Country Report: Saint Kitts and Nevis
Saint Kitts and Nevis is a nation formed by two islands located in the Leeward Islands of the Lesser Antilles. Saint Kitts is the larger and more populous island, with a total area of 168 km². Nevis, located to the southeast of Saint Kitts, covers an area of 93 km².
The country is divided administratively into 14 parishes (nine in Saint Kitts and five in Nevis).
Its estimated population in 2011 was 47,196 (Saint Kitts 34,918, Nevis 12,278. In 1990, the population structure was stationary among people over the age of 40 and slowly expansive in the population under 40. The population structure currently has a mixed configuration, alternating between stationary and slowly regressive.
The population is mainly of African descent (90%), followed by Caucasian (2.7%) and mixed race (2.5%). Adults over the age of 65 represent 7.5% of the population. Life expectancy at birth is estimated at 73.1 years for men and 78.0 years for women.
The country has improved its social and health conditions, as reflected in a per capita income of US$13,330.
Tourism is an important component of the economy. Saint Kitts and Nevis is classified as a high-income country and in 2015 had the highest annual per capita income in the Caribbean (US$13,330) and a Human Development Index of 0.765.
- The progress in health in recent decades is a result of overall improvements in the country, which has managed to sustain and grow its economy. Another important factor is that health policymakers are very concerned about addressing the social determinants of health.
- The government has identified universal health coverage as a priority area for the formulation of policies and programs geared to gradual progress toward higher levels of coverage for the population. It is exploring the introduction of a national medical insurance plan, which it expects to finance with premiums from the economically active population that is employed.
- Future efforts should maintain the same approach. Along those lines, the government has implemented strategies to address rational investment in services; commitment to equity in resource allocation and health sector management; achievement of a healthy, educated, and properly trained workforce; and the protection of vulnerable groups.
- Proposals aimed at improving the nutritional status of the population include consumer education and health-centered policymaking. This will help control factors that encourage excessive calorie, fat, sugar, and salt intake, including price fixing and advertising.
- Policies to be implemented going forward take into consideration that new health technologies are integral to them and underscore the need for medical teams with appropriate technology for diagnosis and treatment.
Figure 1. Distribution of the population by age and sex, Saint Kitts and Nevis, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2012
Source: Pan-American Health Organization, PAHO Health Information Platform (PHIP) (PLISA).
SELECT BASIC INDICATORS
Source: UN Population and Statistics Divisions, 1990; PAHO; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- In 2008, the prevalence of poverty rate 22%, with 1% living in extreme poverty. In 2014, the unemployment rate was 6.5%.
- The literacy rate is higher for women (97.4%) than for men (96.5%) in the 15-to-24 age group. Access to pre-elementary, primary, and secondary education is universal and free of charge.
- There is low representation of women in leadership roles in politics, and in 2015, women held only 20% of seats in the Parliament of Saint Kitts and Nevis and the Nevis Assembly.
- An estimated 98% of the population in the country had access to clean drinking water in 2015 and 87% had access to improved sanitation facilities in 2007. Surface and ground water sources are susceptible to agricultural pollution, as well as to salt water intrusion due to the islands’ low-lying position.
- Drought conditions related to the effects of El Niño in 2015–2016 put pressure on drinking water resources and agricultural production. Mt. Liamuiga poses a latent threat of volcanic eruption. The country is also exposed to floods and tropical storms.
- Land degradation has led to landslides and soil erosion; this degradation is the result of historically intensive land use for the cultivation of sugarcane and other crops.
- Demographic changes in the country have resulted in increased construction and waste generation, and the upsurge in cruise and cargo vessel traffic may raise the levels of air and water pollution.
- There has been an increase in the number of youths affiliated with gangs, which are generally not organized and engage in petty street crime, robberies, and drug trafficking. The government is attempting to encourage youth to disassociate themselves from gangs through targeted programs, services, and employment. There is no confirmed presence of transnational criminal organizations.
- A National Food and Nutrition Security Policy has been developed, which is systematically applied to ensure that national food production is safe and sufficient to meet the current needs of the population.
- Social assistance programs provide food and cash transfers to poor households and assist with unanticipated expenses, such as hurricane damage, fires, and special emergency medical expenses.
- The social protection system includes social security and social assistance components. In 2015, 16.9% of the population was insured.
HEALTH SITUATION AND THE HEALTH SYSTEM
- Between 2011 and 2015, five maternal deaths were recorded (none to two per year). The leading cause of maternal death was eclampsia.
- Major efforts are being made to eliminate mother-to-child transmission of HIV, syphilis, and hepatitis B.
- With a low number of annual deaths, the infant mortality rate fluctuated between 12.0 and 25.3 deaths per 1,000 live births in the period 2011-2015. In 2015, the neonatal mortality rate was 22.2 per 1,000 live births. The main causes of neonatal mortality were perinatal asphyxia and respiratory distress of the newborn.
- In the period 2010-2015, the immunization coverage rate exceeded 90% for all vaccines.
