Data updated for 2001

SAINT LUCIA

GENERAL SITUATION AND TRENDS

Socioeconomic, Political, and Demographic Overview

Saint Lucia is a mountainous island, spanning 238 m2; the Atlantic Ocean is to its east and the Caribbean Sea to its west. The population is concentrated along the coastal areas and the less mountainous areas to the country’s north and south. Hurricane season extends from June to November, posing a continuous threat to Saint Lucia’s agriculture and physical infrastructure. The official language is English; Saint Lucian French Creole is spoken and understood by more than 70% of the population, mainly in the rural areas.

Saint Lucia became independent from Great Britain in February 1979. The country has a democratic system of government patterned after the Westminster model. The most recent parliamentary elections were held in 1992 and the next elections are scheduled for 1997. Saint Lucia is a member of the Commonwealth of Nations and the Organization of Eastern Caribbean States (OECS).

Saint Lucia’s centrally controlled political structure began to be decentralized in the 1980s, in order to make government services better respond to community needs and to involve community members in decision-making. Overall, implementation has moved slowly, with the decentralization of government and/or public services gaining more ground than those in the areas of financial control and decision-making. In the health sector, the administration and delivery of public health services has been decentralized and has led to greater collaboration between staff of the various health departments. Regional health teams were established but have not remained functional. The country has 10 administrative districts.

Saint Lucia has experienced continuous economic growth, averaging 3.9% for 1992–1995 and 3.2% for 1988–1991. The growth rate was 7.1% in 1992 and 4.1% in 1995. The vulnerability of the country’s economy to natural disasters was demonstrated during recent floods and damaging winds. The economy has depended mainly on agriculture, especially the banana industry. Despite having been plagued with problems such as input shortages, the global liberalization of trade policies resulting in a reduction in the price of bananas on the European market, and tropical storm Debbie that was estimated to have damaged 58% of the banana crop in 1994, the industry recorded a 13.6% increase in production in 1995. This increase contributed to an estimated growth rate of 9.3% in the agricultural sector for that year.

The role of tourism in the economy has increased, mainly due to a 36.9% increase in visitor arrivals between 1991 and 1995. Hotel occupancy rates have averaged 66% between 1991 and 1995. The hotel and restaurant sector has ranked fifth in the sectoral share of GDP for 1991 and 1995, but the percentage contribution of this sector to GDP rose from 9.3 % in 1991 to 11.8% in 1995.

The unemployment rate was 15.3% in December 1995 (compared to 16.7% in November 1992): the rate was 12.3% for males and 19.0% for females; it was highest in the age groups 15–19 years old (53.3%) and 20–24 years old (21.2%) and lowest in age groups 25–34 years old (10.7%), 35–44 years old (8.2%), and 45–54 years old (6.2%). The unemployment rates in the 15–19 age group was 63.4 % for females, and 46.6% for males. The leading sectors for employment were agriculture (22%), the public sector (14%), wholesale and retail trade (14%), manufacturing (11%), construction (10%), and hotel and restaurants (10%).

Schooling is compulsory for children aged 5–15 years old. The enrollment rate at the 83 primary schools has averaged 99%, roughly evenly distributed among boys and girls. The percentage of students attending secondary schools rose from 27.5% in 1988 to 37.8% in 1992, and 43.8% in 1994. More girls gain acceptance to secondary schools, with the male-to-female enrollment ratio averaging 1:1.13. There are 15 secondary schools. The number of pupils enrolled in secondary schools increased by 20%, from 9,146 to 11,202 between the academic years 1992–1993 and 1995–1996.

The 1990 literacy survey established the literacy rate as 54.1%, the illiteracy rate as 27.2%, and the functional illiterate rate as 18.7%. Most rural students speak French Creole, which puts them at a disadvantage in the formal education system, which uses English exclusively.

In 1995, Saint Lucia’s estimated midyear population was 145,213, representing an increase of 6.8% since 1991. The average annual population growth rate was 1.6% during the 1992–1995 period. In 1995 the population density was 270 persons per km2, an increase of 7.6% from 1991.

