Saint Vincent and the Grenadines
- Overall Context
- Leading Health Challenges
- Health Situation and Trends
- Full Article
Saint Vincent and the Grenadines is a multi-island state within the Eastern Caribbean. The country extends for 389 km2: Saint Vincent is the largest island, at 344 km2 (); the Grenadines include 7 inhabited islands and 23 uninhabited cays and islets. All islands are linked by sea transport and there are airport facilities on three islands. The country is divided into six parishes, including a single parish for all the Grenadine islands. The population is mainly of African descendent (71.2 %), followed by mixed (23%), indigenous (3%), and East Indian (1.1%) population groups. The country became independent in 1979 and is governed as a parliamentary democracy with election every five years. Christianity is the dominant religion and the official language spoken is English (). Saint Vincent and the Grenadines is a member of the Caribbean Community (CARICOM) and the Organisation of the Eastern Caribbean States (OECS).
According to the 2012 Population Household Census, the total population was 109,991 in 2012, compared with 109,022 in 2001 and 107,598 in 1991. Along with the slow increase in the population, there has been a shift from a female to a male majority. The sex ratio moved from 76 males per 100 females in 1921 to 105 males per 100 females, in 2012 (). Figure 1 shows the evolution of Saint Vincent and the Grenadines’ population structure between 1990 and 2015.
Figure 1. Population structure, by age and sex, Saint Vincent and the Grenadines, 1990 and 2015
The population size increased just 1.7% between 1990 and 2015. In 1990, the structure had an expansive structure, with most of the population being under 30 years of age. By 2015, the structure became transitional, with declining growth in the age groups under 20 years old, as a result of aging and decreases in fertility and mortality, especially in the last two and a half decades.
Source: Pan American Health Organization, based on data from the United Nations Department of Economic and Social Affairs. Population Division. New York; 2015.
In 2012, life expectancy at birth was 73.7 for females and 69.16 years for males (); by 2015, these figures were 77.1 for females and 73.1 years for males. The 2012 census put the population of children under 5 years old at 7.9% of the overall population (), and the age group 60 years and older at 11.5%.
Saint Vincent and the Grenadines, an upper middle-income country, has an economy dependent on agriculture and, to a lesser extent, tourism (). The country utilizes the Eastern Caribbean dollar (EC$) as its currency. The per capita income in 2013 was EC$ 17,395.00, compared to EC$ 17,019.00 in 2012. The balance on fiscal accounts improved in the reporting period, going from a deficit of EC $ 62.16 million in 2011 to a surplus of EC$ 52.55 million in 2012. The Human Development Index remained relatively constant during the period 2010 to 2013 (0.717 in 2010 and 0.719 in 2013) ().
Social Determinants of Health
Universal early childhood education was introduced as a policy in 2009, with strengthening of universal access to secondary education. The adult literacy rate is 70.1%, and education at primary and secondary level is free ().
The last poverty assessment survey, conducted in 2007/2008, found that 30.2% of the population was poor, compared to 37.5 % in 1996 (). Attaining the Millennium Development Goals (MDGs), now the Sustainable Development Goals (SDGs), is at the heart of the government’s 2003 poverty reduction strategy.
Gender and human rights is an integral part of the policies in force or being developed, including policies on adolescent health, HIV, noncommunicable diseases (NCDs) and wellness, mental health, and the elderly. The government has adopted the Quito Consensus of the 10th Regional Conference on Women in Latin America and the Caribbean. The government strives to uphold obligations under the Convention on the Elimination of all Forms of Discrimination Against Women (CEDAW) and the “Convention of Belém do Pará” (Inter-American Convention on the Prevention, Punishment, and Eradication of Violence against Women).
The Health System
Public health services are delivered through primary health clinics, rural district hospitals, and the secondary and tertiary level institution, Milton Cato Memorial Hospital. This is complemented by care provided by several private clinics and by the 12-bed Maryfield Hospital, the only private hospital. As is the case in many other Caribbean countries, some secondary and tertiary care services are accessed out-of-country. Access to health services is almost universal with minimal user fees at the secondary or tertiary levels.
