Country Report: Antigua and Barbuda
Antigua and Barbuda is located in the Leeward Islands in the northern Caribbean. It is composed of three islands—Antigua, Barbuda, and Redonda (uninhabited)—and covers an area of 442.6 km2.
A full 98% of the population lives in Antigua, including 60% in the St. John Parish and 26% in the capital, St. John’s. Antigua and Barbuda is divided administratively into six regions (parishes) and two dependencies (Barbuda and Redonda).
The population in 2011 was 85,567, reaching 90,755 in 2015. In 1990, its structure was expansive, but by 2015, it had acquired a stationary trend in the under-25 age group, as a result of population aging.
In 2015, 9% of the population was over the age of 65 and 24.3% was under 15. Life expectancy at birth was 75.2 years in men and 80.5 years in women. The population is predominantly of African descent (90%).
The economy is dependent primarily on tourism, which contributes almost 60% of the GDP, as well as on construction and financial services. In 2014, the Human Development Index was 0.783.
- The Ministry of Health has reviewed the development activities of the National Strategic Plan for Health and will review the stewardship and leadership roles of the Ministry of Health.
- New legislation is planned, including a food safety law and a review of public health and quarantine laws.
- A process is under way to transition from the Medical Benefits Scheme to the National Health Insurance Program, designed to better support the health system.
- The Medical Benefits Scheme provides a smart card to patients who meet the requirements for specialized health care.
- Activities are under way for the development of policies and manuals to guide family health programs and ultimately improve the health of the population.
- Selected aspects of health promotion activities related to HIV/AIDS have been evaluated to support their integration into primary health care.
- Efforts have begun for the introduction of the human papillomavirus vaccine for adolescents, which will serve to revitalize the country’s cervical cancer prevention program.
- In 2012, a food and nutrition security policy was launched to ensure that all citizens achieve nutritional well-being. There is a risk that climate change will negatively impact agriculture and food security, energy, tourism, the quality and availability of water, human health, marine and land biodiversity, and fisheries.
Figure 1. Distribution of the population by age and sex, Antigua and Barbuda, 1990 and 2015
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
Source: UN Population and Statistics Divisions, 1990; PAHO Health Information Platform (PHIP), 2013, 2014, and 2015.
SOCIAL DETERMINANTS OF HEALTH
- The unemployment rate in 2011 was 10.2% overall (11.2% among men and 9.4% among women), and higher in the 15-19 age group. Unemployment in the 20-24 age group was 20.3% in 2011. The country’s labor laws guarantee equal pay for equal work, regardless of gender.
- In 2006, 28.3% of the population was living in poverty; more recent information is unavailable.
- Many farmworkers are immigrants and have access to health care. However, the impact on the demand for services and specific health threats has not been determined.
- Primary and secondary education has been free and compulsory since 2013, when universal school access was introduced. The literacy rate among adults over the age of 15 is 98.4%.
- The country is prone to hurricanes and seismic activity, which inflict damage on physical infrastructure and crop yields. The last major hurricane, Irma, struck in 2017.
- In 2005, the homicide rate was 3.5 per 100,000 population. By 2015, it had risen to 6.0 per 100,000 population.
- Most households (86%) have access to piped-in drinking water; the rest use cisterns or wells. Sanitation coverage is 84.3%.
- Climate change is expected to have a negative impact on agriculture and food security, energy, tourism, the quality and availability of water, human health, marine and land biodiversity, and fisheries.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In 2015, the annual average number of births was estimated as 2,500. Three maternal deaths occurred between 2010 and 2015.
- Maternal and reproductive health services are offered free of charge at all community health clinics, and are also available in the private sector; 100% of women are covered, and all births are attended by trained personnel in hospital.
- Between 2010 and 2015, the infant mortality rate (children under 1) declined from 18.6 to 13.8 per 1,000 live births. As of 2014, the under-5 mortality rate was 17.2 deaths per 1,000 live births.
- Coverage for vaccines provided through the national immunization program ranges from 96% to 100%.
- The rate of breastfeeding initiation at birth is 95%, but only 30% of infants are breastfed up to 6 weeks of age.
- In 2014, diseases of the circulatory system and neoplasms were responsible for 36% and 23% of deaths, respectively. Hence, almost 60% of all deaths corresponded to one of these two causes.
- Dengue is endemic, with 31 cases in 2011 and 3 cases in 2015, with no associated deaths.
