Country Report: Bahamas
The Bahamas is a country formed by an archipelago of 700 islands and 2,400 keys in the Caribbean Sea, facing the coast of Florida. It has a total area of 13,900 km2.
Approximately 30 islands are inhabited, with a population of 369,670 in 2015; 90% of the population lives on New Providence (especially in the capital, Nassau), where the seat of government is located, as well as on Grand Bahama and Abaco islands.
Between 1990 and 2015, the population grew by 44.2%. In 1990, its structure had a stationary trend in the under-40 age groups. The population pyramid has since become regressive as a result of aging; 9% of the population is over 65.
In 2013, life expectancy at birth was 74.7 years.
The per capita annual income is also relatively high (US$ 21,570), as is the per capita gross domestic product (US$ 25,100), generated mainly by tourism (60%) and, to a lesser degree, financial services (15%).
- The Government of The Bahamas is formulating the "Vision 2040 – National Development Plan," intended as a road map for policy development, decision-making, and investment over the next 25 years. Its four pillars are the economy, governance, social policy, and the environment.
- The National Health System Strategic Plan 2010-2020 was developed with a view to educating individuals and communities to ensure optimal health, longevity, and a good quality of life.
- The Healthy Bahamas Coalition, launched in early 2017, is a major initiative for engaging the different sectors of society to address population-wide health challenges and the risk factors for chronic noncommunicable diseases, including environmental health risks.
- To ensure greater impact of national health plans, the effective participation of community groups and individuals is indispensable, from the design of these plans all the way to their implementation. Furthermore, the role of population health should be prioritized in the National Development Plan.
- In this context, the National Development Plan should prioritize a "Health in All Policies" approach; that is, it should consider the physical, mental, and social well-being of people and communities.
- On the government end, plans also call for intersectoral integration and coordination beyond the health sector. The necessary collaboration should also be expanded to include the perspective of the various social stakeholders to truly address the country’s challenges in health and well-being.
Figure 1. Distribution of the population by age and sex, The Bahamas, 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
- In 2015, the unemployment rate was 12%. In 2013, 12.6% of the population was living below the poverty line of US$ 4,247 per capita per year.
- Youth and Haitian immigrants are the most vulnerable populations, with poor housing and sanitation conditions often observed among the latter. The average educational attainment in 2014 was 12.0 years of schooling.
- The islands have streams and bodies of brackish water and there are no freshwater rivers. Fresh water for human consumption is obtained mainly from boreholes for groundwater or by desalination.
- Improved drinking-water source coverage rose from 96% in 1990 to 98% in 2015, while improved sanitation coverage increased from 88% in 1990 to 92% in 2015.
- Due to its location in the Caribbean Sea, the country is exposed to tropical storms and hurricanes that tend to cause major damage to infrastructure.
- The use of native trees as fuel, especially in poor neighborhoods, causes air pollution and poses the threat of deforestation. This problem has been addressed by enacting specific laws.
- More than 90% of food is imported, subjecting the country to the vagaries of international food and transportation prices. The agricultural sector contributes less than the 2% of the gross domestic product.
- The government has programs to improve the quality of young people’s teaching and learning opportunities. The objective is to improve their ability to obtain employment. There are also programs to improve monetary transfers in the form of subsidies for poor population groups, especially children and pregnant women.
HEALTH SITUATION AND THE HEALTH SYSTEM
- Given the relatively low number of pregnancies (5,900 live births in 2015), there are few maternal deaths. Between 2008 and 2013, 3.5 maternal deaths were recorded per year on average; in some years, no deaths were recorded. In 2015, the reported maternal mortality ratio was 67.6 per 100,000 live births.
- In 2014, 52.9% of pregnant women received antenatal care in the first 16 weeks of gestation.
- Also in 2014, the infant mortality rate was 19.4 deaths per 1,000 live births (including 13.9 neonatal deaths per 1,000 live births). The leading causes were perinatal respiratory disorders, congenital pneumonia, and perinatal pulmonary hemorrhage.
- Factors that influence infant mortality include late presentation to antenatal care, the rate of premature delivery, and multiparity. The prevalence of low birthweight was 13.8% in 2014, and 66.2% of all deaths in children occurred in the low birthweight group.
- From 2013 to this writing, there have been no cases of vaccine-preventable diseases. After 2009, when the coverage rate reached 98%, coverage against measles, mumps, and rubella ranged from 93.6% to 91.5%.
- In 2010, the overall mortality rate was 5.5 deaths per 1,000 population (6.8 in men and 4.3 in women). Diseases of the system and neoplasms accounted for 30% and 20% of deaths, respectively; thus, half of all deaths were from one of these two causes.
