In October 1992, a new government was elected, the first change of political party since 1966. The draft of the National Health Plan has defined objectives and targets for expanding primary health care, improving secondary and tertiary health care and strengthening the management of the health sector. However, new policies to achieve these objectives are not defined. In the broadest sense, the policy objectives of the sector are to increase the span of healthy life for all people in Guyana and to reduce health disparities between social groups. Access to quality health care refers to ensuring universal access to a defined mix of basic services emphasizing above all the essential strategies of the primary health care. The quality objective refers to restructuring several key aspects of the system, so that a patient’s visit to any unit of the system will yield greater and more immediate health benefits. Supporting objectives, which require intersectoral collaboration are intended to create a healthier environment and inculcate a healthier lifestyle in Guyanese, requiring cooperation from the education, environmental, and urban development and housing sectors, and poverty alleviation programs. Achievement of overall objectives will require policys in five areas: institutional structure of the health system; management of the health system; financial structure of the system; primary health care areas, including health promotion, and; secondary and tertiary health care.

2.1 Economic trends. Inflation, which was extremely high in the late eighties and early nineties, as a result of the social adjustment programs, declined from 101.5% in 1991 to 16.1% in 1994. In 1995 the inflation rate fell to 8.1% and in 1996 to 4.5%. Debt continues to be a major concern in the economy. In 1994, interest payments on domestic and external debt absorbed 43% of government’s current revenues. Fiscal policy is fundamentally constrained by the high internal and external debt burden. However, a variety of factors have helped bolster Guyana’s economy including: foreign investment in the forestry and gold mining sectors, construction and buoyant performance in rice and sugar production. The economy still remains highly focused on agriculture and mining. Sugar alone accounted for 33% of the agricultural GDP. The mining sector represents 16% of GDP (1995). World markets have been important as exports such as bauxite, sugar, rice and gold have been sources of growth for these industries as well as for foreign exchange. Preferential access to certain markets has been particularly important as well, however, with the opening of the global markets and reduction in preferential treatment, Guyana’s principal exports are facing increasing competition, and the need to look for new markets is required to sustain the economic growth. The fiscal position of the public sector continued to improve in 1994; the deficit fell to 11.4% of GDP, down from 22.2% in 1993. While 42.3 % of the population live under the poverty line, the unofficial unemployment rate has remained at its 1993 level of 12%. However, under-employment remains high. In addition, the distribution of income seems to be worsening. The growth of the economy has placed demands on transportation, water supply and drainage and sea defenses. As part of economic reform many state industries have been privatized. Steps have been instituted over the past five years towards achieving stability through initiating major foreign trade reforms, stringent fiscal and monetary policies and the establishment of a market economy. The current situation in foreign trade is still far from being the required one for long-term development as tariffs still provide protection to many import-competing goods and raise costs to exports. However, abundant natural resources will play a strategic role in contributing to the development of the country through direct foreign investment and increased exports.

2.2 Demographic trends. The 1995 estimated end of year population was 773,410 (49.3% male, 50.7% female). Latest data (1990) on live births highlight the importance of focusing on teenage and single or unmarried mothers for health and other social interventions: 67.6% of mothers were single mothers and 29.5% of women giving birth were 20 or younger. The percentage of urban population (1993 estimates) has remained fairly stable at 31%. The age structure of the population has shown little fluctuation since 1985. In 1993, children under 15 make up 34.9% of the population, the economically active age group (15-64 years) accounts for 61.2% (up from 52.8% in 1985), and the 65 and over group makes up 3.9% (down from 4.7% in 1985). Amerindians or indigenous persons account for approximately 6.8% of the total population. They rank as the fourth largest ethnic group and comprise most of the population in the remote interior regions. Persons of Indian descent account for 49.5%, African descent 35.6%, and the remaining 15% are made up of Portuguese, Chinese and mixed.

