 in 2000. During 1997-2000, there were 60 pediatric
hospitalizations-15 were for respiratory diseases and 15 were for surgery.
Adolescents: Mental
health is an area of concern among adolescents, especially violent behavior
and the use of illegal substances, mainly marijuana. There was one birth in
the 10-14 years age group in 1998, and none in this age group in 1999 or 2000.
There were 17 births among 15-19 years old from 1998 to 2000.
Adults: There
were 109 births among 20-59-year-olds from 1998-2000. All births 1997-2000 took
place in the hospital and were attended by nurse-midwives, except for one in
2000 that was delivered at home. In 2000, a total of 77 admissions and 49 deliveries
were recorded in the obstetrics ward of Glendon Hospital. There was one maternal
death in 2000 and one stillbirth. Persons in the age group 25-44 years make
up a high percentage of those seeking attention at the Casualty Department of
the Glendon Hospital. In 1999 and 2000, diseases of the respiratory system,
injuries, abnormal clinical findings, and diseases of the musculoskeletal system
were the main reasons for attendance.
Elderly:The
natural disaster especially affected the elderly, many of whom had previously
lived independently. Left homeless and dislocated from their families who had
migrated, they were affected financially, socially and emotionally. This situation
has left them completely dependent and has had a serious negative impact on
their mental health. The 60 years and over age group accounted for 21 % of the
total population in 1999, with a male-female ratio of 1.1:1. Most people in
this age group do not receive a pension and those who qualify receive a monthly
allowance around US$ 150 from the Government. Three homes provide 140 beds for
long-term geriatric care; two of these are run by the Government and one by
an NGO with a subsidy from the Government.
Family health: After
the volcano erupted, 74% of all households were relocated. A social survey in
1997 noted an average of 1.9 persons per household of 1,762 families identified.
37% were single-person households, with the occupant under 60 years of age;
25% were childless; and 14% had occupants that were exclusively 60 years and
over.
Disabled:
There are no special services for the physically disabled. Wheelchairs and other
devices to assist the physically disabled are generally provided by the Montserrat
Red Cross. More complex devices (e.g., an artificial limb) have to obtained
abroad. There are no formal health care facilities for people with learning
disabilities. A number of families with dependent disabled relatives have gone
overseas where facilities are better.
Analysis by type of health problem Vector-borne diseases: Though the vector Aedes aegypti is present on the island, there were no cases
of dengue between 1994 and 2000. In 2000, two cases were confirmed. There were
no cases of malaria, yellow fever, Chagas' disease, schistosomiasis, or
plague during 1997-2000.
Diseases preventable by immunization: Immunizations
continue with high coverage for all antigens administered to children under
1 year old since 1996. An adult MMR campaign was completed in 1999. No cases
of tetanus, mumps, measles, whooping cough, polio, or diphtheria were recorded.
There were 14 cases of hepatitis B from 1998-2000.
Intestinal infectious diseases: There
have been no cases of cholera recorded for many years. There were 83 cases of
gastroenteritis in children under 10 years of age in 1998, 36 cases in 1999,
and 49 cases in 2000. There were 93 cases of food poisoning from 1998 to 2000,
though none were identified as salmonella or shigella.
Chronic communicable diseases: Tuberculosis
is rare in Montserrat with only three cases reported 1997-2000. No cases of
leprosy have been recorded in recent times.
Acute respiratory infections: During
1999, 828 persons attended the Glendon Hospital emergency department with acute
respiratory infections; in 2000, 770 persons attended for that reason.
Zoonoses:There
were no cases of rabies reported 1997-2000.
HIV/SIDA:The
cumulative total of HIV-positive cases in Montserrat is 7, there are 2 cases
of AIDS. No routine testing of pregnant women for HIV is done. There were 34
cases of syphilis in 1998, 47 in 1999, and 5 in 2000.
Nutritional and metabolic diseases: There
were 10 deaths due to diabetes from 1998 to 2000. In 1999, 187 persons attended
the emergency department for diabetes; 289 people attended in 2000.
Diseases of the circulatory system: Cardiovascular
disease accounted for 30% of deaths in 1999 and 35% in 2000. There were 9 deaths
due to cerebrovascular disease in 1999 and 2 in 2000.
Malignant neoplasms: The
number of deaths due to malignant neoplasms was relatively stable, with 8 in
1998 and 7 each in 1999 and 2000. In 1998, all deaths were among males over
60 years of age, with 50% due to prostate cancer. In 2000, 5 deaths were among
females over 65 years of age.
Communicable diseases:An
outbreak of acute viral conjunctivitis occurred in 1998, with 188 cases. There
were 17 cases in 1999 and 11 in 2000.
Oral health: The
Community Dental Service, run by a dental auxiliary, offers basic diagnostic
and emergency treatment for children, pregnant women, the elderly, and special
benefit patients. The sole dentist on the island provides service through the
private sector.
Mental health:At
the end of 1999, there were 93 persons registered at the Mental Health Clinic:
48 suffered from schizophrenia, 23 from alcoholism, 10 from organic psychoses,
6 from neuroses, and 6 from other conditions. The mental health services have
suffered from the effects of depleted human resources. There is no specialized
facility for the care of acute mentally ill patients. Two psychologists were
appointed in 2000 and are providing counseling and support.