Leading Health Challenges
Critical Health Problems
Yellow fever and malaria are not endemic in the country. Dengue is endemic, and there were 619 cases in 2010-2014 (95 in 2013 and 11 in 2014). Chikungunya reached epidemic levels in 2014, with 181 confirmed cases and a male-to-female ratio of 1:1.8; there were 8 cases in 2015. In February 2016, the first case of Zika was confirmed; as of August of that year, there were 38 confirmed and 156 suspected cases. Four confirmed cases of Guillain-Barré syndrome were associated with Zika. During 2009-2013, the House Index (HI) ranged between 19.19% and 45.67% and the Breteau Index (BI) ranged between 31.72% and 20.96%. Prevention and control activities for Aedes aegypti mosquitoes continue through the program of integrated management for vector-borne diseases.
Leptospirosis persists as a public health problem, with 120 cases and 11 deaths during 2010–2014.
In 2011–2015 there were 67 cases of tuberculosis (TB) reported, with an incidence rate ranging from 0.04 to 0.28. TB/HIV coinfection continues to be a concern, with a cumulative 14.9% percent of TB cases being diagnosed with HIV during that period.
As are most other countries in the Americas, Saint Vincent and the Grenadines is undergoing an epidemiological transition, with the consequent increased burden of NCDs. NCDs now are among the five leading causes of death. Ischemic heart disease, cerebrovascular diseases, and hypertension and hypertensive diseases are among the diseases of the circulatory system that are leading causes of death, as is diabetes mellitus. In 2012, the main causes of hospitalization were diseases of the circulatory system, followed by respiratory conditions and endocrine/nutritional/metabolic diseases. Diabetes mellitus, hypertension, and cardiovascular diseases ranked as sixth, seventh, and tenth as causes of hospitalization, respectively. Of those, diabetes had the highest length of stay (10.3 days), followed by hypertension (7.8 days) and cardiovascular (6.2 days).
The Mental Health Centre is the only institution that cares for acute and chronic patients with psychiatric conditions such as schizophrenia, depression, bipolar disorder, and mental retardation. Annually, the patient load (outpatient and inpatient) ranges from 165 to 179. In 2012, the male:female ratio was 4:1 for admissions, and schizophrenia (55%) and schizophrenia with substance abuse (22%) were the main reasons for admission. The mental health facility was refurbished in 2016; the revised Mental Health Act and Mental Health Policy are being finalized.
In 2012-2014, the technical workforce for health in Saint Vincent and the Grenadines comprises 793 persons, including 87 physicians, 341 registered nurses, 46 community health aides, 7 dentists, and 23 pharmacists. Table 1 shows the number and density of workers in Saint Vincent and the Grenadines during 2012-2014.
Table 1. Number of workers and density of human resources for health, by category, Saint Vincent and the Grenadines, 2012-2014
|Category||No. of workers||Population ratioa|
|Community health aides||46||4.2|
a Population ratio: health workers per 10,000 population.
Source: Saint Vincent and the Grenadines, Ministry of Health, Wellness and the Environment, Monitoring and Evaluation Health Sector Report (2014)
Most physicians are graduates of the University of the West Indies Medical School, although there are four offshore medical schools in-country. The Caribbean Association of Medical Councils (CAMC) is the regional mechanism for the registration and monitoring of the practice of medicine along with the United States Medical Licensing Examination (USMLE). A total of 259 nurses registered with the General Nursing Council (GNC) during 2011 to 2015, compared to 250 in the previous five years. Through bilateral arrangements with governments, nurses are sent to other Caribbean countries. Continuing education is required for re-registration for some category of health personnel.
The 2011 Saint Vincent and the Grenadines Health System and Private Sector Assessment found that “while there are sufficient numbers of clinical care providers on the islands, significant personnel and structural challenges exist” (). Personnel gaps include insufficient specialists and a lack of a psychiatrist. Further, there are shortages of specialist auxiliary staff, including health educators, nutritionists, and environmental health workers. Another challenge includes the reduced access to health services by persons living and working in the Grenadine islands. With an estimated 20% unemployment rate among nurses, the country continues to promote a policy of deliberately training nurses to work abroad.
Health Knowledge, Technology, and Information
The Health Information Unit, guided by a health information policy, is responsible for the timely collection of data. The National Health Information System (HIS) captures mortality, morbidity, and other relevant health data from the public and private health sector. Although an electronic system is in place, paper-based records are still widely used. Final implementation of the HIS would link the Ministry of Health administration with all public hospitals, public laboratories, and district clinics, and the information will be synchronized on a near real-time basis. The Registrar General Department (vital statistics area for births and deaths) is fully computerized, and coverage is almost universal. Registration at bedside is done at the public hospitals, where over 98% of births occur; all deaths have to be registered prior to burial.
