Official Name: Anguilla
Capital City: The Valley
Official Language: English
Surface: 91.57 km 2
PAHO Subregion: Non-Latin Caribbean
UN 2 digits Code: AI
UN 3 digits Code: AIA
UN Country Code: 660


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.

    Anguilla is the most northerly of the Leeward Islands and covers 91 km2. It is mostly flat, the highest point being Crocus Hill at 65 m above sea level. Anguilla lies in the tropical storm belt and is at risk from hurricanes. Due its size, there is no urban and rural distinction. The Valley is the capital. Major settlements are accessible by the network of paved and unpaved roads. The island is accessible by two seaports and an airport. Anguilla continues to be a territory of the U.K, the Governor and the Deputy Governor being appointed by the Queen. The Governor presides over the executive council and reports to the legislative council. General elections are held every five years, but can be held at anytime as in 2000.

    According to the Statistical Unit of the Ministry of Finance, the estimated population was 12,871 in 1999, yielding a density of 141 persons per km2. The population growth rate was 2.9% in 2000. The crude birth rate was 13.6 per 1,000 population for 1997-1999, the annual number of live births fluctuating from 169 in 1997 to 193 in 2000. The estimated life expectancy at birth is 71.3 for males and 77.3 for females. There has been increasing migration into Anguilla , particularly from neighboring Islands.

    The economy grew at an annual rate between 9.2% in 1997 and 5.2% in 1998. GDP in 1990 constant prices was US$60 million in 1997 and US$68 million in 1999, the per capita GDP being US$6,073 and to US$6,271, respectively. In spite of the devastation by Hurricane Lenny in 1999, economic activity expanded strongly, mainly due to the construction sector aimed to repair the damage caused by the hurricane. Tourism is the largest contributing sector to the economy in Anguilla , representing more than 30% of GDP and employing over 20% of the labor force. Construction is the second largest contributor (nearly 16%). The offshore financial services sector is being developed to strengthen and diversify the economy. The unemployment rate was 8% in 1999, with a male-female ratio of 1:2. A survey conducted in 1999 revealed that the main occupations of the labor force were professionals (14%), craftspeople (13%), service workers (13%), and 8% clerks, while 35% were unspecified. According to the Land and Surveys Department, during the period 1997-2000 there were a total of 4,276 dwelling units, with an average of three persons per household. It is estimated that 81% of households have access to electricity and sewerage services, 70% to water in their houses, and 78% to installed telephones.

    Education: School attendance is compulsory through age 17 years. Average enrollment in the primary schools was 1,520 in 2000, with a teacher-student ratio of 1:17 in 1999. Females accounted for 51% of students in primary and secondary schools during 1999. The adult literacy rate is 95%, with no difference by sex. Over 80% of the labor force has secondary education, with a further 11% receiving university education.

    Mortality: During 1997-2000, there were 247 deaths (116 males and 131 females), 70% of all them were in the 70 years and older age group, 11 % were 60-69 years old, 9% were 40-59 years and 3 % were under 1 year old. Diseases of the circulatory system accounted for 48% of deaths, malignant neoplasms for 14%, external causes for 6%, and conditions originating in the perinatal period for 2%. The infant mortality rate for the period was 11.8 per 1,000 live births. Most infant deaths occurred in the neonatal period. During 1997-2000, 695 deliveries and 7 stillbirths were recorded. There were no maternal deaths during the period.

    Analysis by population group
    Children (0-4 years): There were 8 deaths among children under 1 year from 1997 to 2000, four of them due to conditions originating in the perinatal period; 2 to slow fetal growth, malnutrition, and immaturity; and 2 due to hypoxia and birth asphyxia. There were 10% and 7% low birthweight infants born in 1997 and 2000. Among children age 1-4 years there were two deaths, one due to accidents caused by fire and one due to signs, symptoms, and ill-defined conditions. Acute respiratory infection is the leading cause of morbidity in this age group. Growth and development of all children under 5 years old are monitored monthly at the district health centers.

    Schoolchildren (5-9 years): During 1997-2000 there were no deaths in this age group. The school health service provides physical examinations, and dental, hearing, and vision screening for children 5-9 years of age. Worm infestation was reported in four children in 1997 and five in 2000.

    Adolescents (10-14 and 15-19 years): During 1997-2000, females under 19 years of age accounted for 12% of all births. Family planning services are available to adolescents and a family life education program, including peer counseling and skills training at the schools. From 1997 to 2000, 43 cases of child abuse, most of them women, were reported and referred to the Social Welfare Department.

    Adults (20-59 years): Prenatal care is provided by midwives and obstetrician/gynecologists in district health centers until 36 weeks of gestation and then at Princess Alexandra Hospital . Nearly 80% of pregnant women in clinics enroll before the sixteenth week of pregnancy. All deliveries are attended by trained personnel at the hospital. Vitamins, iron, and folic acid supplements are distributed routinely. Family planning services are offered at the public health centers, where 258 clients registered in 2000; 61% of them used oral contraceptives, 33% used injectables, and 6% used condoms. Pap smears are available at the hospital, the coverage fluctuating from 198 examinations in 1997 to 132 in 2000. There were 5 cases of noninvasive cervical cancer and no deaths between 1997 to 2000.