The age and sex structure of the population has changed little since 1991. In 1995, women still constitute a slight majority, at 51.4% of the total population. The population is relatively young, with 45.8% under the age of 20 years old. The birth rate was 27 births per 1,000 population in 1991 and 25 births per 1,000 in 1995. Women of childbearing age (15 to 49 years old) make up 26% of the population. The economically active population (age group 15–64 years old) comprise 59% of the total. The age dependency ratio was 0.69 in 1995. It is estimated that 30% of the population lives in urban areas, which has placed increased demands on housing, water, and social services. There is limited data on migration: the 1991 population census estimated that 25% of the population had moved from their place of birth, and that 30% of them resided in the capital city at the time.

Mortality Profile

In 1995, life expectancy rates for males and females were 67.5 and 73.3 years, respectively. The crude death rate was 6.7 deaths per 1,000 in 1991 and 1995, and averaged 6.8 deaths per 1,000 during 1992–1995; in 1995, the rate was 7.3 per 1,000 for males and 6.0 per 1,000 for females.

The average infant mortality rate was 16.5 deaths per 1,000 live births in 1992–1995. There were 3,839 deaths reported during 1992–1995, an average of 960 deaths per year. Non-communicable diseases are the major cause of death, particularly diseases of the circulatory system (33%), malignant neoplasms (15%), and diabetes mellitus (11%). The fact that 66 deaths were labeled "cardiac arrest" underscores the problems with the quality and thoroughness of death certificates.

SPECIFIC HEALTH PROBLEMS

Analysis by Population Group

Health of Children

The major health problems in this group are acute respiratory infections, diarrheal disease, and accidents.

The perinatal mortality rate in 1992–1995 averaged 25 deaths per 1,000 births. In 1995, the infant mortality rate was estimated as 18.5 per 1,000 live births for males and 14.5 per 1,000 for females. Sixty-two percent of infant deaths during 1992–95 were classified under "conditions originating in the perinatal period," of which prematurity and abnormal fetal growth (48%) and birth asphyxia and respiratory problems (36%) were the major causes. The mortality rate for children under 5 years old was 4.6 per 1,000 population for 1992–1995. Deaths in this age group accounted for 7.9% of all deaths during 1992–1995. Of the 62 deaths in the age group between 1 and 4 years old during 1992–1995, 61.3% were males and the main causes were traffic accidents (5), other accidents (11), infections (10), cancers (4), and pneumonia and influenza (4).

There were 27 deaths in the age group 5 to 9 years old during 1992–1995, with the major causes of death being traffic accidents (4), other accidents (5), and anemia (4). Information on the morbidity profile of this age group is not available.

Health of Adolescents

Health services targeted to adolescent age groups (10–14 and 15–19 years old) do not exist. Immunizations are offered to children at school. Twenty-seven deaths were reported during 1992–1995 in the age group 10–14 years; 19 males and 8 females. The major causes were traffic accidents (4), other accidents (8), and cancers (5). In the group 15–19 years of age there were 41 deaths during 1992–1995, 25 males and 16 females; the major causes of death were accidents and external causes (15) and cancers (6).

The fertility rate for the age group 15–19 years of age was 104 per 1,000 population in the age group in 1990, and has remained above 80 per 1,000 during 1992–1995. The 1988 contraceptive prevalence survey indicated that 16% to 17% of girls in this age group were using a family planning method; the most frequently used methods were contraceptive pills (37.0%), condoms (30.1%), and contraceptive injections (21.9%).

Health of Adults

During 1992–1995, 864 deaths were reported in this age group (20–59 years old), of which 64.5% were males. Accidents and external causes (195) accounted for 22.6% of all deaths, with the leading causes being traffic accidents (60 deaths), other accidents (60), homicides (41), and suicides (30). Diseases of the cardiovascular and circulatory systems accounted for 20.8% of deaths, with the major causes being cerebrovascular disease (48 deaths), ischemic heart disease (35), and hypertensive disease (23). Other major causes of death were cancers (14.5%), disease of the digestive system (8.7%), and diabetes (7.2%). One maternal death was reported during 1992–1995.

Health services for this age group focus mainly on the needs of adult females. There are no services specially designed for the male population.

