Data updated for 2001

GUADELOUPE

GENERAL SITUATION AND TRENDS

Socioeconomic, Political, and Demographic Overview

The French Department Guadeloupe have been part of France since 1946. Even though it is located in the Region of the Americas, it is given special protection and granted structural funds from Europe devoted to assist developing European regions.

Guadeloupe is an archipelago of eight inhabited islands; the two largest, separated by a sound, are Basse-Terre and Grande-Terre. The other islands include Les Saintes and Marie Galante to the south, Désirade to the east, and the French section of Saint Martin and Saint Barthélemy some 230 km to the north.

The population of the Department remained stable during the 1960 and 1980 decades. Considerable migration to France occurred during this period, mainly as a consequence of lack of work, followed by a vigorous, although declining birth rate. Since the mid-1980s, and coinciding with declining employment rates in France, adults and retirees have returned to the Department.

The 1990 census showed an average annual population growth of 2.1% in Guadeloupe for the 1982–1990 period. This growth continues, and in 1996 the population density was 248 inhabitants per km2. Population estimates in 1996 were 422,090 inhabitants, the population younger under 15 years representinh 26.5%. In 1994, life expectancy in Guadeloupe was 80.2 years for women and 72.7 for men.

Immigration from neighboring developing countries accounts for part of the growing population. Guadeloupe, being a free port with a thriving tourism industry, has had a four-fold increase in the number of inhabitants in the past eight years; half of the population is foreign.

Since 1986 fiscal incentives have set forward the public works, construction and hotel industries. Unemployment rates in Guadeloupe were 27% in 1986, 26.1% in 1993, 26.1% in 1995, and 29.3% in 1996.

Registered unemployed and underemployed persons account for half of the active population of the Antilles. On the basis of the 1990 census, a survey conducted by the National Institute of Statistics and Economic Studies (INSEE) defined the high-risk population as households occupying makeshift accommodation without water in or near their dwellings and those with an unemployed head of family. An estimated 22 % were considered to be high risk in Guadeloupe. Table 1 presents socioeconomic indicators for this French Department.

  Table 1

Socioeconomic Indicators of Guadeloupe, 1982 and 1990

^(a) These figure do not include dwellings equipped with individual septic tanks.

^(b) Dwellings having fewer rooms than the number of occupants.

Source: National Institute of Statistics and Economic Studies (INEEE), 1982 and 1990 reports.

Morbidity and Mortality Profile

Among the specific health problems affecting Guadeloupe is a high prevalence of sexually transmitted viral infections and an endemic level of dengue with epidemic outbreaks. Among noncommunicable diseases, there is a high prevalence of sickle cell anemia and a high frequency of diabetes, hypertension, and their complications (particularly chronic kidney failure). With the exception of cervical and prostate cancers there is a low incidence of malignant tumors. Traffic accidents contribute enormously to years of potential life lost (YPLL). 

In 1995 there were 5,383 deaths in Martinique, Guadeloupe and French Guiana. The most recent information on death causes is for 1993, since mortality reports are prepared by the National Institute of Health and Medical Research in Paris, independently from mortality data extracted by INEEE from birth, marriage and death registries. 

Based on YPLL, infectious and parasitic diseases are the fourth most frequent death cause for both sexes; accounting for 6% to 7% of YPLL. In Guadeloupe, AIDS accounts for 6.5 % of deaths in infants under 28 days old. Guadeloupe is the Department of France most seriously affected by problems during the perinatal period. The most frequent causes of death in the perinatal period are anoxia and other respiratory diseases.

Injury and poisoning (particularly road traffic accidents) are the primary cause of death among men, contributing to over one-third of YPLL among the male population. Among women, these two causes rank third in Guadeloupe.

While cardiovascular disorders are the largest contributor to mortality, their importance should be viewed in light of the late age at which death occurs. These disorders occupy second place in YPLL. The malignant tumors rank first as a cause of death among women in terms of YPLL. Among men, cancers rank second as a cause of death (13% of YPLL) in Guadeloupe.

