Country Report: Suriname
The Republic of Suriname lies on the northeastern coast of South America and borders Guyana on the west, French Guiana on the east, and Brazil on the south. The country is divided into 10 administrative districts: the 2 urban districts of Paramaribo (the capital) and Wanica, 6 rural districts in the coastal area, and 2 districts in the interior. The urban districts occupy 0.5% of the country’s territory and contain 70% of the population.
In 2012, Suriname had a population of 541,638, 80% of whom lived in the coastal area. In 1990, the population structure was expansive—but it has become stationary in the under-20 age groups, with an aging population. Population growth in the over-60 age group was very pronounced, increasing by nearly 30% over a nine-year period, while the 0-14 age group grew by only 1.6%.
The population of Asian Indian ancestry is the largest ethnic group (27% of the population), followed by the Maroons (22%, of African descent), Creoles (16%), people of Javanese ancestry (14%), mestizos (13%), and Amerindians (4%).
The economy was stable in the period 2008-2012, with average annual growth of 4.1%. The principal drivers of the economy are the gold mining and oil sectors. Following 2008-2012, there was an economic recession, due to a drop in the price of these products.
- The Government of Suriname’s Multi-year Development Plan 2012-2016 states that economic development is the basis for social security, which in turn stimulates economic growth.
- The Development Plan underscores the importance of priority policies to provide social protection for the population, particularly for certain high-priority groups such as young people.
- The Government has presented a stabilization and recovery plan for the period 2016-2018, one of whose objectives is to protect the population—especially the very poor and other vulnerable groups—from a more severe recession.
- In 2014, three important laws relating to social security were passed: the basic health insurance law, the law expanding pension benefits, and the law establishing a minimum wage.
- The 2012-2016 action plan for the control of NCDs includes measures to address a number of priorities and emphasizes the importance of an intersectoral approach.
- The Development Plan proposes major investment projects to increase affordable housing, improve access to safe drinking water and health services, and promote local livestock production.
- A national action plan to protect biodiversity provides a framework for incorporating measures and values related to the conservation of biodiversity, cultural diversity, and natural diversity in national development plans and sectoral plans.
Figure 1. Distribution of the population by age and sex, Suriname, 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
- According to the census, the unemployment rate in 2012 was between 10.3% and 12.8%. It was estimated that 6% of the population over 15 had received no schooling, while the illiteracy rate was approximately 6%.
- Due to diminishing foreign exchange reserves, the official exchange rate had been devalued by approximately 90% as of mid-2016. The population has had to endure a dizzying increase in the price of virtually all products and services, including gasoline, electricity, and other basic goods.
- Approximately 70% of the population has access to running water at home or within 200 meters of home. In some rural districts and in the interior, people depend mainly on rainwater or streams and rivers for their water.
- The number of undocumented immigrants is unknown but is estimated to be higher than that of documented immigrants, especially in the case of immigrants from Brazil and Guyana. This population group has no right to social services of any sort, including free medical care.
- Social inequalities persist in the urban, rural, and interior regions and peri-urban slums. To address this situation, several major investment projects have been planned, with a view to increasing access to affordable housing and piped water and promoting agriculture and local production.
- In 2012, the expansion of illegal small-scale gold mining and the associated use of mercury were declared to be detrimental to the forest and its ecosystems. Diseases resulting from deforestation and alterations in ecosystems (e.g., vector-borne diseases such as leishmaniasis) are on the rise.
- The country has a multiyear development plan, though its implementation has been hindered since 2015 by the financial recession.
HEALTH SITUATION AND THE HEALTH SYSTEM
- The maternal mortality ratio averaged 125 deaths per 100,000 live births in 2000-2013. This figure was 154 per 100,000 live births in 2010 and 139.8 in 2013. The leading causes were gestational hypertension and hemorrhage.
- In 2010, prenatal checkup coverage was 94.9%; 67% of pregnant women had four prenatal checkups; 92.3% of births took place in a health facility; and 94.3% of births were attended by trained health workers. Nearly 48% of women used some form of contraception in that year.
- The infant mortality rate in 2013 was 15.9 deaths per 1,000 live births. The most common causes of mortality reported in children under 1 year of age were respiratory problems, fetal growth retardation, congenital diseases, neonatal septicemia, and external causes. There is inadequate reporting of deaths in children under 1; thus, the mortality rate is probably underestimated. The under-5 mortality rate was 18.5 in 2013.
- In 2015, vaccination coverage was 89% for DPT3 and 94% for the trivalent vaccine (MMR1).
- In 2014, the causes of death were distributed as follows: circulatory system diseases (29%), neoplasms (14%), and external causes (11%).
- Some 30% of adults aged 55-64 had three or more risk factors for cardiovascular disease versus 23% in the 45-54 age group.
- In adults over 65, the leading specific causes of mortality were cardiovascular disease, neoplasms, and diabetes mellitus. Notably, deaths from diabetes are increasing. The median age at death was 67 in 2013.
- Malignant neoplasms have replaced external causes as the second leading cause of death.
- The first case of Zika virus was confirmed in late 2015; since then, the disease has spread through the 10 districts, including rural areas and the interior. As of June 2016, 15 cases of Zika-related Guillain-Barré syndrome had been reported. Zika was confirmed in one out of eight newborns with presumed Zika-related microcephaly.
