Country Report: Anguilla
Anguilla is an autonomous overseas territory of the United Kingdom and is one of the northernmost of the Leeward Islands in the Lesser Antilles group in the Caribbean. It covers an area of 91 km2 and includes some uninhabited islets and keys. It is divided administratively into 14 districts. The entire population is considered urban.
In 2011, the population was 13,572. In 1990, its structure showed a stationary trend among people under the age of 30. At present, its overall configuration is more stationary, although there has been an increase in the average working age groups, especially women.
85.3% of the population is of African descent and 4.9% is Hispanic, with other groups making up the rest. Life expectancy is 81.3 years (78.7 for men and 84.0 for women).
Its economy is considered high-income and is largely dependent on tourism. In 2014, the per capita gross domestic product was US$21,493 and per capita gross national income was US$21,188. The 2008 global crisis weakened the financial sector and undermined its fiscal position.
- The greatest achievements in health include the reduction of maternal mortality and the sustained absence of deaths from vaccine-preventable diseases.
- Anguilla successfully participated in the global switch from trivalent to bivalent polio vaccine in 2016.
- The territory completed the validation exercise for the elimination of mother-to-child transmission of HIV and syphilis in 2016.
- The government has elevated the prevention of noncommunicable diseases to the highest priority, as demonstrated by the adoption of the National Noncommunicable Disease Action Plan and the development of the Chronic Disease Unit. This latter represents a coordinated effort to move away from top-down planning approaches and make better use of resources to address priority public health problems.
- Some of the most important achievements of the 2012-2016 period were the elimination of mother-to-child transmission of HIV and syphilis, reductions in maternal mortality, and the absence of deaths from vaccine-preventable diseases.
- There is a new sexual and reproductive health unit (that also covers sexually transmitted infections and HIV/AIDS), as well as a new unit to address chronic noncommunicable diseases.
Figure 1. Distribution of the population by age and sex, Anguilla, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2014
Source: Pan American Health Organization, PAHO Health Information Platform (PHIP).
SELECT BASIC INDICATORS
Note: Country population data for 2011 are from the 2011 census, according to the Statistics Department of the Ministry of Economic Development of Anguilla.
Source: UN Population and Statistics Division, 1990; PAHO; PAHO Health Information Platform (PHIP) 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- According to the Anguilla Education Act of 2012, school enrollment is compulsory for children aged 5 to 17 and education is free in all public schools. Functional literacy is 93%.
- In 2008 poverty stood at 5.8% and extreme poverty was nonexistent.
- Water scarcity is a serious problem for Anguilla, and the island is heavily dependent on rain and water storage for water supply. Fresh water resources are underground and the water is brackish and unfit to drink. Three out of five households (61%) indicated that their principal drinking water source was bottled water.
- 98% of the population reported that they had access to improved sanitation facilities.
- In 2011, almost all households used the government trash collection system (99.2%).
- The territory is vulnerable to disasters such as flooding and storms. The last major flood was caused by hurricane Gonzalo in 2014, which did not cause any serious injuries or deaths.
- The island is also experiencing some effects of climate variability and change. Increases in atmospheric temperature, reduced annual precipitation, and potential increases in the intensity of tropical storms are expected.
- There is a shortage of farmland due to degraded and infertile soils, caused in part by previous soil mismanagement. This puts constraints on agriculture and food security.
- Immigrants are primarily from the Dominican Republic, Jamaica, Saint Kitts and Nevis, the United States, and other countries of the Caribbean.
HEALTH SITUATION AND THE HEALTH SYSTEM
- No maternal deaths have been reported since 2010, while antenatal care and skilled attendance during delivery remained at 100%.
- In 2014, the stillbirth rate was 13.2 per 1,000 births; 8% of newborns were premature and 23% had low birthweight. Since 2001, there have been between three and zero deaths per year, with a low number of births (202 in 2015).
- Between 2014 and 2015, 5% of preschool children were overweight and 21% were obese. Among sixth grade students, 14% were overweight and 23% were obese.
- Annual vaccination coverage is normally above 95% for diphtheria/pertussis/tetanus (DPT), hepatitis B, Haemophilus Influenzae type b, poliomyelitis, BCG, chickenpox, and the first dose of measles/mumps/rubella (MMR). In 2015, vaccination against the human papillomavirus (HPV) for 9-13 year old girls was introduced as part of the school health program.