SPECIFIC HEALTH PROBLEMS

Analysis by population groups

Health of Children

Child health in Guadeloupe has improved considerably in the 1992–1996 period. This improvement is most marked in regard to infant mortality. Perinatal mortality has dropped to an average rate of 10.1 per 1,000 live births over the 1994–1996 period, but the stillbirth rate remains high (7.4 per 1,000). The number of infant deaths between 7 and 28 days has stayed the same (1.9 per 1,000) in this period. Infant mortality has dropped from 10.4 per 1,000 in 1992 to 7.9 per 1,000 in 1995. The main causes of infant mortality are conditions arising in the perinatal period (50%), congenital anomalies (16%), and infectious and parasitic diseases (12.5%).

Child mortality in the 1–4-year age group during the 1987–1992 period was due to accidental causes in 42% of cases. This percentage is essentially the same for both sexes. Other causes of death were infections (12.6%) and malformations (12.3%).

At 3 years of age, 77% of children were enrolled in kindergarten and underwent health examinations. During the 1994–1995 school year, 1.4% of the children examined had language problems requiring specialized treatment. Out of every 1,000 children, 8 suffer from confirmed hearing impairment and 18 from confirmed sight impairment (7 had confirmed strabismus).

Half of deaths in the 5–14-year age group are caused by accidents: 47% among girls, and 52% among boys. Tumors are the next most common cause of mortality in this age group (11.5%), followed by diseases of the nervous system (9.3%).

Health of Adolescents and Young Adults

Teenagers and young adults (ages 15 to 24) represent 16% of the population in Guadeloupe. This group has a 48 % unemployment rate. In the 15–19-year age group, 86% are registered in schools. A study of deaths for the 1987–1990 period shows that 2.7% occur in this age group. With an annual average of 62 deaths, the mortality rate for this group is 0.7 per 1,000 (1.2 per 1,000 among men and 0.3 per 1,000 among women).

Traffic accidents cause 1 in 3 deaths in this age group. They are followed in descending order by: ill-defined and other accidents and their late effects (28%), tumors (7.3%), and diseases of the circulatory system and disorders of the nervous system and the respiratory tract. Teenagers are most affected by accidents involving two-wheeled vehicles with, respectively, 37% of deaths and 47% of serious injuries on average per year. The 15–24-year age group also accounts for a high proportion of automobile accident victims (21% of deaths and 26% of seriously injured).

A study conducted in 1993–1994 at the University Hospital in Pointe-à-Pitre revealed 71 admissions for attempted suicide among teenagers aged 15–19 years. The risk factors identified included a previous history of psychological problems (42%), frequent failure at school (50%), a high incidence of broken families (76% were children of divorced couples), and a history of attempted suicide by close relatives (7.5%). Past incest or rape were other risk factors frequently reported. Repeated suicide attempts are widespread (30% of cases), with recurrences within an average of 4.5 months.

Illnesses fully covered by the health insurance scheme during the 1989–1991 period accounted for 4% of all hospital admissions in this age group. The main cause of admissions was mental disorders (46% of cases), followed by congenital and valvular heart disease (7.6%), hemoglobinopathy (7.5%), and diabetes and progressive scoliosis (6.2%).

In 1992, 5.4% of pregnancies occurred in girls under 18 years of age. However, between 1982 and 1992 the fertility rate dropped from 45 to 29 per 1,000 in the 15–19-year age group and from 149 to 98 per 1,000 for the 19–24-year age group.

Health of Adults

The principal medical causes of deaths among adults between ages 15 and 60 for the 1987–1990 period were cardiovascular disorders (33%), tumors (19%), trauma (12%), ill-defined causes (7%), diseases of the digestive system (6%), and diseases of the respiratory system (5%). The order of causes differs for the 15–34-year-old age group: accidental causes, road traffic and other accidents are the first two causes of death, followed by suicides and HIV infection. Eight hundred deaths occurred before the age of 65 in the 1987–1990 period. The main causes of these premature deaths are accidents, diseases of the circulatory system, and tumors. About one-half of these deaths were avoidable: 228 by a change in high-risk behavior, and 196 with better screening and/or proper attention by the health system.