Mobile health (“m-health”) and telemedicine services support specialist care for patients.
The Environment and Human Security
The government has launched a management plan for phasing out the use of hydrochlorofluorocarbons as part of the country’s obligations under the Montreal Protocol on Substances that Deplete the Ozone Layer.
In 2015, 95% of the population had access to clean drinking water; the water supply is monitored for residual chlorine. The Central Water and Sewerage Authority monitors fecal and total coliform in the water supply. In 2012, 94.3% of the households used flush toilets (68.5%) or pit latrines. The government commissioned Septage Lagoon to receive effluent from septic tanks for decomposition.
The Solid Waste Management Unit, along with private garbage collection enterprises, collects garbage from 100% of households and disposes of it into the five government-operated landfills, two located on mainland Saint Vincent and three in the Grenadines.
The country is still recovering from Tropical Storm Tomas in 2010, which left damages amounting to US$ 50.7 million. In December 2013, floods claimed the lives of 12 persons and caused significant damage to property and livestock. The National Emergency Management Organization is charged with disaster preparedness and response in country.
The food safety program inspects and monitors foods throughout Saint Vincent, including at ports of entry. Community and public education programs are ongoing as is a certification program for food handlers. In 2014, 617 food handlers were certified.
There were 13,842 persons aged 60 years and older in 2014 (estimated total population of 109,434), 7,012 females and 6,830 males. Persons retire between 55 and 60 years old, and contributors to the social security scheme receive monthly pensions upon retirement; vulnerable elderly receive a government monthly subsistence. Free health care services are provided at the primary and secondary care levels.
Monitoring of the Health System’s Organization, Provision of Care, and Performance
The Ministry of Health is responsible for providing primary, secondary, and tertiary level health care services. Primary health care services are provided through a network of 39 health centers in 9 health districts, 7 of which are on Saint Vincent and 2 in the Grenadines. Each health center serves a catchment population of 3,000 living within a radius of 3 miles. Secondary and tertiary care is accessed mainly through the 211-bed Milton Cato Memorial Hospital, the only government acute care referral institution.
Five rural hospitals, with a 58-bed capacity and an average annual admission of 600 persons, provide a minimum level of secondary care. The government also operates a 106-bed geriatric facility for the indigent and a 186-bed rehabilitation health center, mainly for mentally challenged adults. Five private institutions with a combined bed capacity of 55 offer residential care to the elderly. The Health Promotion Unit continues to educate the general public and targeted groups through various media. Fourteen community and institutional fitness groups were established throughout various communities.
Drug procurement for the public sector was handled through the Pharmaceutical Procurement Services of the OECS, at a cost of approximately US$ 4 to 5 million annually in 2012-2015. Drugs for the private sector were acquired in the open market.
The new Georgetown District Hospital was completed and the Georgetown Health Centre and Chateaubelair District Hospital are being retrofitted through a Pan American Health Organization (PAHO) effort, the “Smart Hospitals” initiative. In addition, upgrades to the Milton Cato Memorial Hospital included the refurbishment of the wards, operating theatre, kitchen facility, and mortuary through support from the European Union and PAHO/World Health Organization (WHO). The government’s policy is to provide universal health care coverage that reflects the principles of equity, affordability, quality, and cultural acceptance for its citizens.
Public health care is financed through the National Consolidated Fund and a minimum fee-for-service system. National health accounts for 2014 showed that the total current health expenditure was US$ 36.85 million in 2014; the per capita health expenditure was US$ 36.66. Total current health expenditure, including both public and private expenditure, represented 5.3% of GDP. Total recurrent expenditure for the Ministry of Health and the public health system is estimated to be 8.9% of total public expenditure. An estimated 89% of spending is on costs related to human resources (public employees).
The National Insurance Service (NIS) provides social security protection through sickness, maternity, invalidity, and employment injury as well as funeral and survivor benefits. There is no National Health Insurance (NHI) system but discussions are under way to assess its feasibility.
