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Plans> NIDS> Background Papers> Health Sector - Section 1 |
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NATIONAL INTEGRATED DEVELOPMENT STRATEGY Health Sector CHAPTER 1 Health is a dynamic state that is individually perceived. Understanding health and illness requires a careful study of both individuals and the entire population. Factors such as culture, education, economics, geographic location and healthcare availability all impact on the health of individuals, families and communities. There is a great diversity of definitions and opinions about the meaning of health and illness. However there seems to be agreement that both terms represent interactive states between social, physical, psychological and/or environmental factors. Within this frame, there are several important points to discuss. Perhaps the most critical one is that health is not only the absence of disease, but encompasses all of man's well-being including social, psychological and spiritual dimensions as well as environmental, economic, educational and recreational factors. Health, as defined by the World Health Organization (1960), is the state of complete physical, mental and social well being and not merely the absence of disease or infirmity. The health sector strategies essentially aim to achieve the following:
The first four objectives outlined above form core elements of a reform strategy; the fifth is considered to be a critical supporting objective given the legacy of a highly compartmentalized and hierarchical public health system. Historical Background The Ministry was established in 1979 as a fourth Ministry taking part of its portfolio from the Chief Minister’s Office and part from what was formally the Ministry of Natural Resources, Immigration and Public Health. It was originally named the Ministry of Social Services which is representative of the subjects for which it is responsible. In 1983, the name was changed to the present Ministry of Health, Education and Welfare. The Ministry has a wide range of distinctly different specialist responsibilities that extend across a broad spectrum, from Caribbean Studies to Prison Management. The services provided by the Ministry are particularly sensitive and attract considerable public attention as they impact on the social, educational and health needs of the territory. The overall goal of the Health Sector is to provide an adequate and effective health service to the entire population of the BVI, and delivery of such services in an efficient manner is the main objective. Currently the health services are administered by the Health Department which has two operational arms; Peebles Hospital and Community Health Services. Main Developments of the Health Sector during the last thirty years
The main structure of the present hospital was completed in 1926. It was described as a cottage hospital with sixteen beds (16) and six (6) cots. Five of the adult beds constituted the main ward and were housed in what was described as "a dark and gloomy room". Two of the latter were blocked throughout the year by chronically ill patients. Since the 1940s the building has been the subject of numerous renovations and extensions, the latest of which were completed in 1982. At present, the hospital is a three-storey building with a capacity for 44 beds. In 1996 sixteen physicians service the territory, 94 nurses (seventy-two trained nurses and twenty-two assistant nurses), five laboratory technicians, two pharmacists, two radiologists, one physiotherapist, as well as a hospital administrator and many support staff. Specialist medical services are available in general surgery, anesthesiology, pediatrics, obstetrics and gynecology, internal medicine, ophthalmology and dermatology. X-ray, ultrasound, medical laboratory, physical therapy and pharmacy services are available. Public Health Programmes began in 1968. This included mobile child health clinics, and counseling and advisory services for the mothers in the Road Town Area and rural districts. Antenatal, food handlers and immigration clinics were held at the Road Town Clinic and visits were made to schools. Prior to this date there was no organized immunization programme; today the territory boasts a 95% immunization coverage for under five years old against diphtheria, pertussis (whooping cough), tetanus, poliomyelitis, measles, mumps, rubella and tuberculosis. The infant mortality rate has been substantially reduced during the past thirty years In 1990, Public Health Department split into two fundamental units. Hospital and Community Health Services. At present, Community Health Services deliver health services on a regular basis through a comprehensive network system which include one Health Centre in Road Town and eight (8) district clinics: four (4) in Tortola, two (2) in Virgin Gorda, one (1) Jost van Dyke and one (1) Anegada. Other services provided by Community Health Services include Environmental Health, Mental Health, Health Education, Dental Health and Nutrition Services. Thirty years ago, the Environmental Health Unit was staffed by one Public Health Inspector and its main focus was solid waste management and investigation of nuisance complaints. The only legal instrument for enforcing public health measurements was the 1950 Public Health Ordinance. Today, the unit is staffed with five (5) Public Health Inspectors and clerical support. A Public Health Ordinance was enacted in 1969 and revised in 1976. The 1976 Ordinance confers ample powers on the Minister responsible for health to make regulations. In 1988, steps were taken to draft new regulations and amend deficiencies of those held over under the 1976 Ordinance. Following the improvements other programmes have been developed in Food Hygiene, Vector Control, Water Quality and Institutional Hygiene. An important area for the conservation of the environment was the decision in 1988 to dispose of solid waste through incineration rather than the traditional method of sanitary landfill. The new incinerator became fully operational in 1994, and consistent with this fact and the increased responsibilities, the unit was given full departmental status the same year. The Solid Waste Department is responsible for the following operations: solid waste collection and disposal, operation of the Pockwood Pond incinerator, street and road cleaning, roadside trimming, ghut cleaning and beautification.
