Country Report: British Virgin Islands
The British Virgin Islands are a British Overseas Territory located in the northeastern Caribbean. They consist of some 50 islands, cays, rocky formations, and islets, with a total surface area of 59.3 mi.2. The largest islands are Tortola (21.5 mi.2), Anegada (15.2 mi.2), Virgin Gorda (8.5 mi.2), and Jost Van Dyke (3.2 mi.2).
In 2015, the population was 34,232, with 83% living on Tortola and 14% on Virgin Gorda. People born abroad represented approximately 60.3% of the population. The population aged 60 or over accounted for 13.3%.
Between 1990 and 2015, the population distribution became regressive, with a higher concentration in the middle-aged group compared with younger migrant workers. In 2015, the crude birth rate was estimated at 9.1 births per 1,000 population, and the crude death rate, 4.7 deaths per 1,000 population. Estimated life expectancy in 2015 was 79.8 years (77.1 in men and 78, 5 in women).
The annual gross national income (GNI) per capita was US$ 42,300 in 2010. The British Virgin Islands’ economy is based on tourism and international financial services, which together represent more than 70% of the territory’s gross domestic product (GDP).
- The British Virgin Islands are effectively addressing the problem of domestic violence with a series of policies, laws, and programs.
- The Cabinet approved the National Domestic Violence Protocol in November 2010.
- The Domestic Violence Act of 2011 expands the definition of domestic violence to include economic abuse, intimidation, harassment, stalking, and property damage and destruction, while offering protection to visitors.
- The National Gender Policy and Plan of 2013 complements the 2010 National Domestic Violence Protocol.
- The Partnership for Peace is a 16-week psycho-educational program for men who exhibit abusive behavior toward women. Its goal is to prevent violence against women.
- In October 2011, the government approved the After Support Program for men who complete the Partnership for Peace program.
Figure 1. Distribution of the population by age and sex, British Virgin Islands, 1990 and 2015
Proportional mortality (% of all deaths, all ages, both sexes), 2010
Source: Pan American Health Organization and PAHO Health Information Platform (PHIP).
SOCIAL DETERMINANTS OF HEALTH
- In 2010, unemployment reached 2.8% and was higher among young people aged 15-29. In 2003, 16% of households and 22% of the population were living below the poverty line. The average household had 2.59 people.
- In 2010, the literacy rate for people aged 15 or older was 97.7%. School attendance is compulsory for children aged 5-17, and public school, including higher education, is free. The public-school system consists of 15 primary schools, four secondary schools, and a technical and vocational school. In addition, there are 10 private primary schools and three private secondary schools.
- Approximately 95% of the population has access to safe drinking water, and a similar proportion to adequate sanitation. By law, all households must have a supply of clean water through rainwater catchment systems or cisterns, unless they have access to the municipal water supply network.
- The Ministry of Health monitors the quality of the water supply. Municipal water distribution also includes a limited amount of desalinated seawater.
- Municipal sewerage systems capture wastewater from 2.6% of buildings. The remainder have septic systems. Solid waste management is a critical problem, due to the limited availability of land and adequate landfill conditions. Waste is disposed of mainly through incineration.
- As a small island developing state (SIDS), the British Virgin Islands are expected to suffer the consequences of climate change in the form of rising sea levels, changes in precipitation patterns, and greater intensity and frequency of hurricanes.
- This requires greater monitoring of coastal areas, reefs, and drainage and sewerage systems; the protection of wildlife and flora; and more vigilance to prevent impacts on human health (especially from vector-borne diseases) and ensure food security, due to the impact on agriculture.
- Conditions for residents of foreign origin can be a complex issue, since the territory is governed by the British Nationality Act, which has implications for access to health care, especially for non-English speakers and undocumented people who have no coverage under National Health Insurance and must pay for health care.
HEALTH SITUATION AND THE HEALTH SYSTEM
- In the past decade, no maternal deaths have been recorded in the territory, and hospital delivery coverage is universal, with all births attended by trained midwives.
- Due to the territory's small population, indicators can vary widely from year to year. Between 2013 and 2015, 835 births were reported, with 8.7% of newborns having low birth weight. Between 2006 and 2015, infant mortality ranged from 26.7 to 11.3 deaths per 1,000 live births.
- Perinatal disorders and congenital birth defects were the main causes of death in children under 5. Acute respiratory infections and gastroenteritis were the principal causes of morbidity in this age group.