Health Situation and Trends
Health of Population Groups
Maternal and Reproductive Health
Maternal and child health remains a priority for all health centers offering prenatal and postnatal care, including child health and family planning services. The Maternal and Child Health Committee conducts annual perinatal audits. There were no maternal deaths in 2015. The country has 100% skilled attendance at delivery, and over 95% of pregnant women receive prenatal care services. There were 1,867 births in 2015. The total fertility rate per women remained fairly constant, at 1.8 children per woman.
Child Health (Under 5 Years Old)
In 2014, children under 5 years old represented 7.94% of the population (1.44% under 1 year old and 6.5% 1-4 years old). There are scheduled clinic visits for children under 5 years old. Before entering school, including preschool, children must have completed the required vaccination schedule. Vaccination coverage for administered antigens ranges between 95% and 100% annually (Table 2). Vaccinations included in the national immunization schedule are polio, hepatitis B, diphtheria, pertussis, tetanus, tuberculosis (BCG), mumps/measles/rubella (MMR), and Haemophilus influenza.
Table 2. Immunization coverage rates (%), by antigen, Saint Vincent and the Grenadines, 2009 2013
Source: Saint Vincent and the Grenadines, Ministry of Health, Wellness and the Environment, Community Nursing Service records (2016).
The infant mortality rate was 15.8 per 1,000 live births in 2014 (). The deaths were attributed to conditions originating in the perinatal period. Between 2010–2014 there were seven deaths among 1-4-year-olds, with three deaths each in 2012 and 2014 and one in 2013 (). The leading morbidities in children under 5 years old were acute respiratory infections, skin conditions, and diarrheal diseases. There are no reported cases of vaccine-preventable diseases.
Clinic data for 2012 indicated that 78.4% of children aged 0-6 months had been exclusively breastfed; 0.8% children under 5 years old were wasted, 0.3% stunted, 3.5% overweight and 0.7% obese.
Health of Schoolchildren and Adolescents (5–19 Years Old)
In 2014, the age group 5-19 years old represented 25.8%; 16.74% were 5-14 years old and 9.07% were 15-19 years old. The main cause of morbidity in this age group in 2010-2014 was accidents and injuries, followed by upper respiratory tract infections, dengue, skin conditions, and eye conditions. In 2015, there were 11 deaths in this age group.
The number of teenage births (proportion of all births) has decreased from 2010 to 2013. In 2010–2013, the teenage births as a percentage of all births ranged from 20.0% to 17.6%, the lowest level observed.20 Special effort is being made in counseling teens and teenage mothers re reproductive health and healthy lifestyles that are addressed in the Adolescent Health policy.
Health of Adults (20–59 Years Old)
Persons aged 20-59 years accounted for 53.61% of the population in 2014 (27.49% males and 26.12% females). Among adults older than 20 years who were screened at community health clinics for NCDs in 2011–2014, the most commonly diagnosed conditions were hypertension; diabetes; and cancers of the breast, cervix, and prostate. In 2012, most persons with these diagnoses were over 45 years old. Of those screened, 0.2% of adults over 20 years old were affected by diabetes, 0.7% by hypertension, and 0.2% by both diabetes and hypertension.20 In 2014, deaths in the 20–59-year age group were mainly from malignant neoplasms and diseases of the circulatory system.
Health of Workers
During this reporting period, two important tripartite documents were developed, one on policies for NCDs in the workplace and the other for HIV in the workplace.
Saint Vincent and the Grenadines has 100% registration of deaths. Malignant neoplasms (121-174 per 100,000 population), ischemic heart disease (96-130 per 100,000 population), and communicable diseases (82-101 per 100,000 population) were the three leading causes of mortality in 2009-2013, along with diabetes mellitus, cerebrovascular diseases, and hypertensive diseases. Diabetes is the main endocrine and metabolic disorder contributing to mortality; it ranks fourth among the leading causes of death, and its rates (43-109 per 100,000 population) are increasing (Table 3). Mortality from communicable diseases is primarily due to septicemia, respiratory infections, acquired immune deficiency syndrome (AIDS), tuberculosis, and other general infectious and parasitic diseases. The most common causes of unintentional deaths are related to motor vehicle accidents and other external causes of accidental injuries, such as falls. The most common intentional injuries are as a result of assaults. Conditions originating in the perinatal period have contributed greatly to the national infant mortality rate. The most common disease of the digestive system contributing to mortality is cirrhosis.