The hospital morbidity survey conducted in 1992–1993 in the short-term facilities shows hypertension, diabetes, and alcoholism to be the diseases most frequently associated with hospitalization.

Health of Older Adults

At the time of the 1990 census, inhabitants age 60 and older represented 11.7% of the total population; in 1995, this sector of the population was 12.3%. Virtually everyone age 60 and over lives at home, due to the protection provided by the traditional lifestyle and the existence of a state home care policy. Cardiovascular disorders are the main cause of mortality (43%), followed by tumors (20%) and ill-defined morbid conditions (9%). Diabetes and hypertension account for 56% of coverage for chronic illnesses, followed by cancer, cerebrovascular accidents, and progressive chronic arteriopathy.

Reproductive Health

The fertility rate in Guadeloupe fell by 27% between 1984 and 1994. Rates for women in the 15–19- and 20–24-year age groups dropped by one-third, and in the 25–29-year age group by one-quarter. The fertility rate has remained constant among women 30 and older.

Data from family planning and education centers show that 75 % of the clients used oral contraceptives, 8% an intra-uterine device (IUD), and 17% other methods. The perinatal mortality survey conducted in 1984–1985 suggests an abortion rate of 26% among the female population of childbearing age. In 1994, the abortion rate was 30 per 100 conceptions. The maternal mortality rate was 51.4 per 100,000 live births for the 1987–1990 period.

Health of the Family

The most salient characteristic of the Guadeloupan family is the role played by single-parent families (one-third of all families); in 86% of cases a woman is the head of household. One-third of children under age 17 are brought up in single-parent families. Special measures seek to encourage child care while parents are at work (help in opening day-care centers and financial assistance for parents using registered care providers); to provide needy families with financial assistance for their children’s basic needs; and to enable children to attend school at an early age.

Health of the Handicapped

In 1992, a random sample from the Departmental Commission for Special Education records shows that moderate and slight mental retardation were the most common disabilities (a rate of 5.1 and 4.8 per 1,000, respectively), followed by peripheral motor disabilities (1.3 per 1,000), extensive motor disabilities (1.2 per 1,000), and multiple disabilities (1.2 per 1,000).

Analysis by Type of Disease

Communicable Diseases

Vector-Borne Diseases. There are 4–5 imported cases of malaria in Guadeloupe every year. There were serious outbreaks of dengue fever in the second half of 1992 and 1994. Dengue-2 virus was isolated in 1994. Seven cases of dengue hemorrhagic fever were recorded in 1995, three of them fatal. Seropositivity is more than 30% during epidemic outbreaks.

The only form of schistosomiasis encountered is Schistosoma mansoni (intestinal bilharziasis). The main transmission sites were eradicated through a biological campaign against the mollusk vector (Planorbis).

Vaccine Preventable Diseases. No cases of poliomyelitis or diphtheria were recorded in recent years. The measles surveillance network set up in 1992 did not report any cases confirmed by serology between 1992 and October 1996, when an epidemic broke out. By the end of March 1997, 85 cases had been confirmed by serology, 79% in schoolchildren between 10 and 19 years of age. There were no cases in children under 1 year old. Of the confirmed cases, 17% had been vaccinated.

No cases of neonatal tetanus have been discovered in the 1992–1996 period. Two deaths from tetanus occurred in 1994: one was an 80-year old woman and the other an unvaccinated female foreigner.

Influenza syndromes as a whole were monitored by the network of sentinel doctors, and influenza surveillance with a nasopharynx search for the virus was instituted in March 1996. This confirmed the existence of an epidemic early in October 1996, and the presence of the H3N2 strain of the type-a virus was established.

Blood donation samples taken in 1989 showed a 2.9% prevalence of hepatitis B. These encouraging results were obtained through rigorous donor selection procedures established to increase the security of blood transfusion products. Positive hepatitis C tests from blood donation samples fell from 21.8 % in 1990 to 0.9% in 1993 and to 0.07% in 1996.

Cholera and other infectious intestinal diseases. There were no cases of cholera in Guadeloupe, and diarrheal diseases are no longer a public health problem, owing to the high quality of the water system and to food-product controls.

