Pan American Health Organization

Country Report: Bonaire, Sint Eustatius, and Saba

The Caribbean islands of Bonaire, Sint Eustatius, and Saba have been special municipalities of the Netherlands since 2010, when public administration responsibilities were transferred from the Government of the Netherlands Antilles to the Netherlands.

As a result, all residents have access to new social and health benefits, which are similar for the three islands. The Ministry of Health, Welfare and Sport makes health care policy for Bonaire, Sint Eustatius, and Saba. In 2012, total health costs for the three islands came to around US$ 102 million.

This summary explores each municipality’s particular social and health determinants. It also describes the health system shared by the three municipalities, which have similar achievements, challenges, and outlooks.


BONAIRE
Bonaire is located 70 km off the coast of Venezuela and has a landmass of 288 km2. Between 2011 and 2016, its population grew by 23% as a result of immigration, totaling 19,408 in 2016.

Population distribution is concentrated around 50 years of age. In 2016, 37% of residents had been born on the island. The rest came from Curaçao (18%), Aruba (2%), the Dutch mainland (14%), and Latin America (18%).

Life expectancy in these municipalities is estimated at 80.2 years.

In 2014, economic growth was 1.6%, with national GDP estimated at US$ 403 million.

Government, real estate, financial services, and tourism are the main economic sectors.

SINT EUSTATIUS
Sint Eustatius lies in the Leeward Islands in the Caribbean Sea between Saint Kitts and Anguilla, with a landmass of 21 km2.

In 2016, the municipality had a population of 3,200 (800 fewer people than in 2014), 79% of whom held Dutch nationality. The population structure is influenced both by in- and out-migration, contributing to a proportionally large working-age population.

Some 34% of residents were born on the island, 11% were born in Sint Maarten, 9% in Curaçao or Aruba, and 6% on the Dutch mainland.

Most of the population (68%) is multilingual: 85% speaks English as a first language, 6% speaks Dutch, and 7% Spanish. The population of Saint Eustatius declined by 21% between 2014 and January 2016.

The gross domestic product per capita was US$ 25,100 in 2014.

SABA
Saba is also located in the Leeward Islands, occupying a landmass of 13 km2. In 2016, it had a population of almost 2,000. The population structure is influenced both by in- and out-migration, especially in the working-age population.

The population grew by 5% between 2014 and 2016, increasing by 136 people. The population is evenly distributed between males and females.

28% of residents were born in Saba; 14% in Sint Maarten; 5% in Aruba and Curaçao, and 5% on the Dutch mainland; 60% of the population has Dutch nationality.

The per capita gross domestic product was US$ 25,100 that year. Tourism, the Saba University School of Medicine, fisheries, and infrastructure investments are the main economic drivers.

Highlights
  • The municipalities’ change in public administration from the former Netherlands Antilles to the Netherlands in 2010 has meant greater benefits related to social and health determinants.
  • Since 2010, the municipalities have had access to a universal system of health insurance, better medical care and education, public housing for low-income residents, and better access to drinking water.
  • Since 2011, all legal residents have had access to compulsory general health insurance, which replaced all prior health regulations and private insurance. This insurance provides medical coverage and long-term care, including general practitioner and specialist care, hospital care, paramedical care, maternal and obstetric care, pharmaceutical care, dental care, and patient transportation.
  • Long-term care, including home care, is available for the elderly and persons with disabilities. In cases that require more complex care, medical transfers to Colombia are provided.

Distribution of the population by age and sex, Bonaire, Sint Eustatius and Saba, 2015


Bonaire

San Eustaquio

Saba
 HEALTH SITUATION
      Bonaire
  • In 2013, 70% of the population aged 15 and over rated their health as good or very good.
  • Between October and November 2016, there were 60 confirmed cases of Zika virus infection (excluding pregnant women), 45 probable and confirmed cases of dengue (22 in women and 23 in men), and 37 confirmed cases of chikungunya virus (23 in women and 14 in men).
  • Almost 80% of the population in this age group reported that they had consulted a general practitioner in the year prior to the study. Just over half of residents visited their dentist at least once a year.
  • In 2013, 35% of the population was overweight, and a quarter was seriously overweight. The same study reported that 8% of the population suffered from diabetes (6.8% of men and 9.3% of women).
  • In 2013, 18.5% of the population reported a history of hypertension over the previous 12 months (14.9% of men and 22.7% of women) and 4.4% indicated that they had been affected by heart disease (4.6% of men and 4.2% of women). Some 48.1% of the population reported having no health problems (57.2% of men and 37.8% of women).
  •   Sint Eustatius
  • Between October and November 2016, 16 cases of Zika virus infection were confirmed (none in pregnant women).
  • In 2013, 80% of the population aged 15 and over rated their health as good or very good; 30% of the population was moderately overweight and 30% was obese.
  • Diabetes prevalence was 10.6% (8.7% in men and 13% in women); 20.6% of the population reported hypertension in the past year (15.3% of men and 27.5% of women); and 52.2% of people reported having no health problems (58.1% of men and 44.7% of women).
  • Most of the population (71.7%) had visited a general practitioner in the year prior to the survey, and just under half (47.6%) had contacted a specialist. Half of residents had visited a dentist at least once in the past year.
  •   Saba
  • Between October and November 2016, 10 cases of Zika virus infection were confirmed (none in pregnant women).
  • In 2014, 80% of the population aged 15 and over rated their health as good or very good; 30% of the population was moderately overweight and 33% was obese.
  • Diabetes prevalence was 7.7%; and 15.4% of the population reported hypertension in the past year (15.2% of men and 15.5% of women); and 62.2% of the population reported having no health problems (68.9% of men and 55.4% of women).
  • Overall, 72% of the population had consulted a general practitioner in the previous year, and 32.9% had consulted a specialist. Half of the population had visited a dentist in the past year.
 SELECT BASIC INDICATORS
Indicator Year Bonaire Sint Eustatius Saba
Population (thousands) 2016 19.4 3.2 2.0
Surface Area (km2) 288.0 21.0 13.0
Population density (population/km2) 2016 67.0 152.0 150.0
Recorded immigration (n) 2015 1,235 170 358
Recorded emigration (n) 2015 829 849 394
Live births 2015 160 36 11
Deaths 2015 102 11 16
Life expectancy at birth (years) 2013 80.2 80.2 80.2
Gross domestic product per capita (US$ thousands) 2014 21.6 25.3 25.1
Households (thousands) 2014 6,8 1,1 0,7
Median annual household income (US$ thousands) 2014 23.4 26.9 25.3
Reported good or very good health (%) 2013 70 80 80
Diabetes (%) 2013 8.0 10.6 7.7
Hypertension (%) 2013 18.5 20.6 1.4
Overweight (%) 2013 35 30 30
Obesity (%) 2013 25 30 33

