Country Report: Grenada
Grenada is a country comprised of three main islands (Grenada, Carriacou, and Petite Martinique) and several smaller uninhabited ones. Located in the southern Caribbean about 160 km north of Venezuela, it has a total area of 344 km2.
Between 1990 and 2015, the population grew by 15.3%, reaching 111,000 inhabitants in 2015, according to United Nations estimates. In 1990, the population structure was expansive; by 2015, it had become stationary for those younger than 30 years of age.
The majority of Grenada’s population is of African descent (82.4%), mixed ethnicity (13.3%), and East Indian descent (2.2%).
In 2014, life expectancy at birth was 74.1 years.
In 2015, per capita income was estimated at US$ 9,156. Tourism and agriculture are the main industries, while tourism is the main supplier of foreign exchange to the economy.
- The Ministry of Health is responsible for spearheading the development of national health policies. For the 2011-2015 period, a series of health sector guidelines were developed to reduce the leading causes of morbidity and mortality. The areas covered included adolescent health (2013), sexual and reproductive health (2013), oral health (2013), and the action plan (2015).
- In 2015, the National Health Sector Strategic Plan (2016-2025) was adopted. This plan presented health legislation and proposals for legislative reform for legal drafting.
- The Food Safety Law was enacted in 2015, covering the safety of food produced, imported, and exported. A National Food Safety Committee was created to raise the standards for domestic food production.
- The Government is aware of the impact of climate change on human lives and has committed to supporting and investing in the public response to climate change. Accordingly, the Ministry of Health continues to build capacity to reduce vulnerability, increase resilience, and promote disaster risk reduction.
- The National Food Safety Policy adopted in 2010 was strengthened with the passage of new food safety legislation in 2015.
- The drug procurement service of the Organisation of Eastern Caribbean States facilitates the procurement of pharmaceutical products at lower prices with better quality assurance.
Figure 1. Distribution of the population by age and sex, Grenada, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization. Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- Education is compulsory and free at the primary and secondary level. The literacy level is 98%.
- In 2015, a prolonged drought threatened the water supply of numerous communities. Disaster preparedness and response capacity has improved since the devastation of hurricanes Ivan and Emily in 2004 and 2005, respectively.
- In 2014, access to safe drinking water was universal (98% of the population). Some 95% of the population has access to water piped into the home, while 2% still use standpipes.
- Improved sanitation coverage included 8.2% with public sewer connections, 53.1% with septic tanks, and 36.3% with latrines or pit latrines.
- Waste collection services are available for 98% of households: 87% are served by government services and 11% by private services.
- Between 2010 and 2014, 9,241 people emigrated internationally, while immigration was insignificant.
HEALTH SITUATION AND THE HEALTH SYSTEM
- The annual number of pregnancies is relatively low (1,750 births in 2014). There was just one maternal death between 2010 and 2014.
- A high percentage of births (99%) occur in hospitals and health care centers and are attended by trained health workers.
- Infant mortality was 12.3 per 1,000 live births (21 deaths) in 2010 and 10.3 in 2014. That year, there were 28 deaths in children under 1 year, attributed to conditions originating in the perinatal period.
- Between 2010 and 2014, there were 14 deaths in the 1-4 age group.
- Vaccination is required for preschool or primary school enrollment, and vaccination coverage for the antigens administered ranges from 95% to 100%.
- There were 4,251 deaths in the period 2010-2014. The crude death rate was 8.8 in 2014. The leading cause of death in 2015 was circulatory system diseases (31% of deaths), followed by neoplasms (20%). The most common malignant neoplasms were 15.1% prostate, 12% lung, 9.3% breast, and 9.3% colon.
- No cases of zoonosis or rabies were recorded during the 2010-2014 period. Dengue is endemic, with 265 confirmed cases in the 2010-2014 period, but no deaths.
- Since 2013, the new emerging diseases caused by the chikungunya and Zika viruses reached epidemic levels.
- A total of 26 laboratory-confirmed cases and 3,070 presumptive cases of chikungunya were recorded between June and October 2014, with no related deaths. The numbers then declined, with no associated deaths. In 2016, 112 laboratory-confirmed cases of Zika were recorded, with 10 cases of Guillain-Barré syndrome; 10 pregnant women contracted the disease in the first trimester.