Acute respiratory infections. The rate for acute respiratory infections is 0.5 per 1,000 among children under age 5. A 1993 study conducted on schoolchildren aged 6–12 years showed a 13.6% prevalence of asthma in the Basse-Terre region.

Rabies and other zoonoses. No case of rabies has ever been discovered in Guadeloupe. Leptospirosis is endemic in Guadeloupe, with 5–6 cases occurring per year. Nineteen cases, including two deaths, were reported in 1996.

As of 31 December 1996, a total of 731 cases of AIDS had been reported in Guadeloupe. The proportion of affected women is high. Transmission is heterosexual in 63% of cases, and the mother-to-fetus infection rate is 3%. The 20–39-year age group accounts for 53% of the cases, and 59% of total cases have died. In 1994, an HIV seroprevalence rate of 2% was found among 1,469 persons tested at screening centers.

A survey conducted in 1996 at the family planning centers and the anti-venereal facility showed a 14.3% prevalence rate for Chlamydia trachomatis in the under-25 age group.

Tuberculosis and Leprosy. In 1990 and 1991 a tuberculosis outbreak resulted in 18.3 and 16.2 cases per 100,000 population, respectively. This was followed by a decline in the global incidence of tuberculosis, stabilizing at an average rate of 10.8 per 100,000 inhabitants between 1994 and 1996. This reduction in incidence is visible mainly among women. No cases were detected among children under age 15. The BCG immunization rate is 90% among 1-year-olds. The two groups most affected are those over age 65 and 24–44-year-olds (28 and 16 per 100,000, respectively). One-quarter of new cases of tuberculosis occur among the foreign population. Half the cases are contagious and show the presence of Koch’s bacillus on direct examination. The tuberculosis/HIV co-infection rate is 27%. The study of antibiotic resistance conducted by the Mycobacteria Center of the Pasteur Institute revealed one case of multidrug resistance.

The leprosy incidence rate (7 new cases in 1995 and 10 in 1996) remains low. In the last two years, 14 of the 17 cases occurred among males. All new cases have been found among persons over the age of 15. The bacillogenic forms predominate (9 in 17 cases). In 1995, there were some 700 cases in the active files, 20% of whom were in treatment and 80% under post-treatment surveillance.

Noncommunicable Diseases and Other Health-Related Problems

Diabetes. Given the estimated 6.6 % prevalence of diabetes and the many complications associated with this disease, in 1996 a five-year action plan was developed to address this health problem in Guadeloupe.

Cardiovascular Diseases. An average of 740 deaths resulted from cardiovascular diseases each year during the 1987–1992 period, making it the leading cause of death (33% of all deaths). Cardiovascular disorders cause one death in five in those under age 65. Cerebrovascular disorders cause an average of 320 deaths per year, accounting for 43% of deaths from cardiovascular diseases.

Hypertension is the condition most often requiring hospitalization. Cerebrovascular accidents account for 9% of admissions for circulatory diseases. In 40% of these cases, hospitalization exceeds 10 days. Cardiovascular disorders constitute 41% of all illnesses for which the patient receives full coverage by the health insurance system.

Malignant Tumors. Cancer is the second most common cause of mortality. Prostate cancer in men, cancer of the cervix in women, and stomach cancer in both sexes are quite frequent. Hospital admissions for cancer account for 5 % of all hospitalizations.

Road traffic accidents pose a priority public health problem in Guadeloupe. Annually, an average of 98 people die and 568 sustain serious injuries (requiring more than six days in hospital). Sixty-three percent of deaths from road traffic accidents are in the 15–44-year age group. Pedestrians and drivers of two-wheeled vehicles account for 22% and 33 % of traffic deaths, respectively. The 15–44-year age group accounts for 69% of those seriously injured.

In 1993, there were 1,565 victims of accidents at work; 10 % were serious or fatal.

The main victims of domestic accidents are children under age 5. The principal causes are poisoning by household products, falls, and burns. In 1996, there were 423 reports of child abuse. In 87% of the cases reported to the judicial authorities, removal of the victim was immediate because of extreme violence and/or sexual abuse.

