Ministry of Health Annual Report 2006
MINISTRY OF HEALTH JAMAICA
ANNUAL REPORT 2006
Prepared By: Ministry of Health Policy, Planning and Development Division Planning and Evaluation Branch 2007 December
Ministry of Health Annual Report 2006
MINISTRY OF HEALTH JAMAICA ANNUAL REPORT 2006 Prepared By: Ministry of Health Policy, Planning and Development Division Planning and Evaluation Branch 2007 December
Ministry of Health Annual Report 2006
Š Ministry of Health, Jamaica 2006 All rights reserved
Short extracts of this publication may be copied or reproduced for individual use without permission, provided the source is fully acknowledged. More extensive reproduction or storage in a retrieval system in any form or by any means – photocopying, electronic, mechanical, recorded or otherwise requires the prior written permission of the Permanent Secretary, Ministry of Health, Jamaica.
Published by the Ministry of Health 2-4 King Street Kingston Jamaica
Telephone: Fax: Website:
(876) 967-1100-9 (876) 967-7293 www.moh.gov.jm
Prepared by: Policy, Planning and Development Division Planning and Evaluation Branch
ISSN 0799-0979 - Ministry of Health - Jamaica Annual Report
Published 2008 March
Ministry of Health Annual Report 2006
LIST OF TABLES, FIGURES AND APPENDICES TABLES 2.1
Regulatory Framework as at March 2007
2.2
Regulatory Activities of the Standards and Regulation Division: 2002-2006
2.3
Regulatory Activities of the Pesticide Control Authority: 2003-2006
3.1
Distribution of Health Service Delivery by Regional Authorities and UHWI for 2005/06 - 2006/07
3.2 3.3
Fee Collection by Regional Health Authorities for 2005/06 - 2006/07 Training of Professional and Auxiliary Nurses: 2005-2006
4.9
Discharge Rates Per 10,000 Population for Public Hospitals and UHWI by Age: 2002-2006
4.10
Discharges, Average Length of Stay and Bed Occupancy: 2002-2006
4.11
Surgery Workload Hospitals: 2002-2006
4.12
Utilisation of Rehabilitative Services in Secondary Care: 2002-2006
4.13
Oral Health Visits to Primary Care Facilities: 2004-2006
4.14
Home Visits: 2002-2006
5.1
Health Indicators: 2002-2006
5.2
Trends in Immunization Coverage for Jamaica: 2002-2006
in
Public
3.4
Proportion of RHA Recurrent Expenditure Allocated to Human Resource ($000,000): 2006/07
5.3 3.5
Utilisation of Pharmaceutical Services in Public Hospitals and PHC facilities: 2004-2006
Summary of AIDS Jamaica: 1982-2006
5.4
AIDS Cases by Age and Gender: 2005-2006
Total Health Centre and Curative Visits: 2002-2006
5.5
AIDS Cases by Parish – 2005-2006
5.6
Asthma Visits to Public Primary Health Care Facilities, Cases Seen in Accident and Emergency and Hospital Discharges Rates: 20022006
4.1
Cases
for
4.2
Attendance and Source of Referral to Public Casualty Departments: 20022006
4.3
Utilisation of Outpatient Speciality Clinics in Public Facilities: 20022006
5.7
Cases of Asthma Seen in Public Outpatient Departments: 2003-2006
Utilisation of Radiography Services in Public Hospitals: 2002-2006
5.8
Visits to Public Primary Health Care Facilities, for Cancer Screening per Referral for Abnormal Pap Smear Results and Percentage of Total Discharge: 2004-2006
5.9
Oncology Treatments administered in Public Hospitals (KPH and CRH) by Type of Treatment and Radiotherapy Clinic Cases: 20022006
5.10
Cardiovascular Disease Visits to Public Primary Health Care Facilities: 2002-2006
4.4
4.5
Use of X-Ray Films: 2002-2006
4.6
Utilisation of Public Laboratory Services by Examination Done: 2002-2006
4.7
Utilisation in Blood Services: 2002-2006
Transfusion
4.8
Utilisation of Physical Therapy Services in Public Hospitals: 20022006
III
Ministry of Health Annual Report 2006
5.11
Diabetes Visits to Public Primary Health Care Facilities, Discharges Rates, Leg Ulcers and Amputation due to Diabetes: 2002-2006
6.1
Admission and Average Length of Stay of Clients Seen in Community Mental Health Clinics by Hospitals: 2005-2006
5.12
Visits to Public Primary Health Care Facilities and Discharge as Percentage of Total Hospital Discharges for Other Monitored Diseases: 2002-2006
6.2
Visits to Public Primary Health Care Facilities for Mental Health Problems: 2002-2006
6.3
Source of Referral of New Patients to Community Mental Health Clinics (CMH) by Regions: 2005-2006
6.4
Major Diagnoses by Gender and Age of Clients seen in Public Community Mental Health Clinics: 2004-2006
5.13
Antenatal Attendance at Sector Facilities: 2002-2006
5.14
HIV Rapid Test Results of ANC and STI Clinic Attendees: 2005-2006
5.15
Postnatal Visits to Public Facilities by Mothers: 2002-2006
6.5
Client Movement - Patricia House: 2005-2006
5.16
Surgical Interventions in Public Hospitals for Obstetric and Gynaecology Conditions: 2002-2006
6.6
Visits for Attempted Suicide at Public Accident and Emergency Departments in Public Hospitals by Age and Gender: 2004-2006
5.17
Utilisation of Outpatient Obstetric, Gynaecology Clinics: 2002-2006
6.7
Suicide by Gender and Method Used: 2002-2006
6.8
Pre-hospital Emergency care by cause and percentage 2000-2006
6.9
MOH/JDF CASEVAC flights 20012006
6.10
Visits to Public Primary Health Care for Injuries by Gender and Cause: 2003-2006
6.11
Utilisation of Accident and Emergency Departments of Public Hospitals for Blunt Injury by Gender and Age: 2004-2006
6.12
Utilisation of Accident and Emergency Departments of Public Hospitals for Stab Wounds and Age: 2003-2006
5.18
Public
Surgical Interventions in Public Hospitals for Urology Conditions: 2002-2006
5.19
Total Family Planning Visits to Health Centres by Female and % New Female Acceptors: 2004-2006
5.20
The Demand for Sterilisation in Public Sector Facilities: 2002-2006
5.21
Perinatal, Neonatal and Foetal Mortality Rates: 2002-2006
5.22
Trends in Nutritional Status of Children 0-35 months attending Public Health Sector Facilities: 20022006
5.23
Antenatal Attendance by Pregnant Adolescents at Public Sector Facilities: 2004-2006
5.24
Postnatal Visits by Adolescents Occurring in Public Sector Facilities: 2004-2006
5.25
Number of Adolescent Births (based on age at last birthday) at VJH, STH, SAB, CRH and Mandeville Hospitals: 2002-2006
6.13 Utilisation of Accident and Emergency Departments of Public Hospitals for Gunshot Wounds by Gender and Age: 2004-2006 6.14
IV
Utilisation of Accident and Emergency Departments of Public Hospitals for Sexual Assault by Gender and Age: 2004-2006
Ministry of Health Annual Report 2006
6.15
Utilisation of Accident and Emergency Departments of Public Hospitals for Human Bites by Gender and Age: 2004-2006
Figures 1.1
Population of Jamaica by Age and Gender: 2006
6.16
Utilisation of Accident and Emergency Departments of Public Hospitals for Burns by Gender and Age: 2004-2006
5.1
Cardiovascular Disease visits to Public Primary Health Care Facilities as a % Discharge of Total Hospital Discharge: 2002-2006
6.17
Utilisation of Accident and Emergency Departments of Public Hospitals for Accidental Laceration by Gender and Age: 2004-2006
5.2
Results of screening (haemoglobin, syphillis and tetanus immunisation) of first antenatal clients: 2002-2006
6.18
Utilisation of Accident and Emergency Departments of Public Hospitals for Poisoning by Gender and Age: 2004-2006
5.3
Utilization of Outpatient Clinics: 2002-2006
5.4
Births Occurring in Public Sector Facilities: 2002-2006
5.5
Low Birth Weight Babies (Public Facilities) as a % of Live Births: 2002-2006
5.6
Exclusive Breastfeeding Status among Babies visiting Public Health Sector Facilities: 2002-2006
5.7
Results of Screening Pregnant Adolescent Women (haemoglobin, syphilis and tetanus immunization) of first antenatal clients: 2003-2006
5.8
Births Among Adolescents Occurring in Public Sector Facilities: 20022006
6.1
Calls received by MOH/JEB EMS by type 2006
6.2
MOH/JDF CASEVAC Flights 20012006
6.3
MOH/JDF CASEVAC Transfers by service 2006
6.19
Utilisation of Accident and Emergency Departments of Public Hospitals for falls by Gender and Age: 2004-2006
6.20
Utilisation of Accident and Emergency Departments of Public Hospitals for Near Drowning by Gender and Age: 2004-2006
6.21
6.22
Utilisation of Accident and Emergency Departments of Public Hospitals for Other Presenting Conditions by Gender: 2004-2006 Utilisation of Accident and Emergency Departments of Public Hospitals for Motor Vehicle Accident by Cause, Gender and Age: 20042006
6.23
Road Traffic Deaths by Gender and Category of Road Users: 2002-2006
6.24
Reported Deaths in Hospital and in Casualty Departments as a % of Hospitals: 2002-2006
6.25
Children in Care by Region: 20052006
6.26
Appendices
Number of Child Abuse Cases Reported to the Police: 2002-2006
7.1
Hearing assessment - 2006
7.2
Breast Cancer Screening Mammography: 2002-2006
Urology
V
A.1
Ministry of Health - Status Report of Capital Projects: 2006-2007
A.2
Utilisation of Pharmaceutical Services in Public Hospitals and PHC Facilities by Region: 2004-2006
B.1
Primary Health Centre Visits Gender and Region: 2002-2006
by
Ministry of Health Annual Report 2006
B.2
Attendance and Source of Referral to Public Casualty Departments by Region (also UHWI): 2002-2006
B.3
Utilisation of Outpatient Specialty Clinics in Public Facilities by Region (also UHWI): 2002-2006
B.4
Utilisation of Radiography Services in Public Hospitals by Region (also UHWI): 2002-2006
B.5
C.7
Utilisation of Outpatient Obstetric, Gynaecology Clinics by Region (also UHWI): 2002-2006
C.8
Total Health Centre Visits for Urinary Tract Infections by Region: 2004-2006
C.9
Utilisation of Outpatient Urology Clinics by Region: 2002-2006
C.10a Total Family Planning Visits to Health Centres by Females and % New Female Acceptors by Age and Region: 2005-2006
Utilisation of Public Laboratory Services at Public Hospitals by Region Examinations Done: 20032006
C.10b Method of Contraception Chosen in Public Sector Facilities by Region (including Postnatal Acceptors): 2002-2006
B.6
Utilisation of Physical Therapy Services in Public Hospitals by Region: 2005-2006
C.11 B.7
Discharges, Average Length of Stay and Bed Occupancy by Region (also UHWI): 2002-2006
Hospital and Home Births as a % of Total Births by Region: 2002-2006
C.12
Surgery Workload in Public Hospitals by Region (also UHWI): 2002-2006
Visits to Public Primary Health Care Facilities for Injuries by Gender, Cause and Region: 2004-2006
C.13
Utilisation of Accident and Emergency Departments of Public Hospitals for Blunt Injury, Stab Wound, Gunshot Wound, Sexual Assault, Human Bites, Burns, Accidental Laceration, Poisoning, Falls, Near Drowning and Motor Vehicle Accidents by Gender, Region and Age: 2004-2006
B.8
B.9
Oral Health Visits to Primary Care Facilities by Region: 2004-2006
B.10
Home Visits by Region: 2002-2006
C.1
Trends in Immunization Coverage for Jamaica by Region: 2002-2006
C.2
List of Notifiable Jamaica: 2002-2006
Diseases
in
C.3
Antenatal Attendance at Public Sector Facilities by Region: 20022006
C.4
Results of Screening (Haemoglobin and Syphillis) and Immunization against Tetanus for first Antenatal Clients by Region: 2002-2006
C.5
C.6
C.14a Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five leading First–Listed Diagnosis: 2002-2006 (under 1 Age Group)
C.14b Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five leading First–Listed Diagnosis: 2002-2006 (1-4 Age Group)
Postnatal Visits to Public Facilities of Mothers According to Region: 20022006
C.14c Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five leading First–Listed Diagnosis: 2002-2006 (5-9 Age Group)
Surgical Intervention for Obstetrics, Gynaecology and Urology by Region (also UHWI): 2002-2006
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Ministry of Health Annual Report 2006
C.14d Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five leading First–Listed Diagnosis: 2002-2006 (10-19 Age Group)
C.14g Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five leading First–Listed Diagnosis: 2002-2006 (65 and over Age Group)
C.14e Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five leading First-Listed Diagnosis: 2002-2006 (20-49 Age Group)
C.14h Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Ten leading First-Listed Diagnosis: 2002-2006
C.14f Percentage Inpatients Discharged from Public Hospitals and UHWI per 10,000 Population by Five Leading First-Listed Diagnosis: 2002-2006 (50-64 Age Group)
VII
D.
Ministry of Health, Hospitals by Region, Parish, Type Bed Complement and Services
E.
Regional Health Authorities
Ministry of Health Annual Report 2006
TABLE OF CONTENT PAGE Acknowledgement
x
CHAPTER 1:
COUNTRY PROFILE 1.1 Geography and Government 1.2 Demographic 1.3 Social
1 1 2 3
CHAPTER 2:
THE HEALTH SYSTEM 2.1 Vision Statements 2.2 Mission 2.3 Strategic Policy Outcomes 2.4 Strategic Objectives 2.5 Organisation and Management 2.6 Regulatory Framework 2.6.1 Legislative Calendar 2.6.2 Pharmaceuticals and Medical Devices 2.6.3 Pesticides Control Authority
6 6 6 6 7 7 24 24 26 28
CHAPTER 3:
RESOURCES FOR THE HEALTH SECTOR 3.1 Financing 3.1.1 Budgetary Allocation 3.1.2 User Fees 3.1.3 External Funding 3.2 Maintenance and Infrastructure 3.3 Human Resource 3.4 Essential Drugs
32 32 32 33 34 35 36 38
CHAPTER 4:
HEALTH SERVICE PROVISION AND UTILISATION
40
CHAPTER 5:
HEALTH STATUS AND WELLBEING I 5.1 Health Indicators 5.2 Veterinary Public Health 5.3 Control of Communicable Diseases 5.3.1 Immunization 5.3.2 Notifiable Diseases 5.3.3 HIV/AIDS 5.3.4 Rheumatic Fever Prophylaxis 5.4 Control of Chronic Disease 5.4.1 Asthma 5.4.2 Cancer 5.4.3 Cardiovascular Disease 5.4.4 Diabetes 5.4.5 Other Monitored Diseases
53 53 54 59 59 61 66 72 72 72 73 74 75 76
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Ministry of Health Annual Report 2006
5.5
CHAPTER 6:
CHAPTER 7:
Reproductive Health 5.5.1 Mother to Child Transmission 5.5.2 Postnatal Services 5.5.3 Other Obstetric Services 5.5.4 Urological Services 5.5.5 Family Planning Services 5.5.6 Intranatal Services 5.5.7 Adolescent Health
77 78 80 81 82 84 85 88
HEALTH STATUS AND WELLBEING II 6.1 Mental Health and Substance Abuse 6.2 Emergency Care 6.2.1 Emergency Medical Services 6.2.2 MOH/Jamaica Defence Force CASEVAC Service 6.2.3 Emergency and Disaster Management 6.3 Accident and Injuries 6.4 Inpatients 6.4.1 Health of Population Groups 6.5 Mortality 6.6 Child Welfare 6.7 Child and Adolescent Mental Health
92 92 99 99 100
HEALTH CARE PARTNERS 7.1 Ministry of Health Agencies 7.1.1 Health Corporation Limited 7.1.2 National Family Planning Board 7.1.3 National Health Fund 7.1.4 National Registration Services
124 124 124 124 125 126
7.2 7.3
127 128 128 131 131 132 133 134 135
7.4
Government Agency - Jamaica Social Investment Fund
Non-Government Organisations 7.3.1 RISE Life Management 7.3.2 Diabetes Association of Jamaica 7.3.3 Heart Foundation of Jamaica 7.3.4 Jamaica Association for the Deaf 7.3.5 Jamaica Cancer Society 7.3.6 Jamaica Society for the Blind 7.3.7 Richmond Fellowship, Drug Rehabilitation Centre – Patricia House Private Partners and Sponsors
103 106 116 116 118 118 122
136
CONCLUSION
137
APPENDICES
138
GLOSSARY
192
BIBLIOGRAPHY
195
IX
Ministry of Health Annual Report 2006
ACKNOWLEDGEMENT
The Ministry of Health expresses thanks to the many persons who have helped in the preparation of this report. To the many partners in health care who have always provided data and information for the report, the Ministry reiterates its appreciation.
The interest, involvement and support of team members who despite demanding work schedule and competing priorities, have consistently acted as editors, is highly appreciated.
Thanks to the printers for being accommodating in assisting the Ministry to produce the report.
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Ministry of Health Annual Report 2006
CHAPTER ONE 1.0
COUNTRY PROFILE
1.1
Geography and Government
The Island of Jamaica, with coordinates 18 15N, 77 30W lies south of Cuba and west of Haiti, and is located almost at the center of the Caribbean Sea. With an area of 10,999 square kilometers it is the largest Island in the Commonwealth Caribbean. The Island’s climate is influenced by north and northeast trade winds, which moderate its tropical temperatures. Temperatures remain fairly constant throughout the year. Rainfall peaks during the months of May and October and is minimal in March and June. The most damaging rains are associated with hurricanes, which usually occur within the hurricane season during the months of June to November. The Island’s lush green vegetation can be attributed to its tropical climate. Approximately, two thirds of the Country is made up of mountains and hills. The principal mountain range is the Blue Mountains that peaks at 2,256 meters above sea level and is the highest point on the Island. The Range consists of a group of volcanic hills that runs generally in an east-westerly direction forming the main watershed for rivers and streams.
Other
geographical features include coastal lowlands and the limestone hills of the Cockpit country that harbours sixty percent of Jamaica’s endemic plant species. The Island is divided into three counties and subdivided into fourteen parishes. Its bustling capital city, Kingston, is home to one of the largest natural harbours in the world.
The Jamaican Constitution in 1962 established a Government similar to that of Great Britain, with the Prime Minister serving as head of the Government and the legal and judiciary system based on English Common Law. Executive power is vested in the Cabinet. The Cabinet consists of fourteen ministries and is headed by the Prime Minister. The Legislative Branch or
1
Ministry of Health Annual Report 2006
Parliament
includes
an
appointed
Senate
and
elected
House
of
Representatives and the Judiciary comprises the Supreme Court and the Court of Appeal. Jamaica has four political parties: the ruling People’s National Party, The opposition Jamaica Labour Party, The National Democratic Movement and the United People’s Party. General Elections must be held within five years of the forming of a new government. 1.2
Demographic
The population for Jamaica in the year 2006 was 2,673,816, representing an increase (0.49%) over the previous year’s revised figure of 2,660,647. There were 1,317,302 males and 1,356,514 females, accounting for a sex ratio of 97.1 males per 100 females. The under 5 and 5-9 years old comprised some 485,686 (18.2%) of the Jamaican population. There were 538,921 persons (20.2%) in the 10-19 age group (Figure 1.1). The 20-29 age group represented 16.5 percent (442,095 persons) of the population and the 30-39 age group, 14.7 percent (393,869). The 40-49 age group comprised 325,123 persons (12.2%), while the 50-59 years age cohort comprised 204,577 (7.7%) and the 60 and over age group consisted of 283,546 (10.6%) persons in the population (Figure 1.1).
