Pan American Health Organization

Saint Lucia

  • Overall Context
  • Leading Health Challenges
  • Health Situation and Trends
  • Prospects
  • References
  • Full Article
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Overall Context

Flag of Saint LuciaSaint Lucia is located northeast of Saint Vincent and the Grenadines, northwest of Barbados, and south of Martinique; it is part of the Windward Islands. The country extends for 620 km2, in very mountainous terrain. Saint Lucia is a parliamentary democracy with elections every five years, with the last election having been held in 2016. Saint Lucia is a member of the Caribbean Community (CARICOM) and home to the Organisation of Eastern Caribbean States (OECS). Saint Lucia is organized into 11 districts.

Demographics

The population is mainly of African descent (85.3%), followed by mixed (10.8%), East Indian (2.2%), and Amerindian (Carib) (0.6%) population groups. Approximately 70% of the population is Roman Catholic. English is the official language, although a French patois is commonly spoken. The total estimated population in 2010 was 166,526, of which 50.2% were females and 49.8%, males. The 2014 estimated mid-year population was 172,255, representing a 3.4% increase compared to 2010 and a 22.1% increase since 1990. The estimated annual growth rate is expected to be just below 1% in 2013 and to continue gradually and steadily declining to 0.63% per annum through 2017. The population density was 796 persons per mi2; 72.0% of the population lived in rural communities and 26% of the population lived in or near the capital, Castries (). Average life expectancy is estimated as 77.8 years in 2016 (78.0 for males and 80.7 for females), compared with 74 years in 2001 (72.5 for males and 75.5 for females). Figure 1 shows Saint Lucia’s population structure in 1990 and 2015.

Figure 1. Population structure, by age and sex, Saint Lucia, 1990 and 2015

Saint Lucia’s population size increased 33.9% between 1990 and 2015. In 1990, the age structure had an expansive structure, with most of the population falling below the 30-year-old age groups. By 2015, the population structure had become transitional, growth declining in groups under 25 years of age. These changes were the result of ageing and lower fertility and mortality, especially in the last two and a half decades.

Source: Pan American Health Organization, based on the United Nations Department of Economic and Social Affairs, Population Division. Revision 2015, New York, 2015

In 2014, females comprised about 51% of the population, with women of childbearing age (15-44 years) accounting for 24%, children (under 15 years old) for 21%, and the elderly (65 years or older) for 9%; the population under 19 years of age represents 29.7% of the population.

The Economy

The country’s economy depends primarily on tourism (65% of GDP), banana production, and light manufacturing. The per capita GDP increased slightly, from US$ 6,626 in 2010 to US$ 6,848 in 2014. According to an International Monetary Fund report, Saint Lucia’s economic activity has recovered and the country’s fiscal situation became stronger in 2014, mainly due to strong tourism inflows and lower oil prices. After the 2012 recession and close-to-zero growth in 2013, in 2014 the economy was again showing signs of recovery, with GDP growth reaching 0.5%, mainly driven by the transportation and hotel industries, although the construction, communication, and agriculture sectors remained in decline ().

Social Determinants of Health

The 2005 poverty assessment study showed that approximately 18.7% of households and 25.1% of individuals were poor, and that 5.3% of households and 7.1% of individuals were indigent (). In 2015, the government conducted a multidimensional poverty study using the dimensions of education, employment, living standards, and health. According to this later study, the adjusted headcount ratio for poverty was 23% and higher for males (24%) compared to females (21%). This survey corroborated the findings of the earlier poverty assessment, which indicated that poverty disproportionately affected rural communities.

According to the 2012 Multiple Indicator Cluster Survey funded by UNICEF, literacy levels for young females 15-24 years old was 99.3%, and did not vary by geographic location, education, age, wealth index, or ethnicity of household head (). Between 2003 and 2013, the male-to-female enrollment ratio was 1:1 at the various educational levels, with girls outperforming boys. Females have the highest enrollment at post-secondary institutions ().

In 2010, males accounted for an estimated 55% of the labor force and females for 45%; the unemployment rate was 20.6% (24.2% for males and 28.2% for females) (). By 2014, unemployment had reached 24.4%, as demand was insufficient to fully absorb the growth of the labor force. Youth unemployment, in particular, rose to an alarming 41.8%().

