Country Report: Trinidad and Tobago
Trinidad and Tobago is a country made up of two main islands (Trinidad and Tobago) and other smaller islands, located in the far south of the Caribbean, near the northern coast of Venezuela.
Between 1990 and 2015, the population grew by 6.4%, reaching 1,328,019 in 2015. Its structure was on an expansive trend in 1990, but by 2015 it had taken on a relatively stationary configuration in the over-50 age groups. In 2013, life expectancy at birth was 71 years.
Between 1990 and 2010, the population aged 60 and over increased by an average of 4.0% annually, compared with the annual reduction of 2.5% seen in the 5-19 age group.
The economy is predominantly industrial and highly dependent on the energy sector, although it has been shifting from oil dependence to an economy based mainly on natural gas.
- The Ministry of Health has a strategic plan for health (2012-2016) whose objectives include strengthening effective leadership in the health sector. Furthermore, it focuses on essential aspects such as evidence-based policymaking, planning, supervision, and evaluation, as well as necessary cooperation and regulatory mechanisms.
- The Ministry of Health has set 12 essential strategic priorities that include chronic noncommunicable diseases, communicable diseases, maternal and child health, mental health, human resources planning, integration of information and communication technology, and management of the health sector.
- The work of the Ministry of Health is supported by partnerships with regional and international organizations that provide technical assistance, training, and mentoring.
- These organizations include the Caribbean Community (CARICOM) Secretariat, the Caribbean Public Health Agency, the Pan American Health Organization/World Health Organization and other agencies of the United Nations system, the World Bank, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and the European Union.
- In addition, policymaking and guidelines adhere to the various health-related international and subregional conventions and agreements that the government has entered into.
- The government has outlined a strategy for achieving universal health care; implementation is under way. Gaps in health care are expected to be bridged significantly as the primary health care system is strengthened.
Figure 1. Distribution of the population by age and sex, Trinidad and Tobago, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization and PAHO 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
- The unemployment rate ranged from 3.5% to 5.9% in 2015. Between 2010 and 2015, average youth unemployment was 12.1%, versus 4.4% in the general population.
- In 2011, 29.8% of the population had a primary education, 43.5% had completed secondary or postsecondary education, and 14.6% had a university or non-university higher education.
- Both improved drinking-water and improved sanitation coverage stood at 94% in 2015. In both cases, there was no major difference in coverage between urban and rural areas.
- The country has difficulty ensuring continuous water supply, and the establishment of an indirect water source is still pending.
- Trinidad and Tobago is at low risk for hurricanes but is more vulnerable to earthquakes. The country tends to receive the indirect impact of tropical storms in the form of heavy rains, floods, and landslides.
- Food security and crops tend to be at risk from the effects of climate change, the scarcity of arable land and farm labor, and the impact of floods, landslides, and droughts.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In 2015, the maternal mortality ratio (based on hospital utilization) was 46.9 per 100,000 live births. Some fluctuations in these data may be due to poor record-keeping. The leading maternal risk factors are complications of hypertension, diabetes, and premature delivery.
- In 2015, the infant mortality rate was 15.0 per 1,000 live births in children under 1. The leading causes were birth defects, prematurity, and birth asphyxia.
- The national immunization scheme is directed to children during the first 5 years of life, and vaccination is mandatory for enrollment in the primary school system, which probably accounts for the high immunization coverage rates (usually over 90%). No cases of vaccine-preventable diseases have been reported since 2006.
- In 2010, the three main groups of causes of death were diseases of the circulatory system (32.6%), endocrine disorders (16.3%), and neoplasms (16.1%).
- Also in 2010, the five leading specific causes of death were heart disease, diabetes, cerebrovascular disease, homicide, and hypertension.
- Large flows of people into the country have facilitated introduction of the chikungunya and Zika viruses, which were initially detected in 2014 and 2016, respectively. By the end of September 2016, 243 cases of chikungunya infection and 498 cases of Zika virus disease, including 294 pregnant women, had been confirmed.