2
Ministry of Health Annual Report 2006
70-74
60-64
50-54
40-44
30-34
20-24
10-14
0-4 6.0
5.0
4.0
3.0
2.0
1.0
0.0
0.0
2.0
4.0 Female
Male
Source: Statistical Institute of Jamaica Figure 1.1: Population of Jamaica by age and Gender: 2006
1.3
Social
Education The education level of a country’s population is a key determinant of its health status. Children aged 6-11 years accessing primary education in 2005/06 numbered 318,734, this was a 2.3 percent decline compared to the 326,411 children that were enrolled in primary education institutions in 2004/05 (ESSJ 2006).
The enrolment rate in public primary schools for
2005/06 was 92 percent. Gross enrolment rate for the primary level was 95.5 per cent, with females having a slightly higher rate of enrolment than males, that is, 97.0 percent and 93.9 percent respectively (ESSJ 2006). Secondary school enrolment decreased marginally between 2004/05 and 2005/06 –from 237,283 to 236,241 respectively. (ESSJ 2006)
3
6.0
Ministry of Health Annual Report 2006
Water Access to potable water is an important factor in the prevention of water borne diseases. In this regard the production of potable water by the National Water Commission in 2006, amounted to approximately 294,384 mega litres; 0.7 percent less than the 296,454 mega litres produced in 2005. Water consumption on the other hand, increased by 1.0 percent, from 94,416 mega litres in 2005 to 95,318 mega litres in 2006. (ESSJ 2006)
Electricity In 2006, the Jamaica Public Service (JPS) had a customer base of 564,467, an increase of 2.2 percent (11,892) when compared to the revised figure of 552,575 for 2005.
Residential customers accounted for 89.5 percent
(505,261), which was 2.1 percent more than the revised figure of 494,935 for 2005 (ESSJ 2006).
Labour force
In 2006, there were 1,253,100 persons in the labour force1, an increase of 2.5 percent from the 1,223,100 persons in 2005. The labour force participation rate increased by 0.5 percentage points, from 64.2 percent (2005) to 64.7 percent (2006). The figures continue to show a higher participation rate for males than females; that is, 73.5 percent for the former 1 The labour force as defined by STATIN consists of persons 14 years and over who were “employed in any form of economic activity for one hour or more during the survey reference week” and persons who “although had no job, were looking for work, or wanted and were willing to accept work during the reference week”
4
Ministry of Health Annual Report 2006
compared to 56.3 percent for the latter. The number of persons employed in 2006 was 1,123,700; this was 3.5 percent more than the 1,085,800 persons employed in 2005. Unemployment on the other hand declined, with rates moving from 11.2 percent (2005) to 10.3 percent (2006). In terms of gender, females continued to account for most of the unemployed, with a rate of 14.5 percent, compared to 7.0 percent for males (ESSJ 2006).
5
Ministry of Health Annual Report 2006
CHAPTER 2
2.0
THE HEALTH SYSTEM
The World Health Organization defines a health system as “… the sum total of all organizations, institutions and resources whose primary purpose is to improve health”.2 The Jamaican Health System which comprises public and private organisations and institutions continued to pursue the goals of equity, access and quality in the delivery of services to improve health.
2.1
Vision Statement
Better Health, wellbeing and quality of life for all.
2.2
Mission
Ensure access to a sustainable, responsive and effective health system that is stakeholder focused and facilitates the health, productivity and well being of Jamaicans.
2.3
Strategic Policy Outcomes
The Ministry of Health shall in keeping with the development goals and philosophies of the Government of Jamaica as well as regional and international guidelines, formulate, monitor and evaluate policies, plans and programmes that:
•
Promote well being and health in the society so that the population enjoys sustained optimum levels of health;
•
Ensure health systems that are well managed and sensitive to the health needs of the population;
•
Continue further improvement and modernization of the health system to promote equitable access to appropriate, affordable, effective services.
2The World Health Report 2000, Health Systems: Improving Performance WHO Geneva Switzerland
6
Ministry of Health Annual Report 2006
2.4 •
Strategic Objectives
To promote wellness and protect the health of the Jamaican population thereby reducing the incidence and severity of preventable illness, injury and disability.
•
To improve individual’s health outcome by ensuring access to effective, affordable and equitable health care services.
•
To improve the quality of health care provided to the nation.
•
To improve the Ministry of Health’s ability to prepare for and respond to health threats from manmade/natural disasters.
•
To strengthen the leadership and management of the Ministry of Health to achieve organizational objectives.
2.5
Organization and Management
The Ministry, through its various departments/units/divisions continued to strive for efficiency and effectiveness through various management practices aimed at improving its systems and service delivery:
•
The Health Systems Improvement Unit continued to concentrate the Ministry’s efforts in providing quality, cost effective health services through its responsibility for ongoing examination and integration of issues as they relate to public health sector reform. Several initiatives were pursued in fulfilment of its mandate, including an evaluation of the performance of the Regional Health Authorities against the indicators and targets set out in the 2005-2006 Service Level Agreement with the Ministry under the main areas of: technical–health related indicators; financial; human resource management; operations and maintenance; and quality improvements. The unit is in an advanced discussion with the University Hospital of the West Indies towards completing a SLA for the period 2006/2007 to 2009/2010.
7
Ministry of Health Annual Report 2006
Other strategies included: -
Provision of leadership for the development of a Customer Service Plan for Health facilities within the public sector, for implementation in 07/08 financial year. Key elements of the Plan are: Waiting time; Payment Methods; Catering to Special Clients; Customer Service Training; Recognition of good customer service; Customer Service Representatives; Volunteers; Centres of Excellence; Customer Service Information; Complaints Mechanism; Evaluation.
-
Findings and recommendations from a National Customer Service Survey, which will inform the finalisation of the Customer Service Plan.
-
A draft framework document is being developed for Public/Private partnerships in health care. This was informed by a preliminary workshop held on October 27th 2006 with personnel from the Ministry and Regional Health Authorities. Further consultations will be held with stakeholders in the health sector.
•
Quality assurance activities are designed to ensure and improve the quality of medical care that is provided.3 In this regard the Ministry’s quality assurance programme continued to support delivery and ensure maintenance of accessible quality health service with emphasis on: Infection Control, Emergency Management in Accident and Emergency Departments.
This focus was achieved through training in infection
control at all monitoring visits; the updating of Accident and Emergency Manual; the review and updating of the Health Facilities Infection Control manual and the inclusion of a new chapter on managing medical waste. Additionally, Accident and Emergency staff were trained to do internal auditing of their departments and draft audit tools for Operating Theatre Department and Intensive Care Unit Departments were developed.
•
Human Resource Training activities involved the provision of training opportunities for health professionals in critical priority areas, inter alia: Veterinary Public Health (22); Dental, Maxillo-facial techniques (36);
3 Glossary, commonly used health care terms accessed from http://www.health.state.mn.us/clearinghouse/glossary.htm
8
Ministry of Health Annual Report 2006
Cardio-thoracic physiotherapy (37), Critical Care Nursing (37). There has also
been
the
re-launch
of
the
Nutrition/Dieticians
Programme and the Psychiatric Aide Training.
Internship
Sessions were also
conducted to train managers and supervisors to conduct performance evaluation and on the writing of output focused job descriptions and workplans. A Human Resource Planning data-base has been developed and populated, as well as the development of an integrated data-base template
to
capture
institutional
scholarships.
The
mentorship
programme for Ministry of Health scholarship recipients has been established and maintained.
•
With the signing of a second Memorandum of Understanding between the Government and public sector employees, the Industrial Relations scene remained calm as negotiations were agreed upon and signed between the Government and Heads of Agreements namely, Nurses Association of Jamaica; Midwives Association; Enrolled Nurses Association; Jamaica Medical Doctors Association and Medical Consultants. Workshops were conducted on the secondment of staff from the established Government to the Regional Health Authorities and also on the features surrounding the implementation of Heads of Agreement. There was settlement of five grievances and two disputes.
•
General administrative activities continued to involve the management of the physical resources of the Ministry with a view to cost effectively supporting its corporate strategies.
The following were among those
activities:
-
The operations of the Property Unit have been automated with the procurement of software to facilitate easy access and manipulation of information in relation to the maintenance, rental collections and length of
-
tenure of residents in government-contracted residence.
Security Committees are now in place at the Ministry of Health and at the Southern Regional Health Authority.
9
Ministry of Health Annual Report 2006
-
Transportation activities included:
the
continued
provision
of
transportation for day-to-day operations for the Ministry of Health; procurement of forty (40) new ambulances for the Medical Sector; participation in ICC Cricket World Cup 2007; provision of Medical Coverage/Ambulance Services and transportation of staff and Medical Equipments. Of a total of 1650 requests for transportation assistance received, 1409 were satisfied. Seventy-eight (78) vehicle repairs were carried out.
-
Procurement of goods and services in accordance with government guidelines, continued to facilitate high levels of staff output and to support the Ministry’s overall objective.
The establishment of a
database to accurately record information on procurement activities, have undergone fine-tuning and will be fully implemented in the ensuing year. Other activities involved the processing and clearing of 263 shipments of vaccines, gifts and purchases of reagents made by the National Public Health Laboratory as well as Ten (10) Containers (40ft.) of donated medical and dental items through private brokers for Ministry of Health and regional entities. In addition, 90 voluntary medical
and
dental
groups
carrying
medical
supplies
and
pharmaceuticals were processed at the ports. Various NGO's such as churches, lions clubs and rotary clubs were assisted in the clearance of health related items and approximately 167 queries relating to the Ministry's gift policies were received and answered. The Unit presided over the opening of twenty-six (26) bid tenders involving HIV/AIDS Programme, Health Services Planning and Integration, Policy Planning and Implementation, with assistance under the National Health Fund and Head Office, MOH and placed fifteen (15) advertisements for tenders. The Unit also processed 2,077 purchase orders, 180 files and responded to 193 requests for procurement, for the National Blood Bank, National Public Health Laboratory and other departments to include General Administration.
10
Ministry of Health Annual Report 2006
Technical Assistance was provided to Caribbean Epidemiology Centre in the development of procurement guidelines for member countries.
•
The Dental Health Services contributed to the oral health of Jamaicans through the following activities: -
Continuing education programmes for development and training of dental personnel. A Training Plan has been formulated and various training sessions were implemented: 2 sessions in Ethics and Professionalism in Dentistry; annual workshop for dental supervisors focussed on clinical audit and governance and project writing; Dental Auxiliaries week conference; supported attendance to Organization for Safety and Asepsis Procedures Symposium in Arizona.
-
Launched a one year “Dental Surgery Internship Programme” at the Kingston Public Hospital.
-
Strengthened the Salt Fluoridation Monitoring System through: the establishment of a nine-member multi-sectoral committee to deal with technical regulations; submission of specifications for fluoride meters to PAHO.
-
Conducted 71 (93%) monitoring visits; prepared and submitted relevant reports and non-conformance reports with a view to ensuring the delivery of the oral health programme in accordance with MOH standards.
-
Signed off and printed the Oral Health Services “Policy and Procedure Manuals.
Regional dissemination sessions were conducted to train
179 staff members in the use of the manual. -
Strengthened oral health education and oral health promotion programmes - facilitated material production around five priority areas; conducted annual oral health month with theme: “It’s more than just a smile”.
-
Completed Phase 2 of NHF-funded survey on children in Jamaica to determine:
-
o
the baseline data on oral health in 3-5 and 12 year olds;
o
Decayed, Missing, Filled Teeth (DMFT) index on 12 year olds
o
Fluoride excretion level in urine of 3-5 year olds.
Prepared project and submitted for infrastructural strengthening of 12 dental facilities.
11
Ministry of Health Annual Report 2006
•
Health promotion is the science and art of helping people change their lifestyle to move toward a state of optimal health; a balance of physical, emotional, social, spiritual, and intellectual health. Lifestyle change can be facilitated through a combination of efforts to enhance awareness, change behaviour and create environments that support good health practices.4 In identifying with the importance of this health strategy and in keeping with the international and regional regulations, the Ministry of Health continued to provide health promotion services at the national level through
health
public
policy,
creating
supportive
environments,
improving personal skills, empowering communities and building healthy alliances.
•
Programmes designed to protect the health and nutritional well-being of the nation is one of the health promoting strategies of the Ministry. In 2006, this programme was supported by the following activities:
-
National Breastfeeding Week was observed highlighting the theme for 2006: “Code Watch: 25 years of Protecting Breastfeeding”. The focus was on the main aim of the International Code of Marketing of Breast milk
substitutes
which
is
to
protect,
promote
and
support
breastfeeding so that infants can receive optimal benefit from exclusive breastfeeding for the first 6 months of life with the introduction of appropriate complementary foods and continued breastfeeding up to two (2) years and beyond. The number of persons breastfeeding exclusively increased in some parishes, though the number of women engaged in exclusive breastfeeding declined nationally.
In an effort to improve the
nutrition of infants and young children 10,000 copies of each of the three brochures in the Eat Right Series for Infants and Young Child Feeding were printed and disseminated to all Regions, as well as to some private maternity facilities. 4 Michael O'Donnell, editor of the American Journal of Health Promotion accessed from http://www.healthpromotionjournal.com/
12
Ministry of Health Annual Report 2006
-
School Feeding programme for early childhood institutions was piloted in St. Mary involving 24 schools. The specific objectives of the programme were to: reduce the cost of nutritious meals, especially for poorer children; improve the accessibility of nutritious meals for all children; reduce the availability of food with poor nutritional content especially in schools.
National roll-out is proposed for September
2007.
-
Nutrition/Healthy Lifestyle activities included: o
Facilitating presentations at various facilities in regard to the Workplace Wellness programmes.
o
Caribbean Nutrition Day was observed in St. Ann under the theme: “Healthy Eating and Active Living – small changes make a difference”.
Over 300 students, teachers, clinic attendees were
encouraged to walk as a means of physical activity and increase consumption of fruits and vegetables. o
Nutrition education was promoted through: -
airing of a number of programmes in the electronic media and articles published in the print media.
-
Various camps – 2 National Youth Service camps in which 600 youths
benefited;
Music
camp
for
80
pre-adolescents;
Cheerleading camp involving 70 students; Teens R Terrific Camp benefiting 50 students; Day camps for 120 children aged 7-12 years old; Change from Within Leadership ‘’camp’ benefiting 80 students and the annual Camp Yellow Bird for children with Diabetes o
Fourth
Annual
Celebrating
Health
Festival
was
held
at
Emancipation Park featuring among others, the Rural Agricultural Development Authority which demonstrated the use of indigenous materials such as Otaheite Apples being used as ‘prunes’. Nutrition formed part of the major display at the festival. o
Participated in the integrated care model pilot for clients with Diabetes.
o
Annual hosting of the Nutrition Promotion Competitions were held: -
National Schools’ Nutrition Quiz co-ordinated by the National
13
Ministry of Health Annual Report 2006
Food and Nutrition Coordinating Committee of Jamaica was conducted in the 6 Education Regions with 41 schools entering, the aim being to challenge students to be advocates for change in reducing the incidence of nutrition-related chronic conditions.
Major sponsorship was received through
Grace Kennedy and Company Limited. -
Caribbean Regional Schools’ Food and Nutrition Competition was conducted via the UWIDEC Facilities of the UWI. The intervention sought to raise the level of awareness of the importance of nutrition to healthy lifestyle and to encourage students to disseminate the valuable information they learn in a competitive but friendly atmosphere.
-
Nutrition Promotion Achievement Competition involved an award to the successful health worker group or community based organisation which documented the winning project or programme that has impacted on the population. Twenty six entries were submitted.
-
Training activities included: o
Infant and young child feeding practices and the Nutritional management of Chronic diseases, to include HIV/AIDS.
Five
hundred and six (506) persons were trained. o
Post graduate nutrition/dietetic Internship programme from which five interns graduated and a further five commenced the 52 weeks programme in October, 2006.
•
Health education involves structured opportunities for learning through some form of communication designed to improve health literacy, including improving knowledge, and developing life skills that are conducive to individual and community health.5 The Health Promotion and Education unit in recognition of this function continued to coordinate and give technical support to the educational programmes of the Ministry of Health. Among the programmes offered for 2006, were: -
High School Cheerleading Initiative in which over 400 students participated islandwide and created projects and presentations which
Adapted from Glossary of Terms used in Health for All series, WHO, GENEVA, 1948 accessed from http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf
5
14
Ministry of Health Annual Report 2006
positively impacted the health of their school. The projects included renovation of bathrooms and cafeteria, painting of walls and backyard gardening.
Presentations included drama, song and poetry on all
areas of healthy lifestyle.
-
Primary School Intervention in which three primary schools upon their request were being closely worked with in terms of guiding healthy lifestyle interventions.
Expectations are to extend the best
practices of these interventions to other schools.
-
The launch of a healthy zone in Hamilton Gardens in keeping with the Ministry’s objective to work with communities to develop safe, green spaces that can be used
for physical activity, recreation and the
facilitation of health interventions.
-
Summer Camps used to build esteem, teach life skills, and encourage healthy eating habits and responsible sexual behaviour among adolescents were held involving over 100 students and participants who have already brought back messages to their communities.
-
Special Events included involvement in the Jamaica Wellfest, Children’s Expo, Eden Gardens Wellness Expo and Reggae Marathon and Half Marathon Event.
-
Dissemination
of
information
regarding the
prevention of the
associated dangers with disasters and diseases, e.g. Malaria outbreak, involved the printing of over 300,000 educational materials including flyers, posters and brochures and distributed on plazas and high traffic roads and in the affected areas.
•
The objective of the violence and injuries component of the National Strategic Plan for the Promotion of Healthy Lifestyles is to reduce risk behaviours that lead to violence, unintentional injury and suicide. The activities of the unit continued to be guided by its five underpinning strategies. They included the following:
15
Ministry of Health Annual Report 2006
1. Public Policy Violence and Injury Data Under the Jamaica Injury Surveillance System, 2006 data from the Hospital Monthly Statistical Reporting System reports captured by 9 major hospitals showed a 16 percent reduction in Sexual Assault, 54 percent reduction in Gunshot Wounds, and 16 percent reduction in blunt injuries in comparison to 2005.
These surveillance reports are
used to guide the formulation of violence and injury prevention policies as well as to provide strategic level guidance to its multiple partners.
Crime Observatory The Crime Observatory was launched in 2006 under the auspices of the Violence Prevention Alliance (Ministries of Health and National Security) through the Geographic Information System (GIS) Unit of the Ministry of Health. The Crime Observatory constitutes a group of individuals from various organizations who use scientific-driven data to prevent and manage crime and violence in Jamaica.
The project
will be placed under the Peace and Justice Centre of the University of the West Indies and will focus on two police divisions - Kingston Western and Kingston Central. The Observatory’s objectives are to: identify “hot spots” using Geographic Information System (GIS) technology; standardize
the
way crime data is analyzed and
interpreted; overlay data from other agencies with crime data; monitor and evaluate the impact of specific interventions on violence and; provide an inter-sectoral team to assist in the coordination and implementation of crime prevention strategies. 2. Empowering
Communities/Individuals
involved
the
following
programmes:
Parenting Programme The Triple P parenting programme, a “home visiting programme” underwent an evaluation in the Flankers and Mountain View communities. The positive impact on the lives of the 64 families and
16
Ministry of Health Annual Report 2006
adolescents was recorded and over 90 percent felt the community benefited from the project in the following ways: improved problem solving skills, ability to realize when something is wrong, better interaction with children, helped to increase children’s responsibility to parents, improved communication and trust, changed attitude, reduced beating of children, importance of knowing what’s happening in children’s life, talk with children, listen more, better understanding of parenting issues, encourage children to do chores, more patience with children, and increased resolution of sibling conflict.
After-school programme This programme also continued under the “Spanish Town Citizens against Gun Violence” Project in which a cohort (60) of preadolescents and adolescents from the Spanish Town Environs namely: Tawes Pen, Ellerslie, Railroad Lane, Gordon Pen, Rivoli Avenue and De La Vega City participated.
The programme offered
JAMAL training, life skills training, cultural animations and basic computer training skills and is poised to implement the Autoskill Literacy programme. The total reach of the programme stood at 195 at the end of 2006.