An estimated 50% of pregnant women use the public health clinics for prenatal care, and of these, 10%–15 % register before 16 weeks. The remaining 50% of pregnant women attend private facilities. As of 1994, pregnant women have been advised to have a routine ultrasound examination at 20–22 weeks gestation.

The last contraceptive prevalence survey was conducted in 1988 and showed that 54.8% of fertile, non-pregnant, and in-union women were using a contraceptive method of which the most frequently used were contraceptive pills (39.2%), tubal ligation (16.3%), and contraceptive injections (15.9%).

Health of the Elderly

In 1995, persons 60 years old and older constituted 8.2% of the total population, and women accounted for 57% of this age group.

During 1992–1995, 2,564 deaths were reported in this age group, which represented 66.8% of all deaths. Women accounted for 53% of these deaths, and the most frequent causes were cardiovascular disease (39.8%), cancers (15.4%), and diabetes (10.7%). Of the 1,021 deaths classified as cardiovascular, the major causes were cerebrovascular (40.8%), hypertensive disease (16.5%), and ischemic heart disease (13.9%).

Family Health

During 1990–1995, an annual average of 42 cases of domestic violence and 100 cases of child abuse were reported to the social services department: 38% of cases were for physical abuse and 35% for sexual abuse.

Victims receive support and counseling from the social services department and the crisis center. The Ministry of Women’s Affairs has prepared materials giving victims and care providers information on victims’ rights and available support services.

Workers’ Health

The Occupational Health and Safety Unit is part of the Department of Labor, and is responsible for monitoring, investigating, and enforcing legislation regarding workers’ health. Available data on workers’ health is limited to an analysis of injury and sick benefit claims submitted to the National Insurance Scheme (NIS), which covers about 60% of workers. During 1989–1994, 80% of claims due to employment injury (718) were submitted by males, and 80% occurred in workers 20–49 years old of both sexes. In 40% of cases the type of injury was unknown or unspecified, 33% were superficial injuries, and 13% were open wounds. Sixty percent of the sickness claims (12,972) were by female workers, and 65% and 75% of them were in the age group 20–39 years for males and females, respectively.

Health of the Disabled

The 1991 population census recorded 9,449 persons with disabilities, which represented 6.9% of the population: 58 % of disabilities occurred in females, 43% occurred in persons 65 years old and older, and 46% occurred in persons 15–64 years old. Locomotor disabilities system and sight impairments accounted for 70% of all disabilities. The cause of the disability was not recorded.

A team of health professionals conducts a monthly clinic for children with multiple handicaps. Community health aides are responsible for community-based rehabilitation and for a pilot program for early stimulation of disabled children.

Analysis by Type of Disease

Communicable Diseases

Vector-Borne Diseases. No cases of yellow fever were reported during 1988–1991 or 1992–1995. The number of reported cases of malaria, dengue, and schistosomiasis were 3, 9, and 8 during 1992–1995, compared with 0, 12, and 21, respectively, for 1988–1991. The two cases of malaria reported in 1995 were imported.

Vaccine-Preventable Diseases. Immunization coverage rates during 1992–1995 ranged between 95% and 99% for BCG and between 92% and 98% for DPT and OPV. The rates for MMR were 72% in 1992 and 92% to 94% for 1993–1995. In 1994, 96% of school girls aged 11–15 years were immunized against rubella. Saint Lucia recorded its last case of poliomyelitis in 1970 and was certified as being free of the transmission of wild poliovirus in 1994. Neonatal tetanus was last reported in 1985; one case of non-neonatal tetanus was reported in 1993. The number of reported cases of suspected measles in children under 15 years old has decreased steadily from 37 in 1992 to 8 in 1995. In the 1992–1995 period, no cases of measles or rubella were confirmed through the surveillance system, nor were any cases of diphtheria or whooping cough reported.

Cholera and Other Intestinal Diseases.  Cholera has not been reported, but it is being monitored in the subregion with the assistance of the Caribbean Epidemiology Center (CAREC), so that public education and surveillance can be engaged when required.