- Between 2009 and 2013, the leading causes of death from malignant neoplasms were cancer of the digestive system (24.9% of cancer deaths) and breast cancer (15.2%).
- In the same period, ischemic heart disease was responsible for 8.7% of all deaths and 3.7% of potential years of life lost (PYLL), with an average of 6.3 lost years per death.
- Sporadic outbreaks of malaria and dengue are recorded; the Anopheles and Aedes aegypti mosquitoes remain present. Nationwide efforts to reduce Ae. aegypti populations have included community cleanup campaigns.
- In 2014, the chikungunya virus was introduced in the country, causing an outbreak of 104 reported cases; in 2015, 4 cases were recorded. Up to early 2017, 10 cases of Zika virus infection had been recorded, 8 of them autochthonous.
- In 2014, 267 cases of HIV/AIDS were recorded. Of the new cases, 63 were diagnosed as AIDS (24%) and 12 died. Between 2005 and 2014, the incidence of HIV/AIDS declined 28% overall, but increased 85% in the population aged 15-24.
- In 2014, 45 new cases of TB were recorded, an incidence of 17 cases per 100,000 population. Of these, 3.7% were multidrug-resistant. Of the new cases, 14 were coinfected with HIV.
- Hypertension caused 9.1% of all deaths and represents 3.5% of all PYLLs, with an average of 5.8 years lost per death.
- Cerebrovascular diseases represented another 6.9% of all deaths and 3.1% of PYLLs, with an average of 6.7 years lost per death.
- Taken together, cardiovascular diseases from hypertension, cerebrovascular disease, and ischemic heart disease caused approximately 24.7% of all deaths during the period 2009-2013.
- In 2012, the overall prevalence of overweight and obesity was 79.2%, without significant differences between the sexes.
- In 2013, 45.7% of children aged 13-15 were overweight and 21.0% were obese; 29.6% had not engaged in physical activity in the previous week; 83.4% had consumed fewer than five fruits or vegetables during the previous week; 28.6% had consumed alcohol, 13.7% had smoked, and 15.1% had used drugs in the previous month; 19.3% considered suicide, while 13.6% had attempted it; 40% had participated in fights in the previous year; and 11.1% were members of violent gangs.
- In 2010, 2.8% of the population had some type of disability. This group has significant social vulnerability: 7.3% did not receive any education, 82.4% of those over the age of 14 were unemployed, and 72% lacked health insurance.
- Mental illness is a major cause of morbidity. The leading causes of admission to the local rehabilitation center are schizophrenia and schizotypal disorders (35%), affective mood disorders (12.3%), and mental and behavioral disorders due to substance use, mostly cannabis (11.1%), alcohol (7.4%), and cocaine (2.3%). A full 27% of all hospitalizations are somehow related to legal and illegal drug use.
- The Ministry of Health is the regulatory entity for the health sector, payer of all public health services, and responsible for delivery of health services in the community.
- In 2016, the National Health Insurance Bill was passed. This law ensures universal access to health services free of charge at the point of care for all legal residents of The Bahamas.
- The first stage, scheduled for implementation in 2017, covers a comprehensive package of primary care services, including medical care, medicines, diagnostic imaging, and laboratory tests.
- The later stages are expected to provide coverage for catastrophic events and will include secondary and tertiary care services.
- As of 2010, 47.2% of the population had some health insurance. The goal of increasing insurance coverage is a key Government concern. In 2013, there were 24.9 physicians, 28.8 registered nurses, and 11.4 clinical nurses per 10,000 population.
- Public health services are provided at the primary level through a network of health care centers distributed across a system of public facilities (28 health centers, 33 main clinics, and 35 satellite clinics) on the major inhabited islands.
- Secondary and tertiary care is provided at three public hospitals: Princess Margaret Hospital (with 400 beds), Sandilands Rehabilitation Center on New Providence, and Rand Memorial Hospital (with 85 beds) on Grand Bahama.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The country has high income levels but, at the same time, a high level of poverty and marginalization of large segments of society, especially the growing migrant population.
- One of the critical gaps in the social development of the public sector is the lack of universal health coverage.
- Challenges that the new legislation must still address include additional sources of financing and the role of private insurers.
- Work has begun on the development of an integrated health information system, known as the Integrated Health Information Management System, an initiative designed mainly to strengthen information and communication technologies (ICTs) in the health sector.
- The geographic distribution of health service delivery to a relatively small population scattered across a large, discontinuous area is an enormous challenge. In this regard, development and implementation of telemedicine and other ICTs for health are particularly important.
- Efforts must be made to tackle the exclusion of major sectors of society, particularly the growing migrant population, from social security and well-being.
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