Child Resiliency Programme The Pre and Young Adolescent Resiliency Programme is in its second year of operation in collaboration with Hope United Church and the Hope Counselling and Wellness Centre.
Various low income
surrounding communities with demonstrated specific family related problems have been identified in Shady Grove, Mona Commons, Land Lease, Tavern and Kintyre with the latter two being particularly violence-prone. The Resiliency Programme is based on the principle that supportive elements in a child’s life must be put in place in the pre-adolescent period in order for them to be able to successfully navigate the adolescent years. Forty (40) students have been through the programme in 2006, while over 120 participated in two annual summer camps.
17
Ministry of Health Annual Report 2006
3. Creating A Supportive Environment Employment Opportunities – provided under the Healthy Alternative Occupations Project continued to be made available for persons in some inner city communities in KSA. Since the start of the project, 246 persons have been screened, 84 persons were successfully placed in jobs including two persons who were placed overseas in housekeeping positions.
In addition, six persons were referred to
HEART Trust training programmes, 14 have been referred to the computer based literacy programme which is being implemented by MOH.
Community-based Activities included: Peace Month Campaign which saw the strengthening of PALS annual Peace Day to Peace Month with a camaraderie of rival communities working
together
for
peace
with
the
support
of
the
media,
entertainment fraternity, private sector and NGOs. Activities involved the mobilization of communities for sport and cultural activities, peace marches and the culmination of a peace concert that saw over 10,000 individuals crossing boundaries.
Learning for Life Autoskills Programme The computerized reading programme targeting males saw the training of 129 community members and approximately 79 high risk young men that span an age range of 14-25 have been enrolled. There are currently six centres that are registered in the programme, namely,
Eastern
Peace
Centre
(Windward
Road);
Rose
Town
Community Centre (Tobias Street); Kingston High School; PORROT (Rema); Holy Network (Barry Street); Flankers Peace and Justice Centre (Montego Bay).
Sports Intervention Schoolboy
Football
Competition
dubbed “Mentors
for
Violence
Prevention – MVP” in collaboration with ISSA, Pepsi and Jamaica
18
Ministry of Health Annual Report 2006
National Building Society saw 92 coaches participating in the training from DaCosta and Manning Cup MVP summer training programme. “No Violence. One Love” promotional campaign also took place at the Manning and DaCosta Cup football matches which has an estimated reach of over 30,000 persons.
The promotion involved violence
prevention messages via message boards and the use of the Healthy Lifestyle mascot SKIP.
Unity Across Communities Sport Activities & Youth at Risk Residential Retreat – PMI Kingston Through partnership with the Peace Management Initiative the corner league football competitions were held with participants from 16 inner-city communities. Among them were: Browns Town (Dunkirk), Mountain View, Woodford Park, Maxfield and Rockfort.
Since the
football and netball competitions, over 12 ‘Community Dances’ have been held by community residents and persons from rival corners were able to attend those events freely.
Churches Violence Prevention Network Partnership with WPRC saw the Churches Violence Prevention Network organized out of a need for the church to be more engaged within communities towards violence prevention through joint action. The goal is that by mutual support member churches will promote more
effective
communities.
peacemaking The
Network
and
violence
saw
the
reduction
participation
in of
their twelve
denominations with monthly meetings sharing strategies, resources and interventions.
Two youth leadership training workshops were
also held in 2006.
Currently, there is an active membership of 14
churches. Summer Activities Each year the violence prevention team supports and participated in three summer camps and a Photography & Lifeskill Summer Project: •
Area Youth Foundation - The Summer Camp 2006 saw 41 adolescents and young adults from Rose Town, Waltham Park,
19
Ministry of Health Annual Report 2006
Jones Town, and Arnett Gardens as participants of the oneweek summer camps.
•
Youth Resiliency Summer Camp - Over 100 pre and young adolescents age 8-14 yrs participated in the “Don’t fight. Play Right’ Healthy Lifestyle summer camp from Kintyre, Tavern, Land Lease and Shady and the environs of Mona.
•
Mentoring Programme – Coalition in Support of Adolescent Leadership Training(CSALT - The camp was comprised of 4 major high schools throughout Jamaica: Cornwall College in Montego Bay, Marcus Garvey High School, Ocho Rios High School both in St. Ann, and Calabar High school in Kingston. There
were
45
boys
in
attendance
from
30
different
communities, all in the 7th grade and between the ages of 11 and 14.
•
Photography and Lifeskill Summer Project - To Shoot Or Not To Shoot – Click is the Answer’ - Nineteen (19) adolescents from Mountain View, Trench Town, Dunkirk and Rose Town were selected between the ages of 14-16 years to participate in this summer programme in an effort to empower youth from “marginalized” society.
4. Reorientation Of The Health Services - KPH Tertiary Intervention with an integration of the hospital surveillance system – Prof. Anthony Harriott, Project Coordinator This is a qualitative project designed to further explore the dynamics of violence – particularly interpersonal violence – by (a) isolating the distinguishing attributes of victim recidivists and (b) identifying the predictors of further violence by using the victim as the research subject. The subjects were all the available patients who turned up for treatment at a single hospital in Kingston (the KPH) during the period of the survey. The process was participatory, focus group discussions and interviews were conducted with persons in all communities to
20
Ministry of Health Annual Report 2006
illuminate their understanding of the social dynamics of the community - particularly the violence profile. The community members also indicated interventions that they thought would help to reduce violence in the community. To date, 260 persons have been interviewed.
CAMP Bustamante Project The Child Abuse Mitigation Project at Bustamante Hospital for Children (CAMP Bustamante) continued in collaboration with UNICEF to offer home and school visitations, referrals to CDA and Child Guidance Clinic and after school placements. In 2006, 282 children were screened, 65 percent were cases of physical assault, 28 percent involved sexual abuse and 7 percent were cases of gun shot wounds.
5. Violence
Prevention
Alliance
(VPA)
continued
to
provide
a
systematic and coordinated approach to violence prevention through: provision of support to over 30 organizations; Strategy Level Guidance for over 28 organisations; sharing best practises at 5 national conferences, dissemination of 25 papers, conducting 100 workshop sessions; sharing information, coordination and development of linkages via 12 general membership meetings, website and newsletter for data sharing; the monitoring and evaluation of 25 programmes. The main activity was the launch of the Safe Communities Initiative by the Former Health Minister and endorsed by the Minister of National Security on February 7, 2006. Since then four communities have been working towards a safer community namely; Rose Town, Mountain View, Flankers and Browns Town.
•
Disease Prevention is considered to be action which usually emanates from the health sector dealing with individuals and populations identified as exhibiting identifiable health risk factors, often associated with different risk behaviours.6 In the Caribbean, over the last three decades, lifestyle related risk factors
Glossary of Terms used in Health for All series. WHO, Geneva,1984, accessed from http://www.ldb.org/vl/top/glossary.pdf
6
21
Ministry of Health Annual Report 2006
have significantly influenced the ranking of chronic non-communicable diseases including diabetes, hypertension, cancer and coronary artery disease to become the leading causes of death. This trend has also been experienced in Jamaica.
There is strong evidence that they may be
prevented or delayed by the adoption of healthy lifestyles and in this light the Ministry of Health has instituted programmes to alleviate this disease burden through its Chronic Disease Programme. Activities involved: -
The proposal of using diabetes as an initial model to pilot a team based, data-driven approach based on Wagner’s Chronic Care Model at the Comprehensive Health Centre in which patient data is shared with the patient and all members of the health care team.
-
Monthly diabetes days were conducted at Comprehensive Health Centre to coincide with chronic disease clinic.
Services offered
included: o
Patient education classes on nutrition, cooking demonstrations, food tasting, food displays and information displays.
o
Exercise session, mental health, blood sugar and blood pressure testing, foot care, BMI calculations, referral for clinical and laboratory services.
-
Celebration of Diabetes Month in November – theme – “Health Care for All”. Emphasis on Diabetes and the Disadvantaged and the Vulnerable.
-
The third annual GOJ/JICA/PAHO/CARICOM leadership training programme
for
the
prevention
and
control
of
chronic
non-
communicable disease for Caribbean countries was held. -
Prevention of Cervical Cancer programme was structured to increase the number of women accessing Pap smear screening with a view to reducing mortality due to cervical cancer.
-
A Pap Smear register has been developed to standardise the documentation in clinics, improve data management and facilitate the tracking of women tested positive and verification of outcome.
-
The Pap Smear Programme has been supported by the training of four medical technologists as Cytotechnologists to improve service delivery particularly, in the turn-around time at the National Public Health Laboratory.
-
Protocols for the Management of Diabetes and Hypertension have
22
Ministry of Health Annual Report 2006
been revised and accompanying pocket references have also been prepared and pilot tested among doctors and nurses at the Comprehensive Health Centre. -
Guidelines for the Management of Nicotine use disorders for easy reference has also been drafted.
23
Ministry of Health Annual Report 2006
2.6
The Regulatory Framework
Health Legislation constitutes governments’ interventions by means of rules, in health care markets or systems with a view to safeguarding equity, access and quality of care.
The Government of Jamaica continues to foster an
environment of equity and quality by supporting health goals through legislation, policies and guidelines. 2.6.1 The following represents legislative calendar action as at March 2007: Table 2.1
Legislative Calendar as at March 2007
MOH LEGISLATION Children (Adoption of) (Amendment) Bill
IMPLEMENTING BODY MOH/CDA
The purpose of this Bill is to revise and improve the adoption process. Chemical Weapons Convention Implementation Bill
MOH
The purpose of this Bill is to implement the Convention on the Prohibition of the Development, Production, Stockpiling and use of Chemical Weapons and on their Destruction. Mental Health (Amendment) Bill
MOH
STATUS The Ministry and the Child Development Agency are reviewing the draft Bill that was received from the Office of the Parliamentary Counsel in order to address areas of concern. The Ministry has written to the Office of the Parliamentary Counsel requesting changes to the draft Bill.
The purpose of this Bill is to provide for the treatment of patients by Mental Health Officers without their consent.
The Legislation Committee agreed to recommend to Cabinet that the draft Bill be approved for tabling in Parliament subject to amendments being made.
Food and Drugs (Amendment) Act
The Ministry is reviewing the amendments that are to be made to the draft Bill. The Ministry is to write to the Office of
MOH
The purpose of this Act is to include and define over-the-counter products and five new categories of substances for human consumption.
the Parliamentary Counsel to request changes to the draft Bill.
Nurses and Midwives (Amendment) Bill
MOH
The Ministry has written the Office of the Parliamentary Counsel requesting that changes be made to the draft Bill based on comments received from the Attorney General’s Chambers and the Legal Reform Dept.
MOH
The Ministry and relevant stakeholders have reviewed the draft Bill. It is now to be submitted to the Office of the Parliamentary Counsel.
The purpose of this Bill is to establish a Nurse Practitioner Council to regulate, control and monitor all categories of Nurse Practitioners. Pharmacy (Amendment) Bill – Companion Bill The purpose of this Bill is to authorize the prescribing by Nurse Practitioners of specified drugs from a prescribed list.
24
Ministry of Health Annual Report 2006
Table 2.1
Legislative Calendar as at March 2007 Cont’d
MOH LEGISLATION Radiation (Safety and Control) Bill
IMPLEMENTING BODY MOH
The purpose of this Bill is to regulate the safety of radiation to the users and unsuspecting public.
Registration (Births and Deaths) (Amendment) Bill
MOH/RGD
Public Health (Amendment) Bill
MOH
The purpose of this Bill is to provide measures for the regulation and control of tobacco use. National Registration Bill
The Legislation Committee recommended that the changes be made to the draft Bill and on completion that a joint meeting be held between the Ministry, the Attorney General’s Chambers and the Legal Reform Department. The Office of the Parliamentary Counsel is making the recommended changes to the draft Bill A Cabinet Submission was prepared seeking Cabinet’s approval for the issuing of drafting instructions. The Office of the Parliamentary Counsel was asked to prepare the draft Bill. They requested additional information. The Ministry information.
MOH
The purpose of this Bill is to provide for the compulsory registration of all citizens ordinarily resident in Jamaica.
Professions Supplementary to Medicine (Amendment) Bill
MOH
The purpose of this Bill is to provide for the increase in fines.
Rotterdam Convention on the Informed Consent Bill
STATUS
MOH/PCA
compiling
this
Cabinet approved the proposal to implement the National Registration System. Cabinet also approved the issuing of drafting instructions to amend the draft Bill based on a proposal to implement the National Registration System. A technical team has been meeting to prepare a report on the specific operational and technical details in implementing the NRS. The National Registration Bill and other pieces of legislation will be reviewed upon completion of report. The Legislation Committee requested that the draft Bill be put on hold until all penalties /fines related to the medical and allied professions are reviewed. The Ministry submitted drafting instructions to the Office of the Parliamentary Counsel with regards to amending all penalties /fines in relation to the medical and allied professions. Drafting instructions are being prepared for submission to the Office of the Parliamentary Counsel.
The Purpose of the Bill is to implement the Rotterdam Convention Source: Ministry of Health, Executive Management NB: The Ministry’s Legislative year runs from April 01-March 31 of the following year. CDA - Child Development Agency RGD - Registrar General’s Department. PCA - Pesticides Control Authority
25
is
Ministry of Health Annual Report 2006
2.6.2 Pharmaceuticals and Medical Devices The Standards and Regulations Division continued the registration of pharmaceuticals to ensure the safety, efficacy and quality of their use in Jamaica. In addition to this activity the Division continued its monitoring role of other products such as narcotics, psychotropics and other controlled substances, health foods, cosmetics, medical devices, chemicals and precursor chemicals. During the period under review the initial phase of activities in the project to establish a mechanism for the sound management of chemicals, sponsored by the United Nations Institute for Training and Research (UNITAR) with its partners of international organisations for management of chemicals was completed.
Jamaica’s inclusion in this pilot project marked a significant
step towards the Government of Jamaica meaningfully addressing the matter of chemical safety as it relates to people and the environment. Significant long-term outputs in this regard included: the development of a chemical website which may be viewed at www.chemicalsafety.gov.jm; the establishment of an inter-ministerial co-ordinating mechanism to provide oversight for the sound management of chemicals; inventory and removal of obsolete chemicals which were posing health and environmental risks from the Queens Warehouse.
Relevant activities will continue beyond 2006
around the national priority action areas identified through the five task forces selected. Quality assurance activities involved the launch of the New Competency Standards in March 2006 to guide all training programmes for Practical Nurses. Standardised training curricula were introduced into the relevant schools and plans are underway to re-name these professionals as well as outfit them with new uniforms. The aim is to ensure their competency level to work outside of Jamaica and to engage meaningfully in Health Tourism initiatives. Six quality assurance workshops and other achievements included: the revision and upgrading of the standards for Nursing Homes; the completion of Monitoring procedure for use by Monitoring Officers of Children’s Homes; the completion of auditing activities in relation to the Human Resource
26
Ministry of Health Annual Report 2006
Department of the Ministry of Health. Additionally, plans to introduce an electronic system for drug registration and the approval of permits have been ongoing in collaboration with Fiscal Services Limited under the Jamaica Trade Point Initiative. It is expected that this will improve the efficiency and accountability in regard to permit approval and payment for service and also greatly reduce the potential for fraudulent importation of any products under the Ministry of Health’s regulatory purview. One of the Ministry’s strategies to ensure client satisfaction has been pursued through the Client Complaint Mechanism operated by the Division. Of the 263 complaints received, 102 were resolved and 73 were referred. Complaints are acknowledged within twenty-four hours.
Table 2.2 Regulatory Activities of the Standards and Regulation Division: 2002-2006 Regulatory Activities Acceptance of Dossiers Review of Other Submissions Registration of Drugs Issue of Import Permits Inspections Narcotics Audit Registration of Nursing Homes
2002 366 596 323 13,806 164 28 10
2003 459 716 328 15,298 114 14 5
Years 2004 452 533 473 15,938 325 17 7
2005 479 642 423 17,434 283 15 2
2006* 352 792 265 17,803 162 29 29
Source: Ministry of Health, Standards and Regulation Division * Preliminary data
Clients from the pharmaceutical sector submitted dossiers and samples for the evaluation and registration of drugs or for the determination of importation status.
In 2006, there was a decrease of 127 (25.5%) in the
number of dossiers accepted over 2005 (479).
This was because many
dossiers presented were incomplete in respect of the regulatory requirements and had to be refused. In some instances for example, there was insufficient scientific support in respect of claims made. In some instances applicants experienced difficulty obtaining technical documents without which the dossiers cannot be accepted. (Table 2.2) Seven hundred and ninety two other submissions (non-drug products, such as foods, cosmetics, devices, chemicals) which did not require registration
27
Ministry of Health Annual Report 2006
were reviewed for safety, efficacy and quality. This represented an increase of 150 (18.9%) over 2005 (642). The year 2006 saw the registration of 265 drugs, 82.8 percent of which were approved in an average time of 97 days, the official lead-time being sixty to one hundred and twenty days.
The approval of applications to import
pharmaceuticals, chemicals and specific devices was the dominant activity of the unit. Of the 19,224 applications received, 17,803 were granted permits, 83 percent being registered in the official twenty four hour lead-time. Fewer inspections to ensure good manufacturing and storage practices were conducted for pharmacies, ports of entry and other facilities in 2006 (162) than in 2005 (283) . A total of 29 narcotic audits were conducted to ensure the compliance of pharmacies to appropriate regulations and 29 nursing homes were also registered.
2.6.3 Pesticides Control Authority (PCA) Regulatory Activities The Pesticides Control Authority (PCA) continued to play its role in contributing to the food safety of the nation through the monitoring of pesticide residue guided by the newly drafted regulations for Maximum Residue Levels. Table 2.3 Regulatory Activities of the Pesticides Control Authority: 2003-2006 Regulatory Activities Registration Re-registration License to Manufacture Minor Use Total
2003-2004 18 34 7 5 64
2004-2005 32 21 15 15 83
2005-2006 40 30 11 8 89
Source: Ministry of Health, Pesticides Control Authority
There were 89 pesticide products registered in 2005-2006 which exceeded the highest record of 83 registered last year (Table 2.3). This indicated that
28
Ministry of Health Annual Report 2006
although there were less applications (93) than the last period (123), a higher percentage of applicants met the registration requirements this year (95.7%) than last year (67.5%).
A breakdown of the types of registration
approved are also presented in Table 2.3. Records show that forty five percent of registrations were new products, while 34 percent were re-registered products and 12 percent were locally manufactured. Importation of Pesticides Pesticides totalling two thousand five hundred and twelve tonnes were imported compared to 2,686.2 tonnes last year, representing a six percent decline.
Of the imports by use categories, the agricultural category
accounted for the largest percentage (54%) of products imported, followed by the household sector (30%) as the next largest category.
Less herbicides
were imported in this reporting period while there was more importation of adjuvants, fungicides and insecticides than the previous period. Pest Control Operator Programme Eighteen (18) companies were licensed and 14 commercial Pest Control Operators (PCO’s) were newly certified under the reporting period. Activities to support safe operations were undertaken in the form of the completion and distribution of guidelines to all PCO’s and the participation of 50 PCO’s in a training workshop in relation to termite control.
Training also took
place in regard to private applicators such as farmers. Registration of Premises to Sell Restricted Pesticides Twenty-three premises were registered to sell restricted pesticides covering 11 parishes.
To date, a total of 142 stores registering 95 percent of the
target (150) have been registered.
Monitoring activities have led to a few
farm stores being closed or modified to comply with registration standards. The programme involved the enforcement of regulations on three sellers for breaches pertaining to selling unregistered pesticides and selling without a license.
29
Ministry of Health Annual Report 2006
It is intended to extend the training of sellers to enable them to assist farmers with proper dilution of pesticides.
To this end booklets with
conversions from metric units to units that are familiar to the farmers have been prepared and distributed. Pesticide Residue Surveillance The pesticide residue monitoring committee continued to monitor pesticide residue through samples collected of imported fresh fruit and vegetables at the Kingston wharves and at supermarkets and from small farmers based on requests from consumers and other government agencies. Residue analyses were conducted in collaboration with the University of the West Indies. Efforts are being made to source external resources to expand the laboratory capacity to handle larger number of samples.
