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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 Turks and Caicos Islands , a British dependent
territory, lie southeast of the Bahamas and north of Hispaniola . The territory
comprises eight large islands and many smaller cays and islets, with a total
landmass of 430 km2. The Turks group includes Grand Turk , Salt
Cay, and some smaller cays. The Caicos group includes East Caicos , Middle
Caicos, North Caicos , Providenciales, South Caicos , West Caicos , Pine Cay,
and Parrot Cay.
Demography: The total estimated population
in 2000 was 17,502. More than 80% of the population lives on Providenciales,
Grand Turk , and South Caicos . Providenciales, with 17,000 inhabitants is
the only island with an urban center, where most of the territory's commercial
and business activities take place. Cockburn Town , on Grand Turk , is the
capital and the seat of government. The Governor represents the Queen of England;
the Chief Minister, appointed by the Governor, is the head of government.
The legislature consists of a unicameral Legislative Council.
Economy: Tourism and related commerce are
the main economic activities, accounting for 25% of GDP and more than 50%
of employment. Service industries, including public sector services, tourism,
banking and insurance, fishing, and agriculture, employ 95% of the labor force.
The unemployment rate was 12% in 1999, with a higher rate for women (25%)
than for men (17%). Approximately 26% of the population are considered poor,
and 3% are extremely poor. Haitians comprise 30% of the population, but accounted
for 38% of the poor. In 1999, 30% (US$ 15.8 million) of the national recurrent
expenditure (US$ 53 million) was allocated to the social sectors, particularly
education, health, youth, and sports. However, the development program is
still very dependent on external funding; some US$ 37 million in development
aid was received in 1999-2000. Per capita GDP remained fairly steady 1996-1998,
at an average US$ 5,973 per year. Total public spending as a percentage of
GDP continued its downward trend, falling from 34% in 1992 to 21% in 1999.
In contrast, total spending on health as a percentage of GDP increased, rising
from 3% in 1996 to over 4 % in 1998. The main problems influencing the health
situation and the delivery of health services are poverty, immigration, and
increased use of private health services and insurance by Turks and Caicos
Islanders. Limited private outpatient services on Providenciales are available
for those who can afford them, and some go abroad, particularly to the U.S.
, even for primary and routine services.
Mortality: There were 306 reported deaths,
1996-2000. Approximately 36% (101) of deaths with defined causes (282) were
due to diseases of the circulatory system; 21% (59) to communicable diseases,
particularly HIV/AIDS; 7.8 % (24) to signs, symptoms, and ill-defined conditions;
8%(22) malignant neoplasms; and 6% (16) to conditions originating in the perinatal
period. The M:F mortality ratio was 0.97:1. The 60 years and older age group
accounted for 49% of overall mortality; the 20-59 years age group accounted
for 37% of overall mortality, 29% of which was due to HIV/AIDS.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): There
were 24 infant deaths, 8% of total deaths, 1996-2000. Conditions originating
in the perinatal period accounted for 68% (16) of all infant deaths, to which
asphyxia and slow fetal growth contributed 6 deaths and one death due to HIV/AIDS.
Intestinal infections and acute respiratory infections accounted for 55% (46
of 84) of hospital discharge diagnoses for infants, 1996-2000. There were
six deaths among children aged 1-4 years, 1996-2000: intestinal infectious
diseases (2), accidental fire (2), nutritional deficiencies and anemias (1),
transport accidents (1). Intestinal infectious diseases and acute respiratory
infections accounted for 40% of hospital discharge diagnoses, and injuries,
for 8%.
Schoolchildren (5-9 years): There
were eight deaths 5-9 years of age, 1996-2000, transport accidents (3) and
HIV/AIDS (2). The leading causes of the 196 hospitalizations in this age group
were intestinal infectious diseases (15 %): injuries; appendicitis and hernia;
and unspecified bronchitis, emphysema, and asthma.
Adolescents (10-14 and 15-19 years): There
were two deaths in the 10-14 years age group, 1996-2000: accidental drowning
(1), acute respiratory infection (1). In the 15-19 years age group there were
two homicides. The 10-14 years age group accounted for 4% of all hospital
discharges, 1996-2000, and the 15-19 age group, for 6%. The leading discharge
diagnoses were injuries; appendicitis; diseases of the nervous system; and
unspecified bronchitis, emphysema, and asthma. Complications of pregnancy
accounted for 7% of all discharge diagnoses in the 15-19 years age group.