Table 3. Mortality rate (per 100,000 population) for the ten leading causes of death, Saint Vincent and the Grenadines, 2009-2013
|Cause of death||2009||2010||2011||2012||2013|
|Ischemic heart disease||96||106||118||107||130|
|Injuries and violence||54||53||44||55||24|
|Heart disease (other forms)||50||37||59||49||141|
|Diseases of the perinatal period||31||29||27||15||22|
|Diseases of the digestive system||24||36||28||23||37|
Source: Saint Vincent and the Grenadines, Ministry of Health, Wellness and the Environment, Monitoring and Evaluation Health Sector Report (2013).
In 2013, 53%-63% of deaths occurred among persons 65 years and older. The age group 45-64 years old accounted for 18% to 22% of deaths, while those aged 15-44 years accounted for 14%-17% of deaths. Children 1-14 years old accounted for the least amount of mortality, at 1%-2 %; under–1-year-olds accounted for 5%-10%.
The country’s HIV prevalence remained low, at under 1% of the population. By the end of 2013 there were 269 HIV-positive clients enrolled in antiretroviral treatment (52.4% males, 47.6% females). Of these, 85.1% received first-line therapy and 14.9% received second-line treatment. The program to prevent mother-to-child transmission (MTCT) that began in 1998 has shown extraordinary promise. By 2016, Saint Vincent and the Grenadines completed the elimination report for the MTCT of syphilis and HIV, and is in the process of verifying the data to prepare for the validation process. The country launched a new HIV/AIDS/STI policy for 2014-2025.
Chronic, Noncommunicable Diseases
Diabetic foot ulcer, the main diabetic complication, is resulting in leg amputations. The Heberprot–P, an innovative Cuban product, has been introduced for treating advanced diabetic foot ulcer. Since the drug’s introduction, amputations have decreased from 20 amputations in 2015 to 14 in 2016. Further, 55 patients have benefited from the drug, with 17 showing complete closure of their wound.
Accidents and Violence
The 2006 Motor Vehicle and Traffic Act prohibits driving or being a front-seat passenger without a seat belt or riding a motorcycle without a helmet. During 2011–2012 there were 1,606 road traffic accidents, with 8 fatalities.
In 2011 there were 21 reported cases of homicide, compared to 28 in 2012; there were 56 reported cases of rape in 2011, compared to 20 in 2012. The number of reported cases of incest was 77 in 2011, with a decrease to 6 cases of in 2012. The Gender Affairs Division of the Ministry of National Mobilization, Youth, and Sports and the Family Court must cope with gender-based violence, as these cases move slowly through the legal system and victims are often unwilling to testify.
Risk and Protective Factors
The 2013–2014 WHO STEPS survey brought to light important information regarding chronic disease risk factors in the country. Of survey respondents, 12% were current smokers of tobacco products, with men having a ninefold higher rate (21.9%) than females (2.5%). In terms of drinking alcohol, 49% of respondents (66.9% males; 31.4% females) stated that they were current drinkers (in the 30 days prior to the survey). Fruits and vegetables were consumed an average of 3.3 days and 3.1 days, respectively, with no difference between the sexes. Only 5.1% of respondents reported consuming five or more servings of fruits and/or vegetables combined (5.9% males; 4.4% females).
According to the study, the proportion of those who were overweight was 27.3% of respondents (28.1% males; 26.4% females), with 26.9% (13.2% males; 40.8% females) reported as obese. Overall, 1.8% of the study population demonstrated the lowest risk for NCDs (i.e., having none of the five risk factors)¾2.7% males and 0.9% of females. Most respondents (71.2%) were found to have one to two risk factors (77.4% males; 65% females) and 26.9% of respondents were found to have three to five risk factors (19.9% males; 34% females). Most respondents (46.5%) with three to five risk factors were 45-69 years old.
As the country looks back to 2010-2015, there is much to be proud of. Saint Vincent and the Grenadines has shown great resilience in the face of an ongoing economic crisis. The government was able to reduce the level of poverty, make education more accessible, and continue to provide social services, including health care, all while facing economic hardship. Moreover, spending on health never went below 6% of GDP, and direct out-of-pocket spending in health accounted for approximately 14% of total spending, a relatively low figure in the context of the average of 30% percent for the subregion. Maternal and child health clearly will remain as a priority, and the country will strive to maintain or improve its 95%-plus immunization coverage. That said, the country must work to find other methods of health financing, including national health insurance.