- The household Aedes aegypti mosquito index was 10.6% in 2014. Malaria and yellow fever are not endemic, although cases of malaria were recorded in 2010 and 2013.
- Between 2010 and 2014 there were 45 cases of leptospirosis (27 men and 18 women), with 2 deaths.
- The prevalence of human immunodeficiency virus (HIV) infection in the adult population was estimated at 0.57% in 2009. By late 2014, a total of 543 confirmed cases of HIV had been recorded since the first case was diagnosed in 1984. Men represented 65% of the cumulative total, and almost 83.9% of the cases correspond to the 15-54 age group.
- In 2014, 26 new cases of HIV were reported (19 men and 7 women). Antiretroviral therapy is provided free of charge. There have been no cases of mother-to-child transmission of HIV since 2010.
- Between 2010 and 2015, nine cases of tuberculosis were recorded (one to four annually), none of which was drug resistant.
- Chronic noncommunicable diseases have become the leading cause of premature avoidable death and disease. In 2010, these diseases and their complications were responsible for 65%-81% of all deaths.
- In 2011, 61.3% of adults had one or two risk factors (65.5% of men and 57% of women), while 35% had three to five (30.5% of men and 39.8% of women).
- Between 2009 and 2015, overweight in children aged 0-3 years increased from 2.2% to 4.7%, and wasting fell from 7.9% to 3.4%. Between 2011 and 2014, overweight in preschool children increased from 2.9% to 3.9%, and wasting fell from 7.5% to 2.5%. The index of overweight in adults was 58.7%, while 25.2% were obese, with a higher prevalence in women.
- According to the results of a survey, in 2013, 72% of secondary school students had consumed alcohol, 27% smoked cigarettes, and 20% used marijuana; 19% of adolescents and adults smoked at the time (30.7% of men and 6.5% of women), while 11.2% smoked daily (19.4% of men and 2.8% of women).
- The Ministry of Health (MoH) is responsible for overseeing the health services and for policy-making and regulation. Health care in Grenada is universal, and Government financing is supplemented by minimal fees for services in public institutions.
- Private institutions offer health insurance, which is the only form of health insurance in Grenada to date. In view of the growing older population, the Government is considering the creation of a national health insurance program. Some safety net programs have been established to help meet the basic needs of the most vulnerable groups.
- Between 2008 and 2014, total health expenditure averaged 5%-6% of the gross domestic product (GDP). Direct disbursements (out-of-pocket expenditure) accounted for 47% of total health expenditure. Total Government expenditure on health was 10%-12% of the total budget.
- In 2014, the country had 10.1 physicians, 0.8 dentists, 31.0 registered nurses, and 21.3 nursing assistants per 10,000 population.
- Health services are provided at the primary and secondary level through the public and private health services.
- There is a network of public health facilities, including 3 acute care hospitals and 36 health facilities, which include 6 health centers (1 in every health district) and 30 satellite medical stations scattered within a 3-mile radius throughout the country.
- Primary health care has been expanded to increase access to care. It is important to point out that the health care program serves the vulnerable segments of the population.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The country has made progress in terms of overall development and health, as well as its health system. Coverage in maternal and child health programs and the health care network has been expanded.
- The vaccination program has broad national coverage, making most vaccine-preventable diseases uncommon.
- Some health issues will continue to be a priority for future action, among them access, health equality, and achievement of the Sustainable Development Goals.
- The national health insurance is designed to be an effective model for achieving universal health coverage that guarantees access and equity to the population.
- Chronic noncommunicable diseases are the main cause of morbidity and mortality, together with the threat of emerging new infectious diseases.
- Risk factors for chronic diseases must be reduced, especially alcohol use and abuse, unhealthy diets and obesity, lack of physical activity, and hypertension.
- Thus, health promotion and disease prevention strategies must be strengthened, particularly for the most vulnerable groups. Important among these strategies are education and providing opportunities to develop healthy lifestyles.
- Emphasis has been placed on the need to improve men’s health to help close the gap in life expectancy between men and women, which is currently 5 years.
- Among other strategies, emphasis will be placed on community participation and sufficient funding to guarantee the sustainability of the achievements of the past decade.
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