Of all births 10% were to teenagers, 2000.
Adults (20-59 years):The
20-59 years age group accounted for 37% of deaths, 1996-2000. The leading
cause of death in the age group was HIV/AIDS (29%), followed by diseases of
the circulatory system (24%). Other important causes of death were homicide
(6%), diabetes (4%), and transport accidents (4%). This age group accounted
for 57% of all hospital discharges, 1996-2000, of which females were 62%.
Main discharge diagnoses were injuries (9%), hypertensive disease (7%), and
appendicitis and hernia (7%). Females accounted for 66% of diabetes diagnoses
and 65% of hypertension diagnoses. Among females in this age group, complications
of pregnancy comprised 11% of hospital discharge diagnoses.
Elderly (60 years an older):There
were 137 deaths 65 years and over, 1996-2000 (45% of all deaths). Diseases
of pulmonary circulation (32), cerebrovascular accidents (20), ischemic heart
disease (16), and diabetes mellitus (15) were major contributors to mortality
in this age group. Malignant neoplasms (12), particularly cancer of the prostate
and cancer of the female breast, were important causes of death. Hypertensive
disease accounted for 18% (105 of 591) of the hospital discharge diagnoses
for this age group, 1996-2000, followed by diabetes mellitus, 15% (90). Other
important discharge diagnoses were diseases of pulmonary circulation (36),
cerebrovascular accidents (29), other diseases often digestive system (28),
injuries (27), appendicitis and hernia (24), and acute respiratory infections
(20).
Analysis by type of health problem Vector-borne diseases: No
cases of malaria or dengue were reported between 1998 and 2000.
Immune preventable diseases:No
cases of measles or rubella were reported, 1998-2000. There were three cases
of hepatitis B in 1998 and four in 2000. There was one case of mumps in 1999.
Intestinal infectious diseases: Intestinal
infectious diseases appeared among the 10 leading hospital discharge diagnoses
for all age groups and accounted for four deaths, 1996-2000.
Chronic communicable diseases:From
1996-2000, there was one death and 28 hospitalizations due to TB. There was
no leprosy.
Acute respiratory infections: Acute
respiratory infections accounted for less than 5% (113) of hospital discharge
diagnoses 1996-2000. There were 2,309 clinically diagnosed cases of influenza
between 1998 and 2000.
HIV/AIDS:HIV/AIDS
is a growing problem, particularly among adolescents and young adults. There
were 40 deaths due to HIV/AIDS (13% of total deaths), 1996-2000. From 1998
to 2000, there were 135 new cases of HIV infection. In 2000, 2% of persons
tested for HIV (35 of 2,079) were positive.
Nutritional deficiencies:
There were two deaths and 61 hospital discharge diagnoses due to nutritional
deficiencies and anemia, 1996-2000. Diabetes accounted for 7% (19) of all
deaths, and 3% (113) of all hospital discharge diagnoses, 1996-2000.
Cardiovascular disease: Cardiovascular
disease was 33% (100) of deaths during 1996-2000 and particularly affected
adults aged 20-59 and the elderly. Important contributors to mortality due
to cardiovascular disease were diseases of pulmonary circulation (44), cerebrovascular
disease (26), and ischemic heart disease (22). Diseases of the circulatory
system accounted for 13% (428 of 3,428) of all hospital discharge diagnoses
from 1997 to 2000; hypertension was the main contributor to this group (65%),
with a M:F ratio of 0.41:1.
Malignant neoplasms: Malignant
neoplasms accounted for 7% (22) of deaths, 1996-2000. Important sites were
the prostate, the female breast, and the digestive system and peritoneum,
which accounted for five deaths each.
Accidents and violence:
External causes accounted for 12% (37) of deaths, 1996-2000, with traffic
accidents and homicides (9 each) being the major contributors.
RESPONSE OF THE HEALTH SYSTEM Health Sector Reform:The
Health Sector Adjustment Program was implemented in 1993-1997. A reform agenda
includes the transfer of the health services procurement function from the
Ministry of Health (MOH) to the Ministry of Finance; completion of a feasibility
study for the National Health Insurance Scheme; restructuring of the MOH,
including the establishment of a Health Policy and Planning Unit, greater
autonomy to health clinic managers, and the design and implementation of management
and information systems and infrastructure improvement programs, and development
of a communications support and a national mental health program.
