Data updated for 2001

GUYANA

GENERAL SITUATION AND TRENDS

Socioeconomic, Political, and Demographic Overview

Guyana extends for 215,000 km² along the northeastern coast of South America. It is the only English-speaking country in South America and is a member of the Caribbean Community (caricom). In 1996, the mid-year population was estimated at approximately 770,000 people. The 0–14-year-old age group represented 36.8% of the population and those 65 and older represented 3.9%. The population growth rate was 1.1 % in both 1995 and 1996, significantly down from the 1992 rate of 2.8%.

Amerindians or indigenous persons account for approximately 6.8% of the total population. Persons of East Indian descent account for 49.5% and those of African descent account for 35.6%. The remaining 15% are made up of Portuguese, Chinese, and persons of mixed descent.

In the 1992–1993 Household and Expenditure Survey, 68.9 % of the total population was classified as rural. Approximately 61.3% of the total population resided in 2 of the 10 administrative regions. Georgetown, the capital, is located in Region 4 (Demerara-Mahaica), which has 41.4% of the country’s population.

In 1992, the illiteracy rate was estimated at 4% (2% for males and 6% for females). Despite the seemingly favorable literacy rate, questions exist as to the functional literacy level of the population, particularly in relation to school dropout rates.

Guyana’s public sector monthly minimum wage was US$ 63 in 1997, up from US$ 52 in 1996, and US$ 25 in 1992. The monthly cost of a basic diet of 2,400 calories ranges from US$ 33 in Region 6, to US$ 42 in Region 10. As part of efforts to provide relief for the poor, the personal income tax threshold was increased from US$ 107 per month in 1996 to US$ 129 per month in 1997.

Average income and living standards have declined for nearly two decades, the burden of which was borne principally by the poor and underprivileged. Guyana’s external public debt burden in the early 1990s was just over US$ 2 billion. In 1989, the Government of Guyana embarked on an economic recovery program concurrently with an International Monetary Fund/World Bank-supported structural adjustment program to transform Guyana’s state-dominated economy to a more market-oriented one. Toward this end, the Government removed restrictions on imports, relaxed foreign exchange controls, and began to privatize many state corporations.

Fiscal policy has been severely constrained by the high internal and external debt burden. In 1996, the external debt stood at US$ 1.5 billion or US$ 1,947 per capita. With total domestic and scheduled external debt services estimated at 61.2% of current revenues in 1996, very little revenue is available for expenditures on the social sector. From 1995 to 1997, the Government took aggressive steps to secure debt relief of US$ 600 million through direct negotiations with its official bilateral creditors.

Economic and social indicators for the 1992–1996 period suggest that living conditions are improving, despite the fact that the percentage of the population living below the poverty level is, by conservative estimates, just above 40%.

The sugar, rice, and bauxite industries account for a significant portion of the country’s gross domestic product (GDP). Consequently, problems in the bauxite industry, together with problems in export markets for sugar and rice are serious causes for concern.

Guyana’s per capita GDP was US$ 766 in 1996, compared US$ 454 in 1992. The average for the period 1991–1994 was US$ 504. The growth rate of real GDP was 7.9% in 1996, up from 5.1% in 1995, and 7.7% in 1992.. In 1995, inflation had fallen to 8.1% and in 1996 to 4.5%. The average rate for the 1991–1994 period was 27.1%.

Mortality Profile

Life expectancy in Guyana was 64 years in 1994. For females it was 67.7 years in 1992, compared with 62.1 years for males. The fertility rate was 2.8 children per woman in 1994, the same as in 1992. The infant mortality rate as reported by the Bureau of Statistics was 27.8 per 1,000 live births in 1995 and 28.8 in 1994, significantly lower than the 1992 figure of 42.9. The Maternal Child Health Unit at the Ministry of Health reports, however, an infant mortality rate of 33.2 per 1,000 live births in 1995. The differences between the two sets of figures are a source of much concern.