An annual average of 150 deaths were attributed to alcohol-related problems between 1987 and 1990. The male-to-female ratio of alcoholism is 8:2. Chronic alcoholism is the fourth most frequent cause of premature death (under age of 65), and the third most common pathology associated with hospitalization. Of alcohol-related pathologies, alcoholic psychosis accounts for about 45 deaths a year. The annual average deaths from cancer of the upper digestive tract and cirrhosis of the liver are 55 and 50, respectively.

An average of 150 tobacco-related deaths were recorded during the 1987–1990 period. Of the victims, 60% were men and 40% women, although breakdown varies according to the pathology group. Cancer of the trachea, bronchus, and lungs is increasing, especially in women.

There has been a transition from dependence on marijuana to dependence on crack cocaine in Guadeloupe. There has been an increase in the number of drug addicts treated by the health and social services and in the number questioned about drug use and trafficking. The population using drugs is young (62 % were under age 30 and 47% under age 25 in 1994), mainly male (92%), and often falls into the inactive population group (two-thirds of cases). In 1994, the two most commonly used substances were marijuana (64%) and crack cocaine (26%).

Guadeloupe is situated in a high-risk zone for natural disasters such as hurricanes, volcanic eruptions, and earthquakes. Hurricanes pose a yearly threat. In 1989, Hurricane Hugo caused considerable damage, as did Hurricanes Luis and Marilyn in 1995.

RESPONSE OF THE HEALTH SYSTEM

National Health Plans and Policies 

The State Department of Health is part of France's Ministry of Labor and Social Affairs. Other participants in health activities are the Ministry of the Interior (drug abuse programs), the Environment, Agriculture (food safety) and National Education (school health). 

A 1992 law provides that all persons residing in France and in French Departments have the right to financial assistance for medical treatment costs in case of need. Access to medical attention for the poor is organized by the Department in which they live. The Department pays either the entire cost or the "ticket moderateur," which is a portion ranging from 0% to 65% depending on the nature of the illness, the care provided, or the type of medication. The costs of care to the homeless are paid by the State. 

Health insurance is provided by the social security system, a State-sponsored mechanism financed with compulsory contributions from salaries. The patient pays the total cost of treatment directly to the health provider and is later reimbursed by a health insurance agency. Reimbursement amounts are negotiated by healthcare providers and the social security system. A growing proportion of the population voluntarily takes out additional insurance to finance non-reimbursable portions. A system of direct payment by insurers relieves the patient from having to advance the cost, particularly for hospital and drug costs. In these cases, the health insurance system pays directly to the healthcare provider and the patient contributes the "ticket moderateur".

Organization of the Health Sector 

Institutional Organization

The State has responsibility for general public health, including community-wide disease prevention, sanitation surveillance, border health control, and the control of major diseases and drug and alcohol addiction. The State oversees training of health personnel, helps define their conditions of work, monitors observance of quality-control regulations and health safety in treatment centers, and regulates pharmaceutical products. Moreover, it supervises the adequacy of treatment and preventive arrangements and regulates the volume of treatment provided. The central Government oversees the functioning of public hospitals, appoints their directors, establishes their budgets, and organizes their staff recruitment. Finally, the State supervises social welfare, its financing, the rules for population coverage, and financial responsibility for treatment. 

A prefect manages the State decentralized services corresponding to each of the Ministries involved, particularly those relating to health issues. At the local level, other prefects manage a Health and Social Affairs Office and the Interregional Social Security Office, common to the three departments and with a central seat in Martinique. 

Under the 1983 decentralization law, certain State medical and social responsibilities were transferred to the Presidents of the General Councils in each Department. These include: maternal and child welfare, immunization, tuberculosis control, sexually transmitted diseases (excluding AIDS), cancer, leprosy, child social welfare, and part of the assistance to the elderly and to disabled adults. The mayors may have certain responsibilities for sanitation and immunization, and chair the boards of directors of public health establishments.