Routine reporting from the District Medical Officer clinics demonstrated that diarrheal infection epidemics occur every two years, with children under 5 years old accounting for approximately 50% of cases; causative pathogens were not identified. During the reporting period, 3,994 cases were reported, a drop from the 4,536 cases reported for 1988–1991.

Tuberculosis and Leprosy. Eighty-two cases of tuberculosis were reported during 1992–1995, compared to 98 cases reported during 1988–1991; all were respiratory tuberculosis cases. Available information for the 56 cases reported during 1993–1995 indicates that they were equally distributed between males and females and that they occurred in the age groups 40–59 years old (34%), 60 years old and older (30%), and 20–39 years (29%). Five cases have been reported in persons with AIDS. There were 27 deaths caused by tuberculosis for 1992–1995.

During 1992–1995, 34 new cases of leprosy were reported, all of whom were in persons older than 15 years old. In 1995, 24 cases were being treated and 11 were under surveillance.

Acute Respiratory Infections. Reported cases of acute respiratory infections declined between 1988–1991 and 1992–1995. During the latter period, 78 cases of pneumonia in children under 5 years old and 1,731 cases of influenza were reported, compared to 321 and 2,298 cases, respectively, for 1988–1991.

Rabies and Other Zoonoses. Eight cases of leptospirosis were reported during 1992–1995, and no cases were reported in 1988–1991. Information is not available on the age, sex, occupation or location of these cases. One death due to leptospirosis was reported in 1995, in a 45-year-old male from a rural area.

Leptospirosis has been diagnosed clinically and through serosurveys in cows. Cryptosporidiosis has been identified in cows in one area of the island. A survey in 1994 did not reveal any cases of brucellosis or tuberculosis in cows. Rabies is not present in Saint Lucia.

AIDS and Other Sexually Transmitted Diseases. The first case of HIV infection was diagnosed in 1985 and the first case of pediatric AIDS was reported in 1990. As of December 1995, there were 140 reported cases of HIV infection and a cumulative total of 81 persons diagnosed with AIDS. The cumulative case fatality rate for AIDS was 88.9%. The male:female ratio for HIV infection is 1.2:1, which points to a primarily heterosexual mode of transmission; 52% of cases were in the age group 30–44 years, and 6 were pediatric cases.

The total number of HIV tests ranged between 4,000 and 5,000 over the last five years, with 33% having been performed by the blood bank, 38% at STD clinics, 20% by medical practitioners in the public and private sector, and 9% as part of seroprevalence surveys.

Information on sexually transmitted diseases is limited to reports from three STD clinics in the country’s north, south, and west, and reports to the epidemiology unit. During 1992–1995, 670 cases of syphilis and 343 cases of gonorrhea were reported to the epidemiology unit, compared to 689 cases of syphilis and 599 cases of gonorrhea reported during 1988–1991.

Noncommunicable Diseases and Other Health-Related Problems

Nutritional Diseases and Diseases of Metabolism. There are pockets of undernutrition, but the extent of the problem is not known. There were nine cases of undernutrition reported in children under 5 years old in 1992–1995, compared to 23 cases during 1988–1991. Iron deficiency is the only micronutrient deficiency that has been identified, but the extent of the problem, particularly among women and children at-risk groups has not been determined.

Diabetes accounted for 8.8% (339) of all deaths during 1992–95; women accounted for 65% and those in persons older than 60 years old, 81%.

Cardiovascular Diseases. During the 1992–1995 period, there were 1,304 deaths due to diseases of the circulatory system, accounting for 33% of all reported deaths and ranking as the main group of causes of death.

Malignant Tumors. The country has no cancer registry. An analysis of histopathological diagnoses of 2,714 specimens examined at the two main hospitals in 1995 revealed that 8.2 % (222) were malignant neoplasms. The main sites affected were the uterine cervix (20.7%), skin (18.9%), female breast (12.2%), and digestive system (10.4%). The sites in 20.7 % were not specified.

Accidents and Violence. Accidents and violence accounted for 7.7% of all deaths in 1992–1995. The majority of these deaths occurred in the age group 15 to 44 years old, and 81% were in males. The number of deaths reported was 296, and the main causes were traffic accidents (28.7%), homicides (16.2%), drowning (14.5%), and suicides (11.8%).