   Source: Statistics Netherlands, 2016.

 SOCIAL DETERMINANTS OF HEALTH
  Bonaire
  • In 2014, the average household income was US$ 30,700. The median income was US$ 23,400 but ranged between US$ 56,800 and US$7,500 for households in the highest and lowest quartiles, respectively.
  • The working-age population (aged 15-74) numbers 14,500, with an employment rate of 68.9% and an unemployment rate of 6.4%.
  • The island has seven primary schools and one secondary school.
  • Crime decreased from 2015 to 2013. The number of violent crimes fell from 116 to 87, and the number of sexual offenses dropped from 19 to 6.
  Sint Eustatius
  • In 2014, the average annual wage was US$ 33,340. Sint Eustatius has the greatest income inequality among the three island municipalities, with median disposable income of US$ 64,000 in the highest earning quartile, compared to US$ 8,000 for the lowest quartile.
  • A total of 26 violent crimes were recorded in 2015, 10 of them sex-related. Property crimes dropped from 19 in 2013 to 8 in 2015.
  Saba
  • In 2014, the average annual wage was US$25,300 and the unemployment rate was 2.5%.
  • The median household income was US$ 25,300, but ranged from US$ 54,100 to US$ 8,800 for households in the highest and lowest quartile, respectively.
  • Over 24% of the population is not seeking employment or cannot work because of their level of education; 53% of households are single-person and 20% are couples without children.
  • There is one primary and one secondary government-funded school on the island. The university on the island is the Saba University School of Medicine, which offers a 10-semester basic science curriculum.
  • Saba’s economic drivers are tourism, the Saba University School of Medicine, fisheries, and infrastructure investments. The economy posted growth in 2015 on the back of solid performance from all three of these sectors.
  • There are several projects aimed at improving Saba’s water supply, which is critical during periods of drought. These projects include the construction of new cisterns and pipes.
 HEALTH SYSTEM SITUATION
  • Health care policy for the three municipalities is set by the Ministry of Health, Welfare and Sport. All legal residents have access to compulsory general health insurance, which took effect in early 2011, replacing existing regulations and private insurance.
  • This insurance scheme, known as ZVK, provides medical coverage and long-term care, including general practitioner and specialist care, hospital care, paramedical care, maternal and obstetric care, pharmaceutical care, and dental care. Patient transportation is also included.
  • Long-term care, including home care, is available for the elderly and persons with disabilities. If specialized care is unavailable in the municipalities, patients are provided with transportation to Colombia.
  • Total health costs in the three municipalities came to US$ 102 million in 2012, representing a health expenditure of US$ 4,834 per capita. ZVK insurance is funded through personal income taxes (around US$ 65 million) and employer payments (some US$ 37 million). The Dutch government finances all deficits, as outlined in the Healthcare Insurance Decree (BES) of 2010.
  • Other health policy measures have been put in place since 2010, including screening to detect 17 types of disorders in newborns (blood samples are sent to the Netherlands). In addition, the Dutch Parliament granted an increase in the length of maternity leave from 12 to 16 weeks.
 ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
  • The municipalities have a relatively good level of socioeconomic and health development, reflected in a per capita gross domestic product of US$ 25,300 to US$ 21,600, an active economy, and a life expectancy at birth of 80.2 years.
  • In addition, there are new and better benefits that offer access to the insurance and health care system, education, social housing, and drinking water. This access has been further developed through the change to administrative dependency on The Government of the Netherlands
  • The quantity and distribution of the population in these municipalities does not follow a pattern of natural growth, but is actively influenced by the complex dynamic of immigration and emigration to and from very diverse countries. This could impact different sectors of the economy and national life, including the health situation and health care.
  • The new insurance system benefits the population through financing that allows for greater insurance coverage and access to various health care services.
  • Another challenge is to harmonize insurance levels among the three islands and establish complementary health services among them and nearby countries. This would ensure timely access to health services with varying degrees of specialization.
 WEB / SOCIAL MEDIA
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