Country Report: Saint Lucia
Saint Lucia is an island nation in the Caribbean, located between Martinique and Saint Vincent and the Grenadines. With a land area of 620 km2, it is divided into 11 districts. It is a parliamentary democracy and holds elections every 5 years.
The population was 172,255 in 2014, with 21.8% over the age of 60. The population pyramid is moving toward a regressive structure as a result of lower fertility and the reduction in premature deaths.
The population is mainly of African descent (85.3%), followed by those of mixed race (10.8%). Average life expectancy in 2016 was estimated at 77.8 years (75.0 in men, 80.7 in women).
Per capita gross domestic product (GDP) was US$ 6,848 in 2014. The economy depends mainly on tourism (65% of GDP).
- The main components of health system strengthening, implemented under the National Strategic Plan for Health (2006-2011), include universal coverage to improve health equity and service delivery, use of a defined national model of care, adequate standards (clinical governance and physical determinants), integrated service delivery, a road map for accreditation, leadership reforms through the evaluation and redesign of the health governance model, and public policy reforms through the development of appropriate policies and related legislation.
- In 2012, through a financial agreement with the European Development Fund, a project designed to support the implementation of universal health care in Saint Lucia was launched.
- Since its implementation in 2013, the project has granted some 250 scholarships in priority areas such as the training of family nurse practitioners, environmental health, diabetes, physiotherapy, midwifery, and mental health.
- At the close of the current planning cycle in 2017, the new strategic plan will attempt to complete the unfinished agenda, focusing on gaps and implementing health systems development models designed during the previous implementation period.
Figure 1. Distribution of the population by age and sex, Saint Lucia, 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).
SOCIAL DETERMINANTS OF HEALTH
- The most recent assessment, in 2005, showed that 18.7% of households and 25.1% of individuals lived below the poverty line. Some 5.3% of households and 7.1% of individuals lived in extreme poverty, chiefly in rural communities.
- Literacy among young females aged 15-24 in 2012 was 99.3%. In 2014, unemployment was 24.4%, and youth unemployment increased to 41.8%.
- More than 80% of households have access to clean drinking water through household connections to the system. The rest of the population obtains its water from public standpipes, trucks, and private cisterns. Most homes (92.5%) have sanitary facilities in the form of sewer connections, septic tanks, or pit latrines.
- The majority (88%) of households have trash collection. Trash is deposited in two sanitary landfills on the island. The remaining households dispose of trash by composting, dumping, or burning it.
- Natural disasters are associated with a high risk of disease outbreaks. Hurricane Tomas hit the island in 2010, resulting in 7 deaths and 36 injuries. In 2013, flooding over the Christmas holiday caused 6 deaths, with some 1,050 people gravely affected.
HEALTH SITUATION AND THE HEALTH SYSTEM
- The crude birth rate remained constant during the period 2010-2015, at 12 live births per 1,000 population. In 2014, hospital delivery coverage was 98%, with a 24% rate of cesarean births. Four maternal deaths were recorded between 2012 and 2014.
- Exclusive breastfeeding at 6 weeks remained under 50% every year, and contraceptive use was 47% among women aged 15-49 in 2008.
- The infant mortality rate was 17 deaths per 1,000 live births in 2014, with most of the deaths occurring during the neonatal period. Over the last 10 years, the percentage of low birthweight infants ranged from 9% to 12%; mortality in children under 5 in 2012 was 24.1 per 1,000 live births. In 2014, most hospitalizations of children aged 1-4 were the result of perinatal conditions, congenital anomalies, and respiratory infections.
- The Expanded Program on Immunization provides protection against the following diseases: poliomyelitis; diphtheria, whooping cough, tetanus, hepatitis B, and Haemophilus influenzae type b; tuberculosis (BCG); and measles, mumps, and rubella (MMR). In 2014, around 98% of infants completed the pentavalent vaccine schedule, 83% received the BCG vaccine, and 98% received the MMR1.
- In 2014, children aged 5-14 accounted for 14.4% of the population. The principal problems of children and adolescents aged 5-19 were related to adolescent pregnancy, drug and alcohol abuse, accidents and violence, homicide, and suicide.
- In 2014, the birth rate among adolescents was 22 per 1,000 females aged 10-19, accounting for 15% of total births.
- In 2012, chronic noncommunicable diseases were responsible for 58% of premature deaths.