Natural Disasters and Industrial Accidents. An oil spill occurred at the Hess Oil Terminal in 1995 with no major health consequences reported. Tropical Storm Debbie caused severe floods in September 1994, which led to landslides and damage to the agricultural sector and to the physical infrastructure. Tropical Storm Debbie resulted in three deaths, and total damage was estimated at US $85 million.

RESPONSE OF THE HEALTH SYSTEM

National Health Plans and Policies

The Ministry of Health’s main policy mandate is "to maintain and upgrade the present and future stock of human resources." The National Health Policy covers revenue collection, use of appropriate technology, health personnel quality, population growth, vulnerable and at-risk groups, substance abuse, workers’ health, and environmental issues. Strategies to address these policies are reflected in the National Ten Year Health Sector Plan, June 1993–July 2003.

The Government will continue to improve the health care system through a primary health care/preventive approach, while also increasing the availability and quality of secondary and tertiary services.

Financial constraints, the rising cost of health care, dwindling external funding, and the public’s demand for more sophisticated and expensive health care have led Saint Lucia to review health services management. At the heart of this reassessment is the question of how to organize the health services so as to promote equity, efficiency, sustainability, accessibility, quality, and consumer satisfaction.

Organization of the Health Sector

Institutional Organization

The Ministry of Health’s technical directorate and the country’s health professional organizations are responsible for leadership in health.

At the central level, heads of departments manage staff and different health development programs; they are supported by national program managers, who manage specific health programs. At the district level, health teams manage the health care administration and services. It should be noted that there are only two teams functioning.

In the public sector, health care is broadly grouped into personal health care services, human resources, and physical resources. Health promotion and prevention, curative, and rehabilitation services are offered and delivered at the primary, secondary, and tertiary levels.

Primary health care services are decentralized and offered at 34 health centers scattered throughout the island. Secondary and specialized services are concentrated in the country’s north and south at the two general hospitals and the psychiatric hospital.

The private health sector is made up of health professionals, nongovernmental organizations, and traditional healers. Medical and dental practitioners have always operated in the private sector, and many work in both the public and private sector. Nurses more recently have been employed in the hotel industry and in private home nursing care.

The Ministry of Health is responsible for establishing user fees in the public sector, but it has no jurisdiction over the operations of private health insurance companies. The main types of health insurance are private health insurance for individuals and groups and coverage by National Insurance Scheme (NIS).

The medical and nursing councils are responsible for the registration and monitoring of doctors and nurses; the Medical Board is responsible for the registration of dentists, pharmacists, and optometrists. The practice of public health professionals is guided by the Public Health laws. Currently, practitioners need not submit proof of continued medical education or a certificate of physical fitness to practice in order to re-register.

There is no national drug regulatory authority; CARICOM is working to establish a Regional Advisory Body on Drugs and Therapeutics (RABDAT), which will serve as the regional regulation authority for the registration of drugs. Trade licenses are required for the importation of drugs, reagents and other medical supplies.

The Pesticide Control Board is responsible for the registration and licensing of pesticides. Mechanisms are in place for the surveillance and control of biological and chemical contamination of water; however, chemical safety and the quality of the air, soil, and housing are not routinely monitored, and monitoring and enforcement of these measures are inadequate.

Food safety and quality are covered under the 1980 Public Health Regulation No. 70, and the executing agency is the Environmental Health Department’s Food Unit. By law, food establishments and food handlers must be registered and in possession of a license.

Health Services and Resources

Organization of Services for Care of the Population

Health Promotion, Health Settings and Environments, Social Communication. Health promotion and education within the Ministry of Health come under the Bureau of Health Education; other Ministry departments, other ministries, and nongovernmental organizations also undertake health promotion activities. Popular theater is increasingly being relied upon for health promotion and education purposes, and Creole is being more widely used to disseminate health news to the public through the media. During 1993–1996, 197 male and 515 female peer counselors received training to provide support and information to youth in the areas of family life, values, human sexuality, and fertility.