- In 2013, six cases of chikungunya fever were confirmed. There have been no reports of new cases since then. In 2016, the first 14 cases of Zika virus infection were confirmed, including a pregnant woman whose infant had no birth defects.
- In 2014, the Aedes aegypti mosquito was found in 6.5% of households.
- The prevalence of HIV/AIDS in the general population was calculated at 1.39% in 2011, declining to 0.89% in 2014. The cumulative number of reported cases from 2011 to 2015 was 215. Of these, 74.0% were people aged 15-49. Only one case of vertical transmission was recorded.
- The incidence of tuberculosis was 3.3 cases per 100,000 population in 2014; for the period 2011-2015, the cumulative number of cases was 248, mainly in men. In 2010, a single case of rifampicin-resistant TB was reported.
- In 2012, diabetes was the third leading cause of death, representing 10.8% of all deaths. Heart disease was the second leading cause in men and women, representing 19.3% of deaths. Cerebrovascular diseases caused 7.7% of deaths.
- Between 2010 and 2012, hypertensive disease corresponded to 7.5% of all deaths. In 2012, chronic obstructive pulmonary disease was the reported cause of 5.5% of all deaths.
- Complications of diabetes and hypertension are the leading causes of hospitalization.
- The risk factors associated with the greatest burden of disease are a high body mass index, an unhealthy diet, and hypertension. In 2015, road traffic accidents caused 13 deaths per 100,000 population.
- The most prevalent nutritional problems in adults and the elderly are obesity and noncommunicable diseases. Between 2003 and 2010, more than 60% of 20-year-olds screened in community clinics were overweight or obese.
- In 2014, 2.9% of children under 5 seen in health centers were malnourished. In 2012, 29.3% of adults were overweight and 36.5% were obese.
- In 2009, 58.8% of students aged 13-15 consumed one or more soft drinks per day, and 54.4% spent three hours a day or more sitting down. Only 31.8% of students were considered physically active (at least 60 minutes a day, five or more days a week), and 7.3% had smoked cigarettes on one or more days during the preceding month.
- The health system is financed primarily with taxes and public revenues to support the Medical Benefits Scheme. This plan, in turn, is financed by a 7% payroll tax that serves as a dedicated source of income for primary and secondary care.
- The Government has begun taking steps for transition to the National Health Insurance Program. Approximately 15,000 residents currently have private health insurance, largely provided through employers.
- The health sector represented 2.7% of the gross domestic product in 2014.
- The health services are furnished by public and private providers. At the primary level, Antigua is divided into six medical districts, with a network of 25 public health centers; Barbuda has a single center.
- Secondary and tertiary health services are provided at Mount St. John’s Medical Center, a 187-bed hospital in Antigua, and an eight-bed medical center in Barbuda.
- All primary health care centers have access to mobile mental health teams, which make home visits and provide community care.
- Although vocational training in medicine, nursing, obstetrics, and pharmacy is available in the country, most students complete their medical education abroad.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- Since 1990, the country has made progress in overall development and health, reflected in a Human Development Index of 0.783 in 2014.
- The health system has achieved high coverage rates for drinking water, sanitation, and skilled birth attendance.
- In 2016, the Cabinet of Antigua and Barbuda approved the National Strategic Plan for Health 2016-2020. The plan is based on a national vision to move toward achievement of optimal health and well-being for all residents of the country.
- The three strategic objectives of the Plan are: to train individuals and families to manage their own health; to improve health systems and community support mechanisms; and to expand strategic partnerships.
- In 2015, the Cabinet approved a national policy for the prevention and control of chronic noncommunicable diseases.
- The Medical Benefits Scheme includes activities for chronic noncommunicable disease prevention, aimed especially at young people.
- These prevention activities focus on obesity, diet, exercise, and the reduction of smoking and harmful use of alcohol. These benefits are available free of charge for 11 diseases.
- Several measures have been instituted to address the country’s vulnerability to natural disasters, such as the development of a risk profile and action plan and public education on climate change.
- Changes in biodiversity contribute to the spread of disease vectors, such as the Aedes aegypti mosquito.
WEB / SOCIAL MEDIA
Regional Office for the Americas of the World Health Organization
525 Twenty-third Street, N.W., Washington, D.C. 20037, United States of America
© Pan American Health Organization. All rights reserved.