RESPONSE OF THE HEALTH SYSTEM National Health Policies and Plans:
Given the devastation caused by the volcano, the Government formulated a plan
for the recovery and rebuilding of the country. A strategic plan was prepared
with input from the community, the private sector, NGOs, government officials,
and regional organizations. The health sector developed a health action plan
with 10 main objectives: 1) To develop appropriate health strategies and plans
to deliver a high standard of care to the population. 2) To review regulations
and policies governing the operation of the health sector. 3) To develop adequate
health care facilities in the safe zone. 4) To strengthen the institutional
management of the Health Department, including performance standards and overall
planning framework. 5) To ensure adequate provision of basic and more advanced
medical and nursing training. 6) To improve disaster preparedness planning within
the health sector. 7) To develop HIV/AIDS prevention policies. 8) To strengthen
health promotion programs. 9) To review and improve the care of the mentally
ill. 10) To improve clinical standards within the context of a primary and secondary
health care program.
Institutional Organization of the Health System: The
Ministry of Education, Health, and Community Services is responsible for providing
accessible, adequate, and affordable health services to the population. It
is also responsible for overseeing and regulating the health system and services,
including water supply and waste disposal. The Chief Medical Officer coordinates
the health services, particularly primary care services. The Secondary Care
Manager is responsible for the functioning of the hospital. The Principal
Environment Health Officer reports to the Permanent Secretary on environmental
matters. Health promotion services are provided by a community health nurse.
Additional water service was needed in the north and approximately 1 million
pounds sterling was spent to improve the water system. Water quality is constantly
monitored by the Environmental Health Department. Sewerage in most households
drains directly into septic tanks. Domestic solid waste was initially a problem
when the influx of persons came to the north of the island. Garbage is compacted
and covered on a regular basis, but disposal of industrial waste, oils, and
abandoned cars is problematic. Garbage is collected by two government-paid
contractors. The Environmental Health Department is responsible for the protection
and control of food supplies and is continuing a limited inspection program.
Health services are divided into Community Services and Institutional Services.
The primary health care services include maternal and child health, immunization,
school health, dental health, mental health, health promotion, and environmental
health; all are categorized as community services. All the services provided
at community level are free to the public. The Institutional Services provide
inpatient facilities, outpatient facilities, long-term geriatric services,
and laboratory, X-ray, and pharmacy services. Users are expected to pay a
fee when they access services at the hospital, though pregnant women, people
over the age of 65, and certain indigent persons are exempt. Long-term geriatric
care is free. The Glendon hospital laboratory conducts hematological and biochemical
testing as well as blood banking. Only basic microbiological investigations
can be performed. There is no sale of blood or blood products and the blood
bank depends on voluntary donors. There are no specialist vision or hearing
testing services on the island other than the basic tests carried out in the
clinics. Eye specialists have recently begun to visit Montserrat to examine
and treat patients in a private capacity. No drugs, reagents, or biologicals
are produced locally for use in the health sector. All items are imported
through the Organization of Eastern Caribbean States/Pharmaceutical Procurement
Service, which performs annual audits. The challenge of retaining staff is
one that Montserrat has been facing since 1995. Nursing services both at the
hospital and in the primary health care clinics rely heavily on trained nurses.
In-service training is carried out for several categories of staff as the
need arises, depending on the availability of tutors to conduct the training.
Montserrat had a nursing school which has been closed since the volcanic eruption.
Thus, all training is conducted off island. Arrangements have been made with
Antigua and Dominica to assist in this training .
Sectoral Expenditure and Financing: During
2000, the Ministry of Education, Health, and Community Services allocated
US$ 4,568,488 for the management and provision of health services, which includes
its headquarters and primary and secondary health care. A total of US$ 1,612,848
of the Ministry of Health's budget was allocated to the hospital. A Regional
Relocation Scheme and an Assisted Passage Scheme were introduced in late 1997
to help Montserratian evacuees. The outward passage scheme, to help persons
who wanted to leave the island, ended in May 1999. DFID then introduced a
Return Air Fare Scheme in 1999 to help those who wanted to return to Montserrat
. DFID is also supporting a program to enable NGOs to assist elderly, disabled,
and other evacuees to become financially independent and socially integrated.
It also supports training awards for evacuees in Antigua . Other donors, such
as the European Union, have allocated 16 million Euros for housing, education,
and a new airstrip. The United Nations Development Program is implementing
a program to assist the Government to strengthen its disaster prevention capacity
by conducting a vulnerability analysis and providing technical advice. PAHO
has increased its regular technical cooperation since the volcanic eruption,
especially in the areas of disaster preparedness and environmental health.
In addition, as part of a DFID/PAHO/Government project, which began in August
2000, it aims to improve the capacity of the health sector in mental health,
treatment of chronic diseases, health promotion, care of the elderly, and
the development of a hospital information system. It also aims to train persons
in areas where retirement will deplete the expertise currently in place.