Programs of Disease Prevention and Control. Preventive services are provided free of charge, except for yellow fever vaccine, vaccines required for college entry, and contraceptive supplies. Pregnant women are screened for anemia, hemoglobinopathies, and syphilis; iron is routinely administered. Cord blood screening is performed. Immunization is routinely offered to children under 15 years old and pregnant women.

Regarding cancer screening, programs are in place for cervical and breast cancer, and prostatic specific antigen is now available for screening for prostate cancer.

Programs also are in place for the prevention and control of schistosomiasis; foodborne diseases; leprosy; AIDS and HIV; and dengue, including Aedes aegypti control. Health education, the reduction of risk factors and early detection, form a major component of disease prevention and control.

Oral Health. Dental services, including dental examinations, prophylaxis, dental sealants, fillings, scaling/root planing, and extractions, are provided at seven dental clinics spread throughout the island. X-ray services are available at three clinics, and one clinic provides treatment exclusively for children; root canal therapy is available only to children. A total of 12,049 patients were treated by the Ministry of Health’s dental services in 1995.

Oral fluoride treatment for children was discontinued in 1994 because of inadequate funding and erratic supplies. A 1994 study of all water treatment plants showed that most fluoride levels ranged from 0–0.2mg/dL.

Epidemiological Surveillance Systems and Public Health Laboratories. Surveillance systems are in place for communicable diseases of international, regional, and national interest. Active surveillance is under way for dengue, diarrheal diseases, poliomyelitis, HIV/AIDS/STD, and measles; the measles surveillance system was put in place in 1991, and surveillance for acute flaccid paralysis began in 1992. Information has been traditionally extracted from reports from District Medical Officer clinic registers.

Drinking Water Services and Sewerage. The Water and Sewerage Authority is responsible for monitoring and managing the municipal water supply, and it operates 37 raw water intakes that supply water to 31 water treatment facilities. Tropical Storm Debbie extensively damaged water treatment and storage facilities. The 1991 census indicated that 75% of households were connected to the municipal water supply. The Roseau dam was completed in 1996.

The improper disposal of chemicals by the agriculture and manufacturing sectors and the unrestricted access to raw water sources threatens water quality.

The 1991 census showed that the pit latrine is the main type of sewerage disposal (49%), with septic tanks being used by 29% of households, and 6% of households being linked to the sewerage system. Eleven percent of households concentrated in rural towns and villages had no excreta disposal facilities.

Solid Waste Management Services. Solid waste management falls under the combined responsibility of the Ministry of Planning, the Environmental Health Branch of the Ministry of Health, the Castries City Council, and the village councils.

Solid waste is not properly stored prior to collection, and is often disposed of inappropriately. Solid waste disposal is handled through open dumps, which are inadequate and not properly maintained.

Air Pollution Prevention and Control. The Ministry of Planning is responsible for the monitoring and control of air quality. The Government is signatory to several international conventions dealing with air quality and has started intersectoral discussions on ways to reduce substances that deplete ozone. In 1994, all Ministry of Health buildings were officially declared as smoke-free areas, and this policy was extended to all government buildings in 1995.

Food Protection and Control. The Food Unit of the Environmental Health Department is responsible for handling all aspects of food protection, control, and safety, including the inspection of commercial premises involved in food preparation, inspection of meats and other foods, training and registration of food handlers, and the investigation of foodborne illnesses.

Organization and Operation of Personal Health Care Services

Ambulatory Services, Hospitals, and Emergency Services. Medical and pharmaceutical services are available at least once a week at the 34 health centers throughout the island. Inpatient, outpatient, and accident and emergency services are available at the two general hospitals. The two district hospitals offer primary health care services and limited secondary care and emergency services. Patients move from the public to the private sector and between different levels of care to seek medical attention.

Auxiliary Services for Diagnosis and Blood Banks. Laboratory, colposcopy, and diagnostic radiology services are available in the public and private sector. The National Blood Transfusion Service is based at the main hospital. Donors are screened initially by a questionnaire, and then tested for HIV, HTLV-1, HBsAg, and VDRL.

Inputs for Health

Drugs. Saint Lucia procures some of its drugs and pharmaceuticals through the Eastern Caribbean Drug Service (ECDS). The National Drug Formulary Committee selects drugs and pharmaceuticals for procurement and awards contracts to approved suppliers.