- In 2015, acute respiratory infections and gastroenteritis were the leading causes of morbidity in children under 5. Adolescents are exposed to significant risks, including overweight and obesity, a sedentary lifestyle, substance abuse, physical violence, and sexual assault.
- In 2012, 33% of all deaths were caused by diseases of the circulatory system and 18% by neoplasms. Together, these two groups of causes accounted for more than half of all deaths in the country.
- In 2013, the leading specific causes of mortality in adults were malignant neoplasms (163.8 deaths per 100,000 population), cerebrovascular diseases (71.1), diabetes mellitus (62.5), ischemic heart disease (32.3), and intentional injuries (25.9).
- A total of 314 cases of malignant neoplasms were reported between 2011 and 2014. The most prevalent types of cancer were breast (19.1%), cervical (19.7%), and prostate (19.7%).
- The leading causes of morbidity in adults are overweight, hyperlipidemia, hypertension, diabetes mellitus, schizophrenia, depression, and substance abuse.
- Between 1984 and 2014, a total of 385 cases of HIV were reported, 149 of which were AIDS cases, with 112 deaths. The total number of HIV infections increased from 57 to 65 during the period 2011-2015 in comparison with 2006-2010.
- Antiretroviral treatment is available free of charge, and all confirmed cases of tuberculosis are tested for HIV. Since 2011, no cases of TB/HIV coinfection have been reported.
- Twelve cases of tuberculosis were reported in 2011-2015, a slight reduction from the 15 cases reported in 2006-2010.
- A total of 63 cases of endemic dengue were recorded during 2011-2014; no cases were recorded in 2015. Two cases of imported malaria were reported from 2011 to 2015.
- There were 28 confirmed and 627 suspected cases of chikungunya virus infection in late 2014, and three cases of Zika virus infection were reported in 2016.
- There were no reported cases of cholera, rabies, leprosy, or other neglected diseases in the period 2010 2015.
- The prevalence of diabetes mellitus, the third leading cause of death in 2013, has been estimated at 20%.
- The leading psychiatric disorders in the period 2011-2015 were schizophrenia (793), schizoaffective disorders (297), bipolar disorder (190), depression (120), and cannabis-induced psychosis (54).
- In 2011, 32.5% of secondary students were overweight and 14.4% were obese. That same year, six adolescent deaths were recorded, five of which were homicides.
- In 2008, 33.5% of adults aged 25-64 were overweight and 45% were obese.
- As a two-island federation, there are two ministries of health with parallel organizational structures. Each island has a Minister and Permanent Secretary, who are responsible for organizing and managing public health services.
- Each Ministry is organized into three programs: the Office of Policy Development and Information Management, which includes the health information unit; Community-Based Health Services, which includes family health services, environmental health, and health promotion; and Institution-Based Health Services, which includes patient care services. There is a single Chief Medical Officer for the Federation.
- Leadership and governance in health are guided by the health policy and essential services established in the current legislation.
- Health expenditure increased from 2.54% of GDP in 2010 to 2.72% in 2014.
- In 2015, Saint Kitts and Nevis had 23.3 physicians, 36.6 nurses, and 3.5 dentists per 10,000 inhabitants. Of the 118 physicians registered in 2015, 21% worked in the public sector and 32% in both the private and public sectors.
- The main public referral hospital is the 150-bed Joseph N. France General Hospital, located in Saint Kitts. The Alexandra Hospital is a 50-bed hospital located in Nevis. There are two district hospitals on Saint Kitts that provide basic inpatient care. There are 17 public primary care facilities (11 on Saint Kitts and 6 on Nevis).
- There are also long-term public and private geriatric services. Persons requiring tertiary level care, such as chemotherapy and radiotherapy, must usually go abroad, which entails substantial personal expenditure.
- Medical care is provided free of charge at all levels (primary, secondary, and tertiary) to all residents (citizens or foreigners with legal residency in the Federation of Saint Kitts and Nevis) who cannot afford the associated costs. The government is currently working on a registry of disabled persons in order to develop a policy and plan for this population.
- The Caribbean Civil Registry and Identity System (CCRIS) was created in 2013 to facilitate computerized birth and death registration and provide timely vital statistics.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The transition from the Millennium Development Goals to the Sustainable Development Goals has been made primarily through the restructuring of the national debt (with a significant reduction in the debt-to-GDP ratio), the development of a draft Food and Nutrition Security Policy, and continued emphasis on human development.
- Perceived risks to sustainable development may be due to climate and environmental vulnerabilities, and progress has been made toward the demarcation of habitable areas. The country has developed a risk map that can be used to establish which areas are appropriate for human settlement.
- The National Social Protection Strategy 2012-2017 seeks, through social and educational programs, to address issues such as the impact of poverty on women and men, the effect of unemployment on heads of household, and the challenges faced by at-risk children.
- “Customer service” and overall patient satisfaction have improved but should be optimized through a “patients’ statute” and policy that governs the quality of care.
- A draft strategic plan on mental health and substance abuse, a strategic plan to control drug abuse, and a mental health law are in the final stages of preparation.
- Population aging presupposes a higher demand for social protection and health services.
- The government has established a national information and communication technology governance board.
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