Draft
legislation, adopted from the European Union, for maximum residue levels for pesticides on foods were finalised and posted on the website. On being passed into law the new legislation will determine the levels of pesticides that are allowed in imports and on local foods for circulation. Public Awareness Statistics reveal that the main age group of those admitted in public health facilities for pesticide poisoning was less than five years old. In this regard, special focus has been placed on caregivers and farmers during the public awareness campaigns to gain compliance. National and regional interventions were undertaken to improve interagency coordination towards better agrochemicals management for the region. Locally, a public awareness campaign to provide additional information on the PCO certification programme was launched in March through the Jamaica Information Service. A
workshop
under
the
theme
“Sub-Regional
Workshop
on
the
Implementation of Chemical Conventions for English Speaking Caribbean Countries� was held under the co-sponsorship of the United Nations Environment Programme (UNEP) and the Government of Jamaica. The workshop enabled better understanding of the obligations under the
30
Ministry of Health Annual Report 2006
Stockholm Convention in relation to other chemical conventions; facilitated the
exchange
of
experiences
between
countries
on
planning
and
implementing activities in response to the identified obligations as well as discussions pertaining to the existing framework for chemical management and to co-ordinate the implementation of the conventions. The main public awareness campaign was conducted during the Pesticides Awareness Week.
Others included: camp workshops, a sub-regional
consultation on the Rotterdam Convention in which Jamaica was requested to share its experience on ratifying the convention as well as expositions. Linkages were maintained through various organisations and agencies: •
A joint workshop sponsored by the PCA and Environmental Health Unit was conducted to expose commercial pest control operators to mosquito control and public health workers to general rodent and roach control.
•
Under the (Jamaica) Certification of Agricultural Produce Project (CAPP) farm audits and farmer training continued.
Linkages were
formed surrounding the Codex Alimentarius fruit and vegetables and pesticide residue committees with a view to addressing programmes for several food safety responsibilities and promoting national implementation of these standards. •
Termite control has now become an integral part of the building code through consultations with the Bureau of Standards and the Master Builders Association.
•
The University of the West Indies and the Food Storage and Prevention of Infestation Laboratories collaborated to monitor residue levels.
•
As the designated National Authority for the Rotterdam Convention, the PCA continued to maintain its role as a member of the Chemical Review Committee of the Convention.
31
Ministry of Health Annual Report 2006
CHAPTER THREE 3.0
RESOURCES FOR THE HEALTH SECTOR
The resources for the health sector consist of the people who deliver healthcare, the finances, materials, infrastructure, as well as systems that guide, direct and regulate the provision of actions geared at improving the health of the population.7 3.1
Financing
3.1.1 Budgetary Allocation The total Ministry of Health’s expenditure in the 2006/07 fiscal year, was J$17.7 billion, which represented a 27 percent improvement compared to the J$13.9 billion expended in 2005/06. This budget expenditure can be broken down into, J$16.8 billion (recurrent), J$441.0 million (Capital A) and J$528.0 million (Capital B). This increase was mainly the result of increases in salary and travelling allowances granted to various categories of staff in keeping with the Memorandum of Understanding.
Capital A and B, showed mixed results
when compared to the previous year, the former reflected an increase from J$50.0 million (2005/06) to J$441.0 million (2006/07) and the latter, a decrease from J$533.8 million (2005/06) to J$528.0 million (2006/07). The expenditure under Capital A was increased in order to finance activities in preparation for the Cricket World Cup which was hosted between March and April 2007. However, the expenditure under Capital B remained flat which primarily funded activities to combat the spread of HIV/AIDS in Jamaica. The responsibility of the delivery of health services to the population rests with
the
Regional
Health
Authorities
(RHAs).
To
undertake
this
responsibility, they along with the University Hospital of the West Indies (UHWI), are provided with a grant by the MOH for the programme of Health Service Delivery.
7 The World Health Report 2000, Health Systems: Improving Performance WHO Geneva Switzerland
32
Ministry of Health Annual Report 2006
Table 3.1 Distribution of Expenditure of Health Service Delivery by Regional Authorities and UHWI 2005/06 - 2006/07 Regional Health Authority South East North East Western Southern UWHI Total
2006/07 (J$’000m) 6,095.66 1,985.84 2,868.72 2,640.00 3,352.069 16,942.30
2005/06 % 36.0 11.7 16.9 15.6 19.8 100.0
(J$’000m) 5,215.28 1,669.51 2,449.17 2,275.22 1,981.201 13,590.37
% 38.4 12.3 18.0 16.7 14.6 100.0
Source: Jamaica Estimates of Expenditure for year ending March 31, 2006
Health care delivery in the public health sector is mainly the responsibility of the Regional Health Authorities (RHAs) and the UHWI.
In 2006/07, the
recurrent expenditure on this activity J$16,942 million was 24.6 percent more than J$13,590.0 million for 2005/06 (Table 3.1). UHWI is funded 69 percent by Ministry of Health, 23 percent by Ministry of Education and 9 percent by regional governments.
The amount included in Table 3.1
represents only the amount funded by Ministry of Health. 3.1.2 Fee Collection Table 3.2 Fee Collection by Regional Health Authorities for 2005/06 – 2006/07 Regional Health Authority
2006/07
South East
Actual (J$m) 671.98
North East Western Southern Total
223.85 431.81 383.5 1,711.15
%
2005/06
39.3
Projected (J$m) 573.00
13.1 25.2 22.4 100.0
200.04 386.88 289.68 1,449.60
% 39.5
Actual (J$m) 646,280
13.8 26.7 20.0 100.0
209,300 383,198 362,453 1,601,231
% 40.4
Projected (J$m) 573,447
39.5
13.1 23.9 22.6 100.0
200,000 386,901 289,652 1,445,000
13.8 26.7 20.0 100.0
Source: Jamaica Estimates of Expenditure for year ending March 31, 2005 and 2006, and Ministry of Health’s Finance Division
During the period under review, the RHAs collected a total of J$1,711.15 million mainly in user fees, 6.4 percent more than the collection in 2005/06. It was also 15.3 percent more than the projected amount. Total user fees collected was 10.2 percent of the RHAs recurrent expenditure in 2006/07. A regional breakdown can be found in (Table 3.2).
33
%
Ministry of Health Annual Report 2006
3.1.3 External Funding Extra budgetary funding was obtained from foreign governments, bilateral and multilateral development organisations (APPENDIX A: Table A1). These resources are used to fund capital projects focused on programme development such as those targeted at controlling the HIV/AIDS epidemic, Drug Abuse and selected groups, like children and adolescents. Other areas of focus include infrastructural development, for example works at the National Public Health Laboratory. The tangible support they provide come in the form of grants or loans and is usually in partnership with GOJ. The resources flowing from these organisations are accounted for annually in the Ministry’s Capital B budget, which was J$528 million for the period under review. Outlined below is a list of the major agencies providing support during 2006/07: •
Bilateral Agencies -
•
USAID
Multilateral Agencies -
International Bank for Reconstruction and Development
-
UNICEF
-
the Global Fund
-
PAHO/WHO
In addition to the expenditure under Capital B, the Ministry received approximately $163 million in funding from other multilateral agencies. Assistance from external sources also involves "in kind" support, which includes gifts of pharmaceutical items, other medical supplies and technical assistance. The Ministry also received funding from the National Health Fund under their Institutional Benefits Programme to fund projects in the public health system.
The funding covered projects ranging from civil works and the
purchase of medical equipment to Primary Care programmes such as Immunisation. The value of projects approved by the National Health Fund for the 2006/07 was $1.147 billion dollars.
34
Ministry of Health Annual Report 2006
3.2
Maintenance and Infrastructure
Health authorities strive to guarantee safe, effective, and good-quality medical equipment and inputs by embarking on strategies that include renovating or retrofitting those facilities that are in poor working condition or have become obsolete.
This is done with the aim to expand access and
coverage and to improve the health care provided to the population.8 In keeping with its mandate to set standards, monitor and audit operations of the maintenance function within the public health sector and to be more responsive, the Health Facilities Maintenance Unit (HFMU) with the assistance of a consultant, has proposed a new organizational structure of the unit which is currently being reviewed. During 2006, the main focus of activities was the plant and equipment at the common health facilities where over 600 jobs were requested and handled on an emergency basis.
Activities involved the development of
detailed preventative maintenance programmes for the major equipment assigned to the National Public Health Laboratory (NPHL), the National Blood Transfusion Services (NBTS), Dental Auxiliary School (DAS) and the Inservice Education Centre. commence in 2007.
Implementation of these programmes will
Additionally, planned maintenance contracts were
negotiated for the maintenance of the air conditioning systems installed at these locations. It is expected that the implementation of these contracts will lead to improved performance and gradual reduction in the operating costs of these units. Other activities included: ⇒ The commencement of the auditing and monitoring of the main items of equipment related to diagnostics and treatment functions in all the Type A and Type B hospitals. ⇒ Conducting scheduled audits of the maintenance function of all major items of equipment in the common health facilities.
PAHO: Annual Report of the Director: Advancing the People’s Health, Chapter 5, Health Systems and Services Development, p83
8
35
Ministry of Health Annual Report 2006
3.3
Human Resources
The Ministry endeavoured to address the shortage experienced in the nursing cadre by placing the following categories of health professionals who were trained by the Ministry: 192 Registered Nurses; 30 Midwives; 73 Enrolled Assistant Nurses; 50 Interns; 31 Locum Interns 31; 70 Senior House Officers; 8 Radiographers; 7 Dentists; 4 Pharmacists. A total of 157 staff members (excluding those of the RHAs) were appointed and promoted and 197 requests for retirement were processed. All staff in the Registered Nursing Group was transferred to the Regional Health Authorities as of September 2006 and all other groups of health workers as well as managerial, administrative, support and ancillary staff were transferred as of January 2007. Some communication strategies have been developed with a view to widening the human resource pool.
They included the creation of informational
brochures on careers in Health; the erection of Careers in Health booths at major human resource conferences; and the participation in career expositions at secondary, tertiary and professional levels. Table 3.3 Training of Professional and Auxiliary Nurses: 2005-2006 Course Registered Nurse Enrolled Assistant Nurse Direct Entry Midwives Post-basic Midwives Psychiatric Nursing: - Registered Nurse - Enrolled Assistant Nurse Accident and Emergency Critical Care Public Health Nurse Nurse Anaesthetist Nurse Practitioner
Intake 2005 2006 366 471 44 57 39 43 66 60 24 15 1 17 15 8 6
15 20 5 17 20 7 5
Graduates 2005 2006 275 228 45 88 30 64 62 23 1 15 12 7 11
15 4 17 12 4
Length of Course 3 years 18 months 24 months 1 year 6 months 4 months 6 months 1 year 2 years 32 months 2 years
Source: Ministry of Health, Nursing Services
There was an increase of 105 (22.3%) in the enrolment of students in the Registered Nurse Programme for 2006 (471) up from 366 for 2005. A similar trend was noted for enrolment in the Enrolled Assistant Nurse Programme where there was a twenty two point eight percent increase (13) up from 44 in
36
Ministry of Health Annual Report 2006
2005 to 57 and 49 percent rise in graduates (13) up from 45 to 88. For the Direct Entry Midwives programme 43 new students enrolled; there were no graduates recorded from this batch. The post-basic programme had 60 new enrolees and 62 graduates. Psychiatric nursing had a total intake of 35 persons with 15 Registered Nurses graduating. The Accident and Emergency Programme received five persons while 17 enrolled in Critical Care with one and 17 graduating respectively.
Since
September 2006 the Operating Theatre and Critical Care Courses at the University Hospital of the West Indies has reduced to six months. Twelve (12) graduates and 20 enrolees were recorded from the Public Health Nurse training.
There were seven enrolees for the Nurse Anaesthetist
Programme and no graduates. The Nurse Practitioner Programme had 80 percent graduates as five persons were trained and four completed successfully. Table 3.4 Proportion of RHA Recurrent Expenditure Allocated to Human Resource ($000,000): 2006/07 Human Resource Cost
Regional Health Authority
Recurrent Expenditure
Salary
South East
6,095.66
4,457.22
303.24
4,760.46
North East Western Southern Total
1,985.84 2,868.72 2,640.00 13,590.23
1,468.42 2,075.62 1,928.31 9,929.57
133.13 164.75 168.88 770.01
1,601.55 2,240.37 2,097.19 10,699.58
Travelling
Total
Human Resource Cost as a % of Recurrent Expenditure 78.09 80.65 78.10 79.43 78.72
Source: Calculated from Data from the MOH’s Finance Division
Human resource accounts for the largest portion of the Ministry’s recurrent cost, however, the bulk of the staff is located in the RHAs. In this regard, human resource cost as a proportion of their total expenditure averaged 78.7 percent, in 2006/07. The actual expenditure for human resource for the period under review was J$10,699 million (Table 3.4).
37
Ministry of Health Annual Report 2006
3.4
Essential Drugs
Ensuring access to and availability of essential drugs and vaccines at low cost, their rational use, and their quality and safety are a major goal for WHO. The Ministry of Health, therefore, uses the market expertise of the Health Corporation Limited to source and procure drugs and medical sundries for the public sector facilities. The company had to concentrate its efforts on purchasing vital items due to cash flow constraints experienced during the year. Preparations were in place to establish a new Drug Serv pharmacy in Santa Cruz, however, after inspection the Pharmacy Council reported that minor modifications were required. The opening will take place in the next fiscal period. The total number of operational Drug Serv pharmacies is nine (9). Table 3.5 Utilisation of Pharmaceutical Services in Public Hospitals and PHC Facilities: 2004-2006 Year 2004- Total - Hospital - PHC 2005#- Total - Hospital - PHC 2006*- Total - Hospital - PHC
Number of Clients
Items Prescribed
Items Dispensed
677,052 523,206 153,846 645,692 492,083 153,609 682,203 514,095 168,108
1,856,863 1,409,936 446,927 1,809,576 1,375,209 434,367 1,956,832 1,477,443 479,389
1,388,989 1,077,712 293,940 1,409,530 1,101,927 307,603 1,549,031 1,174,199 374,832
Items Dispensed as a Percentage of Items Prescribed 74.8
77.9
79.2
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
The total number of clients using public sector pharmacies increased from 645,692 in 2005 to 682,203 in 2006. Additionally, the number of items prescribed and dispensed increased from 1,809,576 (2005) to 1,956,832 (2006) and from 1,409,530 (2005) to 1,549,031 (2006) respectively. Thus, approximately 79.2 percent of pharmaceutical items prescribed were dispensed by government hospitals and primary health care facilities islandwide (Table 3.5). At the public hospital level in the year 2006, there were 514,095 clients utilizing pharmacy services and 1,477,443 items were prescribed. The total items dispensed at hospitals were 1,174,199.
In the primary health care
setting, client utilization of pharmacies increased from 153,609 (2005) to
38
Ministry of Health Annual Report 2006
168,109 (2006). There were also increases between 2005 and 2006 in the number of items prescribed as well as dispensed (Table 3.5). During 2006, the number of patients utilizing pharmaceutical services within the regions ranged from 118,548 (Southern Region) to 253,369 (South East Region). The number of items prescribed was between 332,202 (Southern Region) and 730,069 (South East Region), while the number of items dispensed was between 267,326 (Southern Region) and 581,726 (South East Region) (APPENDIX A: TABLE A.2).
39
Ministry of Health Annual Report 2006
CHAPTER FOUR
4.0
HEALTH SERVICE PROVISION AND UTILISATION
Individuals may opt for either private or public health care or both. The choice is based on, but not limited to, factors such as distance to the facility, availability and cost of transportation, diversity of services offered, perceived quality of care, opening hours, the severity of illness and the cost of the service as well as access to health insurance. Services in the Jamaican health care delivery system are provided through the four Regional Health Authorities by the Ministry’s 23 hospitals; the University Hospital of the West Indies; and 322 health centres.
Table 4.1 Total Health Centre and Curative Visits: 2002-2006 Year 2002 2003 2004 2005# 2006*
Health Total 1,543,905 1,586,630 1,535,530 1,514,415 1,525,680
Centre Visits Male Female 468,562 1,075,343 480,635 1,105,995 463,592 1,071,938 459,889 1,054,526 464,017 1,061,663
Curative Visits Total Male Female 680,231 232,395 447,836 695,125 232,605 462,520 669,398 220,390 449,008 654,658 217,683 436,975 677,435 226,942 450,493
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data
Total visits to health centres in 2006 were 1,525,680, a marginal increase of 0.7 percent when compared to the previous year. As is the general trend, females
dominated
visits
to
health
centres,
which
accounted
for
approximately 70 percent (1,061,663) of total visits (Table 4.1). Curative visits comprised the largest service provided by health centres and totalled 677,435 (44.4%) in 2006.
This represented an increase of 3.5
percent when compared to 2005. Female visits were almost twice that of males, which were 450,493 and 226,942 respectively (Table 4.1). Of the four Regional Health Authorities (RHAs), the South East region had the highest number (613,808) of health centre visits for the period under review.
This represented approximately 40 percent of the total visits.
(APPENDIX B: TABLE B.1)
40
Ministry of Health Annual Report 2006
The Southern region had the second highest visits to health centre during 2006. There were 352,460 visits to primary health care facilities in this region, which represented 23 percent of total visits. (APPENDIX B: Table B.1) There were 290,666 visits to health centres in the Western region and 268,746 in the North East region. These visits represented 19 percent and 18 percent of the total health centre visits, respectively. (APPENDIX B: TABLE B.1)
Table 4.2 Attendance and Source of Referral to Public Casualty Departments:2002-2006 Total Receiving Care
Total Referral
REFERRAL BY SOURCE
Year
Total Visits
2002
695,239
680,784
636,211
553,030
11,629
13,262
14,620
7,111
36,559
2003
746,844
727,977
693,048
611,667
11,951
13,692
13,582
7,505
34,651
2004
775,727
758,835
714,447
633,777
12,672
12,882
11,755
7,304
36,057
2005#
694,354
682,009
638,830
558,312
11,811
11,388
11,353
7,469
38,497
2006*
715,707
702,783
661,835
581,905
12,010
12,292
11,694
7,301
36,633
Self
Private Doctor
Health Centre
Police
Other Hospital
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data
In 2006, a total of 715,707 visits were made to public hospitals’ Casualty Departments.
