Country Report: Barbados
Barbados is the easternmost country in the Caribbean, with a surface area of 430 km2.
Between 1990 and 2015, the population increased by only 3.5%, to 276,633 inhabitants; its structure is aging and becoming more regressive. Life expectancy at birth is 75.1 years (73.1 years in men, and 77.9 years in women).
Barbados is considered a high-income country. The per capita gross domestic product (GDP) was US$ 15,600 in 2015. Barbados has an open economy—dominated by tourism, international trade, and retail commerce—under the influence of international financial markets.
- Barbados supports the global effort to reduce antimicrobial resistance. In 2015, a national action plan on antimicrobial resistance was drafted, incorporating the objectives of the WHO-sponsored global plan.
- The national plan highlights three goals, which include reducing the appearance of resistant bacteria and preventing the spread of resistant infections.
- Another goal is to optimize national surveillance efforts in order to combat resistance and improve international cooperation and capabilities in antimicrobial resistance prevention, surveillance, and control, in addition to improving antibiotics research and development.
- Efforts have been launched to improve education on infection control measures in health institutions.
- A series of TB strains resistant to antibiotics has been identified; however, no multidrug-resistant tuberculosis has been detected.
- Screening tests have been conducted for drug-resistant HIV. Currently, approximately 80% of patients are receiving first-line therapy, of which 20% combine first-line therapy with second- or third-line regimens.
- In light of this progress, the need to successfully address antimicrobial resistance in order to reach the health-related SDGs should be reiterated.
Figure 1. Distribution of the population by age and sex, Barbados, 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
- Unemployment in 2015 was 10.7%, almost half of which corresponded to young people between 15 and 19 years of age. In 2010, 15% of households lived below the poverty line. Of these, 25% were affected by unemployment, and 62% were headed by women.
- The literacy rate in the country is 97%; primary and secondary education are compulsory and free.
- All households have access to the Government-run solid waste collection system.
- The Health of the Nation Study (2015) estimated that one in every three employed persons has private health insurance.
- The island is vulnerable to hurricanes, and its main environmental challenges include indoor and outdoor air quality, vector-borne diseases, solid waste disposal, the relative scarcity of water, deforestation, and soil erosion.
- In some cases, migrants and tourists can receive free assistance, as with an emergency, prenatal care, immunization, or major public health problems, such as treatment for human immunodeficiency virus (HIV).
HEALTH SITUATION AND THE HEALTH SYSTEM
- Between 2010 and 2015, five maternal deaths were reported. Hospital care for delivery is universal. In 2011, 12.3% of deliveries were to mothers less than 19 years of age.
- Mortality in children under 1 year of age between 2012 and 2014 was 11.6 per 1,000 live births, and 12 per 1,000 for children under 5.
- Vaccination coverage for measles, mumps, and rubella (MMR), and against chickenpox, was approximately 96% in 2015. No vaccine-preventable diseases were reported. The human papillomavirus (HPV) vaccine was introduced in 2014 for girls aged 11 and older.
- In 2010, 4% of the population suffered from some type of disability.
- The crude death rate was 8.4 per 1,000 inhabitants in 2012, and the adjusted rate was 5.9. Diseases of the circulatory system caused 31% of deaths in 2013, and neoplasms 23%.
- The five leading causes of death correspond to the chronic noncommunicable disease group, mainly ischemic heart disease, cerebrovascular disease, hypertensive heart disease, and diabetes mellitus. In 2012, this group of chronic diseases was responsible for 25.9% of deaths in men, and 32.6% in women.
- Between 2010 and 2012, 110 confirmed cases of leptospirosis were reported, with 3 deaths. Dengue is endemic, with outbreaks in 2013 and 2014 totaling 2,955 cases and 12 deaths (4% case fatality rate). The chikungunya virus has been diagnosed since 2014, when 1,851 suspected cases were reported, and 139 confirmed.