    Elderly (60 years and older): The elderly constitute around 18 % of the total population. Most of them live at home with the extended family, but a growing number live alone. Health care providers make periodic home visits for routine monitoring and medical care. The estimated number of housebound elderly on the island is 93 (34 males and 59 females). A senior home with 16 geriatric beds provides institutional care.

    Family Health: The 1992 census revealed that 25% of households were single-person households, 42% were nuclear families, and 12% were extended families. Public health services at primary and secondary care levels are very accessible, and include maternal and child health services and general medical care. Families can seek exemptions from the nominal charges at the hospital through the Social Welfare Department.

    Analysis by type of health problem
    Vector-borne diseases: Except for 14 cases of dengue fever over the 1997-2000 period, there were no other vector-born diseases. The Aedes aegypti mosquito is highly prevalent on the island.

    Diseases preventable by immunization: There were no confirmed cases reported during the period 1997-2000, while immunization coverage was 100% for BCG, 99% for MMR, 94% for polio, and 96% for DPT. Pentavalent vaccine was introduced in 2000. All pregnant women are immunized against tetanus and diphtheria.

    Intestinal infectious diseases: There have been no reported toxic or bacterial-related cases. According to the laboratory at the hospital, there were 14 cases of trichuriasis, 4 cases each of ancylostomiasis and necatoriasis (hookworm), 2 cases of ascarias and one of strongyloidosis, during 1997-2000.

    HIV/AIDS: Blood investigations from the laboratory at the hospital revealed a total of 8 positive HIV cases between 1997 and 2000, one being a blood donor. Four cases were males and four females, and all were in the 20-60 year age group. There were no deaths from AIDS during the period.

    Sexually Transmitted Infections: Between 1997 and 2000, there were 19 cases of syphilis. Blood investigations in the same period showed 2 blood donors positive for syphilis and 14 for hepatitis B, one of them in a blood donor.

    Nutritional and metabolic diseases: Obesity, particularly among women and children, is one of the major health problems facing Anguilla , but no data is available. Anemia was found in an estimated 7% of 5- and 6-year-olds and in 5% of 12-year-olds in 2000. In 1997, an estimated 20% of prenatal women were anemic.

    Malignant neoplasms: Malignant neoplasms accounted for 10% (25) of deaths during the period 1997-1999. The main areas of malignancy were female breast (24%), lip, oral cavity, and pharynx (16%), stomach (8%), and prostate (8%). Deaths due to malignancy of the female breast included women 45 years of age and older.

    Accidents and violence: During 1997-1999, there were four deaths due to accidents. Police statistics for 1997-2000 registered 13 cases of rape, 37 cases of indecent assault, 1 case of murder, and 311 cases of wounding and assaults.

    Oral Health: The number of visits to the Dental Unit ranged from 9,029 in 1997 to 9,369 in 2000, with tooth extractions ranging from 1,501 to 1,660, respectively. The ratio of tooth extraction to fillings was nearly 1:4 during 2000.

    National health policies and plans: In 1996, the Ministry of Health adopted the Primary Health Care (PHC) approach and in 1997 the PHC Department was instituted to ensure that appropriate affordable and accessible services are delivered to the people of Anguilla in a timely manner. A Health Authority Project Board was formed in 2000.

    Organization of the health system: The Minister of Health and Social Development is responsible for the management of health services. The Permanent Secretary of Health, the Health Planner and the Director of Health Services advise the Minister of Health. The Director of Health Services is responsible for the effective functioning of all departments and delegates responsible to the PHC Manager, Health Services Administrator and Principal Nursing Officer. A strategic management group, chaired by the Director of Health Services, meets monthly to plan, discuss policy issues, quality assurance issues, and financial and budgetary reviews in the public and private sector. The group is responsible for the overall management and coordination of publicly provided health services. The PHC Management Team and the Hospital Management Team are responsible for the day to day management of their services. The private health sector in Anguilla is small, but growing. It is limited to primary and selected tertiary care. The Government has group insurance for all public servants.

    Organization of health regulatory actions: The medical council certifies physicians and monitors medical practices; there is still no mechanism for the practice of other health professionals. The Environmental Health Section (EHS) of the PHC Department is responsible for solid and liquid waste management, food hygiene, vector control, environmental sanitation, beach and roadside cleaning, improving hygiene practices, occupational health and safety, and the provision of low-cost sanitation services. The EHS is severely constrained by limited human resources, training and technology.

    Health promotion services:
    Health Committees were formed in two districts. Informal intersectoral programs have been established, including water monitoring and solid waste management, a dental mobile unit and health/education liaison committee. Two health educators deliver education programs that focus on the promotion of health and wellness and emphasize behavior modification and lifestyle changes, targeting primary and secondary school children, young adults and community groups. Weekly radio programs disseminate health information.