In terms of environmental issues, extending the scope and efficiency of solid and liquid waste disposal will be added to gains already made in access to clean drinking water and to sanitation services. The country has continued to cope with natural disasters: the National Emergency Management Organization continued to respond to disasters, and a draft Health Disaster Plan is currently being finalized.
As the country considers the health of the population in the next five years, some issues also loom large. On the one hand, NCDs now lead as causes of mortality and morbidity among Saint Vincent and the Grenadines’ adult population, with malignant neoplasms at the forefront in 2010-2015. Yet, while the number of infections and communicable diseases has markedly declined over the past 10 years, emerging vector-borne diseases such as chikungunya and Zika continue to pose serious public health threats. Other issues of concern include coping with the aging of the population and the growing needs of the elderly; tackling drug and substance abuse among the teenage population, and the increasing level of violence nationwide; and developing a Human Resource for Health (HRH) plan that addresses current gaps and needs.
1. Encyclopedia of the Nations. St. Vincent and the Grenadines. Hinsdale, IL: Advameg Inc; 2016. Available from: http://www.nationsencyclopedia.com/Americas/St-Vincent-and-the-Grenadines.html.
2. Central Statistical Office (Saint Vincent and the Grenadines). Population and housing census report 2012. Kingstown: CSO. Available from: http://www.planning.gov.vc/planning/images/stories/pdf/censusreport2012.pdf.
3. United Nations Development Programme. Human development report 2014: sustaining human progress. UNDP; 2014. New York: UNDP; 2015. Available from: http://www.hdr.undp.org/sites/default/files/hdr14-report-en-1.pdf.
4. Ministry of Finance and Planning (Saint Vincent and the Grenadines). St. Vincent and the Grenadines poverty assessment 2007-2008: living conditions in a Caribbean small island developing state—final report. Kingstown: MFP; 2009. Available from: http://www.stats.gov.vc/LinkClick.aspx?fileticket=gxP733Q3EZk%3D.
5. Rodriguez M, Williamson T, Vogus A, Macgregor-Skinner E, Pena D-L, Wilson A, et al. Saint Vincent and the Grenadines health system and private sector assessment. Bethesda, MD: Health Systems 20/20 project / Abt Associates Inc.; 2012. p. xx. Available from: https://www.hfgproject.org/wp-content/uploads/2015/02/Saint-Vincent-and-the-Grenadines-Health-Systems-and-Private-Sector-Assessment.pdf.
6. Grosvenor A. CDM Conference 2013: key outcomes [transcript]. St. Michael, Barbados: Caribbean Disaster Management Agency; 2013. Available from: http://studyslide.com/doc/467776/andria-grosvenor.
7. Central Statistics Office (Saint Vincent and the Grenadines). St. Vincent and the Grenadines 2014 population and vital statistics report. Kingstown: CSO; 2014. Available from: http://stats.gov.vc/LinkClick.aspx?fileticket=aeScnpIF7eA%3d&tabid=60.
1. Data from the Health Planning Information Unit, 2016.
2. One US$ is equivalent to EC$ 2.70.
3. Central Statistical Office, 2012.
4. Ministry of Finance and Planning, Assessment of Millennium Development Goals, 2011.
5. Percentage of houses infested with Aedes aegypti larvae and/or pupae.
6. Number of positive containers per 100 houses inspected.
7. Normal indices should be 5% or below.
8. Ministry of Health/GNC Register of Nursing Professionals.
9. The use of mobile devices to support public health, often related to self-care.
10. The use of telecommunication and information technology to provide clinical health care from a distance.
11. Information from Ministry of Health and the Environment.
13. Central Water and Sewerage Authority (CWSA) data.
15. Ministry of Health data.
16. Information from the National Insurance Services.
17. Information from the Ministry of Health and the Environment.
18. The initiative is “designed to establish an integrated approach to building and retrofitting health care facilities to ensure that they are environmentally friendly and disaster resilient” ().
19. Central Statistical Office, 2012.
20. Health Planning Information Unit, 2016.
21. By law, all deaths must be registered prior to burial.
22. Government of Saint Vincent and the Grenadines police records.