The Health System

The Ministry of Health is responsible for overseeing the health of the population by providing finances, issuing regulations, and developing and enforcing public health policies. Saint Lucia’s health system offers primary, secondary, and some tertiary level of care. Primary health care is delivered through a network of 33 health centers, two district hospitals, and one polyclinic in each of the eight health regions. In addition, there are two acute care general hospitals, Victoria Hospital in the north and St. Jude Hospital in the south, and one private hospital that mainly provides secondary care. A psychiatric hospital provides mostly inpatient care, including rehabilitation.

Leading Health Challenges

Critical Health Problems

Emerging and Neglected Diseases

Between 2010 and 2014, there have been 44 confirmed cases (18 males; 26 females) of influenza A (H1N1), and no confirmed cases in 2015.

A baseline survey aimed at declaring the elimination of schistosomiasis is being conducted with Pan American Health Organization (PAHO)/World Health Organization (WHO) support. Two cases of schistosomiasis were reported in 2011-2015; the disease’s incidence has continued to decline since 2006-2010, when there were 5-10 cases.

Tuberculosis

During the period 2011–2013, there were 45 cases of tuberculosis recorded between 2011 and 2013 (33 males and 12 females); there were 2 deaths with coinfection with HIV in the same period. In 2015, there were 11 cases (7 males and 4 females), with an incidence rate of 6.3 per 100,000 population.

Adolescent Pregnancy

In the past decade, births to teenagers have declined markedly, reaching their lowest levels in 2012 and 2013, with 14% of total births. In 2014, however, teenage births accounted for 15% of total births, with a rate of 22 per 1,000 females 10-19 years old. Table 1 shows selected adolescent pregnancy indicators for 2006-2014.

Table 1. Selected teenage pregnancy indicators, by year, Saint Lucia, 2006-2014

  Year
Indicator 2006 2007 2008 2009 2010 2011 2012 2013 2014
Total births 2074 2081 2113 2051 1826 1908 1934 1975 2066
Teenage births 360 383 328 322 308 280 270 272 302
Percentage of total births 17 18 16 16 17 15 14 14 15
Rate per 1,000 females 10-19 years 24 26 22 22 21 19 19 20 22

Source: Saint Lucia, Ministry of Health and Wellness, Fertility Database.

Chronic Conditions

In 2012, chronic noncommunicable diseases (NCDs) accounted for 58% of premature deaths and 73% of all preventable deaths excluding infant mortality. The five leading causes of death for persons aged 65 years and older in 2014 were the same for males and females, although the rank order differed. The leading five causes of death accounted for about two-thirds of all deaths in both sexes: malignant neoplasms, 110 deaths per 100,000 population; heart disease, 96; cerebrovascular diseases, 84; and diabetes mellitus, 43. The death rates for cancers, heart diseases, and cerebrovascular disease were higher for males, with cancer and heart rates in males doubling those in females. Among cancer deaths in the group 60 years old and older, prostate cancer–related deaths were higher. Table 2 shows the 10 leading causes of death, by sex, in 2014.

Table 2. Number of deaths, percent of total deaths, and rank of the 10 leading causes of death, by sex, Saint Lucia, 2014

Causes (ICD-10 code) Male % Rank Female % Rank Both % Rank
Malignant neoplasms (C00-C97) 142 19.5 1 97 17 1 239 18.4 1
Heart diseases (105-109; 120-152) 108 14.8 2 73 12.8 3 181 13.9 2
Cerebrovascular diseases (160-169) 62 8.5 3 62 10.8 4 124 9.5 3
Diabetes mellitus (E10-E14) 45 6.2 4 78 13.6 2 123 9.4 4
Hypertensive diseases (I10-I150 37 5.1 5 49 8.6 5 86 6.6 5
Chronic lower respiratory diseases (J40-J47) 36 4.9 6 10 1.7 6 46 3.5 6
Assault (X85-Y09) 34 4.7 7 0 34 2.6 7
Chronic liver disease and cirrhosis (K70-K74) 19 2.6 8 9 1.6 7 28 2.2 8
Influenza and pneumonia (J09-J18) 17 2.3 9 10 1.7 6 27 2.1 9
Perinatal conditions (P00-P96) 17 2.3 10 9 1.6 7 26 2 10

Source: Saint Lucia, Ministry of Health and Wellness, Mortality Database.