Organization of the health sector: The
MOH is responsible for the provision of efficient and effective preventative
and curative care through the Health Department. This is carried out in partnership
with the community, and with private and overseas providers. Decision-making
is very centralized. The Permanent Secretary chairs the Senior Management
Team, which is comprised of the Undersecretary, the Chief Medical Officer,
the Chief Nursing Officer, and senior program managers. Private sector activity
is limited to outpatient care and is focused on general practice. Residents
have total access to healthcare throughout the country and at public health
care facilities, clients are treated regardless of their ability to pay.
Health Insurance:Employed
persons pay a premium to receive benefits. Social Security covers the cost
of medical expenses for occupational injuries; however, most employees are
also enrolled in private insurance schemes. An estimated 20% of population
has private health insurance; the remainder are covered by the MOH. Premiums
for private insurance are paid jointly by the employer and the employee.
Organization of regulatory actions: The
MOH is responsible for regulating the health sector, but there are no mechanisms
in place to regulate private health insurance. It is also responsible for the
supervision, evaluation, and control of health service delivery by public and
private providers. Intersectoral activity is promoted, but there are no formal
mechanisms for collaboration or community participation. The Health Practitioners
Board Ordinance is responsible for the establishment of health facilities and
for the regulation and control of health professionals and allied health workers.
The Board is also responsible for the accreditation of public and private sector
health facilities. The Department of Environmental Health is responsible for
vector control; monitoring of food and water supplies; inspection of food establishments
and other buildings; and solid waste collection and disposal. Environmental
health officers are stationed throughout the islands. Most of their activities
are performed in close collaboration with the Department of Primary Health.
The Public Environmental Laboratory is the main laboratory within the National
Public Health Laboratory System. Its primary role is to monitor food sanitation
and environmental quality. The Department of Primary Health is responsible for
the prevention and control of communicable and noncommunicable diseases. It
also implements various public health programs, including health education activities,
through clinics. Health information n is not available on a timely basis: there
is no coding system and data are processed manually.
Organization of the health care services:
The public hospital network is comprised
of the main facility, Grand Turk Hospital (35 beds), and the Myrtle Rigby
Health Clinic (10 beds), located on Providenciales. These facilities provide
general acute care and specialized services, as well as mental health, geriatric,
and rehabilitative care on an inpatient and outpatient basis. Some secondary
level services are offered in county, and others may be procured abroad; all
tertiary level services must be procured abroad. There are two clinical laboratories
in the public sector, located on Grand Turk and Providenciales, and two private
clinical laboratories on Providenciales. The National Blood Bank Service is
based at Grand Turk Hospital.
Health supplies: The
procurement of pharmaceuticals and monitoring of public sector pharmacies
is conducted by the Chief Pharmacist. All persons seeking health services
in public institutions have access to prescribed drugs, when available. Equipment
distributed among the two public hospitals includes two ultrasound, two X-ray,
and four dialysis machines. The private sector does not have high technology
equipment.
Human resources:The
number of health staff has increased since 1995, but shortages continue. Most
personnel are foreign nationals, which is particularly critical, since they
often hold senior managerial positions (e.g., Chief Medical Officer), and
there is a high degree of temporary staff. The Government is seeking to employ
more nationals, and the Community College has begun to train clinical nurses.
Sectoral expenditure and financing:The total national expenditure on health in 1998 was
estimated at US$ 16.5 million: public expenditure on health was estimated at
US$ 7.5 million (45%) and private expenditure at US$ 9 million (55%). Annual
Government spending per capita is approximately US$ 310, and individuals spend
at least US$ 375 per year out-of-pocket. Therefore, the minimum per capita health
expenditure was estimated at US$ 685 in 1998. Private insurance accounted for
21% of national health expenditure. Services provided in Turks and Caicos accounted
for 48% of total expenditure, and services procured abroad accounted for 52%.
A user fee system is in place at public facilities, though those deemed unable
to pay are exempt. Other excluded categories include elderly pensioners, welfare
recipients, prisoners, and children under 18 years of age. The Government pays
for some overseas care for individuals on a case by case basis. There are no
public financing modalities for private health insurance. The Institute for
Health Development reported a 7% increase in the health budget in 1997 and a
39% increase in 1998. The latter increase is mainly for the strengthening of
primary care, including the Myrtle Rigby Health Clinic, medical treatment overseas,
and the integration of the HIV/AIDS Program in the MOH.
External health technical cooperation: DFID
and PAHO/WHO provided technical cooperation and financial assistance to the
Turks and Caicos Islands during the review period.