Immunobiologicals. All vaccines used in the public sector are procured through PAHO’s Revolving Fund, which awards contracts to suppliers and monitors vaccine quality. The Ministry of Health provides vaccines to the private sector at a minimal cost. Hepatitis B and Haemophilus influenza B vaccines, and hyperimmune sera used in hospitals are purchased from local or overseas drug agents without any mechanisms for quality control.

Human Resources

Availability by Type of Resource. The number of personnel employed by the public sector increased during the reporting period: in 1995, there were 71 medical doctors, 7 dentists, 401 nurses, 15 pharmacists, 5 health educators, and 280 environmental health staff in all categories working at the Ministry of Health and in Saint Jude Hospital, a semi-private hospital serving the population living in the south of the island.

Education of Health Personnel. The Sir Arthur Lewis Community College is the only local institution that trains health professionals. The college began training of general nurses and midwives in 1988, and in 1994 conducted a Community Nutrition Diploma Course for Field Nutrition Officers. Community health aides are trained by the Community Nursing Department. Training for other categories of health professionals has to be pursued at regional and international institutions, and it is severely constrained by lack of financial resources.

Research and Technology

The Ministry of Health has increased the use of new technologies in several areas. The Environmental Health Department has introduced the use of ultraviolet lights, mist blowers, sensitizer strips, and thermometers in its vector control and food quality and control programs, as well as the use of ventilated improved latrines. Ultrasound and colposcopic services are available in the public and private sector, a computed tomography services in the private sector.

The country has no regulatory policies that address health research and technology, nor are there formal structures to assess and evaluate the impact of health research and technology. Health technology use has not been assessed.

Expenditures and Sectoral Financing

Information on public health expenditure is available for health institutions and specific programs. Information is not available, however, on private health expenditure or on the resources of institutions, corporations, and community and nongovernmental organizations.

The health sector is the second highest recipient of total government resources. The approved health budget averaged 12.5% of total government expenditure over the 1993–1995 period. For the fiscal years 1991/1992 to 1994/1995, recurrent public health expenditure averaged 1.6% of the total government budget for preventative health programs, 5.4% for hospitals (excluding Saint Jude Hospital), and 3.9 % for drugs and medical supplies (excluding vaccines). The Government pays for the salaries, wages, and gratuities of the staff at Saint Jude Hospital. The execution of major capital works has relied heavily on international aid.

The major source of funding for government recurrent expenditure comes from income tax, other taxes, and user fees. Because Government revenues from all sources are placed in a consolidated fund, revenue from user fees does not directly benefit the department or Ministry that collected the fees. Saint Jude Hospital is an exception, in that it keeps its user-fee revenue for its expenditures.

Recurrent health expenditure is financed from allocations from the consolidated fund, plus the National Insurance Scheme’s annual contribution to the fund to cover inpatient hospital expenses for its members.

In 1992, user fees for the public sector were reviewed upward, and as a result, the contribution of user fees to total health revenue increased from 29.5% in 1989/1990 to 49 % in 1992/1993.

External Technical and Financial Cooperation

Saint Lucia’s health sector receives technical and financial assistance from several agencies. The health sector also benefits indirectly from assistance to other ministries and agencies.

The Pan American Health Organization, the Caribbean Epidemiology Center (CAREC), the United States Agency for International Development, the United Nations Children Fund, the Peace Corps, and the French Government have provided technical assistance and funding for training activities; special programs such as immunization, breastfeeding, and cervical cancer control; and hospital furnishings and equipment. The health sector also receives assistance from CARICOM and the University of the West Indies. During the 1993–1996 period, financial support for capital projects has been received from the following donors: US$ 140,000 from the Basic Needs Trust Fund for the Gros Islet Polyclinic; US$ 11.3 million from the European Union for Victoria Hospital’s phase II project; US$ 1.06 million from the Government of France for Victoria Hospital’s phase I project; and US$ 1.96 million from the Caribbean Development Bank, US$ 2.45 million from the Global Environmental Trust Fund, and US$ 4.56 million from the World Bank all destined for the solid waste management project.