Mental Health

The Ministry of Health has given priority to mental health: to that end, it has implemented the revised strategic plan, which aims to incorporate mental health into primary health care. Further, families of the mentally ill are provided opportunities to become more involved with their care, to ease the burden on the institution and the government. An estimated 5% of the national health expenditure is allocated each year to mental health. In 2012, the main admitting diagnoses were schizophrenia and delusional disorders, including psychosis (not drug-induced), followed by disorders due to psychoactive substance abuse, including alcohol; and mood disorders, including depression, bipolar disorder, and manic episodes. A greater proportion of admitted mental health patients are males (73%), largely 20-39-year-olds (61%).

The National Strategic Plan for Health 2006-2011 outlines the strategic road map for proposed health reforms and the impetus for action and change in the health system. In the absence of a new plan since 2011, the current plan continued to guide the operations of the Ministry of Health. A new five-year National Strategic Plan for Health is being developed and should be implemented by the end of 2017.

In Saint Lucia, the number of doctors available in the private sector far outnumbers that of the public sector. As of December 2014, the number of doctors in the public health system was 82, servicing an estimated 2,101 persons, compared to 250 doctors in the private sector serving 689 persons. A strategy for human resources in health was developed in 2014 to strengthen staffing functions. In 2012, through a financial agreement with the European Development Fund, a project designed to support the implementation of universal health care in Saint Lucia was launched. Since its implementation in 2013, the project has issued some 250 scholarships in priority areas such as family nursing, environmental health, diabetes, physiotherapy, midwifery, and mental health. The 60 new midwives, 4 family nurse practitioners, and 6 pharmacists boosted existing staff. By December 2014, the Ministry of Health had 275 nurses (including family nurse practitioners and midwives), 113 nursing support staff, 23 pharmacists, 77 allied health professionals, and 7 dentists, among others.

Health Knowledge, Technology, and Information

Two units within the Ministry of Health are primarily responsible for health information systems: the National Epidemiology Unit, charged with collecting and analyzing health data, and the National Health Management Information System (HMIS) Unit, responsible for implementing the electronic national system known as the Saint Lucia Health Information System (SLUHIS). The system, launched in 2011, is responsible for setting up data collection in all 36 primary care facilities throughout 2016-2017. As of this writing, the system had been rolled out at 31 health care facilities, including the Gros Islet Polyclinic and the Dennery Hospital. The electronic system will greatly enhance, and in some cases replace, the current system of collecting and recording written records. It will also make data and patient records easier to retrieve, such as when patients relocate and must receive services at different health facilities.

According to the Office of the Civil Registry, which is legally mandated to collect information on births and deaths, almost all (99.8%) births occur within an established institution. In 2014, the Registry implemented the process of bedside registration at the National Hospital. Deaths must be registered prior to burial.

The Environment and Human Security

Saint Lucia is vulnerable to natural disasters such as hurricanes and the potential floods and disease outbreaks that may occur in their aftermath. With the ongoing effects of climate change, the country is likely to face more and more severe weather events, sea level rise, and altered patterns of precipitation, all of which could interfere with the safety and livelihood of its citizens. In response, Saint Lucia is working on putting in place a broad range of preparedness and adaptation measures.

In 2010, Hurricane Tomas resulted in 7 deaths and 36 injuries. Then, during Christmas 2013, the country experienced torrential rains and strong winds that resulted in six deaths; roughly 1,050 persons were severely affected. Saint Lucia suffered total losses of approximately US$ 99 million as a result of that event, mainly due to serious damage to infrastructure, including nine bridges and several roads. A dengue outbreak in 2011, with 749 confirmed cases, and the first chikungunya outbreak, in 2014, followed natural disasters.

The population has access to piped drinking water of satisfactory quality. Over 80% of homes have private connections to the system, and the rest of the population gets its water through public standpipes, trucks, and private tanks. Most homes (92.5%) have sanitary facilities through sewer connections, septic tanks, or pit latrines. The Ministry of Health’s Food and Water Safety Unit monitors and evaluates sanitary facilities for compliance with public health standards.