There were 5,098 deaths in 1995 The 60 and older age group accounted for the most deaths: 2,291 (45 % of the total).

SPECIFIC HEALTH PROBLEMS

Analysis by Population Group

Health of Children

According to the Health Statistics Unit (Ministry of Health), there were 18,360 live births in 1995, of which 15.3% had low birthweight (<2,500 g). Of the 72,740 children under 5 years old who enrolled at clinics in 1996, 13,215 (18.2%) were assessed as moderately malnourished at least once during the year. The percentage of moderately malnourished children under 1 year of age was 21%. The percentage for children 1–2 years old, 3–4 years old, and 4–5 years old were 17%, 17%, and 12%, respectively. The number of children diagnosed as severely malnourished was 683 (less than 1%), with a rate of 2% for infants under 1, 1% for children 1–2 years old, and less than 1% for children 2–5 years old. In 1996 the nutritional status of 288 children 0–4 years old was assessed and 34 (11.8%) of the children showed levels of undernourishment and stunting, and only 3 (1%) of the children were overnourished. In 1996, of the 17,726 infants attending clinic at three months, 5,844 (33%) were breast-fed exclusively, 9,910 (56%) were partially breast-fed.

In 1995, the stillbirth rate was 22.9 per 1,000 total births. The perinatal mortality rate was 36.9 per 1,000 live births, while the neonatal mortality rate was 17.5 per 1,000 live births.

Between 1992 and 1996, vaccination rates for BCG, DTP, OPV, measles, and MMR were above 80% in most cases.

For the 0–4-year-old age group, the five leading causes of illness treated at reporting clinics during 1996 were: acute respiratory infections, with 12,975 cases (43.2% of total cases); worm infestation, with 3,506 (11.7%) cases; diarrheal diseases, 2,689 (9%) cases; scabies, 1,036 (3.5%) cases; and accidents and injuries, 844 (2.8%) cases. Together, these five cause groups accounted for 70.2% of all cases treated in 1996.

In 1995, there were 736 deaths in the 0–4-year-old age group. The leading cause of death for this age group in 1995 was certain conditions originating in the perinatal period with 277 deaths.

The primary school-age population (5–9 years old) comprises approximately 11% of Guyana’s population. In 1995, there were 41 deaths in this age group being "other accidents" the leading cause of death.

Health of Adolescents

Adolescents in the 10–14-year-old age group comprise 12 % of the population, and those in the 15–19-year-old age group comprise 11.5%. In 1995, there were 29 deaths among 10–14-year-olds and 97 deaths in the 15–19-year-old age group. In both groups "other violence" was the leading cause of death.

Health of Adults

In 1996, of 17,496 women receiving prenatal care for the first time during a pregnancy, 11% were under 15 years of age. Only 32% of the women sought care during the first 20 weeks of pregnancy. The maternal mortality rate among admissions in 1996 at Georgetown Public Hospital was 148 per 100,000.

Of the 12,603 clients attending family planning services for the first time in 1996, 5,469 (43%) used oral contraceptives; 479 (4%), IUDs; 1,313 (10%), condoms; and 990 (8%), other methods. In 1996, 758 abortions were performed at Georgetown Public Hospital.

In 1995, there were 1,797 deaths in the 20–59-year-old age group. the five leading causes of death were: endocrine and metabolic diseases, 285 deaths (15.9%); ischemic heart disease and cerebrovascular diseases, each accounting for 173 deaths (9.6%); diseases of other parts of the digestive system, 165 deaths (9.2%); and diseases of pulmonary circulation, 111 deaths (6.2%).

Health of the Elderly

Persons 60 years and over, of whom 52.7% are female, represent 5.9% of the population. Of these older adults, 20,127 (20.5%) were National Insurance Scheme pensioners in 1996.