Residents of the French Departments enjoy unrestricted access to a wide range of primary and secondary medical services in France. In 1991, the University Hospitals and Regional Cancer Control Centers in France provided 61,000 hospital days to 4,500 patients from the French Departments, which represent an estimated 11% of hospital operation in Guadeloupe. More than 25% of those days were for treatment of cancer patients, followed by patients suffering from cardiovascular disorders and genitourinary diseases. The social security system reimburses hospital expenses, but pays airfares for only a small proportion of patients requiring medical treatment not available in the Departments. 

Public and private hospitals provide full hospitalization, ambulatory treatment, and outpatient consultations. Inpatient care is divided into short-term treatment (acute conditions), follow-up (convalescence, readaptation, and functional rehabilitation), and long-term care (designed essentially for the elderly). Private practitioners provide most ambulatory or home care, although patients may also avail themselves of outpatient services at hospitals or treatment centers. 

The public and private sectors differ in some regards. Teaching and research are part of the specific missions of the public hospitals. They are obliged to accept all patients and employ only salaried staff. Physicians in private hospitals charge fees. 

Since 1985, public establishments have been financed primarily through a grant made by the State on an annual basis and paid by the health insurance scheme. Private establishments are funded through lump-sum payments and daily rates fixed by the regional health insurance offices. Their funding is thus proportionate to their activity, which is not the case for public hospitals. 

Organization of Health Regulation Activities 

Environmental protection: These are the responsibility of the State in each Department. Water for human consumption and use (including sea water and swimming pools) and treatment of wastewater are periodically inspected. 

Food safety: The Departmental Bureau of Health and Social Affairs and the Veterinary Department (Ministry of Agriculture) conduct food poisoning surveys. The Departmental Bureau of Competency, Consumption and Fraud Elimination (Ministry of Internal Revenue) performs quality control of comestible goods and food preservation. 

Health Technology: Health equipments are nationally supervised; all equipments can be installed at health facilities only after clearance from national authorities, on the basis of a sanitary map which shows the relation of bed capacity and major medical equipments to the number of inhabitants.

Health Services and Resources

Organization of Services for care of the Population 

Health promotion: The Center for Health Education of France develops campaigns on a variety of health and hygiene topics that are delivered by the Departments. In addition, the National System of Medical Insurance conducts screening and prevention campaigns (for example, for cervical and breast cancer). The Departmental Bureau of Health and Social Affairs has the capacity to conduct campaigns using education materials sensitive to the local conditions. 

Disease Prevention and Control Programs; Residents of the Departments have access to regular examinations during their school years and in the workplace. Also, maternal and child welfare services are available to pregnant women and young children. The Departmental Bureau of Health and Social Affairs is responsible for reporting notifiable communicable diseases. 

Organization and Operation of Personal Health Care Services 

The Guadeloupe health system is organized around 25 health establishments; 10 are in the public sector (one regional university hospital center, five hospitals, one psychiatric hospital, two local hospitals, and one long-term care hospital) and 15 are private, for-profit clinics on Basse-Terre and Grande-Terre. As of January 1996, the capacity for short-term medical, surgical, and gynecological/obstetric care was 1,146 beds in public and 900 beds in private facilities. There were 417 beds in public hospitals and 21 in private clinics for psychiatric admissions, with 214 public and 209 private beds available for follow-up and rehabilitation.

Certain specialized care is provided on the two main islands, including: emergency admission and treatment, resuscitation, neonatal care and resuscitation, treatment of chronic kidney failure (322 patients were on dialysis and 7 kidney transplants were performed in 1996), and gynecological/obstetric medical treatment.

Service networks: A system of municipal hospitals is available to provide intoxication and hepatitis C therapy, which strengthens the coordination among hospital doctors and private practitioners. There are also HIV infection information and healthcare centers. 

Diagnostic ancillary services and blood transfusion units: Blood transfusion units operate nationally under the French Blood Agency. Regionally, a physician monitors proper blood-transfusion practices. 

There are 22 private and 8 public biomedical labs in Guadeloupe. The prefect may authorize the operation of private laboratories taking into account local conditions, personnel qualifications and available equipments. The public labs are part of the hospitals. 