    Prevention and control programs: Vector control activities concentrate on the Ae. aegypti mosquito and rodents. The national Ae. aegypti control program uses a community-based approach, including larvicidal fish for water storage facilities, house inspections, and treatment. Rodent control includes baiting at food premises, schools, and public institutions. Rodenticides are sold to the public through the Environmental Health Unit (EHU).

    Epidemiological surveillance: A Public Health Nurse Supervisor has been responsible for the collection of data on communicable diseases since 1998. The Health Information System, based at the hospital, aims to improve medical record keeping and timely and appropriate information for quality assurance, epidemiology, resource management, and planning.

    Solid waste and residue services: The EHS is responsible for the collection of refuse from Government institutions, public roads, and beaches. Hotels and other commercial establishments are required to make their own arrangements for collection of waste.

    Potable water and excreta disposal services: The Water Laboratory started its first Water Quality Monitoring Program in 1999. The Anguilla Water Department is responsible for the planning, construction, operation, and maintenance of water supply works. Treatment and testing of groundwater is done by the Water Laboratory. The EHS is responsible for inspection and treatment of cisterns. All sewerage is treated and disposed of on site by means of septic tanks soak-aways (84% of households), pit latrines (12%) and package treatment plants, which are used primarily by hotels, commercial establishments, and government institutions.

    Food safety: The EHU conducts periodic inspections of premises where food, drink and other commodities are sold. There is a program for the examination, certification, and of registration of food handlers and food establishments. Education of food handlers is an integral component of the program. In 2000, there were 76 food establishments and 249 food handlers registered.

    Organization of individual health services: The health care delivery system consists of a public and private sector. The public sector services include primary health care and secondary health care. Each of Anguilla 's five health districts has a health center providing primary health care within defined boundaries. Health clinics are staffed with a public health nurse, a clinic aide, and an environmental health officer, who provide basic core services, including maternal and child health, family planning, immunization, nutrition advice, care of the elderly, management of chronic diseases, health education, and environmental health. Basic medical clinics are conducted semiweekly by a medical doctor. The Valley Health Center also has support from the nutritionist, health educator, pharmacist as well as a district medical officer. Other staff at the health center includes a public health nurse, a district nurse-midwife, district nurse, a community health aide, and a clinic aide. Secondary Health Care is delivered at the hospital, which is a 36-bed facility. Hospital services include emergency treatment, outpatient and inpatient care for surgical, medical, pediatric, gynecological and obstetric cases, laboratory, and radiological diagnostic services. The main pharmacy is located at the hospital and serves both the private and public sectors. A doctor or a public health nurse makes referrals to services at the hospital from the primary care level. There is a referral system for all patients discharged from the hospital returning to their respective clinics. The hospital's Accident and Emergency Department also offers scheduled outpatient services. To enhance services, a laboratory with modern facilities and a maternity unit have been added to the hospital. The Emergency Medical Service was introduced in 1998, with two ambulances and a team of nine emergency medical technicians. Public dental services are located in the central unit in the Valley and supported by a mobile unit that provides care to the primary schools. Two dental surgeons, four dental auxiliaries and three dental assistants staff this service. The Miriam Gumbs Senior Citizen's Home provides care for the elderly and destitute. A psychiatric nurse provides community mental health services, and is responsible for the care of all mentally ill patients. A visiting psychiatrist from Barbados supports the services in diagnosis and treatment review. In 2000, 276 clients were counseled and treated; 17 were new clients. The island has no tertiary level care facilities; such care is sought from overseas, having 62 cases referred between 1997 and 1999. Patients requiring specialized hospital care are referred to neighboring islands at the expense of the Government.

    Health Supplies: Anguilla obtains pharmaceutical and medical supplies monthly through the Pharmaceutical Procurement Service (PPS), a regional scheme for procurement. The PPS also gives support in the areas of inventory control and organization. There is no national formulary and purchases are guided by the regional PPS formulary. Similarly, there is no stipulated list of essential drugs. Vaccines for the Expanded Program on Immunization are obtained through the PAHO revolving fund. Inventory control is good and a reliable service is maintained. Standards and protocols for this program are stringently adhered to.

    Human resources: In 2000, there were 9 doctors, 40 trained nurses, 2 dentists, 4 dental therapists/nurses, 3 dental assistants, 3 pharmacists, 1 laboratory technologist, 3 laboratory technicians, 2 radiographers, 5 environmental health officers, 1 nutritionist, 2 health educators. There are no training institutions for health personnel in Anguilla . Depending on needs, personnel are sent for training to various Caribbean islands, the U.K. or the U.S. Increasingly, local training workshops, on both primary and secondary health care issues are organized; it is the government's policy to support the public and private sectors.

    Health sector expenditure and financing: Health received 14% of the recurrent budget. Of this, 5% goes to primary health care and 9% to secondary health care. Approximately 9% of the total recurrent expenditure for health is collected in user fees for dental, hospital, and pharmacy services. Approximately US$30,000 in revenue was collected at the hospital during 1999-2000. The funds collected go directly to the general consolidated fund and cannot be used by the hospital. Total expenditure on health in 2000 was US$2,550,380. Drug expenditure for 2000 was US$130,597.