In 1995, there were 2,291 deaths in the 60 years and over age group, 1,939 deaths in 1994, and 1,882 in 1992. The five leading causes of death for this age group were: cerebrovascular disease, with 515 deaths (22.5% of deaths in 1995); ischemic heart disease, 331 deaths (14.5%); diseases of pulmonary circulation and other forms of heart disease, 253 deaths (11%); endocrine and metabolic disease, 179 deaths (7.8%); and other diseases of the respiratory system, 172 deaths (7.5%).

Family Health

According to data in the 1993 Household Income and Expenditure Survey, females headed 29.5% of households. The proportion is much higher in the depressed urban areas than in the rural areas. Afroguyanese women account for approximately 50% of all female-headed households, compared with East Indians (35.2%) and Amerindians (2.6%).

Workers’ Health

There were 3,848 reported industrial accidents in 1996. Of the accidents, 90% occurred in the agricultural sector. The 1996 figure represents a 26% reduction from the 5,174 accidents in 1995 and a decrease of more than 50% from the 1993 figure of 8,383. Despite the decrease in total accidents, the number of fatalities increased substantially; there were 11 fatalities in 1996, compared with 5 in 1995, and 8 in 1993.

Health of Indigenous Populations

The Amerindian population is estimated to represent 6.81% of the total population and comprise most of the population in the remote interior of Regions 1, 8, 9, and a significant portion of Region 7. They have the highest incidence of poverty, with approximately 85% falling below the poverty line. The geographic isolation of many of the communities poses major problems in achieving equitable access to both health and educational services. Malaria, tuberculosis, diarrhea, and respiratory infections are the leading forms of morbidity among the Amerindian population.

Analysis by Type of Disease

Communicable Diseases

In 1996, there were no cases of dengue, Chagas’ disease, or schistosomiasis reported in Guyana, although vectors for all these diseases are present. Malaria was the second leading cause of morbidity in the country, with 34,075 cases reported. P. falciparum accounted for 52.7% of cases. Measles has not been detected since 1992; yellow fever has not been reported since the 1970s; whooping cough was last reported in 1991; there have been no cases of neonatal tetanus reported since 1988; and no cases of poliomyelitis have been reported in recent years. Two cases of tetanus were reported as of mid-year 1997. In an outbreak of cholera, 556 cases were reported between November 1992 and early January 1993. No further cases of cholera have since been reported. In 1995 there were 257 deaths from intestinal infections, 8 of which were due to typhoid fever, 4 to amebiasis, and 245 classified as "other and ill-defined intestinal infections." In 1994, there were 203 deaths from intestinal infections, of which 10 were due to typhoid and 193 classified as "other and ill-defined intestinal infections."

Tuberculosis cases have risen from 296 in 1995 to 303 in 1996 (38.27 per 100,000 to 40.19 per 100,000). In 1996, 32 deaths due to tuberculosis were recorded at Georgetown Public Hospital and the chest clinic.

In 1996, there were 21 new leprosy patients (13 males and 3 females.

Acute respiratory infection was the leading cause of illness seen at outpatient departments in 1996. It was the leading cause of morbidity in the 0–19-year-old age group, the second leading cause in the 20–44-year-old age group, and the third leading cause among persons 65 years and older.

There has been no rabies in dogs or humans. In 1996, 20 cases of equine encephalitis in Region 6 were diagnosed based on clinical signs and symptoms.

Between 1987 and 1995 there were 1,241 reported cases of HIV and AIDS, of which 796 were AIDS cases. Females accounted for 34.4% of the cases. Of the cases reported since 1989, 45 % were persons whose major risk factor was heterosexual contact. This population increased to 85% in 1995. In 1995 there were 132 reported AIDS deaths, of which 48 were female. Up to the end of 1995, the National Blood Transfusion Service had screened 20,472 units of blood for HIV and 275 units (1.34%) tested positive.

In 1995, 625 cases of gonorrhea, 325 cases of syphilis, and 856 cases of nongonococcal infections were diagnosed. These figures only include persons treated at the Genitourinary Medicine Clinic at the Georgetown Public Hospital.