- In 2015, vaccination coverage with the first dose of the vaccine against measles, mumps, and rubella (MMR) was 100% and for the second, 88%. The territory's vaccination program includes administering the chickenpox vaccine to children under 5. Except for 8 cases of chickenpox between 2013 and 2015, no other cases of vaccine-preventable diseases were recorded.
- The greater health needs of people aged 65 and over were related to the high prevalence of chronic diseases among them and the lack of state homes for their care.
- In 2010, circulatory system diseases were responsible for 25% of deaths, and neoplasms 18%. In 2014, the leading causes of death included hypertension (12.6%), neoplasms (10.8%), and cardiovascular disease (9.9%), especially arteriosclerosis, ischemic cardiopathy, coronary disease, hypertensive cardiovascular disease, myocardial infarction, and congestive heart failure.
- The leading causes of death from malignant neoplasms were prostate, breast, lung, stomach, uterine, and colon cancer, which together ranked third among the causes of death in 2014. Deaths from respiratory system diseases included pulmonary edema, pulmonary infarction, bacterial pneumonia, and obstructive pulmonary disease.
- HIV reporting began in 1983; as of 2016, 127 cases of HIV/AIDS had been reported, 69 in men and 58 in women, with 40 AIDS-related deaths. No cases of tuberculosis were reported between 2013 and 2015.
- In 2009, a high proportion of the population aged 25-64 that was interviewed was overweight and had hypertension, and 46% had three or more risk factors for chronic disease.
- The Ministry of Health and Social Development is implementing a 10-year strategy for the prevention of non communicable chronic diseases, based on a multisectoral approach.
- The Ministry of Health has been reviewing and updating its legislative framework to improve leadership and governance, with the aim of increasing access to the care provided by the national health insurance system, and generally improving the health system.
- Health services are financed through the National Health Insurance (NHI), launched in 2016. This insurance, receives contributions from employers and employees, in addition to direct government investment and reimbursement for care provided in the public and private sectors.
- All legal residents are required to subscribe to this insurance, which acts as the primary source of health coverage in the territory. It covers a comprehensive benefits package that includes medical, dental, and vision services. Copayments are 0% in public clinics, 5% in public hospitals, 10% in the network's private establishments, and 20% in centers outside of the network.
- The Health Services Authority is responsible for health services on the islands. Public primary health services are provided through 10 primary health care centers and four health posts. Public secondary health care is provided at Peebles Hospital, which offers services in the principal medical specialties. There is also a well developed private health system, including a private hospital.
- The majority of tertiary care is provided on the U.S. mainland and in Puerto Rico, the United Kingdom, and certain Caribbean locations.
- Visiting medical specialists from the English-speaking Caribbean, Puerto Rico, and the U.S. mainland also provide care in public and private institutions, generally once a month or as the demand dictates. Specialized services are provided in fields such as neurology, rheumatology, urology, ophthalmology, and plastic surgery.
- There are no centers for training health professionals in the British Virgin Islands, so nationals must study abroad. The majority of health workers are employed in the public sector.
- In 2015, there were 102 registered physicians, including 88 in active practice; of these, 45 were in the public sector. Of the 13 practicing dentists, only two worked in the public sector. A total of 207 professional nurses were registered to practice, 162 of whom worked in the public sector.
- The majority of health service providers use electronic health records and other forms of electronic data management, although use of the information produced is limited. However, since data management in the health sector is fragmented among the various providers, evidence-based decision-making is difficult.
- Since 2011, there has been an electronic information system for managing Civil Registry birth and death data. Another system is in place for communicable disease reporting. All other data are reported to the Ministry of Health on paper forms.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- The establishment of the National Health Insurance System in 2016 has led to great strides in universal coverage and access for the entire population, while reducing the impact of price as a health care access barrier. This represents a major step toward achievement of universal health care access and coverage.
- In order to meet this goal, a roadmap must be created for renewing primary health care and ensuring that sufficient additional resources are available to address the social determinants of health.
- Additional resources are also necessary to develop both an effective action strategy for dealing with chronic non communicable diseases and a cyber health policy that includes legislation to protect personal information.
- The territory continues to be at risk of endemic vector-borne diseases that affect health and productivity and ultimately have an impact on tourism.
- Total health expenditure is expected to increase in the short run due to the establishment of the new health system. However, expenditure is then expected to stabilize as previously unmet health care demands are met. This will require the constant monitoring of changes in the system and health expenditure, as necessary.
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