2.3 Social trends. Although the economic has stabilized, gaps still remain in the provision of social services, adequacy of infrastructure and the improvements of the quality of life. Basic issues related to access and equity in health, education, housing, water and sanitation will need to be further addressed before the conditions of the poor can improve. The Social Impact Amelioration Program (SIMAP), begun in 1990 as a transitional device to accompany the structural adjustment program, focused on damage limitation and sustainable development for vulnerable groups and individuals. The response by communities and NGOs for projects has been so great that it has commitments for nearly US$50 million in projects. 92% of students enrolled in school fall between first and second levels and university students account for only 1%. At the primary level, 60% of the teachers are trained, down from 77% a decade ago. At the secondary level, a decrease is seen from 68% a decade ago to 61% now. A higher proportion of students at almost all levels of education system are women, except for the primary/secondary level. The adult literacy rate is estimated at 96%, based on a 1993 survey. The illiteracy rate for males is 2% and 6% for females. The Women’s Affair Bureau monitors and helps to advance the participation of women in all aspects of life and development and is addressing the status of women. Women still face a high degree of inequality and discrimination. They suffer from high levels of violence within (and outside) the household. The Domestic Violence Bill, submitted for approval, will provide greater protection for women. Legislation in 1995 legalized abortion. Women work in traditionally low-paying areas with poor working conditions, occupational health and safety protection, and low job security. They are paid lower wages than men. The National Policy of 1995 reaffirms the government’s commitment to give women’s integration a high visibility and to ensure an effective means to monitor, coordinate and link programs designed to increase women’s participation in the development process. In 1993 the incidence of poverty was highest among the Amerindian population, among whom 85% fall below the poverty line and lack equitable access to health and educational services. Amerindian’s in 1992 were given a voice in national matters and hold 16% of the seats in the National Assembly. Among other ethnic groups, the incidence of poverty among Afro-Guyanese households is 43%, Indo-Guyanese households, 33.7% and in mixed households, 6.2%. The Afro-Guyanese households are equally located in both urban and rural areas, while the Indo-Guyanese population is more heavily concentrated in rural areas. Rural poor are typically employed through subsistence agriculture and wage labor. Most of the poor are self-employed in agriculture. Other disproportionately poor job types include mining, construction and other manual labor jobs with approximately half of the population working in these professions fall below the poverty line. Access to adequate housing is a major problem. Difficult financing hinders many individuals from building their own homes. Occupancy rates for renting are close to 100%. Squatting on public land, has increased over the past decade and homelessness is a common problem for many adults and children. Also, crime in Guyana has become more widespread and is highest among the poor and heavily concentrated in urban areas.

2.4 Food supply and nutritional status. Protein-energy malnutrition has leads to low birth weight babies, and a high rate of mortality among children. A survey in children under 5 found that 23.6% were moderate and 3% severely malnourished. Maternal and child health issues are linked to the availability and access to nutritious food along with women’s educational level. Iron deficiency remains a serious health concern through out the population. Data from the Maternal Child Health (MCH) clinic show a high degree of iron deficiency among pregnant women: in 1995, 7.4% of the pregnant women attending clinics were severely anemic (<8 g/dL Hb), 24.1% were moderately anemic (8-9 g/dL) and 37.7% had acceptable levels of 10g/dL or more.

2.5 Lifestyle. There has been an increase in teenage pregnancies, transmission of STDs and HIV/AIDS. Between 1992-94, 24% of all children delivered at Georgetown Public Hospital were born to teenage mothers. The use of abortion as a means of birth control is common. Access to condoms and other contraceptives in Georgetown is quite good, however, availability decreases as one moves into more rural and interior areas. Anout 31% of women in Guyana use contraceptives (1990), however, among teenagers aged 15-19, only 18% (1994). In 1992, 7.2% of the blood donors were positive for STDs, while 1.5% of blood donors were positive with HIV. As of 1995, 799 cases of HIV have been reported. Their is a high degree of domestic violence against women. Thus, The Domestic Violence Bill, is intended to counter this trend. In addition, the utilization and abuse of drugs continues to climb particularly among the young.

3.1 General protection of the environment. A qualitative assessment indicates that the environmental health conditions in Guyana declined substantially since 1977. This is evidenced in the poor distribution and quality of the drinking water, poor and non-functioning sewerage disposal facilities, and poor refuse disposal practices. Actions taken to improve the environment include: adoption of a National Health Plan, establishment of an Environmental Protection Agency, drafting of a new Occupational Health and Safety Act , creation of a computerized occupational accident database and privatization of refuse collection in Georgetown. The major constraint faced by the country is a lack of financial resources, as well as lack of skilled manpower, due in part to the economic decline and concomitant emigration of skilled labor.

3.2 Water supply and sanitation. In 1992, 90% of the urban population and 45% of the rural population had drinking water supply services. However, the biological and chemical quality of the drinking water is not routinely tested anywhere in the country. Also in 1992, 81.8% of the urban population and 80.4% of the rural population had sewerage and excreta disposal service, but most septic tanks drain into open drains along the roads and pit latrines are poorly constructed and maintained. However, The Guyana Water Authority has recently embarked on an extensive program of upgrading and providing water supply services in the rural coastal area.