Specialized services: Psychiatric services in France are organized by geographical areas. Each adult psychiatry service covers an area of about 70,000 inhabitants; for each three of these services there is a child psychiatry service. 

There are two administrative offices in charge of the disabled: the Departmental Commission for Special Education reviews all the employment applications of disabled persons under 20 years of age, as well as financial support applications from their families. For disabled persons 20 years of age and older, the Commission for Technical Orientation and Professional Reclassification of each department offers work placement services and assessment of financial assistance and special referral services.

Since 1984, the French prison population has received medical coverage equivalent to that of the general population.

Inputs For Health

Drugs and immunobiological products: In the Antilles and in French Guiana there are 308 pharmacies, (140 in Guadeloupe, 139 in Martinique, and 29 in French Guiana) and 7 wholesale distributors (2 in Guadeloupe, 2 in Martinique, and 3 in French Guiana). All pharmaceutical products, including vaccines, are imported from France. Usually, drugs are available by doctors’ prescription and the patient is reimbursed by a health insurance agency. A system of direct payment by insurers relieves the patient from having to advance the cost. The authorities set the price of reimbursable drugs. Generic drugs have yet to find a significant niche in the French drug market. The price for drugs in the Departments is adjusted to offset transportation costs. In the last 20 years there has been a sharp increase (approximately eightfold) in expenditures for medications by households in the French Departments.

Quality control of pharmaceutical products is based on health surveillance activities, alert systems, operation manuals, continuing education of pharmaceutic personnel (soon to be mandatory), and site inspections to pharmacies in each region. Drug advertising to the public and physicians is regulated. Health authorities conduct periodic information campaigns on drugs and their proper use.

Medical equipment: Implementation of major medical equipment requires authorization of the prefect. Some equipments are shared by the three departments. For example, a magnetic resonance imaging device in Martinique and a lithotriptor in Guadeloupe.

Human resources

Education and training: Doctors are trained in the medical schools attached to the university hospitals. A tertiary cycle of medical studies exists with a training capacity of 5 specialists and approximately 100 general practitioners per year in the Departments. This takes place through an agreement between the University of Bordeaux II and the Antilles-French Guiana Training and Research Unit, which is attached to the University of Antilles-French Guiana.

The Fort-de-France and Pointe-à-Pitre teaching hospitals serve as supervised practical training facilities for medical students. A school in Martinique, attached to the Fort-de-France university hospital, trains 14 midwives a year; a school for operating room nurses at the Lamentin Hospital in Martinique trains 10 nurses a year; and there are two schools for ambulance staff, one in Martinique and the other in Guadeloupe. There is also a school of nursing in each of the Departments, training a total of 61 nurses per year. Other health professionals are trained in France.

Continuing medical education is provided for salaried doctors in the health establishments where they are employed, and has been compulsory for private doctors since 1996. This training is managed by Regional Councils for Continuing Education and the National Council for Continuing Education.

Healthcare Personnel: As of January 1997, the ratio of private doctors in the Departments was 66 general practitioners and 40 specialists per 100,000 population. Private doctors are paid for each consultation, while other health professionals may be salaried or may practice privately and be paid for each consultation.

Health research and technology

The National Institute of Health and Medical Research has a unit in Guadeloupe devoted to emoglobinopathy. The Institute has Research Guidance Committees in each Department.

External technical and financial cooperation

To ensure access to care for the destitute, Physicians of the World, a nongovernmental organization, provides free medical consultations. Likewise, the AIDES Association, in partnership with State authorities, is involved in the fight against AIDS.

Specific projects are assisted through the Inter-ministerial Fund for the Caribbean. The Fund, which receives approximately 10 million francs (US$ 1.8 million) annually, is administered by an inter-ministerial delegation responsible to the prefect of Guadeloupe, and is designed to support bilateral cooperation projects involving at least one Department and a neighboring foreign country. One-sixth of the Fund is devoted to health. Health facilities, particularly the Fort-de-France and Pointe-à-Pitre teaching hospitals, negotiate cooperative activities with neighboring countries in the areas of training, telemedicine, and on-site visits by health practitioners to administer treatment.