Noncommunicable Diseases and Other Health-Related Problems

Nutritional Diseases and Diseases of Metabolism. A 1996 survey by the Ministry of Health assessed vitamin A, beta-carotene, iron, and iodine status in the population. Of the 269 pregnant women and 438 adults aged 15–30 tested for hemoglobin, 52% and 42.2%, respectively, were found to have deficient hemoglobin levels. Severe iodine deficiency in the 5–14-year-old age group was higher in females (3.9%) than males (2.5%), while 2.1% of the 285 pregnant women tested had severe iodine deficiency. In 1995 there were 65 reported deaths from nutritional deficiencies, compared with 51 deaths in 1994. In 1995, 37 of the deaths occurred in infants under 1 year old.

In 1995, cardiovascular diseases accounted for 1,966 deaths (38.6% of all deathsbeing 992 male deaths and 974 female deaths).

Malignant tumors were responsible for 319 deaths in 1995 (156 males and 163 females). Malignant neoplasms of digestive organs and peritoneum and neoplasms of genitourinary organs accounted for 67.7% of deaths due to malignant tumors.

Accidents and violence accounted for 525 (10.3%) of reported deaths in 1995, up from 474 (10.8%) deaths in 1994. Males accounted for 78.2% of those deaths in 1995. Statistics from the Police Department suggest that these figures underestimate the number of deaths due to violence and injuries.

Data on the prevalence of mental health problems in Guyana are not available. In 1996, mental disorders ranked eighth among the 10 most common causes of discharges from Georgetown Public Hospital, with 400 discharges for the year.

In August 1995, Guyana recorded its worst-ever environmental disaster when a breach occurred in the tailings pond used to store cyanide-laced water and waste at the Omai Gold mines. The Omai and Essequibo rivers were severely affected by the discharge, and many dead fish were sighted following the spill. By the time the breach was contained, 4.2 million cubic meters of tailings had escaped from the pond. The contamination had both environmental and economic impacts.

In 1996, severe flooding due to extensive breaches in sea defense dams affected thousands of homes and farms in several communities in the upper Demerara and Upper Berbice regions. This resulted in damage to rice fields and other crops, along with the death of cattle. There were no human deaths or major health emergencies created by the flooding, and the impact was primarily economic.

RESPONSE OF THE HEALTH SYSTEM

National Health Plans and Policies

Proposals in the 1997 National Development Strategy addressing health sector reform emphasize health promotion. The strategies proposed to improve the physical, social, and mental health status of all Guyanese are to: promote a better home, work, and general living environment; ensure that health services are as accessible, affordable, timely, and appropriate as possible, given available resources; ensure that health standards are developed, implemented, monitored, and updated; empower individuals to take responsibility for their own health through health promotion and disease prevention; enhance health personnel effectiveness through continuing education, training, and management systems; invest and share responsibility with communities, organizations, institutions, and ministries; and collaborate with other countries.

Organization of the Health Sector

Institutional Organization

The institutions, organizations, agencies, and individuals involved in health care delivery in Guyana can be classified into seven broad categories: (1) Government Ministries—particularly the Ministry of Health and the Ministry of Public Works, Communication, and Physical Development; (2) Government agencies such as the National Nutrition Council, the Guyana Water Authority, and the Guyana Sewage and Water Commission; (3) quasi-public institutions such as the Guyana Sugar Corporation and the LINMINE and BERMINE bauxite companies, that provide health care services for employees and their dependents; (4) the National Insurance Scheme, to which all employed and self-employed persons are required to make contributions, a portion of which is used to cover some health benefits; (5) nongovernmental organizations, a variety of which are involved in health delivery; (6) a private sector that includes six private hospitals; a large number of private medical and dental practitioners, pharmacists, and traditional healers; and private insurance companies that offer health insurance; (7) international donor agencies including the Inter-American Development Bank, The World Bank, the European Union, PAHO, and the United Nations Children’s Fund.