The majority (88%) of households are served by two sanitary landfills on the island. The remaining households dispose of waste by composting, dumping, or burning. Residential or institutional and commercial waste account for more than half of the waste produced ().

A food safety policy and an emergency response plan for food-borne diseases were implemented in 2015 to guide food surveillance activities. There was a 31% increase in the number of food handlers certified to handle and sell food to the public in 2015 compared to the figure in 2014.

Aging

In 2010, persons 60 years old and older accounted for 12% of the population; by 2014, they represented 21.8% of the population, an increase that highlights the growing importance of the needs of the elderly in all government development planning policies and programs. Males accounted for 44.6% of this age group (9,738). Elderly males died at a higher rate than did elderly females during the period 2006 to 2014. The death rate for females fell progressively to its lowest level for the period in 2010 (about 1 per 10,000) from its highest level (21 per 10,000) in 2007, and was 9 per 10,000 in 2014. Similarly, the death rate for males fell to its lowest level in 2011 (3 per 10,000) from its highest level in 2008 (28 per 10,000), but was 17 per 10,000 in 2014.

Migration

Between 2001 and 2010, 8,435 persons migrated out of the country, of which 42.7% were males and 52.3% were females (). In 2010, 8,436 persons migrated to Saint Lucia (3,855 males and 4,581 females).

Monitoring the Health System’s Organization, Provision of Care, and Performance

The National Strategic Plan for Health (2006–2011) is currently being revised. The new plan will focus on universal coverage to improve health equity and service delivery; use of a defined national model of care; adequate standards (clinical governance and physical determinants), integrated service delivery, and an accreditation road map; leadership reforms, through an evaluation and redesign of the health governance model; and public policy reforms, through the development of appropriate policies and related legislation.

Universal health coverage is the overarching framework that guides the Ministry of Health’s efforts to achieve health equity, sustainable health coverage, quality care, and improved health outcomes. To this end, the Ministry pursues a cost-effective approach designed to reduce segmentation and to ensure fair access that upholds human rights. A basket of services has already been identified and efforts towards finalizing this and other related initiatives are currently under way.

Services are free, and will continue be provided at the 36 health facilities and 2 main hospitals, all within easy reach of the population. The Ministry of Health makes it possible to access services that are not available in-country, including CT scans, treatment for severe burns, and some oncology services. Affected persons often receive treatment in Martinique under a government-to-government arrangement. In support of the implementation of universal health coverage, the Ministry of Health launched a “Health Financing Strategy and Policy” with funding from the European Union, which will be fully implemented after the passage of related legislation. A package of health care services was designed based on an analysis of epidemiological and demographic trends, as well as consideration of social determinants of health. The package, which includes specific services within the framework of a comprehensive model of care, is already being offered in many of the health facilities across the island.

The National Health Sector Policy currently in force addresses the following imperatives: investment in health, tackling health challenges, strengthening people-centered health systems, and creating resilient communities. Policies already have been set for chronic NCDs, mental health, and nutrition.

A new health sector governance model has been proposed to come into effect with the commissioning of the new national hospital (the Owen King EU Hospital), whereby the government need not own or directly control any health facility or provider. According to this model, the Ministry of Health’s role as steward and regulator is clearly defined, as is a dedicated health fund. There will be mechanisms to engage all health actors in maintaining acceptable standards of performance in the delivery of care for clinical and nonclinical care and support. The proposed governance model , along with a new integrated health care model , will provide a framework for the delivery of the essential package of health services. The integrated care delivery model emphasizes primary prevention and related services to create a more patient-friendly and effective experience. An operational procedure for the “Integrated Health Services Delivery Network” is currently being developed with assistance of PAHO, and should be in place by the end of 2017.

An assessment of the country’s legislative system has been conducted as a way to strengthen the Ministry of Health’s stewardship role. In light of this review, the following pieces of legislation were updated or enacted: the Public Health Act; the Health Practitioners Act; the Mental Health Act, the Health Records Act, and laws that govern the hospitals. These acilities are managed by an independent board and receive an annual subvention from the government.

