Pan American Health Organization

Country Report: Turks and Caicos Islands

The Turks and Caicos Islands is a British Overseas Territory located southeast of the Bahamas. An archipelago of approximately 40 islands and cays distributed in two groups (Turks Islands and Caicos Islands), it has a combined land area of 417 km2.

The total population was 31,458 in 2012. The population pyramid in 1990 was expansive but has since widened in the intermediate age groups, due in part to the immigration of working-age adults.

Life expectancy at birth in 2015 was 76.9 years in men and 82.6 years in women.

The 2012 census showed substantial internal migration, from South Caicos to Grand Turk and from North Caicos to Providenciales, which is home to 75% of the territory’s residents; between 2001 and 2012, this island saw an 82% increase in population.

Highlights
  • The three priority challenges facing the territory in the coming years are the health of migrant populations; health service access barriers; and intersectoral work, especially in relation to chronic noncommunicable diseases.
  • Notable among the initiatives to address these challenges are the National Health Insurance Plan; the promotion of universal access and universal health coverage, including for migrant populations; and the strengthening of human resources for health, aimed at bolstering the health care workforce and ensuring that the population has access to adequate care at the appropriate level, with emphasis on primary care.
  • Recent achievements in health legislation in the Turks and Caicos Islands include the restructuring of the Ministry of Health and Human Services in 2015, in which the Department of Agriculture portfolio was added to underscore the impact of this sector on health.
  • The Vision 2020 health sector plan includes a primary health care renewal strategy aimed at reducing the use of expensive hospital services and increasing access to primary care.
  • The Mental Health Ordinance of 2016 promotes compliance with international human rights law relevant to the field of mental health. The Tobacco Control Ordinance was enacted in 2015.
  • The purpose of the Health Regulation Ordinance, issued in 2016, is to enforce regulations pertaining to the health sector and ensure compliance with standard operating procedures for health care facilities and quality of care.

Figure 1. Distribution of the population by age and sex, Turks and Caicos Islands, 1990 and 2015

 MORTALITY CAUSES
Proportional mortality (% of all deaths, all ages, both sexes), 2014

Source: Pan-American Health Organization, World Health Organization, and PAHO Health Information Platform (PHIP).

 SELECT BASIC INDICATORS
Population (thousands)
1990
11.5
2015
31.4
 
0
100
  • Population (thousands)
  • Gross national income by purchasing power parity (ppp, US$ per capita)
  • Human development index
  • Mean years of schooling
  • Improved drinking-water source coverage (%)
  • Improved sanitation coverage (%)
  • Life expectancy at birth (years)
  • Infant mortality (per 1,000 live births)
  • Maternal mortality (per 100,000 live births)
  • TB incidence (per 100,000 inhabitants)
  • TB mortality (per 100,000 inhabitants)
  • Measles immunization coverage (%)
  • Births attended by trained personnel (%)

Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.