This figure represented a 3.1 percent increase from the
previous year’s total of 694,354 (Table 4.2). A total of 702,783 persons received care in 2006, an increase of 3.0 percent when compared to the previous year’s total of 682,009. Total referrals to casualty departments also increased from 638,830 to 661,835 between 2005 and 2006 respectively; an increase of 3.6 percent (Table 4.2). Self-referrals continue to be the main source of entry to Public Casualty Departments with 581,905 cases in 2006, up from 558,312 in 2005, representing an increase of approximately 4.2 percent (Table 4.2). For the Regions, self-referrals as a percentage of total referrals range between 78.5 for the North East and 93.0 for the Western. (APPENDIX B: TABLE B.2)
41
Other
Ministry of Health Annual Report 2006
Table 4.3 Utilisation of Outpatient Specialty Clinics in Public Facilities: 2002-2006 Year
Number of Clinics
2002 2003
Number of Cases Total
New
14,925
487,692
88,133
15,637
500,628
91,083
2004
17,154
594,709
100,429
2005#
16,904
494,752
94,956
2006*
15,611
483,426
93,455
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data
As the public health sector continued its drive to meet the health care needs of the population, 15,611 specialist clinics were held throughout the island in 2006. This represented a decrease of 7.6 percent from the previous year’s figure of 16,904. A declining trend has been evidenced since 2004 (Table 4.3). The total number of cases seen at outpatient specialty clinics decreased by 2.3 percent (from 494,752 to 483,426); additionally, the number of new cases decreased by 1.6 percent (from 94,956 to 93,455) (Table 4.3). In 2006, the South East Region saw the highest number of clients for outpatient specialty clinics – 201,259, followed by the Western Region with 95,989. The University Hospital of the West Indies saw 89,036 clients, while the Southern saw 63,818 clients and the North East Region saw the least amount with 34,921 clients (APPENDIX B: TABLE B.3). Table 4.4 Utilisation of Radiography Services in Public Hospitals: 2002-2006 Number of Clients
Year
Number of Exams
Total
Inpatient
Outpatient
2002
208,694
197,137
44,156
152,981
2003
245,936
223,898
49,198
174,700
2004
264,336
225,991
47,357
178,634
2005#
243,667
211,405
46,378
165,018
2006*
261,688
216,936
45,022
171,914
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data
42
Ministry of Health Annual Report 2006
The radiography units in the public sector perform examinations such as xrays, ultrasound and echocardiograms. During 2006, 261,688 examinations on 216,936 clients were conducted. These figures represented increases of 7.4 percent and 2.6 percent over the previous year’s figures of 243,667 and 211,405 respectively (Table 4.4). The South East conducted the most X-Ray examinations in 2006, with 108,184. The Southern and Western region did 57,972 and 53,210 examinations respectively. The North East region had the least X-Ray examinations performed (42,322) (APPENDIX B: TABLE B.4). Table 4.5 Use of X-Ray Films: 2002-2006 2002 Region
Used
Jamaica SERHA
279,651 128,398
Rejected 26,462 12,074
NERHA 44,556 4,105 WRHA 64,590 8,395 SRHA 42,107 1,888 Source: Ministry of Health, * Preliminary data
2003 Used 314,345 139,701
Rejected 30,648 11,645
2004 Used 315,508 124,652
48,527 3,341 56,950 69,257 11,603 73,834 56,860 4,059 60,072 Planning and Evaluation Branch #Revised data
Rejected 35,605 16,022 3,280 13,578 2,725
2005#
2006*
285,010 103,684
Rejected 40,094 23,794
297,288 117,577
Rejected 31,050 10,044
57,547 69,433 54,346
2,700 11,335 2,265
59,468 69,750 50,493
2,908 14,783 3,313
Used
Used
In 2006, the total number of X-Ray films used in government hospitals island wide totalled 297,288 with 31,050 (10.4%) rejected (Table 4.5). In terms of usage, the South East Region accounted for 117,577, the highest regional count, while the Southern Region on the other hand accounted for the lowest with 50,493 (Table 4.5).
Utilisation of Public Laboratory Services Public health laboratories are linked to every sector of the public health infrastructure as a basic part of the public health delivery system.9 The National Public Health Laboratory has the mandate for the provision of timely, reliable laboratory services for clinical diagnosis and patient
9 Promoting Health in the Americas – Annual Report of the Director, 2001, Chapter 4, Health Services and Systems Development, PAHO, Pan American Sanitary Bureau, Washington D.C.
43
Ministry of Health Annual Report 2006
management, public health surveillance and interventions. To improve its ability to fulfill its mandate, the NPHL embarked on a number of capacity building activities; modernisation of the Laboratory Management Services; installation of
a Laboratory Information System; continuous quality
improvement and human resource development.
Routine Clinical Diagnoses The Laboratory continued to provide clinical laboratory services: •
for the main public tertiary hospital – Kingston Public Hospital
•
as the main reference laboratory for all public sector laboratories.
Services included 24 hour emergency coverage.
Modernisation of Laboratory The first phase has been completed with the identification of core functions and strategic objectives and the completion of prior options review. During the interim before the next phase, areas identified for improvement such as customer service training of staff and the development of a preventive maintenance plan has been tackled.
Laboratory Information System Infrastructural changes such as uninterruptible power supply and wide area network have been completed to support the system.
This facilitated
connections between the National Public Health Laboratory, National Blood Transfusion, the Ministry of Health, Kingston Public Hospital, Victoria Jubilee Hospital, the Comprehensive Health Centre and the National Council on Drug Abuse.
Specifications for the system were developed, tender
processes completed and vendor selected.
Continuous Quality Improvement Training has been completed in Laboratory Operations and Quality Management under the strengthening of Medical Laboratories in the Caribbean – CARICOM/European Union funded programme managed by CAREC. In addition, a significant portion of the implementation of a Quality Management System has been completed according to the International Standards IO/IEC 17025 and 15189.
Quality Manuals and most
departmental Standard Operating Procedures have been completed and
44
Ministry of Health Annual Report 2006
where appropriate have been signed-off by the relevant authorising bodies. Various proficiency programmes were participated in and a number of internal and external audits were completed with the Laboratory showing continued improvement.
Human Resource Development A number of technical persons were trained in various laboratory areas such as assessment for laboratory accreditation. For the future, attempts will be made to overcome the challenges that were encountered such as repairing of the incinerator to facilitate the Waste Management
Programme
and
the
development
of
a
full
preventive
maintenance programme to offset equipment downtime. Table 4.6 Utilisation of Public Laboratory Services by Examinations Done: 2002–2006 Year
Total
2002 2003 2004 2005# 2006*
1,619,562 1,801,442 1,884,915 2,004,054 1,968,832
Chemistry 734,009 817,554 803,425 925,619 917,415
Haemat ology 754,753 859,482 948,828 924,253 870,782
Examinations Done Microbiology Histology TB Other 1,144 47,597 4,666 1,232 40,810 5,644 1,427 47,940 5,173 1,241 54,933 6,476 916 58,123 5,179
Source: Ministry of Health, Planning and Evaluation Branch
* Preliminary data
Urinalysis 14,029 17,439 16,673 15,456 13,262 #Revised data
In 2006, there were 1,968,832 tests conducted in government hospital laboratories, representing a decline of 1.8 percent in comparison to the previous year. In keeping with the trend of previous years, the Chemistry (917,415 - 46.6%) and Haematology (870,782 - 44.2%) Departments performed the bulk of tests (Table 4.6). Of the total 1,968,832 laboratory examinations performed and reported in the Hospital Monthly Statistical Report (HMSR), the highest number was done in the Western Region, with 731,472 representing 37.2 percent of the total number of tests performed; followed by the Southern Region with 626,166 (31.8%). The total number of examinations performed in the North East Region was 396,604 and 214,590 in the South East. (APPENDIX B: TABLE B.5).
45
Other 82,514 59,281 61,449 76,076 103,155
Ministry of Health Annual Report 2006
Utilisation of Blood Transfusion Services (NBTS) Blood transfusions are used daily to treat various medical conditions that will not respond to any other therapy. Because the permanent availability of safe blood and blood products in health facilities is essential, the technical and operative capability of transfusion services must be strengthened.10 The Blood Transfusion Services sought to increase donor inflows by: scientifically organizing donor recruitment and retention; broadening and strengthening its partnerships.
The Services hoped to continue renovations
and improvements of the blood donor centres and the laboratory information system and improve on customer and general service with continued awareness and sensitization being offered to the public.
Additionally,
continued education for staff and enactment of legislation governing the NBTS were among the objectives for 2006.
These objectives were not fully achieved; however there have been some important positives. Taking lessons from the previous year, there were no frequent public appeals for blood donation.
It was decided to focus on
outreach to various interest groups in order to augment blood inflows step by step.
Table 4.7 Utilisation of Blood Transfusion Services: 2002–2006
2002
27,488
Blood Requested From KPH/VJH Only 29,999
21,693
306,730
2003
26,092
30,485
10,489
2004
23,600
27,319
13,476
332,743(+) 212,655
2005
22,155
19,000
13,611
290,009
2006*
23,018
24,000
14,000
n/a
Year
Blood Collected
Source: National Public Health Laboratory * Preliminary data (+) Revised
Components Prepared (Units)
Laboratory Tests
n/a = not available
The target for 2006 was 2,100 units per month or no less than 25,000 units for the year. interim target.
A collection of 23,018 units was made, falling short of the This represents a 3.9 percent reduction in the number of
10 Promoting Health in the Americas – Annual Report of the Director, 2001, Chapter 4, Health Services and Systems Development, PAHO, Pan American Sanitary Bureau, Washington D.C.
46
Ministry of Health Annual Report 2006
units collected the previous year (Table 4.7). In terms of requests for blood and blood products we continue to see a marked imbalance. Approximately, 24,000 units of blood were requested and only 14,014 (58.8%) were supplied, indicating that achieving the target is an uphill task that requires an acceptable marketing strategy that aims at educating our population about voluntary blood donations and making it a habit rather than just a crisis replacement. Alliances with different interest groups continued to be forged from which sponsorships in cash and kind were received and used to offset the costs of promotion and preparation for numerous mobile sessions.
Three major
mobile sessions were held: Emancipation Park, Digicel and Devon House. Additionally, collections made from the University of the West Indies mobiles which have now been put on the University’s calendar have consistently yielded in excess of 200 units per session. Other alliances have been forged with CARIMAC in terms of an agreement to undertake the marketing programme over the next five years. PAHO also continued to give invaluable support to the blood programme and gave advice, co-sponsored events and participated in continued education. Among its activities, the Organization sponsored the Annual World Blood Donor Day Celebrations and sponsored one blood bank personnel to the X International Colloquium on Voluntary Blood Transfusion in Chile. Under the National HIV/STI Programme, the NBTS received funding for: the procurement of hardware and software in relation to the laboratory information system; training and workshop activities, the provision of equipment, reagents and staff for the use of Polymerase Chain Reaction (PCR) in the screening of blood. Two pilot studies were conducted on the feasibility of the PCR. The NBTS continued to screen the blood collected for the following infectious markers: HIV, HBsAg, HCV, HTLV1 and Syphilis in accordance with the requirements of the World Health Organisation.
The prevalence of all
markers remained steady over the past five years excepting syphilis which recorded a two point three percent (2.3%) prevalence for 2004 and 2005 and
47
Ministry of Health Annual Report 2006
dropped to 0.63 percent in 2006. However, this may be due to long turnaround time of confirmation tests and inadequate system of updating figures on a regular basis. Policy matters were undertaken in the usual manner by the National Blood Advisory Committee as it met on a quarterly basis to discuss and advise on policy issues.
Final drafts of the National Policy on Blood and the
Legislation governing the National Blood Transfusion Services are being completed by a subcommittee.
Additionally, editing of a short document
“Guidelines to Transfusion-Jamaica� has commenced. Audit investigations by the chief internal Auditor of the Ministry were conducted to review the recording systems of the NBTS in face of public reports that replacement receipts were being sold at the blood bank. The individuals involved were dismissed and the recommendations emanating from the audit report are being implemented. Expectations for 2007 will focus on improved voluntary blood donations through the new partnerships, as well as the completion and publication of policy documents and improved physical and personnel resources. Table 4.8 Utilisation of Physical Therapy Services in Public Hospitals: 2002-2006 Year 2002 2003 2004 2005# 2006*
Total Number of Clients Total Inpatient Outpatient 28,124 11,021 17,103 29,573 11,223 18,350 27,130 10,703 16,427 28,045 11,877 16,168 25,914 10,261 15,653
Total Number of Treatments Total Inpatient Outpatient 325,854 116,563 209,291 352,796 122,155 230,641 296,621 102,763 193,858 242,300 92,642 149,658 257,377 85,823 171,554
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data
During 2006, the utilisation of public physical therapy services decreased in the number of clients seen compared to the previous year. The number of clients decreased by 7.6 percent, from 28,045 (2005) to 25,914 (2006). However, for the same period, there was an increase in the number of treatments from 242,300 in 2005 to 257,377 in 2006 (6.2%) (Table 4.8).
48
Ministry of Health Annual Report 2006
The South East Region had the largest number of clients utilizing physical therapy services in public hospitals, 8,032. The total number of treatments given was also highest in the South East region with 91,065. The UHWI saw 6,556 clients
in
2006,
while
36,551 treatments
were
administered
(APPENDIX B: TABLE B.6). Table 4.9 Discharge Rates Per 10,000 Population for Public Hospitals and UHWI by Age: 2002-2006 Age Groups (years)
2002
2003
2004
2005#
2006*
<1 1-4 5-9 10-19 20-49 50-64 65+
2,047 430.6 175.6 312.8 580.2 440.0 841.3
2,174.8 471.9 179.6 304.3 558.8 447.9 884.6
5,730.8 434.9 160.0 303.2 570.1 472.3 923.0
6658.0 416.7 183.9 301.7 558.1 413.7 851.3
4645.8 381.1 138.0 244.5 375.5 398.0 772.3
Year
Source: Ministry of Health, Planning and Evaluation Branch
* Preliminary data
In 2006, discharge rates for public hospitals in the under one (babies discharged after hospitalisation for illness) and over 65 years age groups were 4,645.8 and 772.3 per 10,000 population respectively. The discharge rates for these two age groups remained the highest over the 2002-2006 period, while for the same period the lowest discharge rates were among the 5-9 age group (Table 4.9). Table 4.10 Discharges, Average Length of Stay and Bed Occupancy: 2002-2006 173,614 179,322
Average Length of Stay 6.9 6.4
Percent Bed Occupancy 79.8 65.9
2004 2005#
181,983 178,001
6.8 6.3
66.8 66.7
2006*
172,697
6.4
65.9
Year
Discharges
2002 2003
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
During year 2006, total discharges decreased to 172,697 from 178,001 in 2005, a 3.0 percent decrease. The average length of stay for patients in all
49
Ministry of Health Annual Report 2006
government hospitals in 2006 was 6.4 days with a 65.9 percent bed occupancy rate (Table 4.10) The regions with the largest number of discharges were the South East (70,260) and Southern (31,809). The average length of stay for patients in the South East Region was 8.4 days and 4.4 days for patients in the Western Region. The discharges at UHWI totalled 16,159 with an average length of stay of 6.4 days and a bed occupancy rate of 67.6 percent. (APPENDIX B: Table B.7) Table 4.11 Surgery Workload in Public Hospitals: 2002-2006 Year
Total**
2002 2003 2004 2005# 2006*
47,803 52,860 50,238 46,090 52,074
Elective No. % 21,926 45.9 21,975 57.0 21,295 42.4 20,055 43.5 25,817 49.5
Surgery Emergency No. % 14,082 29.5 16,555 31.3 16,808 33.5 15,099 32.8 16,039 30.9
Day No. 11,795 14,330 12,135 10,936 10,218
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data ** Excludes minor operations (outpatients)
% 24.7 27.1 24.2 23.7 19.6
Minor Operations (Out-patients) 5,855 12,073 15,599 16,092 18,989
(+) Revised data
A total of 52,074 operations were done in public hospitals in 2006, an increase of 13.0 percent over the previous yearâ&#x20AC;&#x2122;s figure of 46,090 (Table 4.11). Of the total number of surgeries performed in 2006, electives (first in rank) represented 49.5 percent while emergencies (second in rank) represented 30.9 percent (Table 4.11). There were a total of 17,714 operations performed in the South East Region; the Western Region had 9,150, the Southern Region 9,073 and the North East with 5,132. (APPENDIX B: TABLE B.8) The region with the highest percentage of elective surgery performed was North East Region (52.7%). The highest percentage of emergency operations was done in the South East Region, which accounted for 43.9 percent of the total operations performed.
The University Hospital of the West Indies
(UHWI) accounted for 11,005 operations in 2006 with electives representing 69.6 percent and emergency 15.1 percent. (APPENDIX B: TABLE B.8)
50
Ministry of Health Annual Report 2006
Table 4.12 Utilisation of Rehabilitative Services in Secondary Care: 2002-2006 Year 2002 2003 2004 2005# 2006*
Bed Complement 63 55 55 55 55
Average Length of Stay 77.0 86.0 78.9 80.9 167.1
Turnover Rate 2.2 2.2 1.9 2.3 1.2
Bed Occupancy 88.1 101.2 97.6 91.4 80.1
Admission
Discharge
Inpatient Days
148 120 105 119 83
141 120 105 127 66
20,357 20,369 19,562 18,350 10,638
Outpatient Clinic Clients No. New Total 62 316 1,181 61 364 1,060 61 332 1,017 55 296 954 41 230 2,255
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, average bed complement at Sir John Golding Rehabilitation totalled 55 with average length of stay per patient being 167.1 days.
The total
discharges for the year was 66 while the number of clients at outpatient clinics held was 2,255 of which 230 were new patients (Table 4.12).
Table 4.13 Oral Health Visits to Primary Care Facilities: 2004-2006 Age (Years) < 10 10 - 14 15-39 40+ Total Male Female Male Female Male Female Male Female Male Female 2004 181,052 81,296 99,756 28,782 30,564 19,861 22,860 22,485 32,602 10,168 13,730 2005# 171,193 75,502 95,691 24,984 27,078 19,232 22,603 21,341 32,124 9,945 13,886 2006* 169,131 74,132 94,999 24,545 27,001 18,113 21,256 21,120 31,831 10,354 14,911 Year
Dental Visits
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
The number of dental visits made to government health centres island-wide in the year 2006 indicated a decline of 1.2 percent when compared to the previous year. Declines were also noted in the pattern of gender utilization, females continued to be the major users (Table 4.13). In relation to visits by age, females within the 15-39 age cohort continued to be the largest clientele. In 2006, for the same age cohort, a total of 31,831 females utilized the oral health services at Primary Care facilities. The 40 and over age group had the least number of visits for both male (10,354) and female (14,911) during the year (Table 4.13).
51
Ministry of Health Annual Report 2006
The South East region had the most dental visits to governmentsâ&#x20AC;&#x2122; health centres island-wide, totalling 71,602, followed by the Southern region (46,623), the North East region (26,812) and finally the Western region (24,094) (APPENDIX B: TABLE B.9). In 2006, majority of the clients in the South East and Western regions were children under 10 years of age, while for the North East and Southern regions, majority of the clients were between the 15-39 age group (APPENDIX B: TABLE B.9). Table 4.14 Home Visits: 2002-2006 Year 2002 2003 2004 2005# 2006*
Total 357,720 359,461 333,145 286,482 294,594
Home Visits Maternal Child Health No. % No. % 31,987 8.9 175,739 49.1 8.5 174,416 48.5 30,448 27,301 24,231 22,542
8.2 8.5 7.7
159,834 138,280 134,470
50.0 48.3 45.6
Other No. % 149,99 42.0 154,597 43.0 146,010 43.8 123,971 43.2 137,582 46.7
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
A home visit in the primary health care system is a very important function, as it serves to promote good health in the family. In addition, it also acts as a mechanism to detect and deal with disease in the home. The total home visit for the year 2006 was 294,594. This represented an increase of 2.8 percent of the previous year. Home visits made by health professionals for child health services represented 45.6 percent of the total home visits while 7.7 percent were for maternal health services (Table 4.14). Of the four regions, the South East region had the largest number of home visits (116,724). Most of the home visits were for child health services, which ranged between 29.6 percent (Western region) and 53.2 percent (South East region). (APPENDIX B: TABLE B.10)
52
Ministry of Health Annual Report 2006
CHAPTER FIVE 5.0
HEALTH STATUS AND WELLBEING I
In discussing its mission, the Health Ministry has sought to enhance the quality of life of the people and ensure access to adequate health care. With this in mind, a set of indicators (Table 5.1) is used to measure progress. 5.1
Health Indicators
Table 5.1 Health Indicators: 2002-2006 Health Indicators Life Expectancy at Birth (years) Contraceptive Prevalence (percent)* Total Fertility Rate (per woman)* Crude Birth Rate (per 1,000 mean population) Crude Death Rate (per 1,000 mean population) Infant Mortality Rate (per 1,000 live birth) Maternal Mortality Ratio (per 100,000 Live Births)** (hospital based)
2002 74.13 66.0* 2.5
2003 74.13 68.8* 2.5
Years 2004 74.13 69.1* 2.5
2005 69.01* 2.5
2006 69.01* 2.5
19.97
19.3
17.6
17.25
17.04
6.45
6.0
6.3
6.1
5.69
19.9
19.9
19.9
19.9
19.9
106.2**
106.2**
106.2**
94.8***
94.8***
Source: Statistical Institute of Jamaica, * Reproductive Health Survey 1997, 2002, ** Access to Care and Maternal Mortality in Jamaican Hospitals 1993-1995 *** Surviving Pregnancy in Jamaica – Changing Epidemiology and Challenges in the 21st Century, 20012003 # revised
Life Expectancy at birth within the period 2002-2004 was 74.13, up from 73.25 years between the period 1999 and 2001. Generally, life expectancy in Latin American and Caribbean (LAC) countries increased from 63.4 years in the period 1975–1980 to 72.2 in the period 2000–2005, and the population aged 65 years and older is expected to almost double, from 5.5% in 2000 to 9.8% in 2025.