- The prevalence of HIV/AIDS remained relatively stable at around 1.5% of the population between 2009 and 2012, rising slightly to 1.6% in 2014. That same year, 1,053 new cases of HIV infection were reported, with women representing 43% of cases. The 15-49 age group accounted for 64% of cases.
- In 2015, the incidence of tuberculosis was 17 per 100,000 population, with coinfection in 2.9 per 100,000 population.
- Between 2010 and 2015, chronic noncommunicable diseases caused approximately 53% of hospitalizations.
- In 2011, the prevalence of diabetes in the population aged 15-64 was 20.6% (19.8% in men and 21.2% in women). The prevalence of hypertension in this group was 20.8% (25.5% in men and 16.4% in women).
- That same year, the prevalence of overweight was 36.9% (40.3% in men and 33.7% in women), while 25.7% of the population (19.4% of men and 31.7% of women) was obese.
- During the period 2010-2012, there were 5,909 reported cases of domestic violence. The victims were under the age of 19 in 6.6% of cases, aged 20-29 in 29.2%, and aged 30-39 in 44.2% of cases.
- The leading mental health problems are schizophrenia, mood disorders, mental and behavioral disorders, and substance abuse.
- In 2010, there were 12.1 deaths from suicide per 100,000 population (4.6 in women and 19.6 in men).
- In 2010, the overall prevalence of daily smoking was 18.4% in adolescents. Among smokers, the average age they began smoking was 17 years in men and 19 years in women.
- As of 2013, 61.4% of the population did not engage in sufficient physical activity (55.4% of men and 67.2% of women).
- The Ministry of Health is the supervisory agency for the health care system. It is also responsible for financing, regulating, and governing the system, establishing the necessary policies and legislation.
- The health system includes the public and private sector, the latter of which includes nongovernmental organizations.
- The public system predominates and offers all care free of charge. The system is funded by the government and subscribers.
- Health care management and delivery care have been decentralized among five semiautonomous Regional Health Authorities (RHAs), four in Trinidad and one in Tobago.
- The Ministry of Health also administers several vertical services and national programs.
- The private health sector charges by type of service. Fees are often high and unaffordable for the majority of low-income salaried workers.
- The system has a network of 96 health centers, 9 district health facilities, and 9 hospitals. All Health Regions have at least one district health facility and one referral hospital. Approximately two-thirds of the health centers are in the western half of the island, which is the most densely populated area.
- The country is facing a labor shortage in all health occupations. Given these constraints, the government is finishing a 10-year human resources plan (2016-2025) and making efforts to recruit and train more personnel, in cooperation with local universities.
- Ministerial action has also been taken to hire foreign health professionals. Since 2011, the country has recruited 446 health professionals, including 109 physicians and 228 nurses from Cuba.
- Although computerized systems for health data collection are available, there is still a significant unmet need for broader, more comprehensive, and effective integration and automation.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The country has improved the social and health situation, in particular achieving high immunization coverage: no cases of vaccine-preventable diseases have been reported since 2006.
- Population aging, stemming from the reduction in fertility and mortality, constitutes both an achievement and a foremost challenge. In 2015, 15.8% of the population was over 60 years of age.
- Hypertension, diabetes, arthritis, Alzheimer’s disease, and heart disease, all of which become more common in old age, are the leading causes of hospitalization among the elderly. The expected growth of this population, which, in turn, is related to a higher prevalence of chronic diseases, will have a significant impact on care requirements and heighten the need for resources in the health system.
- Accordingly, the government is making efforts to meet the expected demand for health care among older adults. It has taken on the challenge of implementing a special approach for the reduction of chronic noncommunicable diseases and their risk factors over the next 5 to 10 years.
- The key objectives for the health system are focused on securing adequate levels of financing for the management of noncommunicable diseases, health service delivery, infrastructure, human resources, and support for sector expansion.
- The 10-year Human Resources for Health Strategic Plan 2016-2025 will have to address current deficiencies in the health care workforce, especially in professional occupations, to provide for future needs and sustainably strengthen human resources.
- Primary health care facilities need to be modernized to offer not only access to comprehensive services but to ensure that health care centers have proper health information systems.
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