The Ministry of Health is responsible for the regulation of health policies and legislation, the establishment and enforcement of standards for the delivery of health care and the protection of public health nationally, accreditation of all health facilities, identification of human resource needs in the health sector, development and placement of health personnel.

A Standards Unit was created in the Ministry of Health in 1991. A major achievement of the Standards Department in 1994 was the inspection of private hospitals for the first time in more than seven years. During 1996 and continuing in 1997 steps were taken to establish a quality assurance program for the clinical laboratory and to enhance infection control monitoring. There are numerous other entities with an interest in standards development and enforcement. These include the Guyana Medical Council, the Guyana Nursing Council, the Guyana Medical Association, the Guyana Nursing Association, the Public Service Union, private hospitals, the Pharmacy and Poison Board, the Guyana Pharmacy Association, the Private Hospital Inspection Board, the Central Board of Health, and the Government Analyst Department.

Health Services and Resources

Organization of Services for Care of the Population

The Ministry of Health and the municipalities have retained responsibilities for traditional environmental health concerns, while a variety of agencies are responsible for monitoring the environmental health impacts relating to business and industry.

The Vector Control Service is responsible for the control of malaria, filariasis, leishmaniasis, and dengue fever, and is the Ministry of Health’s main device for the diagnosis and treatment of malaria in Guyana.

A National Oral Health Education Program for primary schoolchildren was launched in 1995. The program aims to reduce the prevalence of oral diseases by increasing children’s awareness of the importance of oral hygiene, emphasizing that they take responsibility for their own oral health. The American Dental Association in collaboration with Health Volunteers Overseas and the Guyana Dental Association has scheduled a program that includes a national oral health survey, continuing education for dentists and dental nurses, and oral health education

In 1996, an MMR vaccine follow-up campaign was conducted as part of the strategy to eradicate the indigenous transmission of measles. Between April and September 1996, 76,384 children aged 12 to 59 months were vaccinated with MMR.

In 1996 the Nutritional Surveillance Program provided nutritional assessments, breast-feeding promotional, iron/folate supplements to pregnant women, and a supplementary feeding program targeting pregnant and lactating mothers. The National Breast-Feeding Committee coordinates the establishment of regional committees on breast-feeding promotion.

Data from the Bureau of Statistics indicate that 89.6% of the urban population and 45.2% of the rural population had drinking water supply services. The Bureau of Statistics also reports that 91.8% of the urban population and 80.4% of the rural population had sewage and excreta disposal services.

Another persistent environmental health problem has been the management of solid wastes in Georgetown.

The Veterinary Public Health Unit developed a Food Safety Plan of Action and prepared for the introduction of the HACCP system in the fish and seafood industry. During the early part of 1997, surveillance activities for foot-and-mouth disease, rabies, and bovine tuberculosis were carried out in various regions.

The Ministry of Health recognizes health education and promotion as the strategic approach for the planning and delivery of health care in Guyana and relies heavily on resources from international agencies (PAHO and UNICEF) for activities that include training of health workers and community groups.

With funds from the World Bank, the Ministry of Health embarked on a Primary Health Care Project in three regions that focuses on health development through community participation and action.

Organization and Operation of Personal Health Care Services

Health care services are delivered across five different levels. There are 39 health posts found in Regions 1, 2, 7, 8, 9, and 10 that provide mainly health promotion and preventive care in remote areas. There are 194 health centers throughout the country that provide mainly preventive care, as well as some promotion, curative and rehabilitative care. Eighteen district hospitals with 420 beds provide basic inpatient and outpatient care along with selective diagnostic services. There are four regional hospitals with 717 beds in Regions 2, 3, 6, and 10. They provide general inpatient and outpatient services, diagnostic services, and specialist services in obstetrics and gynecology, general medicine, general surgery, and pediatrics. The Georgetown Public Hospital has 601 beds and provides a wide range of diagnostic services and specialist inpatient and outpatient referral services. It is intended to provide high-cost specialized treatment and sophisticated diagnostic tests. There are three specialty hospitals including a psychiatric hospital in Berbice, a leprosarium at Mahaica, and a geriatric hospital in Georgetown. In addition, there are six private hospitals in Georgetown and five company hospitals located in Regions 1, 4, and 10.