Health Perspectives in the BVI The overall goal of the health sector is the provision of high quality and accessible primary and secondary health care services to improve the quality of life and the standard of living of the people of the B.V.I. To accomplish this goal the Government aims to promote high quality, cost effective services, choice for the public, and as wide a scope of local services as possible within their technical and financial capability. Health Sector development has to be viewed in the overall context of the BVI economy. The territory has experienced unprecedented economic growth within the last two decades, fuelled by the expanding and lucrative tourism and financial services industries, with concurrent improvements in communication, transportation and standards of living. This growth has also attracted a large and needed pool of immigrant labour and placed increased demands on housing, the social services, the educational system and the health services. Furthermore, as standards of living have improved, so has the average life expectancy of the population, resulting in greater incidences of chronic diseases and disabilities associated with lifestyles and longevity. These dramatic demographic changes with the attendant shifts in disease profiles are inflicting new pressures on the health service sector. Superimposed on this picture are the health needs of a large tourist population. A successful response will require a review of both the numbers of providers and the level of skills that these providers will bring to a rationalized and forward-looking health service in the BVI. In particular, the critical care services and emergency response capability of the hospital will demand recruitment and training of several categories of specialists health care providers. Health care delivery in the BVI involves the public and private sectors. Government is the major provider and financier of health services. Persons requiring care that is not available in the territory are assisted by referrals overseas for diagnostic and treatment services. Primary Health Care in the territory is provided by: one (1) Hospital (Peebles Hospital), one (1) Health Center in Road Town, a network of eight (8) District Clinics (East End, Long Look, Capoons Bay, Cane Garden Bay, Anegada, Jost van Dyke, The Valley and North Sound), as well as two satellite clinics in Brewers Bay and Sea Cows Bay. Programmes in the clinics especially target mothers and young children. They include the following: growth, nutrition, and developmental surveillance, immunization, vision and hearing screening, school health, antenatal, postnatal and family planning, family life education, home visiting and AIDS and sexual health counseling. Other services offered include community mental health, dental health, environmental health, health education and community nutrition. In addition there are a growing number of establishments promoting healthy eating, natural remedies, physical exercise and traditional therapies such as massage. Private medical practice is an important aspect of the health care delivery system in the BVI. All government consultant physicians and surgeons are allowed private practice on a part time basis. It is estimated that around fifty percent of the population use private practitioners in the territory and in neighboring Puerto Rico and the U.S. Virgin Islands. The Health Information System does not capture these health incidents and thus an accurate picture of the health of the country may not be obtainable. Private health care is provided by one (1) private hospital, two (2) private dental surgeries, two (2) private medical complexes and nine (9) private physicians. Bougainvillea Hospital has eight beds and mainly offers reconstructive surgery services although some general surgery also is done. The number of admissions in 1991 was 58, and the average length of stay was 3.5 days; the occupancy rate is 32.0%. Secondary Health Care is provided at the Peebles Hospital that offers accident and emergency services, in-patient care on medical, surgical, pediatric and obstetric wards and through resident and visiting specialists. The BVI has no facilities for Tertiary Health Care. Clients requiring this service are referred to overseas facilities at the University Hospital of the West Indies, in Jamaica, Queen Elizabeth Hospital in Barbados, hospitals in Puerto Rico, the United States of America. There is also a reciprocal agreement with the United Kingdom in which BVI nationals are able to procure tertiary care. Under this scheme, 5 children received care for the years 1996 and 1997.
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