- Three cases of Zika virus (none of them in pregnant women) were confirmed between 2010 and 2015. Yellow fever and malaria are not endemic in Barbados; 28 cases of imported malaria were reported, with no deaths. There have been no recorded cases of Chagas disease, nor has leishmaniasis been detected in the country. There were 11 confirmed cases of tuberculosis, 2 of them imported, and 1 coinfected with HIV. None of these cases was drug-resistant.
- Through the end of 2013, 3,797 cases of HIV had been diagnosed, with 1,712 deaths. Between 2001 and 2013, mortality from AIDS dropped from 11.2% to 2.3%, thanks to the introduction of universal access to antiretroviral therapy. Furthermore, an initiative to eliminate mother-to-child transmission of HIV and syphilis has been implemented.
- The prevalence of diabetes was 18.7% in adults in 2015, reaching 45% in people 65 years or older.
- In 2015, 80% of men and 90% of women presented at least one risk factor for chronic noncommunicable disease. Two out of three adults were overweight, and one out of every three was obese. The prevalence of obesity was almost twice as high in women (43%) as in men (23%). One out of 10 women and 1 out of 20 men had a body mass index (BMI) equal to or greater than 35. In children, the obesity rate was 14.4%.
- The 2015-2019 Strategic Plan for the Prevention and Control of Non-communicable Diseases was completed in 2015. It includes measures to reduce salt and sugar intake, eliminate trans fats, increase exercise and physical activity, and reduce alcohol and tobacco use.
- In 2015, 9% of the adult population smoked (13% of young people aged 13-15). Laws prohibit selling tobacco to minors and smoking in public places. Furthermore, tax-free concessions have been eliminated, and taxes on tobacco products have been raised.
- The Health Services Act (1969) and the Drug Service Act (1980) provide the legislative framework for universal access to health. The national policy is to provide free medical services at the time of use, so they are accessible to all.
- The Ministry of Health is responsible for health services management, operations, and delivery. To this end, it defines policies, establishes strategic directions, regulates the sector, and finances these services.
- Health expenditure represented 10.6% of total public spending in 2014–2015. Taxes finance 55% of the total; another 38% comes from households, and approximately 5% from private health insurance. One-third of the people employed have private health insurance.
- The medium-term growth and development strategy focuses on Government policies for intersectoral issues, such as health systems development, family health, communicable and chronic noncommunicable diseases, mental health, and the environment.
- The primary health care services are well developed and easy to access. Queen Elizabeth Hospital provides secondary and tertiary care. Furthermore, there are three district hospitals, a psychiatric hospital, and geriatric hospitals, as well as a center for persons with disabilities and another for children with
physical and mental problems. In cases involving patients who require specialized care, it is necessary to send them outside the country.
- Barbados is self-sufficient in training human resources for its health system. In 2012, there were 21 physicians and 44 nurses per 10,000 population.
- The health information system continues its gradual implementation. A highlight is the Med Data system, which has been set up with different modules in five of the country’s nine polyclinics and in Queen Elizabeth Hospital.
- District and geriatric hospitals provide care to elderly patients who need long-term nursing and rehabilitation.
- The Safety and Health at Work Act (which went into effect in 2013) establishes the rights and responsibilities of employees and employers. In 2014, 639 workplace accidents were reported, 2 of them fatal.
- In 2015, a national conference on the health system was held; its main conclusions proposed reforming the health financing structure and increasing the efficiency of the health delivery system.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The 2016-2021 strategic health plan includes directives in line with the United Nations Sustainable Development Goals (SDGs), Caribbean Cooperation in Health, and the objective of achieving universal health coverage.
- The Ministry of Health is considering new policy goals: the reorganization and improvement of primary care, prevention and management of chronic noncommunicable diseases, and improvement of the monitoring and evaluation of health services and their financing mechanisms.
- In the coming years, greater expansion in the use of information and communications technology (ICT) is expected to improve health systems and provide the necessary support for evidence-based decision-making.
- This ICT will improve programs’ prognoses, planning, estimates, and resource allocation and contribute to better monitoring and evaluation. In the final analysis, this is expected to lead to better health outcomes for the population.
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