A serious access problem faces persons with disabilities in rural areas, since rehabilitation institutions are concentrated in the capital and larger towns. Several agencies provide aspects of rehabilitation for children with disabilities; services for adults are provided through the physiotherapy service of the Ministry of Health and the Guyana Society for the Blind.

At the community level, the nongovernmental, externally funded Guyana Community-Based Rehabilitation Program has reported success in widening access to basic but essential rehabilitation through service delivery to children and adults with disabilities. The program, which uses volunteers for the delivery of services, has gained the active participation of the family and wider community in the rehabilitation process, thus ensuring the utilization of all available community resources and sustainability of programs.

Inputs for Health

In the public sector, drugs and medical supplies are purchased from a variety of sources including UNIPAC, a unit of UNICEF that provides drugs and medical supplies to governments at competitive prices. The Guyana Pharmaceutical Corporation produces some drugs and medical supplies for the local market. Private procurement and distribution of drugs and medical supplies is also extensive.

The Government Analyst Department must certify pharmaceuticals entering the country for use in both the public and private sectors. The Ministry of Health uses the Caribbean Regional Drug Testing Laboratory (established to allow Member States of CARICOM to benefit from cost-effective arrangements) to test the supplies it purchases. Distribution is done by the Ministry of Health or Regions, or it is contracted out to the private sector. Guyana has a draft National Drug Policy, but it has not been fully implemented.

Human Resources

There are a total of 3,405 health workers in Guyana. Of this total 43 are physicians, 83 general medical officer, 27 consultants, 32 general dentists, 129 pharmacists and 757 professional nurses.

Research and Technology

Guyana depends almost entirely on foreign imports for health technology. The development and maintenance of systems to monitor the quality, condition, location, and utilization of biomedical and other equipment are considered to be priorities. A preventive maintenance program is being established with the assistance of external agencies.

Expenditures and Sectoral Financing

Since 1990, government allocations to health have increased. In 1996, G$ 2.88 million (US$ 20.5 million) was spent on health, compared to G$ 0.4 million (US$ 10.1 million) in 1990—more than a sixfold increase in six years. In 1996, health expenditures accounted for 6.3% of the national budget, compared with 8.3% in 1995, and 5.3% in 1992. For 1992–1995, the increase in health spending was due primarily to capital expenditures, which accounted for 42% of total expenditures in this period, compared with 17% in 1990. The increase resulted from the construction of the Ambulatory Care, Surgical, and Diagnostic Center at Georgetown Public Hospital, and the 63% decrease in capital expenditures from 1995 to 1996 was due to the completion of this project.

Government health expenditure per capita also increased during recent years. While the figure amounted to G$ 538 (US$ 13.6) in 1990, it came to G$ 3,741 (US$ 26.56) in 1996. These figures are quoted in nominal prices, so part of the increase is attributable to inflation.

The inflation factor is largely eliminated when public health expenditures are seen in relation to GDP. In 1996, government health expenditures amounted to 3.45% of GDP, a decrease from more than 4% in previous years. In 1995, the figure was as high as 5.17%. Again, the relatively high figures for the years 1992 to 1995 can be explained by the capital costs of the construction at Georgetown Public Hospital. However, compared to the 1990 figure, estimated real levels of expenditures on health have still shown significant improvement, even when excluding the construction costs.

External Technical and Financial Cooperation

The United Nations Development Program’s contributions to the health sector from 1992 to 1996 amounted to US$ 1,097,473. In 1996, the contribution was US$ 269,141, distributed through the United Nations volunteers Multi-Sectoral Project. The focus of this project with respect to the health sector is to provide technical assistance to enhance health service delivery as well as to strengthen the capacity of national counterparts working in the health sector.

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