However, globalization, inclusive of the mass
media, has contributed to an increase in unhealthy lifestyles in LAC countries, such as worsening dietary patterns and lower levels of physical activity. These changes in lifestyle have in turn contributed to the epidemic of Non-Communicable Diseases and injuries.
With regards to the developed world, the United States ranked 17th in average life expectancy on a list of 33 developed nations, with 75.0 years,
53
Ministry of Health Annual Report 2006
while Japan held the lead at 79.1 years (The U.S. Centres for Disease Control). Therefore Jamaica and by extension other Latin American and Caribbean countries are not far behind that of developed nations in terms of life expectancy at birth.
In 2006, contraceptive prevalence was 69.06 percent; total fertility rate was 2.5 children per woman in the reproductive age group and maternal mortality ratio decreased by 11.4 percentage points (Table 5.1). Ministry of Health therefore, endeavours to support and maintain these varying levels of health and well-being through several targeted programmes: -
Environmental Health Veterinary Public Health Control of Communicable Diseases Control of Chronic Diseases Reproductive Health Mental Health Emergency Care Disaster Preparedness
5.2
Veterinary Public Health
Veterinary Public Health (VPH) may be defined as: "The contributions to the physical, mental and social well being of humans through an understanding and application of veterinary science".11 The scope of VPH is clearly multidisciplinary, involving not only veterinarians in both governmental and non-governmental sectors, but also other health professionals and scientists as well as paraprofessionals who treat, control or prevent diseases of animal origin. Despite the many challenges encountered as a result of the emergence and increasing importance of zoonoses, globalization of trade and the lack of financial resources, the Veterinary Public Health Programme of the Ministry of Health continued its contribution towards public health.
11
WHO/FAO, 1999 Conference on Veterinary Public Health
54
Ministry of Health Annual Report 2006
Milk Hygiene During 2006, a total of 14.5 million litres of cowâ&#x20AC;&#x2122;s milk was produced; only 187 milk samples were tested for compliance with the microbiological standards. The specimens originated in six (6) parishes namely: St. Mary, St. Elizabeth, St. Ann, St. Catherine, Kingston and St. Andrew. Although there is a downturn in the Dairy industry it was noted that several parishes have drastically reduced the level of surveillance of milk quality in Jamaica. Forty-eight percent (48%) of samples were raw milk and 54 percent processed milk products, which include plain and flavoured milk. There was an overall improvement in the quality of raw milk with 67 percent meeting the national standard. Processed milk on the other hand - only 58 percent were in compliance with the national standard. Only 20 samples of whole Milk distributed on the local market were tested for adulteration all were in compliance in terms of the fat content. Bovine Brucellosis The scaled down surveillance of this disease in cattle continued in 2006. A total of 417 samples which represents less than one percent of slaughtered cattle were submitted from the public health sector to the Veterinary Diagnostic Laboratories. Of the samples submitted 54 were heamolzed and were not suitable for testing. Only two Brucella Ring Tests were done on bulk milk from two Dairy farms and 254 live Cattle were tested for Brucellosis. All tests had negative results. It should be noted that although no case of Bovine Brucellosis has been diagnosed in Jamaica for many years, Jamaica is still required by International Animal Health codes to continue surveillance of this important Zoonoses. We continue to monitor imported dairy products to ensure that these products are from Brucella free countries.
This programme is to be
expanded to monitor for residues and compliance with national standards. Bovine Tuberculosis Only 256 live animals were tested for tuberculosis all with negative results.
55
Ministry of Health Annual Report 2006
Only one suspicious Post mortem lesion from a Porcine Lung was submitted from St. Thomas for culture during the year but it was not analyzed. The National Public Health Laboratory no longer has the capacity to culture TB samples and this is an area for priority attention during 2007. The Tuberculin testing of live animals was severely affected. Leptospirosis A total of 824 cases of Leptospirosis were notified, however, the majority of these cases had no laboratory results. Of the total, there were 180 Laboratory confirmed cases of Leptospirosis in 2006. The confirmed cases were mainly from KSA, St Catherine St Elizabeth and St Mary. In 2007 the Leptospirosis Surveillance programme will involve closer monitoring and feedback to match the Notifications with the Laboratory results. Four persons died of Leptospirosis in 2006. The Media has been supportive of the programme during the year by means of providing information to the public thus increasing awareness about Leptospirosis when there were heavy rains and flooding in the country.
Avian Influenza In collaboration with USAID, the Director of Veterinary Public Health conducted training of 300 backyard poultry farmers in five parishes Manchester, Clarendon, St Catherine, St Elizabeth and St Thomas - on how to protect their farm from the deadly H5N1 sub-type of the Avian Influenza virus. The opportunity was also used to train the farmers on Sanitary Broiler Processing. The Pan American Health Organisation also sponsored two similar training activities for Backyard Poultry Farmers in Trelawny, where some 110 farmers were in attendance. Similarly, St Mary Poultry Farmers and Public Health staff was trained with sponsorship from the Agricultural Support Services Project in the Ministry Of Agriculture. More seminars are planned for 2007 to target Layer farmers as well as other stakeholders. Veterinary Public Health continues to represent the Ministry of Health on the task force to prepare a national avian influenza plan for Jamaica.
56
Ministry of Health Annual Report 2006
West Nile Virus There was no reported case of hospitalized encephalitis and hence no human samples were submitted for testing during the year.
Twenty (20) Equine
specimens from a survey were submitted to CIRAD (Quadelope) for Westnile Testing, the results of which were negative. Some 34 dead bird cloacal swabs were also tested with negative results. Three Thousand Five Hundred (3500) Culex Quiquifaciato and a few negripalpen collected in December 2004 were tested in 2005 at the New York State Health Department - the West Nile virus was not isolated. No sentinel reports were received from the parishes selected for Westnile surveillance, a reminder will be sent to the relevant parishes. Salmonella Enteritidis Surveillance of Table Eggs A total of 23 egg samples were tested during 2006. It should be noted that each sample contains 25 eggs taken as per the FDA salmonella sampling programme for Salmonella enteritidis.
St. Mary was the only parish in
Jamaica that did monthly surveillance of 3 egg farms in that parish. No farm was positive for SE during the year. The Western Region, during their investigation of foodbourne Disease outbreaks in the region inspected and sampled some 7 farms. Of this, none were found positive for Salmonella Enteritidis. Cornwall Regional Laboratory provided all the Laboratory support for SE testing of Table eggs in Western Jamaica. In 2006 the Egg Farmers Association and the Ministry of Agriculture opened an egg processing plant in Montego Bay. VPH Inspectors participated in hands on training for the facility and developed a monitoring tool for this new establishment. This particular facility will supply hotels with liquid eggs that have been pasteurized, which will go a far way in reducing the incidence of Salmonella infections in Hotels. VPH will continue to monitor this facility. Meat Hygiene In 2006 we continued to provide training for Butchers at the annual Butchers licensing sessions. The maintenance of slaughter facilities to meet public health standards continued to be a challenge in 2006.
57
Ministry of Health Annual Report 2006
An audit was conducted of two major meat processing facilities. A total of 28,451 cattle were slaughtered producing 6,003,311 kg beef during the year. This represented a 43 percent reduction in beef over the previous year. During the year, 134,000 pigs were slaughtered producing 6,003,311 Kilograms of pork; there was a decline in the number of pigs slaughtered. A total of 39,515 goats were slaughtered producing 669,738 kilograms of goat flesh. Only 498 sheep were slaughtered during the year producing 7,936 kilograms of mutton. A total of 247,376 kilograms of meat were condemned as unfit for human consumption. Poultry Inspection continues to be a challenge for public health inspectors. Of the approximately 104 million chickens projected to be slaughtered, only 69 million was done under Public Health Inspection. The shortfall in meat production was met with imports. Veterinary Drug Registration During 2006, five Veterinary products were assessed and submitted to the Ministry of Health for registration.
Training and Public Education Fifty hours of lectures in Meat hygiene were delivered to the UTECH third year Environmental Health students over the period January â&#x20AC;&#x201C; April 2005. Two Public Health Inspectors are at the Guyana School of Agriculture in Guyana pursuing the Veterinary Public Health Diploma. They received full sponsorships from the Government of Jamaica.
58
Ministry of Health Annual Report 2006
Assessment of Port Health Services in Jamaica In compliance with the International Health Regulations 2005 (IHR 2005), the Ministry of Health through the VPH conducted an assessment of the Port Health Services in Jamaica under the Technical Cooperation between countries (TCC) Port Health Surveillance system project. The assessment of the main ports of entry in Jamaica was conducted over the period January 9-11, 15 and 16, 2006. The strategy involved the development of indicators and assessment ratings for the areas of port health surveillance as guided by the IHR (2005).
Seven points of entry were assessed, namely Donald
Sangster and Norman Manley International Airports, Kingston Wharves, Montego Bay Freeport. Ocho Rios, Reynolds and Ken Wright Piers.
The
assessment covered: •
Imported food inspection and local food handling establishments at ports of entry.
•
Vector control at ports including disinsection procedures, treatment of used tyres, etc.
•
General sanitation of port grounds
•
Waste disposal/management
•
Processing of vessels
•
Veterinary quarantine
•
Animal import/export controls
•
Human resource capacity
•
Investigation of reported illnesses and deaths
•
Procedure for import/export of human remains
•
Legislation
•
Rest centres and quarantine facilities
5.3
Control of Communicable Diseases
5.3.1 Immunization Immunization, long recognised as one of the most cost-effective interventions in public health and as a result of its predictably excellent health outcome record, has encouraged governments to incorporate such programmes into their policies.
Jamaica’s Expanded Programme on Immunization (EPI) was
established in 1978.
59
Ministry of Health Annual Report 2006
Expanded Programme on Immunization Objectives The Jamaican government has through the Ministry of Health continued to intensify its efforts in facilitating and ensuring an increase in immunization coverage levels through its Expanded Programme on Immunization.
The
overall objectives undertaken by the Family Health Services for 2006 were to:
⇒ Achieve at least 95% coverage for all antigens under the Expanded Programme on Immunisation (EPI). ⇒ Ensure availability of vaccines/supplies and maintenance of the cold chain. ⇒ Ensure timely and complete reporting of EPI coverage ⇒ Ensure Zero cases of Polio, Measles, Rubella, Neonatal Tetanus, Diphtheria, and Congenital Rubella. ⇒ Re-sensitize and train health care workers, teachers, nursery operators and parents on EPI and the Immunization Law ⇒ Strengthen
the
surveillance
system
from
vaccine-preventable
diseases. Trends in Immunization Coverage Table 5.2 Trends in Immunization Coverage for Jamaica: 2002-2006 Year
BCG
OPV
DPT/DT
Measles/ MMR
Hib
Hep. B
Average Coverage
2002
90.3
85.8
86.5
85.7
n/a
n/a
87.1
2003
89.6
83.8
84.9
78.6
n/a
n/a
84.2
2004
89.6
75.4
81.2
85.9
77.4
76.9
81.1
2005
94.5
83.6
87.5
84.0
88.6
87.2
87.6
2006*
89.9
85.8
85.3
87.2
86.7
85.2
86.7
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data n/a = Hib and Hep B were not introduced until June 2003
There was an overall average of 86.7 percent coverage level which was below the 95.0 percent target.
However, the coverage for Polio (OPV) and
measles/MMR improved compared to the previous year by 2.0 and 3.2 percentage points respectively. Conversely, there was a fall off for BCG, DPT, Hib and Hepatitis B. Although BCG coverage fell considerably (by 4.6%) in
60
Ministry of Health Annual Report 2006
comparison to 2005, it registered the highest coverage overall (Table 5.4). Constraining issues such as limited home visits and outreaches due to lack of budgetary allocation contributed to the overall fall off. There was heavy reliance on donor or external funding to support the programme. Annual data collection for Hib and hepatitis B began in 2004. No case of polio, measles, rubella, CRS, perussis or diphtheria was reported. There was only one case of tetanus found in a vaccinated 10 year old. The target population for the South East, Southern, Western and North East Regions were 20,969; 10,621; 9,577 and 7,070 respectively. South East was the only region that had reached its target for BCG, DPT+DT; HIB and Hepatitis B with 95.97%, 90.21%, 93.40% and 89.99% respectively. (APPENDIX C: TABLE C.1) The efforts to re-sensitize and train in the area of the EPI and Immunization Law has not borne expected results as some schools are still not fully compliant with the Law and children are still being accepted in schools without adequate vaccination. In relation to strengthening the surveillance system the Family Health Services and the Surveillance Unit commenced development of EPI guidelines; developed immunizable disease Kits to be distributed to health centres and hospitals; conducted training in Surveillance including EPI diseases in all parishes. There were adequate supplies for sample collection to support the system. 5.3.2 Notifiable Diseases Outbreaks Foodbourne Most outbreaks were foodbourne related and occurred at schools and hotels. Hotels in the Northeast and Western Regions had small outbreaks while there was a large outbreak in a school in Kingston. The ability of outbreak investigations in hotels to identify the etiology or source of outbreaks as well
61
Ministry of Health Annual Report 2006
as the cooperation and response of hotel management in maintaining recommended practices remain a challenge.
Gastroenteritis The seasonal increase in gastroenteritis that usually occurs in the first quarter of the year was more severe than in the previous two years. For the entire year 44,922 cases were seen at the sentinel sites in comparison to 21,202 in 2005. The gastroenteritis was associated with significant vomiting and during the outbreak 33 deaths were reported.
Most deaths were
investigated and death reviews held in some regions (APPENDIX C: TABLE C.2).
Malaria November 6, 2006 saw the commencement of an outbreak of locally transmitted Plasmodium Falciparum malaria that continued into 2007. The Ministry of Health initiated intensive house-to-house fever surveillance, vector surveillance and control activities, as well as hospital active surveillance and out-patient clinic surveillance. There were 186 confirmed locally acquired cases mainly from Kingston 12, 13 and 14 (APPENDIX C: TABLE
C.2).
All
confirmed cases
received radical
treatment
with
Chloroquine and Primaquine under the supervision of health personnel. Follow up blood smears from treated persons revealed that all had adequate parasitological responses.
There were no confirmed malaria deaths.
In
addition, there were 8 imported cases due to P. Falciparum (6), P. Vivax (1) and a single mixed infection of both P. Falciparum and P. Malariae. Diseases of the Expanded Program of Immunization Acute Flaccid Paralysis (AFP)/ Polio Jamaica continued to maintain surveillance for acute flaccid paralysis in its commitment to preserve its eradication status in regard to poliomyelitis since 1982.
Three cases of polio vaccine derived strain (Sabin Poliovirus
type 2 and 3) were identified over the year.
No associated outbreak was
identified, and laboratories surveillance has been strengthened to ensure reporting of all cases.
62
Ministry of Health Annual Report 2006
Thirteen (13) cases of acute flaccid paralysis (AFP) were reported (APPENDIX C: TABLE C.2) and 10 were under 15 years old, exceeding the target of 8-9 cases under 15 years of age.
All target indicators were met (that is, the
number of cases identified, timely investigation and adequate sample collection).
Fever and Rash (Measles and Rubella) The fever and rash surveillance for measles and rubella was maintained throughout the year.
One hundred and thirty (130) cases were reported
compared to 115 cases from the previous year (APPENDIX C: TABLE C.2). All results were received, none were confirmed as measles or rubella, 22 were Dengue IgM positive and eight were HHV-6 IgM positive.
Diphtheria No case of diphtheria was reported during 2006 (APPENDIX C: TABLE C.2).
Neonatal and Non-neonatal Tetanus There was no neonatal tetanus case (APPENDIX C: TABLE C.2). There were 8 clinically confirmed cases of non-neonatal tetanus with ages ranging from 10-79 years. Three were from St. Catherine and four cases were fatal.
Pertussis-like Syndrome One case of pertussis-like syndrome was reported compared with eight in 2005 (APPENDIX C: TABLE C.2).
Congenital Rubella Syndrome Monitoring for congenital rubella syndrome continued and no case was identified (APPENDIX C: TABLE C.2).
Tuberculosis (Tb) Ninety-eight (98) confirmed cases of Tuberculosis were recorded in 2006, when compared with the 95 cases reported in 2005 (APPENDIX C: TABLE C.2). Forty-five cases (46%) were reported from SERHA consistent with the annual case distribution trends.
63
Ministry of Health Annual Report 2006
Sixteen (24%) of sixty-six (66) confirmed TB cases tested for HIV were TB/HIV co-infected (information for the other confirmed cases were not available at the time of the report). There has been continued increased use of anti-retroviral in co-infected cases and there were six TB deaths.
Hansenâ&#x20AC;&#x2122;s Disease (Leprosy) Six (6) newly confirmed cases of Leprosy were reported in 2006, a decrease when compared with the nine (9) cases reported in 2005 (APPENDIX C: TABLE
C.2).
chemotherapy.
By
December,
twenty
(20)
cases
were
undergoing
The average compliance rate was eighty percent which is
below the 100 percent target.
The prevalence rate of 0.08/10,000
population attained the WHO elimination status.
Typhoid Fever Very low activity was recorded in Typhoid fever surveillance during 2006. No confirmed diagnosis was recorded from the six (6) suspected cases investigated. In 2005, three (3) confirmed cases were reported (APPENDIX C: TABLE C.2).
Accidental Poisoning Five hundred and thirty-eight (538) suspected cases of accidental poisoning were reported to the Surveillance Unit compared to five hundred and twentysix (526) cases in the previous year (APPENDIX C: TABLE C.2). For those that had known causes - bleach, kerosene, pharmaceuticals (medication) and pesticides were the most common agents.
Bleach is consistently the
most common agent implicated in accidental poisoning.
The majority of
cases reported occurred in children under 4 years of age with the vast majority of those children being 2 years or younger.
Dengue Fever Dengue Fever is endemic to Jamaica.
There were 71 confirmed cases of
dengue fever compared with 27 for the previous year (APPENDIX C: TABLE C.2). Eight parishes had cases, and KSA was the parish reporting the most cases (16). Most fever and rash samples submitted for measles and rubella surveillance were screened for dengue.
64
Ministry of Health Annual Report 2006
Meningitis Four hundred and fifty-one (451) suspected cases of meningitis were reported to the Surveillance Unit. This is significantly lower than the 1,085 reported cases for the previous year (2005), when there was an outbreak in the first quarter of the year, but comparable to 579 cases in 2004 (APPENDIX C: Table C.2). There was a decrease in the number of investigation reports received from 249 in 2005 to 145 investigation reports in 2006 and hence a decrease in the final conclusive results for the suspected cases. There have been 13 laboratory confirmed cases of bacterial meningitis. There was also a confirmed case of Angiostrongylus sp. identified in a St. Catherine resident, one case of meningococcal meningitis (that matched the strain responsible for an outbreak in New York) and two confirmed cases of encephalitis reported.
Leptospirosis Two hundred and four (204) confirmed cases of Leptospirosis were reported this year, which represents a decrease of 124 (38%) compared to the 328 reported in 2005 when there was an island-wide outbreak (APPENDIX C: Table C.2).
The number of confirmed cases reported corroborates the
endemic status of the disease in Jamaica. There was no major outbreak but notable numbers of cases were reported from KSA, St Catherine, St Mary and St Elizabeth. Sustained Leptospirosis surveillance and control intervention were enacted in most endemic areas.
Maternal Death Forty-nine (49) maternal deaths were reported for the year; nineteen (43%) were in the age group 30 â&#x20AC;&#x201C; 34 years. The Family Health Division led the development of a strategic plan for Safe Motherhood and launched the first meeting of the National Maternal Mortality Committee. A five year strategic plan was developed with emphasis on surveillance, quality of care/service provision, health promotion, and policy with a view to effect strengthening
65
Ministry of Health Annual Report 2006
and standardization of the maternal mortality investigation and review process at the regional and national levels.