Saint Lucia’s health services are funded primarily through a government consolidated fund, donor contributions, out-of-pocket payments, and private health insurance schemes. Under the new governance strategy, all of these financing mechanisms and funds will be consolidated into a single pool, with the funds allocated based on service level agreements.

Health expenditure, as a percentage of total government expenditure, ranged from 6% to 8% between 2004 and 2014 (). Health expenditure accounted for somewhat more than 2.5% of GDP in 2014/2015. The bulk of recurrent expenditure in health goes to secondary and tertiary care, namely to the three main public hospitals. This includes staff remuneration, maintenance, and, over the last three years, a significant increase in capital expenditure for the construction and equipping (EU grant funding) of the Owen King EU Hospital and the reconstruction of the St. Jude Hospital.

Pharmaceuticals are sourced through the Pharmaceutical Procurement Service of the OECS. A formulary committee reviews the essential pharmaceuticals list at regular intervals and updates it accordingly.

Prospects

As the Ministry of Health moves into its next planning cycle in 2007, it will focus on continuing to strengthen Saint Lucia’s health system, particularly by boosting the Ministry’s stewardship role and improving health outcomes. The new strategic plan will attempt to complete the unfinished agenda. Specifically, it will work on establishing the virtual integration model and fine-tuning the health financing strategy and the quality management framework. In terms of human resources for health, including training and succession planning, the new plan will identify key indicators for service delivery, outcomes, and health status.

References

1. Central Statistics Office (St. Lucia). 2010 population and housing census: preliminary report. Castries: CSO; 2011 [updated April 2011]. Available from: http://192.147.231.244:9090/stats/images/OtherPublications/StLuciaPreliminaryCensusReport2010.pdf Accessed on 6 June 2017.

2. International Monetary Fund. St. Lucia: 2015 Article IV Consultation–press release; and staff report. (Country report no. 16/52). Washington, D.C.: IMF; 2016. Available from: https://www.imf.org/en/Publications/CR/Issues/2016/12/31/St-43713 Accessed on 29 November 2016.

3. Kairi Consultants Limited; National Assessment Team (Saint Lucia). Trade adjustment and poverty in Saint Lucia 2005/06: volume I, main report. St. Michael, Barbados: Caribbean Development Bank; 2007. Available from: http://www.caribank.org/uploads/publications-reports/economics-statistics/country-poverty-assessment-reports/SLUCPAMainReport.pdf Accessed on 6 June 2017.

4. World Bank. Microdata Library. St. Lucia – Multiple Indicator Cluster Survey 2012 [Internet]. Washington, D.C.: World Bank/International Bank for Reconstruction and Development; 2014. Available from: http://microdata.worldbank.org/index.php/catalog/2209 Accessed on 6 June 2017.

5. Chitolie-Joseph E. Education for All 2015 national review report: Saint Lucia. Castries: Ministry of Education; 2014. Available from: http://wedocs.unep.org/bitstream/handle/20.500.11822/9760/-National_Education_for_All_Report-2015StLucia_NationalEducationforAllReport_2015.pdf.pdf?sequence=3 Accessed on 29 November 2016.

6. Solid Waste Management Authority (Saint Lucia). Solid waste management report; 2011. Castries: SLUSWMA; 2011.

7. Knoema.com. World Data Atlas: Saint Lucia health—total health expenditure as a share of GDP, 2003–2014 [Internet]. McLean, VA: Knoema; 2017. Available from: https://knoema.com//atlas/Saint-Lucia/topics/Health/Health-Expenditure/Health-expenditure-percent-of-GDP Accessed on 6 June 2017.

8. World Bank. The growing burden of non-communicable diseases in the Eastern Caribbean. Washington, D.C.: World Bank/International Bank for Reconstruction and Development; 2012. Available from: http://documents.worldbank.org/curated/en/954761468224410323/The-growing-burden-of-non-communicable-diseases-in-the-Eastern-Caribbean.

9. Flaskerud JH, DeLilly CR. Social determinants of health status. Issues in Mental Health Nursing 2012;33(7):494–497. doi: 10.3109/01612840.2012.662581.

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Reference/Note:

1. The proportion of weighted deprivations that the poor experience in all the total potential deprivations that the society as a whole might experience.

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