- Years of productive life lost as a result of chronic diseases in the population aged 16-64 were slightly higher in men than in women (24.7 years and 24.3 years, respectively).
- In 2014, the total death rate was 7.6 per 1,000 population (54.5% in men and 45.5% in women). Some 32% of deaths were caused by circulatory system diseases and 19% by neoplasms; these two groups of causes together were responsible for half of the total deaths.
- In 2014, the leading causes of death from chronic noncommunicable diseases included heart disease, stroke, diabetes mellitus, and hypertension.
- Although communicable diseases no longer rank among the 5 leading causes of death, influenza, pneumonia, and perinatal conditions remain among the top 10 causes.
- Dengue is endemic in Saint Lucia, with 1,253 confirmed cases in the period 2010-2014, 749 of them during the outbreak of 2011. There were three deaths in 2011 and one in 2014.
- An outbreak of chikungunya in April 2014 resulted in 899 suspected cases. Children aged 0-4 accounted for 22% of all cases. It was estimated that roughly 60% of the suspected cases actually were chikungunya.
- Zika was first confirmed in 2016. By September of that year, 50 cases had been reported, with 1 Zika-associated case of Guillain-Barré syndrome and 40 confirmed cases in pregnant women.
- In the period 2011-2015, there were 101 cases of leptospirosis, with 6 deaths.
- Prevention and control activities to reduce the presence of the Aedes aegypti mosquito continue through the program for integrated management of vector-borne diseases.
- Between 2010 and 2014 there were 44 confirmed cases of influenza A (H1N1), but there were no confirmed cases in 2015.
- Since 1985, 1,091 cases of human immunodeficiency virus (HIV) infection have been diagnosed. During the 5 years between 2011 and 2016, no cases of vertical transmission were recorded.
- In the period 2011-2013, there were 45 recorded cases of tuberculosis (33 in women and 12 in men), with 2 deaths from HIV coinfection. In 2015 there were 11 cases of tuberculosis, with an incidence rate of 6.3 cases per 100,000 population.
- Between 2010 and 2014 a total of 98 people died in road traffic accidents, with a male-female ratio of 5:1. There were a total of 166 homicides between 2010 and 2014, but the number per year declined over that period. There were 54 suicides recorded during those years, with an upward trend.
- Within the framework of the National Strategic Plan for Health (2006-2011), aimed at achieving universal coverage, a national policy for the health sector was prepared that addresses four main imperatives: investing in health, tackling health challenges, strengthening people-centered health systems, and creating resilient communities.
- This strategy provides a general framework for achieving equity. In this context, the Ministry of Health has designed an approach that seeks to reduce segmentation, ensure fair access, and respect human rights. Services are provided free of charge through 36 health care facilities and 2 hospitals. In the recent development of health policies, emphasis has been placed on chronic noncommunicable diseases, mental health, and nutrition.
- The Ministry of Health is responsible for health policy and for the financing and regulation of the health system. The system has three levels of care: primary, secondary, and tertiary. Primary health care is delivered through a network of 33 health centers, 2 district hospitals, and 1 polyclinic in each of the 8 health regions. There are 2 general hospitals and a private hospital that mainly provides secondary care; there also is a psychiatric hospital.
- Funding for health services comes primarily from four sources: a consolidated government fund, donor contributions, payments by users, and private health insurance schemes. Under the new governance strategy, these financing mechanisms will be consolidated in a single fund, the health fund.
- Health expenditure accounted for 2.5% of GDP in the period 2014-2015. The bulk of recurrent expenditure in health goes to secondary and tertiary care—that is, to the public hospitals.
- Efforts have been made in recent years to establish the virtual integration model and improve the health financing strategy and quality management framework.
ACHIEVEMENTS, CHALLENGES AND PERSPECTIVES
- As a result of a national survey on risk factors conducted in 2012, recreational fitness programs were introduced for all age groups.
- A food security policy and emergency response plan were developed and implemented in 2015. These plans guide programming and surveillance activities for food safety and security.
- The National Strategic Plan for Health outlines the need to support implementation of the national model of care and address staffing needs.
- Establishment of the virtual integration model, the health financing strategy, and the quality management framework are Ministry of Health priorities.
- Climate change will pose a major threat to ecosystems and populations, as a rising sea level, extreme weather events, rising temperatures, and altered precipitation patterns interfere with people’s activities and means of subsistence.
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