- In the 2010-2014 period, 52% of the 341 reported deaths were due to noncommunicable diseases. The largest category was cardiovascular diseases, including cerebrovascular diseases (9%), ischemic heart disease (7%), and hypertensive disease (5%).
- In 2014, prostate cancer was the main cause of cancer death among men and cervical cancer, among women.
- In 2014 an imported case of malaria (P. falciparum) was confirmed. Dengue is endemic; the highest annual number of cases reported in the 2010-2015 period occurred in 2014, with eight cases.
- Chikungunya virus arrived in 2014, with 55 confirmed cases that same year, followed by three in 2015. Local transmission of Zika virus was confirmed in June 2016, and as of late September that year, there were five laboratory-confirmed cases.
- The territory has a low prevalence of human immunodeficiency virus (HIV) and AIDS, with a total of eight cases (two in women) identified between 2010 and 2015. No new cases of HIV were identified in the 2014-2015 period. No cases of tuberculosis have been reported since 2010. In 2016, the territory completed the validation exercise for the elimination of mother-to-child transmission of HIV and syphilis.
- Suicides are relatively rare in Anguilla; one suicide was reported in 2013, and none in 2014.
- Health care is the responsibility of the Ministry of Health and Social Development, which is responsible for the governance and regulation of the entire health care system, including both the public and private sectors.
- The health care system is divided into three districts and includes a polyclinic, four health centers, and the 32-bed Princess Alexandra Hospital—all under the management of the Health Authority of Anguilla. Tertiary care is not available in Anguilla and must be obtained abroad.
- In 2013, the Government adopted the Framework for Fiscal Responsibility, committing it to open and transparent management of public finances, which should help achieve sustainability in the health system.
- The National Policy and the Strategic Plan for Health 2015-2020 are being fully implemented.
- Health care services are provided on a co-payment basis, and not all the population is insured, meaning that there are financial barriers to access.
- In light of this problem and to promote access, the Ministry of Social Development provides financial assistance (based on means testing) for those who cannot afford to pay for services. There may also be language and cultural barriers to access for migrant populations.
- The number of physicians, nurses, and dentists available in the public sector is 12.5, 26.3, and 1.3 per 10,000 population, respectively. Care is supplemented by visiting health professionals in both the public and private sectors.
- The Health Information Unit compiles information from approximately 67% of the communicable disease reporting sites and manages all birth and death records. To date, no formal assessment of data quality has been conducted.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- Anguilla enjoys a high income level thanks to the tourist industry, as well as political and social stability.
- The territory has made great strides in the quality of education, drinking water, and sanitation. Progress in health is evidenced by the decline of vaccine-preventable diseases and deaths, reduced maternal mortality and deaths from communicable diseases in general, and a relatively low level of infant mortality.
- The government has made chronic noncommunicable diseases its number one priority, as demonstrated by its adoption of the National Noncommunicable Disease Action Plan 2016-2025 and the establishment of a Chronic Disease Unit in 2015.
- Due to population aging, a National Policy for Older Persons was established (2009), as well as a National Policy on Residential Care Facilities for Older Persons (2012).
- The 2013 adoption of the Framework for Fiscal Responsibility is a commitment to open and transparent management of public funds, in accordance with the highest standards of governance and democracy.
- There is some unfinished business, as well as new challenges that must be addressed. Prominent among these is the burden of chronic noncommunicable diseases, the general sustainability of health care financing, and universal access to health services.
- The health system must adequately prepare to handle unprecedented demand for care in the future related to population aging and the increase in chronic noncommunicable diseases.
- Anguilla is highly dependent on tourism and its market is sensitive to natural disasters and the threat of communicable diseases, given the island’s vulnerability to natural disasters and climate change. These remain important challenges.
- The patterns of climate change and their potential impact on health are being monitored. The increase in mosquito-borne diseases and the appearance of new threats and emerging diseases, such as chikungunya and Zika virus, for example, are of critical concern.
- Emphasis continues to be on response capacity in natural disasters and public health emergencies.
- The limited number of trained health professionals in the territory is another problem that must be addressed, along with strategies to train, recruit, and retain such professionals.
Furthermore, the current health information system must be modernized to make it more accurate and efficient.
- There is a national commitment to address current and future challenges.
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