4.1 Human resources for health. Lack of adequately trained health care personnel, both in number and distribution, poses a challenge to the health care system, particularly in delivery of services:pharmacy, laboratory, radiography and environmental health, as well as in management of the system. Moreover, the shortage of nurses severely hampers quality care. Almost all health-related training is carried out by The University of Guyana (UG) and Ministry of Health (MOH). The development and management of human resources is still not approached in an organized fashion. Difficulties are experienced in recruitment, retention, training, development and utilization of staff. Low salaries and benefits; poor working conditions; little in-service training; the lack of career opportunities; poor coordination of training; a shortage of adequately trained teaching staff and teaching materials, and the absence of a comprehensive human resources development and management plan are underlying causes. Some areas are better served than others by health personnel. Almost 70% of the doctors are in Georgetown, where only about one quarter of the population lives. In rural areas many communities have extremely limited, or no, access to physician services. In contrast, the private sector, which offers better pay and conditions of service and is much more able to recruit and retain staff.

4.2 Financial resources for health. Since 1990 a continuous increase in government allocations to health has taken place with more than a six fold increase over the six years 1991-1996. In 1996 government health expenditures amounted to 3.5% of GDP and 6.4% of total government expenditures was allocated within the health sector. The private health sector plays a significant role in providing health care to Guyanese patients. Traditionally, bauxite and sugar companies, the two largest employers of labor, have played major roles in health care delivery in Guyana. However, the bauxite mining company in Linden has backed out of the responsibility for its workers health, while the sugar company runs 18 health centers and one Diagnostic Center. The National Insurance Scheme pays most of its money out to private hospitals and doctors, although the public sector is the major player where health expenditures are concerned. Access to health services is restrained by geographical factors and aggravated by lack of good transportation and communication. Also, effective access to health care is impeded by a general lack of health personnel, medical supplies and, in certain cases, low quality of care delivered at public health institutions. In 1993 access to health services was not equitable for the poorest sections of the populations. The priorities of the Ministry of Health are: strengthening and expansion of primary health care; improvement of secondary care; improvement of tertiary care at Georgetown Public Hospital, and; improvement of the general management of the health delivery system.

4.3 Physical infrastructure. Health infrastructure buildings are old and deteriorating. Utilization rates in some facilities are very low, especially in public hospitals, due to shortage of supplies, equipment, health personnel, and inaccessibility. A variety of donor agencies are involved in the rehabilitation of health centers and hospitals. In 1996 The Ministry of Health opened a new Ambulatory, Diagnostic and Surgical Center (ACDC) at the Public Hospital Georgetown.

4.4 Essential drugs and other supplies. The public sector purchases drugs and medical supplies from a variety of sources, and The Guyana Pharmaceutical Corporation produces some drugs and medical supplies. Essential drug supply has not been constant over the last year affecting both remote facilities and the referral hospital. Required finances are lacking, but improved management could increase efficiency. The Ministry of Health in collaboration with PAHO is developing an essential Drug List. The major constraints affecting the procurement and distribution of drugs and medical supplies are: national drug policy not fully implemented; insufficient pharmacy staff within public system; inadequate storage facilities at both central and regional levels; non-functioning management information system; logistics of drug distribution in the interior; prescribing practices; government regulations; inadequate consumer awareness about proper medication use; little management coordination in pharmaceutical industry; lack of timely lab results; no drug price regulation in private sector, and lack of enforcement of existing pharmaceutical legislation.

5.1 Health policies and strategies. The draft of the National Health Plan served as an input for the National Development Strategy, which identified problems. In terms of causes of morbidity and mortality, malaria, sexually-transmitted diseases, acute respiratory infections, diseases preventable by immunization and perinatal problems are high priorities. Malnutrition, accidents and injuries, diabetes, hypertension, dental caries, mental health, drug abuse, and skin conditions are also priorities. The plan strives to improve secondary and tertiary health care, and strengthen the management of the health sector, while focusing on the entire health sector not simply public services. The strategic component articulates the vision, mission statement, principles and values as a guide. It analyzes the existing health situation and establishes priorities, assesses the health delivery system and sets objectives for the next five years including: strengthening and expanding primary health care; improving secondary care services; improving tertiary care; and strengthening the general management of the health sector. Equity and access are the basis of reform and formulation of policies and health legislation are being rewritten to this end.