Draft maternal mortality
investigation forms were developed and disseminated. 5.3.3 HIV/AIDS It is estimated that 25,000 persons representing 1.5 percent of the adult population is living with HIV and 5,000 persons have advanced HIV. At the end of June 2006, the cumulative number of AIDS cases in Jamaica was 11,004 and the cumulative number of AIDS deaths was 6,437. In the first six months of 2006, 451 persons with AIDS (256 males and 195 females) and 196 AIDS deaths (117 males and 79 females) were reported compared to 473 persons with AIDS and 305 AIDS deaths in the corresponding period of 2005. AIDS case rates among men continue to exceed AIDS case rates among women although the data suggests that the gender difference may be narrowing. Consistent with previous years, the majority (65%) of all reported AIDS cases are in the 20-44 year old age group, the main risk factors being multiple sex partners, STD history, usage of crack/cocaine and sex with commercial sex workers. There was a small increase in the number of reported paediatric AIDS cases (34 paediatric AIDS cases between January and June 2006 compared to 24 paediatric AIDS cases between January and June 2005). This has contributed to intensified efforts in case findings. In keeping with its commitment to staunch this epidemic the national HIV/AIDS/STI Prevention and Control Programme continued to work within its five priority areas in 2006: 1. Prevention, Knowledge, and Behaviour Change A diverse approach to HIV prevention was undertaken in 2006 as universal access to prevention has been recognized as a means to halt and reverse the HIV epidemic. For example, increased access to condoms was achieved by the establishment of more than 100 non-traditional condom outlets; over 5,000 men who have sex with men (MSM) and 3000 commercial sex workers (CSW) were reached since 2004 through targeted
66
Ministry of Health Annual Report 2006
community interventions and interventions among the most vulnerable populations; increased awareness about HIV issues including prevention, condom skills and risk appraisal occurred in various sectors (education, tourism, labour, national security) by partnering with line ministries. Social marketing continued to be an important tool for increasing public knowledge about HIV and promoting safer behaviour as several media campaigns were developed in 2006 (an adherence campaign, the voluntary blood donor program campaign, an abstinence campaign, VCT expansion of testing and Friends helpline). Numerous materials, including low literacy STI brochures and risk cards, were also distributed. In 2006, PLACE (Priority for Local Aids Control Effort) was rolled out to May Pen and St. James. PLACE is a mapping tool used to identify and characterize the locations where people meet new sexual partners. 2. Expansion of HIV Testing In 2006, increased access to HIV testing was made possible through various initiatives: -
Opt-out testing for STI and ANC clinic attendees
-
Reduced cost and waiting time for HIV testing
-
Introduction of rapid testing and community outreach testing
-
Establishment of decentralized laboratories
-
Development of provider initiated testing protocol for VCT
The success of a nationwide campaign to encourage HIV testing was reinforced on World AIDS Day when 5,522 persons were tested for HIV under the theme â&#x20AC;&#x153;Stop AIDS. Keep the Promise - Get Testedâ&#x20AC;?. 3. Treatment, Care and Support Multidisciplinary teams consisting of physicians and nurses trained in HIV care, adherence counsellors, pharmacists, nutritionists and contact investigators, staff the 18 sites offering public access to ARVs since September 2004. AT the end of November 2006, two thousand and seven hundred (54%) persons with advanced HIV have been placed on ARV
67
Ministry of Health Annual Report 2006
treatment.
The impact of the treatment program is becoming evident
with the decreased number of AIDS deaths in the first half of 2006 compared to the corresponding period of 2005 (196 AIDS deaths from January to June 2006 compared to 305 AIDS deaths from January to June 2005). The successful implementation of the prevention of mother-to-child transmission of HIV (pMTCT) program has resulted in the testing of more than 90 percent of pregnant women in 2006 which was confirmed by a 2005 survey conducted by UNICEF. This survey found that 93 percent of urban women and 87 percent of rural women who were pregnant within the last 2 years report being tested for HIV during pregnancy. Data from the pMTCT program also indicate that at least 65 percent of HIV infected pregnant women and 80 percent of HIV exposed infants received ARV for pMTCT, resulting in a significant decrease in vertical transmission of HIV. Other key activities to improve the treatment care and support of persons living with and affected by HIV and AIDS (PLWHA) in 2006 were: -
Revision of guidelines for management of the HIV infected patient and pMTCT.
-
Development of a comprehensive adherence program with more than 200 counsellors trained, including PLWHA.
-
Development of a home-based care program for persons unable to access treatment sites.
-
Improved laboratory capacity to identify indicators of progression of infection/immune impairment (e.g. CD4 count; viral load and others).
-
Procurement of materials for infectious waste handling.
4. Policy, Advocacy, Legal, and Human Rights Stigma and Discrimination is also being addressed through Advocacy, Policy and Law including providing legal assistance to PLWHAs. Some of the most noteworthy policies developed recently include the National HIV/AIDS Policy, National Plan of Action for Orphans and Other Children made Vulnerable by HIV/AIDS in Jamaica 2003-2006, National Policy for
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Ministry of Health Annual Report 2006
HIV/AIDS Management in Schools, National Workplace Policy on HIV/AIDS, and a National HIV/AIDS policy passed in parliament in 2005. The NAP and its partners continued to strengthen the policy environment through several activities: -
Drafting of a substance abuse and HIV/AIDS position policy.
-
Development and implementation of HIV/AIDS workplace policies in large public and private sector organizations reaching at least 149 schools, 55 private companies and 11 government ministries.
-
Implementation of the HIV/AIDS Management Policy in Schools
-
Engaging
churches
Churches (CCC)
through
and
The
engaging
Caribbean
political
Conference
and
private
of
sector
leadership in discussions regarding policy and legislative issues. -
Capacity building of the Jamaica Network of Seropositives (JN Plus) including hiring of new staff.
-
Development
of
tools
to
capture
reports
of
stigma
and
discrimination against PLWHA -
Mass Media Campaigns to reduce stigma of people living with HIV and AIDS including the launching of the popular â&#x20AC;&#x153;Getting on with Life campaignâ&#x20AC;? on September 15, 2006.
-
Provision of income generating assistance, financial support and back to school grants to PLWHAs and children living with or affected by HIV.
5. Monitoring and Evaluation In 2006, new data collection tools were developed including a second generation surveillance of MSM, which will be conducted in 2007. Several activities were undertaken to strengthen the existing surveillance system including development of databases such as HATS (a web-based HIV/AIDS case reporting system) and an electronic HIV register, convening of the Monitoring Evaluation Reference Group, and drafting of a new Monitoring and Evaluation framework.
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Ministry of Health Annual Report 2006
Table 5.3 Summary of AIDS Cases for Jamaica: 1982â&#x20AC;&#x201C;2006 Year 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Cumulative Total
Total AIDS Cases Male Female Total 1 1 1 1 3 7 20 26 46 46 78 95 137 200 322 307 372 410 539 515 511 580 609 603 696 659 6,783
1 14 10 19 24 65 40 82 135 189 184 237 233 353 388 428 409 461 509 648 527 4,956
3 8 34 36 65 70 143 135 219 335 511 491 609 643 892 903 939 989 1,070 1,112 1,344 1,186 11,739
Total Paediatric AIDS Cases Male Female Total
3 6 4 5 7 4 10 16 28 16 36 36 49 39 37 36 29 42 37 440
1 1 1 4 3 4 4 8 20 11 21 28 19 34 34 26 44 31 32 36 36 398
Source: Ministry of Health, National HIV/STI Control Programme
In 2006 a total of 1,186 new AIDS cases were reported. Of this, 659 were males and 527 females. This represented a decrease of 158 in comparison to the previous yearâ&#x20AC;&#x2122;s figure of 1,344. From the 1,186 new cases reported in 2006, there were 73 paediatric AIDS cases, where 37 were boys and 36 girls. Overall, there was a decrease of 5 cases when compared to the previous year, which saw 78 cases. The cumulative total of AIDS cases in Jamaica (from 1982 to 2006) is 11,739 (Table 5.3).
70
1 1 4 10 7 9 11 12 30 27 49 44 55 70 83 65 81 67 61 78 73 838
Ministry of Health Annual Report 2006
Table 5.4 AIDS Cases by Age and Gender (Cumulative): 2005-2006 Age Group (Years) <1 1-4 5-9 10-19 20-29 30-39 40-49 50-59 60 & Over Unknown Total
Gender Male Female 2005 2006 2005 2006
2005
2006
}246
}306
}246
}267
}528
}573
124 35 906 2,087 1,506 796 321 70 6,091
134 44 973 2,284 1,689 904 373 76 6,783
116 109 1,056 1,465 858 351 187 41 4,429
131 123 1,179 1,632 965 399 218 42 4,956
240 144 1,962 3,552 2,364 1,147 508 111 10,553
265 167 2,152 3,916 2,654 1,303 591 118 11,739
Total
Source: Ministry of Health, National HIV/STI Control Programme
In 2006, the cumulative total for AIDS case by gender is 6,783 (male) and 4,956 (female). The sex ratio was 137 males per 100 females. The 30-39 age group accounted for the largest proportion of AIDS cases with 3,916 (33.4%). This was followed by the 40-49 age group with 2,654 (22.6%). (Table 5.4) Table 5.5 Cumulative AIDS Cases by Parish: 1982 to 2005/2006 Parish St. Catherine Kingston and St. Andrew St. Thomas Portland St. Mary St. Ann Trelawny St. James Hanover Westmoreland St. Elizabeth Manchester Clarendon Parish Unknown Overseas Address
Cumulative Total Number 2005 2006 1,437 1,606 4,214 4,616 195 213 221 238 302 335 637 711 257 298 1,639 1,817 244 283 500 591 229 260 260 298 390 440 18 22 10 11
Rate per 100,000 Population 2005 295.2 637.9 210.6 275.5 267.7 369.0 351.9 902.1 367.8 350.9 157.0 133.5 161.8 0.0 0.0
2006 324.8 697.7 228.6 291.4 295.1 413.4 396.8 992.1 407.5 410.4 173.2 157.2 179.7 0.0 0.0
Source: Ministry of Health, National HIV/STI Control Programme
The top three parishes reporting the largest cumulative total of AIDS cases were Kingston and St. Andrew (4,616); St. James (1,817) and St. Catherine (1,606). The parishes reporting the least number of cumulative cases were
71
Ministry of Health Annual Report 2006
St. Thomas and Portland, with 213 and 238 cases respectively. The rates per 100,000 population for both parishes were 228.6 and 291.4 respectively (Table 5.5). 5.3.4 Rheumatic Fever Rheumatic Fever remains the most common cardiovascular disease in children and young adults. It is an acute inflammatory disease involving joints, skin, the heart and other tissues, usually occurring in children and is caused by the body's immune reaction to a preceding streptococcal infection. The average monthly number of persons given prophylaxis (treatment to prevent or protect against Rheumatic Fever) in the health centres was 771. 5.4
Control of Chronic Diseases
5.4.1 Asthma Asthma is a chronic disease that affects the passage of air in the lungs. Focus is usually placed on children under five years, as it is generally the leading cause of hospital discharge for children in that age cohort.
Table 5.6 Asthma Visits to Public Primary Health Care Facilities, Cases Seen in Accident and Emergency and Hospital Discharge Rates: 2002-2006 Year 2002 2003 2004# 2005 2006*
Primary T 8,580 10,087 10,236 9,930 9,750
Health M 3,656 4,272 4,282 4,185 4,017
Care F 4,924 5,815 5,954 5,745 5,733
Accident T 38,884 36,797 39,896 35,942 35,601
and Emergency M F 20,550 18,334 19,625 17,172 21,350 18,546 19,345 16,597 19,004 16,597
Discharges T M F 2,362 1,275 1,087 1,916 985 931 1,954 1,000 954 2,587 1,417 1,170 1,518 836 682
Source: Ministry of Health, Planning and Evaluation Unit * Preliminary Data # Revised data
Year 2006 recorded a 1.8 percent decline in health centre visits for Asthma between 2005 (9,930) and 2006 (9,750). A total of 35,601 persons were seen for Asthma at public Accident and Emergency departments, of which 53.4 percent (19,004) were males. The total number of hospital discharges for Asthma in 2006 was 1,518 down from 2,587 in 2005 (Table 5.6).
72
Ministry of Health Annual Report 2006
Table 5.7 Cases of Asthma Seen in Public Outpatient Departments: 2003 - 2006 Year 2003 2004 2005 2006*
No. of Clinics 97 105 96 119
Respiratory/Asthma New cases Total Cases 126 1,090 158 1,320 247 1,415 389 1,511
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data
In 2006, there were a total of 1,511 cases of Asthma seen in public outpatient departments, where 119 clinics were held.
The total Asthma
cases for that year represented a 6.8 percent decrease when compared to the 2005 figure of 1,415. Of the Asthma cases in 2006, 389 were new (Table 5.7). 5.4.2 Cancer Cancer, a malignant growth that affect any part of the body, is among the chronic diseases accounting for more than half the deaths annually. However, changes in lifestyle practices such as healthy eating habits, exercise and avoidance of smoking may prove to delay the onset of the disease. Table 5.8 Visits to Public Primary Health Care Facilities, for Cancer Screening per Referral for Abnormal Pap Smear Results and Percentage of Total Discharge: 2004- 2006 Year 2004 2005 2006*
Visits to PHC for Cancer Screening Prostate Breast Cervix Exam Exam. 1,103 76,896 26,571 1,043 73,771 26,843 913 72,014 26,860
Referrals for Abnormal Pap Smear Results <25
25-54
55+
Total
860 574 588
1,698 1,201 1,516
116 94 166
2,674 1,869 2,270
Percentage of Total Discharge Cervical Prostate Cancer Cancer 0.2 0.2 0.2 0.2 0.3 0.2
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
Overall visits to health centres for cancer screening decreased between 2005 and 2006 with the exception of cervical cancer screening where there was an increase of 17 cases in 2006, from 26,843 to 26,860. The total referrals for abnormal Pap smear results in 2006 were 2,270 up from 1,869 in 2005. The largest number referred by age group was 25-54, with 1,516 persons (66.8%) (Table 5.8).
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Ministry of Health Annual Report 2006
Hospital discharges for cervical and prostate cancer represented 0.3 and 0.2 percents respectively of total gender discharges. Table 5.9 Oncology Treatments Administered in Public Hospitals (KPH and CRH) By Type of Treatment and Radiotherapy Clinic Cases: 2002-2006 Year 2002 2003 2004 2005 2006*
Total Treatments 39,927 49,434 40,100 36,116 25,330
Chemotherapy 634 687 507 410 567
Type of Treatment Superficial Radium/ Cobalt Therapy Caesium 37,671 1,385 115 46,169 2,341 98 38,218 1,230 106 35,631 4 71 24,738 0 25
Radiotherapy OP Clinics Other
No.
Total
New
122 139 39 0 0
441 475 459 431 368
9,217 9,983 9,480 7,486 5,541
1,340 1,016 944 865 717
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
There was a decrease in the total Oncology treatment administered, from 36,116 in 2005 to 25,330 in 2006. By extension, there were declines evidenced in most types of treatment given. Cobalt decreased by 10,893 (from 35,631 to 24,738), Superficial Therapy by 4 (the machine was currently not in use), Radium/Caesium by 46 (from 71 to 25) treatments during the period while Chemotherapy increased by 157 (from 410 to 567). (Table 5.9). 5.4.3 Cardiovascular Disease Cardiovascular diseases describe disorders that affect the heart muscle or the blood vessels of the heart. They include any condition that impacts the blood vessels, such as poor circulation due to blockage causing heart attack or stroke. Listed below in Table 5.10 are the more frequent types of cardiovascular diseases. Table 5.10 Cardiovascular Disease visits to Public Primary Health Care Facilities: 2002-2006 Disorder Hypertension Other CV Diseases Chronic Rheumatic Heart Disease
2002 103,913 11,052 4,359
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data
74
PHC Visit 2003 2004 2005 112,943 114,279 119,740 12,876 14,438 14,999 4,133 4,034 4,217
2006* 123,521 14,436 4,223
Ministry of Health Annual Report 2006
In 2006, 123,521 persons visited health centres for Hypertension, 14,436 visited for other cardiovascular diseases and 4,223 for chronic rheumatic heart disease. When compared to the previous year, increases were noted for hypertension
and
chronic
rheumatic
heart
disease
while
other
cardiovascular diseases decreased by 563 cases. (Table 5.10). In 2006, Hypertension represented 1.6 percent of total hospital discharges. Heart diseases and strokes were 0.2 and 1.6 percents respectively of total discharges (Figure 5.1) while Chronic Rheumatic Diseases and Other Cardiovascular Diseases represented 0.1 percent each.
3 2.5 2 1.5 1 0.5 0
2002
2003
2004
2005#
2006*
Hypertension
2.5
2.8
2.8
1.5
1.6
Other CV Diseases
0.02
0.05
0.04
0.01
0.01
Heart Disease
0.02
1.5
1.3
0.2
0.2
Chronic Rheumatic Disease
0.1
0.1
0.1
0.02
0.01
Stroke
1.5
1.5
1.5
1.3
1.6
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data # Revised data
Figure 5.1: Cardiovascular Disease visits to Public Primary Health Care Facilities As % Discharge of Total Hospital Discharges 2002-2006
5.4.4 Diabetes Diabetes, a disease in which the body cannot convert food into energy because of a lack of or inability to use insulin, seriously increases the risk of complications ranging from numbness to loss of vision to coma and also significantly raises the risk for other problems, such as stroke and heart disease. It is especially important to control weight and blood cholesterol with a low-fat, low-cholesterol diet and regular exercise.
75
Ministry of Health Annual Report 2006
Table 5.11 Diabetes Visits to Public Primary Health Care Facilities; Discharge Rates; Leg Ulcers and Amputation due to Diabetes: 2002 -2006 Year 2002 2003 2004 2005 2006*
T
Visits to PHC M F
31,225 30,152 28,907 27,080 25,454
6,989 6,980 6,851 6,381 6,103
Leg Ulcers M F
Percent Discharged
T
3.1 1.6 2.9 2.0 2.2
1,400 675 804 956 1,114
24,236 23,172 22,056 20,699 19,351
606 277 359 452 606
794 398 445 504 508
T
Amputation M F
208 237 172 278 248
114 112 79 125 109
94 115 93 153 139
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data
In 2006, the percentage discharge rate from public hospitals for persons living with diabetes was 2.2, an increase of 0.2 percentage point of the previous yearâ&#x20AC;&#x2122;s figure.
Visits to health centres island-wide for diabetes
totalled 25,454, a decrease of 1,626 when compared to the year 2005. Of this total, there were 19,351 female visits and 6,103 male visits. Leg ulcers increased from 956 to 1,114 between 2005 and 2006 respectively (Table 5.11). 5.4.5 Other Monitored Diseases Table 5.14 shows other diseases that are monitored at the primary health care level. Table 5.12 Visits to Public Primary Health Care Facilities and Discharge as Percentage of Total Hospital Discharges for Other Monitored Diseases: 2002-2006 Disorder
Percentage Discharge of Total Discharges
PHC Visit
2002 2003 2004# 2005* Respiratory Tract 108,342 128,305 121,359 112,588 Infections Skin Diseases 101,834 106,743 99,087 92,681 Musculo- skeletal 44,100 51,854 52,507 48,701 Disorders Gastro- intestinal 20,349 22,014 22,674 21,226 Disorders Diabetes Mellitus and 37,852 40,286 45,328 65,327 Hypertension Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data n.s. = not significant
2006
2002
2003
2004#
2005*
2006
115,701
8.0
8.1
6.3
6.7
7.6
89,009
2.2
2.4
2.0
1.0
1.0
51,854
1.0
1.1
0.9
n.s.
n.s.
22,769
n.s.
n.s.
n.s.
n.s.
n.s.
