Pan American Health Organization

Country Report: Sint Marteen

Sint Maarten is situated in the northeastern Caribbean Sea, at the northern end of the Leeward Islands of the Lesser Antilles. It borders to the north with Saint Martin, one of the French municipalities in the Americas. The total area is estimated at 34 km2. Sint Maarten became a constituent country of the Kingdom of the Netherlands in 2010.

In 2015, the estimated population was 37,224. All its inhabitants reside in urban areas.

In 1990, the population structure showed an expansive trend, with a population increase in the intermediate ages. That population is now in the older age groups, while the structure remains relatively stationary for groups younger than 30. The average life expectancy at birth for the total population in 2015 was 80.6 years for women and 75.8 years for men.

In 2002, 5% of the population was aged 60 or over, compared to 11% in 2012. Tourism and construction are the main drivers of economic activity. More than 90% of food products are imported.

Highlights
  • The State should analyze the current health system and its sustainability, as well as ways to cushion this sector from economic shocks, since national income is closely tied to the external economic situation.
  • The government finances social programs through the national budget, providing financial assistance to needy families and even covering medical expenditures for nationals and the elderly based on their income.
  • In meeting this responsibility, Sint Maarten faces significant challenges in terms of the financing and sustainability of its health services. The Ministry of Public Health, Social Development and Labor seeks to guarantee universal access to health services, ensure good governance, and provide effective leadership. It should be noted that 30% of the population is uninsured and that the public health budget is 2% of GDP.

Figure 1. Distribution of the population by age and sex, Sint Maarten, 1990 and 2015

 MORTALITY CAUSES
 SELECT BASIC INDICATORS
Population (thousands)
1992
32.2
2015
38.2
 