5.2 Intersectoral cooperation. Institutional and management responsibility for the public sector’s health care system is dispersed among various Ministries and agencies. At present, operational responsibility for implementation of the central program is with the Regional Health Officer (RHO). It reports to the Regional Executive Officer (REO), who also has the financial authority and responsibility for programs in all sectors. The REO, however, is not a public servant, and is not accountable to the policy-making Ministries. The Minister of Health therefore, has virtually no downstream control on the implementation of its policies, and therefore no mechanism to hold the REO accountable for the delivery of sectoral programs. Collaboration in the health planning process is nonexistent or ad hoc at best, both among these institutions and between the public health system and other stakeholders. There is no single unit in the Ministry of Health responsible for the delivery of primary health care, and responsibility is divided between the Regional Health Director and other officers.

5.3 Organization of the health system. The range of institutions, organizations, agencies and individuals which are involved in health care delivery in Guyana can be classified into seven broad categories: 1)government ministries: the two key ministries are the Ministry of Health (MOH) and the Ministry of Public Works, Communication and Physical Development. The Ministry of Labor is also responsible for the Geriatric Hospital and the Leprosarium. The MOH has responsibility for developing and implementing health policies and standards, and funding and the management of vertical programs. It is further responsible for the National Referral Hospital in Georgetown, and for the procurement and distribution of drugs and medical supplies to all government facilities. Under the Ministry of Public Works, Communication and Regional Development, Regional Administrations have responsibility for the management and funding of health services in the region; 2) other government agencies such as the National Nutrition Council, Guyana Water Authority, and Guyana Sewage and Water Commissioners;3) parastatals: The Guyana Sugar Corporation (GUYSUCO), and the LINMINE and BERMINE bauxite companies provide health care services for employees and their dependents;4) National Insurance Scheme (NIS); 5)non-governmental organizations;6) independent private sector; 7) international donor agencies. Health services in the public sector are provided at five different levels. Health posts and centers focus primarily on promotional and preventable care, with some curative and rehabilitative care. District hospitals focus on basic in-patient and out-patient curative care, and selective diagnostic services. Regional hospitals provide general in and out patient services, diagnostic services, and specialist services in obstetrics and gynecology, general medicine, general surgery, and pediatrics. The national referral hospital and specialist hospitals provide a wide range of diagnostic services and specialist in and out patient referral services. Currently primary health care activities are fragmented. Health Education is the responsibility of the Ministry of Health (MOH). Environmental Health responsibilities are shared by the Ministry of Health and the Regional Administrations, Maternal and Child Health, and programs addressing endemic health problems are run as separate vertical programs. There is no clear integrated overall primary health care strategy in place.

5.4 Managerial process. Management of public health services needs improvement including clearer lines of authority, particularly in key positions. It is noted that many senior managers are doing more that one job.

5.5 Health information system. Inadequacies in the health information system affect: data collection; reporting forms and procedures; trained staff; quality control and feedback. Data collection and submission are not seen as a priority by many key stakeholders in health care delivery. Decision making tends to be more reliant on precedent than on analysis.

5.6 Community action. Policy is based on maximum community participation in health actions to empower it to take responsibility for its own health by measures that include the formation of community hospital associations with an active participation on the Board of Directors of the hospitals; the development of a draft plan for community involvement in primary health care; the development of a program for sharing existing health information with the community; and the training of health staff and local individuals in the strategies for community development.

5.7 Emergency preparedness. An Environmental Protection Agency (EPA) was established in 1997. Flooding in 1996-1997, showed the need for a more active and decentralized disaster management program. Thousands of homes and farms were affected. In 1995, the worst ever environmental disaster occurred, when cyanide-laced water and waste flowed into the river at the Omai Gold mines. The impact was immediate and far ranging affecting the natural economy as a whole. International agencies, NGO’s and foreign governments contributed to relief efforts.

5.8 Health research and technology. Guyana depends almost entirely on foreign imports for its stock of health technology. Priority issues in this area include the development and maintenance of systems to monitor the quality, condition, location and utilization of biomedical and other equipment.