- Dengue continues to be endemic, and new chikungunya and Zika epidemics suggest the need for more effective control of the Aedes aegypti vector.
- The incidence of malaria has declined below elimination levels in all subdistricts except for one in the interior. Nevertheless, the proportion of imported cases (principally among gold miners from French Guiana) increased to over 70% of the total in 2015, Plasmodium vivax being the predominant parasite.
- The number of diagnosed and treated cases of cutaneous leishmaniasis increased during the period 2004-2012. This phenomenon was influenced by deforestation in the interior related to gold mining and logging.
- In 2014, the recorded prevalence of human immunodeficiency virus (HIV) infection in the 15-49 age group was 0.9%. In 2000-2013, the disease remained undiagnosed in some 40% of people with the infection. Mortality from HIV/AIDS was 22.4 deaths per 100,000 population in 2010 and 16.4 in 2013.
- The estimated tuberculosis diagnosis rate rose from 58% in 2012 to 71% in 2014; the reporting rate was 28.6 per 100,000 population in 2013.
- HIV prevalence in TB patients declined from 34% in 2010 to 29% in 2014, but mortality in TB patients continued to be highly correlated with HIV infection. In 2011, the country began implementing directly observed treatment, resulting in higher treatment success, from 61% in 2010 to 75% in 2013.
- Stroke, ischemic heart disease, and diabetes rank high among the diseases responsible for the most disability-adjusted life years.
- Suicide rates have increased: in 2012, the rate was 26.7 per 100,000 population, far higher than the world average of 16 per 100,000 population. The male-female suicide ratio averages between 2 and 3 to 1, while the suicide attempt ratio is the reverse (0.7 men to 1 woman).
- Malnutrition rates in children under 5 were low (5.8%).
- In 2013, 15% of male and 25% of female adolescents were overweight or obese, and 40% drank sugary beverages daily; 11% consumed at least five servings of fruits and vegetables; 62.7% had adequate levels of physical activity; and 10% stated that they were smokers.
- In 2013, more than half of adult women and one-quarter of adult men were obese and had experienced an increase in waist circumference (central obesity).
- The overall prevalence of smoking was 20% (six times higher among men than women). The prevalence of diabetes and hypertension was 11% in men and 20% in women. Both diseases increased with age and were more frequent in certain ethnic groups (particularly the populations of Asian Indian and Javanese descent).
- Overall, 60% of adults met recommended levels of physical activity. The rate of inactivity in women (51.0%) was higher than in men (38.0%).
- The country lacks an integrated waste management policy to deal with open dumps, illegal dumps, and refuse accumulating on roadsides and in the country’s open waters, posing health and environmental hazards. The country also has no provision for storing or eliminating hazardous waste, and there is no regulation on safe pesticide use and storage.
- Migrants legally working in Suriname have the right to public pensions but to no other social welfare benefits.
- Total estimated health expenditure as a percentage of gross domestic product was 6% in 2014.
- Employees pay up to 50% of the health insurance premium, employers pay the other half, and the government subsidizes coverage for people unable to pay.
- The regional health services consist of 43 primary care facilities in the coastal area.
- Misión Médica, a faith-based organization, receives financing from the government to administer nearly 56 primary care facilities in the districts in the interior.
- There are 5 hospitals, 4 located in Paramaribo and 1 in the district of Nickerie, on the western border. The only psychiatric hospital is in Paramaribo. The Bureau of Public Health is responsible for the country’s public health programs, including environmental health and sanitation, and for overseeing the operations of a public health laboratory.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- In 2014, the national basic health insurance law was passed, providing access to a basic package of primary, secondary, and tertiary care services for all Suriname residents. In 2013, all people under the age of 16, as well as older persons (aged 60 and over), had the right to free health care paid for by the Government.
- The decentralization of health facilities, particularly hospitals, began with the construction of a hospital on the country’s eastern border.
- Universal access to health care for pregnant women and newborns remains a pending challenge. Persistent deficiencies in access to health care are related to lack of access to insurance systems.
- Maternal and child health services must be improved to ensure sustainability. Universal access to high-quality maternal and neonatal care will remain a priority in the coming years, as will incorporating a greater number of vaccines into the immunization program.
- The endemic nature of the four dengue virus serotypes and the outbreaks of chikungunya and Zika virus infection throughout Suriname (rural, coastal, and interior areas) reflect the failure of vector control measures targeting the Aedes aegypti mosquito.
- Malaria has been virtually eliminated in towns in the interior since 2007. However, there are groups at risk—principally migrant miners coming to extract gold on a small scale, especially from Brazil.
- The national suicide prevention plan for 2016-2020 calls for the adoption of a vigorous intersectoral approach to address the factors underlying this public health problem.
- The principal threat to the entire health sector is the overall cut in financing. Bills and subsidies are not paid on time, and rates are no longer high enough to keep the services functioning adequately.
- Recently, both the Medical Association and Parliament urged the Government to intervene to prevent the health care system from collapsing and endangering the health and life of the country’s residents.
- Adequate legislation is needed to promote healthy lifestyles in schools and workplaces and to increase the population’s access to healthy food and recreational and sports facilities to reduce the prevalence of chronic noncommunicable diseases (NCDs).
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