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
  • The economy is projected to grow at less than 1% in 2016 and 2017, according to the International Monetary Fund.
  • The national budget allocated to education was 18.4% and 19.4% in 2013 and 2014, respectively. An estimated 30% of the population does not have insurance and 10% has private health insurance.
  • The 50-60-year age group represented 22% of the population, with the older segment of that group projected to grow the most.
  • This demographic shift will be a major contributor to the rise in health care costs and will put added pressure on the limited financial and human resources in the health sector.
  • In 2009 there were 216 ambulance calls associated with violence (for wounds, cuts, stabbings, and gunshots). This figure fell by almost 50% in 2010 (110).
  • The main environmental problems are related to the availability of water and sanitation, water pollution, trash collection, hospital waste management, and landfill management.
  • Drinking water is obtained from the sea through desalinization plants. Wastewater disposal coverage is scarce, with only a small portion of households in the country connected to the sewerage system.
 HEALTH SITUATION AND THE HEALTH SYSTEM
  • In 2013, one maternal death was recorded, and in 2014, the Sint Maarten Medical Center attended 523 births.
  • One hundred percent of antenatal care was provided by trained personnel in 2016, and hospital deliveries that year were also at 100%.
  • Between 2010 and 2013 there were 685 deaths, for an average of 171 per year. Ischemic heart disease was the main cause of death in 2012, followed by diabetes. A significant increase in neoplasms as the cause of death has been observed.
  • In 2010, a single case of measles was reported.
  • In May 2013, the pneumococcal vaccine was introduced. In September of that year, the human papillomavirus vaccine (HPV) was introduced for girls aged 9-10.
  • Cases of dengue were reported in 2010. Sint Maarten reported its first confirmed case of chikungunya virus in December 2013, with a total of eight cases that year.
  • In 2015, 13 cases of dengue were reported. There were no autochthonous cases of malaria in 2010 2013, but two imported cases were recorded.
  • No cases of cholera were reported in the 2010-2013 period.
  • Salmonellosis was the leading enteric disease reported, with 11 cases between 2010 and 2013. Two cases of shigellosis were reported.
  • In 2011, 18 new cases of human immunodeficiency virus (HIV) were recorded, 57.1% in men and 49.9% in women. Of these, four were diagnosed as AIDS.
  • The age groups most affected by HIV were 20-24-year olds and 40-44-year olds.
  • In 2013, 83.3% of adults diagnosed with HIV began antiretroviral treatment within 12 months of diagnosis.
  • In 2009, almost 40% of children (aged 12-18) were overweight and around 54% were obese.
  • The Ministry of Public Health, Social Development and Labor (VSA) oversees the health system. The Ministry faces great challenges as it strives to ensure universal access to health services, good governance, and effective leadership.
  • An estimated 30% of the population is uninsured. Public health expenditure is approximately 2% of the gross domestic product (GDP). In 2014, 6.3% (US$ 15 million) of the fiscal budget was allocated to the health system.
  • Primary and secondary care are provided through a combination of private and nonprofit facilities that offer a variety of plans, which means that the system is fragmented.
  • Two State-funded agencies provide care: the White and Yellow Cross and the Baby Clinic.
  • The White and Yellow Cross serves the older population, providing care in nursing homes, geriatric care, rehabilitation, and a residence for persons with disabilities.
  • The White and Yellow Cross serves the older population, providing care in nursing homes, geriatric care, rehabilitation, and a residence for persons with disabilities.
  • The Baby Clinic provides maternal and child health services to pregnant women and 90% of the children under 4; private pediatricians cover the remaining 10%. The team includes a general practitioner, three nurses, a dentist, and a receptionist. The Clinic also offers dental care coordinated by an oral health promoter. In its school program, the team includes a general practitioner, two registered nurses, and a dental and oral health promoter.
  • Other entities that provide primary care services include voluntary health care services and some nongovernmental organizations, such as the Sint Maarten AIDS Foundation, the Diabetes Foundation, and the Positive Foundation (for cancer prevention).
  • Complex health care services are guaranteed through an agreement between the insurer—mainly Social and Health Insurance (SVZ)—and facilities in Aruba, Colombia, Cuba, Curaçao, the United States, the Dominican Republic, and Venezuela.
  • The Sint Maarten Medical Center (SMMC) is private and unsubsidized and provides primary and secondary care. It also provides health care support to nearby islands, including Saba, Saint Eustatius, and Anguilla, serving a total population of approximately 54,000.
  • In 2014, the Medical Center had 66 beds and 260 employees, including patient care, administrative, and technical staff. It has both outpatient and inpatient departments, in addition to emergency, radiology, and dialysis wards. The inpatient section includes medical, pediatric, and surgical wards; an intensive care unit and delivery room; an operating theater and a recovery room with an on-call system in case of emergency surgery; an admissions department; and a patient care department.
  • In 2014, there were 12 pharmacies and 12 pharmacists. In 2011, there were 130 physicians with 26 registered specialties. Educational efforts are currently under way at the SMMC to license nurses who are already practicing.
  • In 2014, there were 12 pharmacies and 12 pharmacists. In 2011, there were 130 physicians with 26 registered specialties. Educational efforts are currently under way at the SMMC to license nurses who are already practicing.
  • Health and statistical information continues to be generated and recorded on paper, which hinders data consolidation and, consequently, hampers effective and timely decision-making.
  • In order to alleviate this situation, the government is currently looking into various computer software and hardware in an effort to integrate health information from the many health-related institutions involved.
 ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
  • Although it is a small country and economy, Sint Maarten has legislation that establishes various social security and insurance systems for different interest groups, including general oldage insurance, widower’s and orphan’s insurance, accident insurance, illness insurance, and severance pay insurance.
  • In 2014, the Government launched the National Mental Health Plan 2014-2018.
  • The Ministry of Public Health, Social Development and Labor subsidizes the Mental Health Foundation (MHF), the only community mental health service provider on the island. Social security covers 80% of the population, providing full coverage for psychotropic drugs.
  • Civil servants are covered by the General Specialized Illness Insurance Act, which includes health plan coverage, and the Government Health Insurance Fund.
  • Furthermore, the General Pension Fund provides pensions for the elderly, persons with disabilities, dependent persons, orphans, and civil servants.
  • The government finances social programs through the national budget, providing financial assistance to households based on income level.
  • The challenges are to strengthen the health system, achieve higher levels of organization and coverage, and increase the recording of data and statistics to improve the capacity to monitor the health of the population, with special emphasis on chronic noncommunicable diseases and the social determinants of health.
  • The evolving demographic and epidemiological profile of the population (marked by progressive population aging and increased chronic diseases) will drive up the cost of health care and put additional pressure on the health sector’s limited financial and human resources.
 WEB / SOCIAL MEDIA
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