6.1 Health education and promotion. Although the Ministry of Health recognizes health education and promotion as the strategic approach for planning and delivery of health care, there is much resistance by program managers, who do not considered it a priority. Nevertheless, PAHO and UNICEF have consistently provided funds for health education and promotion, including training of health workers and community groups in using health education and promotion. However, the intrasectoral Ministry of Health collaboration is limited and the directorate of Health Education and Promotion needs to take the lead in strengthening this collaboration. Dissemination of information is the major activity undertaken in the education process and focus must also be given to improving the quality and relevance of the materials through research and pre-testing. The Ministry of Health with the assistance of PAHO has procured a grant of US$100,000 from UNDP to build the capacity of the health sector in the development and production of health learning materials. The school health education program is gaining momentum, with the identification in the Ministry of Health as a focal point for school health education. The University of Guyana does not offer any courses or training in Health Education and Promotion, and the of lack of trained personnel to teach this course is a problem.

6.2 Maternal and child health/family planning. The maternal and child health/family planning has been strengthened over the last several years through training in recommended MCH norms and standards and with the use and interpretation of MCH data. Also, in 1995, a simplified computerized MCH data collection instrument was initiated, which enhanced timely reporting. The Regional Supervisors received training in the use and interpretation of this data and have trained other local staff members. The major constraint that faces the MCH program is the high attrition rate of qualified nursing staff. The three nursing schools continue to train nurses, but they soon join the private sector.

6.3 Immunization. In 1995, the national immunization schedule incorporated the measles, mumps and rubella (MMR) vaccine and in 1996 there was a follow up campaign. Community health workers in remote areas received additional training to enable them to administer vaccines in to their own communities. Quarterly EPI evaluation meetings continue where targets are assessed and the achievements and the constraints in the program are presented and discussed. Through the EPI coverage, vaccination rates for BCG, DPT, OPV, measles, and MMR have been above 80% in most cases. In 1996, BCG coverage was 88.4%, DPT 83%, OPV3 83%, and MMR was 96%.

6.4 Prevention and control of locally endemic diseases. Health education is the responsibility of the Guyana Agency for Health Education and Food Policy. The health education division within Georgetown City Council, Guyana Sugar Corporation, Ministry of Labor, private firms, and community groups also provide health education activities. However, there is little coordination of activities. The MOH and the municipalities have retained responsibilities for traditional environmental health concerns, while others are responsible for monitoring the environmental health including industrial impacts.The Vector Control Service is responsible for control of malaria, filaria, leishmaniasis and dengue fever, receiving funding from MOH, PAHO and Social Impact Amelioration Program. A Veterinary Public Health Unit undertakes activities in food hygiene and protection; zoonotic prevention and control and health education. It works closely with PAHO, The Inter-America Institute for Cooperation in Agriculture, the MOH, the Ministry of Agriculture Veterinary and Fisheries division, the Regional Education Program for Animal Health / Public Health Assistance, CARICOM, and the University of Guyana (UG). It is anticipated that during 1997, with the support of PAHO a program regarding diabetes and hypertension.

7.1 Life expectancy. Life expectancy was 64 years in 1994, compared with 64.9 in 1992. Life expectancy for females was 67.7 years in 1992, compared with 62.1 years for males.

7.2 Mortality. There were 5,098 deaths in 1995 compared with 4,372 in 1994. The 15-60 year age group had the second highest number of deaths in 1995 with 1,892 (37%) deaths compared with 1,483 (37%) deaths in 1992. In 1995, there were 737 (14.5%) deaths among children under 5, up from 488 (12.2%) deaths in 1992, ranking this group third in number of deaths. Deaths under one year old account for 75% of all deaths from malnutrition and 95% of all deaths from malnutrition among children under 5. Also, 21% of children under five years died from acute diarrheal disease. The ten leading causes of death (all ages) reported in 1995 were: Cerebrovascular Disease, 13.7 % of total deaths; Ischemic Heart Disease, 10.2%;Endocrine and Metabolic Disease, 9.6%; Diseases of Pulmonary Circulation, 7.4%;Other Diseases of the Respiratory System, 6.8%; Certain Conditions Originating in the Perinatal 5.4%; Diseases of other Parts of the Digestive System, 5.2%; Intestinal Infections, 5%;Hypertensive Disease, 4.1%; Other Violence, 3%. The infant mortality rate was 27.8 in 1995 and 28.8 in 1994. The five leading causes of death for the 0-4 age group were: Certain Conditions Originating in the Perinatal Period, Intestinal Infectious Diseases, Other Diseases of the Respiratory System, Congenital anomalies, and Nutritional Deficiencies. These top five causes were responsible for 610 of the 736 deaths in the age group. In 1995, the major causes of Maternal Mortality were: Toxemia of Pregnancy, Hemorrhage of Pregnancy and Childbirth, Residual, Complication of the Puerperium. Together these four causes were responsible for 28 deaths. There were 37 Malaria deaths reported in 1995 of which 65% were males. In 1995 there were 257 deaths from Intestinal Infectious Diseases, 8 of which were due to Typhoid Fever, 4 of which were Amebiasis, while 245 were classified as Other and Ill-defined Intestinal Infections. There were 43 reported TB deaths in 1994 and two from leprosy in 1995. In 1995 there were 132 reported AIDS deaths. There were 8 reported deaths from Venereal Diseases. Malignant Tumors were responsible for 319 deaths in 1995, 156 were male and 163 female. Malignant Neoplasm of Digestive organs and peritoneum accounted for 110 of those deaths, Malignant Neoplasm of Genitourinary Organs accounted for 106 deaths. Together these two groups accounted for (67.7%) of deaths due to Malignant Tumors in 1995. Women accounted for 27 of the 33 deaths due to Malignant Neoplasm of Bone, connective tissue, skin and breast in 1995. There were 11 fatal accidents.