 SOCIAL DETERMINANTS OF HEALTH
  • In 2012, the unemployment rate was 17% (12% among nationals and 20% among foreigners). Nearly 20% of the workforce was employed part-time.
  • That same year, the poverty rate was 22% for the population and 16% for households. Turks and Caicos nationals had a poverty rate of 18% and made up 34% of the poor population.
  • Literacy is 98.0%. Primary and secondary education is free and compulsory for children aged 5-16, with both public and private schools available. Higher education is offered through the Turks and Caicos Islands Community College.
  • Housing conditions in the Turks and Caicos Islands were generally good in 2012, as the vast majority of the population had access to electricity, clean drinking water, and in-home sanitation. An estimated 10% of dwellings had two or more indicators of deficiency.
  • The islands are highly dependent on food imports, which represent over 90% of the food consumed. Local agriculture accounts for less than 1% of gross domestic product (GDP), due primarily to the scarcity of arable land (2.3% of total land area) and low annual rainfall.
  • For 2015-2016, the records show 352 cases of domestic violence.
  • A climate change policy was developed in 2011. National public health surveillance systems have been strengthened, especially for waterborne and foodborne diseases.
  • In 2012, 82% of households had access to safe drinking water through indoor (piped) plumbing, and 67% collected rainwater in cisterns for personal use. More than 90% of the population used bottled or filtered water for drinking.
  • Approximately 16% of households used pit latrines or had no toilet facilities in 2012. Domestic wastewater is collected mainly in septic tanks. There were 75 wastewater treatment plants.
  • Since 2012, personal income has steadily risen, even for undocumented immigrants, who come mainly from Haiti and the Dominican Republic. This affluence is due in part to the demand to fill construction and service jobs. Many undocumented immigrants are not enrolled in the National Health Insurance Plan and could therefore overwhelm the health care delivery system.
 HEALTH SITUATION AND THE HEALTH SYSTEM
  • Given the relatively small population, health indicators can show marked variations between consecutive years, and there may even be some years in which no events of public health importance were recorded.
  • No maternal deaths were recorded between 2011 and 2015, a period that saw one or two neonatal deaths per year. One post-neonatal death occurred in 2014.
  • Immunization coverage reached 80% in 2012, with higher levels for the pentavalent (95.3%), oral polio (95.3%), and triple viral (MMR1) vaccines (98.2%).
  • In 2013 there were 53 deaths in people over 60 years of age, representing 66.1% of all deaths that year.
  • In 2014, 78 deaths were recorded (26 in women and 52 in men). The leading causes of death were circulatory system diseases (38%), external causes (13.0%), and neoplasms (13%).
  • There were 9,354 recorded visits to public health clinics in 2015, 61.0% of which were by women. Among women who received prenatal care, Haitian nationals accounted for the largest share (38.3%), followed by Turks and Caicos Islands nationals (28.0%).
  • In the period 2010-2016, vector-borne diseases that posed new and emerging threats included dengue, chikungunya virus, and Zika virus. Integrated vector management practices and other public health measures have been adopted to mitigate and respond to these threats.
  • During that same period, dengue became endemic, with spikes in cases after the rains. Chikungunya virus was first detected in June 2014 in travelers, with subsequent local transmission; as of September 2016, a total of 26 cases had been confirmed.
  • Zika virus infection was first detected in June 2016 in travelers, with subsequent local transmission. As of September 2016, eight cases had been confirmed.
  • In the period 2009-2014, 119 people tested positive for human immunodeficiency virus (HIV), 58.8% of whom were men and 41.2% women. four pregnant women tested positive for HIV in 2015.
  • Chronic noncommunicable diseases (NCDs) contribute substantially to morbidity, mortality, and the cost of medical care in the Turks and Caicos Islands.
  • Three categories of noncommunicable diseases accounted for most NCD-related deaths in 2013: circulatory system disorders, such as heart disease, cerebrovascular disease, and hypertensive disease (40%); malignant neoplasms (20%); and endocrine disorders, such as diabetes mellitus (11%).
  • The Tobacco Control Ordinance was enacted in 2015 to protect the population and visitors from the harmful effects of smoking.
  • The Domestic Violence Ordinance of 2014 provides greater protection for victims of domestic violence.
  • The health system has public and private service providers. Universal coverage has been achieved through the implementation of the National Health Insurance Plan (NHIP) in 2010. This is a social insurance program that provides universal coverage of basic health care for all residents free of charge at the point of care.
  • Primary health care is delivered through Government-run public health clinics across the islands, as well as by private clinics staffed with primary care physicians. The Ministry of Health and Human Services operates eight primary health care clinics: one in Grand Turk, two in Providenciales, two in North Caicos, and one each in South Caicos, Middle Caicos, and Salt Cay. There are six private primary care clinics, all located in Providenciales.
  • In 2008, the Government contracted Inter-Health Canada Ltd. to manage Turks and Caicos Islands Hospital for 25 years.
  • Many patients continue to use Turks and Caicos Islands Hospital, instead of the primary care system, as the first point of care.
  • The Vision 2020 health sector plan includes a primary health care renewal strategy aimed at reducing the use of expensive hospital services and increasing access to primary care.
  • The density of health care professionals was 18.7 physicians, 57.1 nurses, and 1.8 dentists per 10,000 population in 2015.
  • A total of 3,514 hospital admissions were recorded in 2013-2014 (18.2% in Grand Turk and 81.8% in Providenciales). Women accounted for 64.0% of hospitalizations.
  • In 2013, 35 people were receiving kidney dialysis at the two centers in Grand Turk and Providenciales.
  • Most medicines in the Turks and Caicos Islands are subsidized by the Government through the insurance system and dispensed through private pharmacies. A National Pharmaceutical Policy was developed in 2016 to ensure equitable access to efficacious quality medicines and medical products and their rational use at an affordable cost.
  • The health insurance system includes a program for treatment abroad that covers the cost of medical care that cannot be provided within the territory, including travel and subsistence expenses.
 ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
  • In 2015, the Ministry of Health and Human Services adopted six strategic orientations to address gaps and challenges in the period 2016-2020, namely: strengthen human resources for health; deliver services based on the principles of primary health care; strengthen capacity to respond to identified priority diseases/conditions and programs; provide high-quality services; ensure financial affordability; and strengthen intersectoral coordination.
  • A national plan of action for the prevention and control of noncommunicable diseases and health promotion in the Turks and Caicos Islands has been developed for the period 2016-2020. The plan’s guiding framework includes the following approaches: human rights, equity, leadership, and stewardship of the health sector; multisectoral action; and the empowerment of people and communities.
  • In 2013, a review of local capacity to comply with the International Health Regulations was conducted. Based on this analysis, an action plan was developed to address deficiencies in four areas: legislation, diagnostic laboratory capacity, port health, and surveillance and capacity to respond to chemical and radiological incidents.
  • In 2016, in collaboration with the Caribbean Public Health Agency (CARPHA), the Turks and Caicos Islands launched the Tourism Health and Safety Initiative. It includes a multisector program to ensure the health and safety of tourists, recognizing the tourist sector’s importance to the economy.
  • The program is also a part of an ongoing initiative to improve public health surveillance.
 WEB / SOCIAL MEDIA
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