7.3 Morbidity. In 1996, dental caries posed a serious oral health problem, as the dental service is essentially tooth extraction, lacking materials for more advanced care. In 1996, Malaria morbidity in the country totaled 34,075 reported cases. Between 1987 and 1995 there were 1,241 reported cases of HIV/AIDS of which 796 were AIDS cases. Females accounted for 34.4% of the cases. In 1995 there were 192 and 42.2% of the cases were females. In 1995 blood screened by the National Blood Transfusion Service for HIV found that 1.3% of blood units tested positive. In 1995, gonorrhea and syphilis were prevalent. In 1996, the number of new Hansen Disease patients was 21. In 1996, were an estimated 128 cases of reported rubella and in the first quarter of 1997, 35 cases have been confirmed. There were 302 identified cases of tuberculosis in 1996. In addition, Anemia among pregnant women was a considerable problem in 1995 as an estimated 11% of 9,743 women tested were severely anemic.

7.4 Disability. In 1993, the Pan American Health Organization (PAHO) estimated that there were 71,800 persons with disabilities. However, rehabilitation professionals and planners indicated that while the demand for services is increasing, the availability of such disability services is decreasing especially at the secondary and tertiary levels where institutional and specialist care are needed. At the community level, the non-governmental, externally funded Guyana Community-Based Rehabilitation (CBR) Program has reported success in widening access to basic but essential rehabilitation through its methods of service delivery to children with disabilities over the past seven years and more recently to adults with disabilities. The Ministry of Health in collaboration with PAHO and the Caribbean Council for the Blind is undertaking an Eye Care program which aims at the improvement of services to persons with visual problems. The program aims to provide services at all levels of the health system - health posts, health centers, district and regional hospitals and includes components for prevention of blindness and promotion of proper eye care through public education, early detection and intervention and improved medical services. "Ear Care 2000-Guyana", a program aimed at deafness prevention and provision of rehabilitation services for persons with hearing impairments is also being developed by the Ministry of Health with the assistance of the Commonwealth Society for the Deaf (CSD) and the Overseas Development Agency (ODA). The objectives are to provide audiological services, deafness prevention programs through education, early identification and intervention at both institutional and community levels, rehabilitation and improvement of communication through the provision of hearing aids. A draft National Policy on the Right of People with Disabilities in Guyana, has been submitted to Government for consideration. As part of the implementation of the National Policy, a National Commission on Disability will be established to promote the rights of people with disabilities.

8.1 Future vision. The vision statement: "It is the aim of the Government that Guyanese citizens be among the healthiest people in South America and the Caribbean". The mission statement: "Our mission is to improve the physical, social and mental health status of all Guyanese". The principal strategies to be adopted for achieving this mission are: 1) promoting a better home, work and general living environment; 2) ensuring that health services are as accessible, acceptable, affordable, timely and appropriate as possible, given available resources; 3) ensuring that health standards are developed, implemented, monitored and updated; 4) empowering individuals to take responsibility for their own health through health promotion and disease prevention; 5) enhancing health personnel effectiveness through continuing education, training, and management, and; 6) involving and sharing responsibility with communities, organizations, institutions and other ministries, and collaborating with other countries.