68,602
3.1
3.1
5.5
3.5
3.8
Respiratory tract infection accounted for 115,701 visits to primary health care facilities, the highest number of visits recorded in 2006. There was a discharge rate of 7.6 percent for the same condition from public hospitals. Visits for skin diseases ranked second highest with a total of 89,009 and discharge rate of 1.0. (Table 5.12)
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Ministry of Health Annual Report 2006
5.5
Reproductive Health
Table 5.13 Antenatal Attendance at Public Sector Facilities: 2002 -2006 Year
Total Visits
2002 2003 2004# 2005 2006*
138,828 137,723 133,839 133,502 131,797
No. of First Antenatal Visits 32,034 30,524 30,014 29,741 29,023
First Attendance
Average Visit per Woman 4.3 4.5 4.5 4.5 4.5
0-15 weeks No. 8,032 7,842 8,161 8,092 8,153
% 24.8 25.7 27.2 27.2 28.1
16-28 weeks No. 20,095 18,805 18,220 17,968 17,569
% 62.7 61.6 60.7 60.4 60.5
29 weeks & over No. % 3,907 12.2 3,877 12.7 3,633 12.1 3,681 12.4 3,301 11.4
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
During the year 2006, the total number of antenatal visits made to public sector facilities was 131,797, representing a slight decrease of 1.3 percent from 2005 (133,502).
Additionally, the number of first antenatal visits
declined by 2.4 percent from 29,741 in 2005 to 29,023 in 2006. Despite the decline reported in visits, the average visit per woman was 4.5, a stable trend evidenced since 2003. A total of 8,153 (28.1%) pregnant women first visited the antenatal clinic at 0-15 weeks; at 16-28 weeks, there were 17,569 (60.5%) first visits and at 29 weeks and over, the number of first attendance was 3,301 (11.4%) (Table 5.13).
Of the four Regional Health Authorities
(RHAs), the South East received the most antenatal visits (50,701) to health centres. In the Southern, there were a total of 32,782 visits followed by the Western and North East with 27,067 and 21,247 visits respectively. (APPENDIX C: TABLE C.4)
77
Ministry of Health Annual Report 2006
In keeping with best practices for immunization of pregnant women, approximately 65.0 percent of these women visiting public antenatal clinics were immunized against Tetanus in 2006, representing a 5.3 percentage point decrease over the previous year (59.7%) (Figure 5.2). 100.00% 80.00% 60.00% 40.00% 20.00% 0.00% Hb<10 gms/dl
2002
2003
2004
2005#
2006*
13.90%
14.20%
13.50%
15.70%
13.80%
Syphilis positive
1.40%
1.60%
0.90%
1.30%
1.10%
Immunized against tetanus
75.50%
76.90%
64.00%
59.70%
65.00%
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
Figure 5.2: Results of Immunization): 2002-2006
Screening
(haemoglobin,
syphilis
and
tetanus
Thirteen point eight percent (13.8%) of the number of pregnant women visiting health centres island-wide had Haemoglobin levels less than 10gms/dl in 2006 while 1.1 percent were Syphilis positive (Figure 5.2) In 2006, at the regional level, the percentage of pregnant women who visited health centre and had test results for Haemoglobin less than 10 gms/dl, ranged between 8.9 percent (Southern) and 15.0 percent (North East). The results for syphilis positive ranged between 0.5 percent (North East) and 2.6 percent (Western). (APPENDIX C: TABLE C.4) Immunization against Tetanus in 2006 ranged between 48.7 percent (Southern) and 95.1 percent (North East). (APPENDIX C: TABLE C.4)
5.5.1 Mother to Child Transmission (pMTCT) The pMTCT programme has been implemented in all major hospitals islandwide and has resulted in the testing of more than 90 percent of pregnant women in 2006 attending public antenatal clinics. This is confirmed by the
78
Ministry of Health Annual Report 2006
2005 MICS conducted by UNICEF which found that 93 percent of urban women and 87 percent of rural women who were pregnant within the last 2 years report being tested for HIV during pregnancy. Similarly, the most recent KABP confirmed that public knowledge of pMTCT is high among women (63%). It is estimated that at least 60% of pregnant women access the public health system and at the end of December 2005, at least 65% of HIV-infected mothers attending public antenatal clinics and 80 percent of HIV exposed infants received ARVs for pMTCT resulting in a significant decrease in vertical transmission of HIV. Data on pMTCT in private sector is not readily available. Other key activities were implemented in 2006 to improve the treatment care and support of HIV-infected mothers, namely: -
Revised guidelines for pMTCT island wide (pMTCT plus) resulting in a significant reduction of maternal to child transmission of HIV were developed and disseminated.
-
Forms for collection of regional pMTCT and other HIV data were designed and implemented.
Table 5.14 HIV Rapid Test Results of ANC and STI Clinic Attendees: 2005-2006 CLINIC Total Tested In STI Clinic Total Tested In ANC Clinic TOTAL
Number tested
Positive
2005
2006
2005
22,725
23,615
1,168
28,914 51,639
29,297 52,912
463 1,631
Source: Ministry of Health, National HIV/STI Prevention and Control Programme
79
2006 1,377 526 1,903
Ministry of Health Annual Report 2006
More women (2.4%) utilised the Rapid Test Programme in 2006 than 2005 and 16.6 percent more tested positive than 2005. For the year 2006, a total 59,912 women were tested in the STI clinics (23,615 â&#x20AC;&#x201C; 44.6%) and ANC clinics (29,297 â&#x20AC;&#x201C; 55.4%). Of the ANC attendees tested, 1.8% persons were positive and of the STI clinic attendees, 5.8 tested positive. (Table 5.14)
5.5.2 Postnatal Services Table 5.15 Postnatal Visits to Public Facilities by Mothers: 2002 -2006
Year 2002 2003 2004# 2005 2006*
Postnatal Visits by Mothers Coverage (as a % of estimated Total visits births) 36,018 69.9 36,530 70.9 34,364 67.4 35,906 74.4 33,344 69.1
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
# Revised
There were 33,344 visits to postnatal clinics island-wide. The figure represents a 7.1 percent decrease from the previous year (35,906).
The
coverage as a percentage of estimated births was 69.1 percent, down by 74.4 percent in 2005. (Table 5.15). There were decreases for postnatal visits in health centres for all the regions in 2006 when compared to 2005.
The visits for postnatal services in the
South East Region decreased from 14,248 in 2005 to 13,189 (7.4%) in 2006 and from 8,709 in 2005 to 7,942 in 2006 (8.8%) in the Southern Region. The Western and North East Regions showed 4.7 and 7.0 percentages decline respectively. In 2006, total visits for the Western Region was 7,185 and for the North East Region it was 5,028. (APPENDIX C: TABLE C.5)
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Ministry of Health Annual Report 2006
5.5.3 Other Obstetric Services Table 5.16 Surgical Interventions in Public Hospitals for Obstetric and Gynaecology Conditions: 2002 -2006 Year 2002 2003# 2004 2005 2006*
Total 8,237 8,636 8,732 8,312 8,132
Obstetrics EmerListed gency 4,426 3,901 4,986 3,650 4,992 3,740 4,795 3,517 4,614 3,518
C-Section Rate Day Minor Total 139 262 658 511 362
0 592 702 879 397
12.7 14.2 14.2 13.8 15.3
5,545 5,524 5,825 5,058 5,738
Gynaecology EmerListed Day gency** 1,591 3,954 845 1,639 3,885 1,080 2,022 3,803 1,425 1,631 3,427 1,507 1,918 3,820 1,831
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data #Revised data ** Includes emergency Tubal ligations
During 2006, data revealed that surgical interventions for obstetric conditions (emergency and listed) totalled 8,132, a 2.2 percent decrease from the previous yearâ&#x20AC;&#x2122;s figure of 8,312. Minor surgeries for obstetric condition stood at 397 and the Caesarean section (C-section) rate was 15.3 percent of mothers who were delivered in public hospitals (Table 5.16). In 2006, there were 3,708 obstetric surgeries (emergency and listed) in the South East Region, while for the North East, Southern and Western Regions there were 887, 1,522 and 2,015 respectively. (APPENDIX C: TABLE C.6) Surgical interventions for Gynaecology in the regions ranged between 615 (Western) and 2,297 (South East). Surgeries at the UHWI for gynaecology conditions totalled 588. (APPENDIX C: TABLE C.6)
81
Minor 279 343 204 412 1,103
Ministry of Health Annual Report 2006
Table 5.17 Utilisation of Public Outpatient Obstetric, Gynaecology Clinics: 2002-2006 Utilisation Year 2002 2003 2004# 2005* 2006
Obstetric No. of Clinics Total Cases 1,144 64,548 1,149 59,362 1,320 60,060 1,097 60,085 1,129 58,387
New 13,266 12,308 14,300 13,643 13,080
Gynaecology No. of Clinics Total Cases 697 28,957 738 29,203 883 30,759 874 30,605 902 32,742
New 5,564 5,367 5,953 5,642 5,442
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
During 2006, the total number of outpatient obstetric clinics held was 1,129 which represented an increase of 32 clinics when compared to the previous year (1,097 clinics). There were a total of 58,387 cases, of which 22.4 percent (13,080) were new. During the same period, 902 clinics for Gynaecology were held, with 32,742 cases and 5,442 new cases (Table 5.17). The total number of outpatient obstetric clinics held in the regions in 2006 ranged between 126 (North East) and 298 (South East).
Data from the
UHWI showed that there were 274 outpatient obstetric clinics held, and 218 gynaecology clinics. (APPENDIX C: TABLE C.7) 5.5.4 Urological Services Of the 16,119 visits made to public health centres in 2006 for diseases of the Urinary Tract, the South East Region accounted for 8,152, the North East Region - 3,284, the Southern Region - 3,104 and the Western Region with the lowest number of visits of 1,579. (APPENDIX C: TABLE C.8) Twenty one thousand, one hundred and fifty (21,150) clients received care at public accident and emergency departments for complaints related to the urinary system.
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Ministry of Health Annual Report 2006
Table 5.18 Surgical Interventions in Public Hospitals for Urology Conditions: 2002 â&#x20AC;&#x201C; 2006 Year
Total 2,625 4,685 5,401 4,257 4,603
2002 2003 2004 2005 2006 *
Urology Emergency Listed 94 787 123 707 233 671 140 614 231 619
Day 129 213 21 135 96
Minor 1,615 3,642 4,286 3,368 3,657
*Preliminary data
Source: Ministry of Health, Planning and Evaluation Branch
The total number of surgical interventions for urology conditions in 2006 was 4,603. The number of minor surgeries increased to 3,657 over the previous year (3,368). (Table 5:18). In 2006, surgical intervention for urology ranged between 15 (Southern Region) and 350 (South East). (APPENDIX C: TABLE C.6) During 2006, a total of 603 urology clinics were held in public hospitals where 20,122 cases were seen. The number of new clients seen in that year was 3,400 (Figure 5.3). 2006*
Year
2005 2004 2003 2002 0
5,000
10,000
15,000
20,000
25,000
2002
2003
2004
2005
2006*
No. of Clinics
449
620
671
600
603
Total Cases
16,510
19,765
19,434
19,661
20,122
New
2,437
2,587
2,843
3,079
3,400
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
Figure 5.3: Utilisation of Outpatient Urology Clinics: 2002-2006
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Ministry of Health Annual Report 2006
The majority of urology clinics were held in the Southern Region (151) while the least number of clinics were held in the North East Region (79). The total cases seen in the Southern and North East Regions were 1,419 and 2,879 respectively. At the University Hospital of the West Indies, 102 clinics were held where 4,527 cases were seen. (APPENDIX C: TABLE C.9) 5.5.5 Family Planning Services During 2005, the National Family Planning Board (NFPB) continued its health promotion and health education activities, through expansion of access to the emergency contraceptive pill as well as to the Reproductive Health information to adolescents and men. Table 5.19 Total Family Planning Visits to Health Centres by Female and Percentage New Female Acceptors: 2004-2006 Year
Total Female Visits
New Acceptors by Age Group 10-19 years 20â&#x20AC;&#x201C;29 years 30 & Over No.
%
No.
%
No.
%
New Acceptors by Method (%) Pill
Injection IUD Condom Other
2004
247,353
25,498
10.3
112,908
45.6
108,947
44.0
26.6
49.1
1.2
22.4
0.4
2005
242,458
24,553
10.1
110,036
45.4
107,869
44.5
26.2
48.2
1.3
23.9
0.3
2006*
241,346
23,911
9.9
107,060
44.4
110,375
45.7
24.9
49.3
1.6
23.3
0.8
Source: Ministry of Health, Planning & Evaluation Branch * Preliminary data
Year 2006 saw a decrease in the total number of female visits for family planning (which includes postnatal acceptors) when compared to the previous year, from 242,458 (2005) to 241,346 (2006). Of the total visits, almost one half (49.3%) accepted the injection method, followed by the pill (24.9%), then condom and IUD with 23.3 percent and 1.6 percent respectively. Most of the new female acceptors were the 30 and over age group (110,375) (Table 5.19). In 2006, the South East Region had the highest number of visits for family planning (103,420).
The Southern had 60,381, Western 41,448 and the
North East Region 36,097. The 20-29 age group had the highest percent of mothers who became new family planning acceptors for all regions except for the Southern (30 and over age group). (APPENDIX C: TABLE C.10a)
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Ministry of Health Annual Report 2006
The injection as a method of contraception was the most popularly used means overall. In the Southern Region this was represented by a percentage of 52.6 followed by the South East Region with 50.9 percent, then the Western and North East Regions with 43.2 and 39.4 percent respectively (APENDIX C: TABLE C.10b). Table 5.20 The Demand for Sterilisation in Public Sector Facilities: 2002â&#x20AC;&#x201C;2006 Year 2002 2003 2004 2005 2006*
Total No. of TL done in Hospital 2,135 2,013 2,774 2,617 2,352
% TL done as day Surgery and Minor Elective 41.6 47.3 56.1 29.5 26.1
Sterilisations Performed at Health Referral to Hospital Centre Total Male Female Total Male Female 771 2 769 182 8 174 573 11 562 121 1 120 585 5 580 123 0 123 524 7 519 85 2 83 371 7 364 91 2 89
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data Tubal ligation includes minor (outpatient) operations
Twenty six point one percent (26.1%) of the tubal ligations done in hospitals were carried out as Day and Minor Elective Surgery.
The 2,352 tubal
ligations done in 2006 demonstrate a 10.1 percent decline from 2005 (Table 5.20). During the year 364 females and only 7 males were referred to hospital for sterilization. At the health centres, a total of 91 persons (2 of which were males), received sterilizations (Table 5.20).
5.5.6. Intranatal Services Plans to guarantee satisfactory child health begins during pregnancy and continues through the intranatal and neonatal periods up to age 6 years. Ninety eight percent (98.2%) of the total births in 2006 were hospital births while 1.8 percent was home births (Figure 5.4).
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Ministry of Health Annual Report 2006
120.0 100.0 80.0 60.0 40.0 20.0 0.0
2002
2003
2004
2005#
2006*
% Home Births (as a % of total births)
2.7
2.6
1.8
2.0
1.8
% Hospital Births (as a % of total births)
97.3
97.4
98.2
98.0
98.2
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
Figure 5.4: Births Occurring in Public Sector Facilities: 2002â&#x20AC;&#x201C;2006
A high of 99.3 percent of total births in the Western Region were hospital births while the Southern Region represented the lowest with 95.4 percent. The highest rate of home births (4.6%) was experienced by the Southern Region while the lowest was recorded in the Western (0.7%) (APPENDIX C: TABLE C.11). Table 5.21 Perinatal, Neonatal and Foetal Mortality Rates: 2002-2006 Year
Perinatal Mortality Rate/1000
Early Neonatal Mortality Rate/1000
Foetal Death Rate/1000
2002
31.1
12.5
18.9
2003
29.5
11.7
18.0
2004#
27.4
10.9
16.8
2005
31.2
12.2
19.2
2006*
28.3
11.6
16.9
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, there were decreases in Perinatal, Neonatal and Foetal Death rates when compared to 2005.
Perinatal Mortality rate decreased by 2.9
percentage point, making it 28.3 per 1,000 births. Early Neonatal Mortality rate decreased by 0.6 percentage point (12.2 in 2005 to 11.6 in 2006). Foetal Death Rate decreased from 19.2 per 1,000 births to 16.9 (Table 5.21).
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Ministry of Health Annual Report 2006
During the year 2006, 13.5 percent of all newborn babies (livebirths) in Public Sector weighed less than 2.5 kilograms and as such are regarded as being below the normal birth weight (Figure 5.5). 16.00% 14.00%
13.50%
12.00% 10.00%
11.40% 9.60%
10.00%
9.60%
8.00% 6.00% 4.00% 2.00% 0.00% 2002
2003
2004
2005#
2006*
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
Figure 5.5: Low Birth Weight Babies (public facilities) as a % of Live Births: 2002-2006
Preliminary data in 2006 revealed that babies visiting government health centers who were exclusively breast-fed represented 43.6 percent while at 12 weeks it was 32.7 percent. (Figure 5.6).
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
Figure 5.6: Exclusive Breast Feeding Status among Babies visiting Public Health Sector Facilities: 2002-2006
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Ministry of Health Annual Report 2006
Table 5.22 Trends in Nutritional Status of Children 0â&#x20AC;&#x201C;35 months Attending Public Health Sector Facilities: 2002-2006
Year
Above Normal
Normal
Moderate
Severe
Male
Female
Total
Male
Female
Total
Male
Female
Total
2002
15,841
100,784
101,266
202,050
2,706
5,636
8,342
92
129
221
2003
15,380
100,926
100,654
201,580
2,693
5,736
8,429
65
110
175
2004#
14,574
97,982
97,503
195,485
2,731
5,359
8,090
54
87
141
2005
14,826
100,557
101,325
201,882
2,178
4,900
7,078
65
102
167
2006*
14,560
97,248
98,049
195,297
2,368
5,233
7,601
93
100
193
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
Year 2006 data revealed 195,297 (89.7%) of all children 0-35 months attending public facilities had normal weight for age.
A total of 14,560
(6.7%) children between 0-35 months were above normal weight for age. Ninety three (93) males and 100 females (0-35 months) were severely under weight. There has been an increase in severe malnutrition (from 167 to 193) between 2005 and 2006 (Table 5.22).
5.5.7 Adolescent Health (10â&#x20AC;&#x201C;19 Age Group) Young Jamaicans (adolescents) are increasingly being exposed to and influenced by varying types of risky behaviours.
These include the
use/abuse of drugs and alcohol among others. Early sexual activities, which ultimately lead to pregnancy, are directly related to the use of these substances.
In this regard, the Ministry of Health continued to foster a
caring, protective and participatory environment supportive of adolescents through its Adolescent Reproductive Health Unit.
Table 5.23 Antenatal Attendance by Pregnant Adolescents at Public Sector Facilities: 2004 - 2006 Year
Total Visits
2004# 2005 2006*
33,593 32,617 32,401
0-15 weeks No. % 2,275 27.9 2,174 26.9 2,300 28.2
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
88
First Attendance 16-28 weeks 29 weeks & over No. % No. % 4,900 26.9 709 19.5 4,640 25.8 746 20.3 4,596 26.2 670 20.3
Ministry of Health Annual Report 2006
Antenatal visits made to health centres by pregnant adolescents in the year 2006 decreased by 216 of the 2005 figure of 32,617.
During 2006, the
adolescent group accounted for 28.2 percent (2,300) of the total antenatal visits during the first trimester, 26.2 percent (4,596) in the second trimester and 20.3 percent (670) in the third trimester (Table 5.23). Thirty-three point two percent (33.2%) of those who visited antenatal clinics and had haemoglobin levels less than 10gms/dl were adolescents. Twentyfive point one percent (25.1%) of those who were immunized against tetanus were adolescents and 18.6 percent of those visiting antenatal clinics who tested positive for syphilis were adolescents. (Figure 5.7). 35.00% 33.20% 30.00%
29.60%
30.0%
23.40%
23.40%
16.90%
17.0%
29.40% 25.50%
25.00%
25.10%
20.00% 18.60% 17.30%
15.00%
10.00%
5.00%
0.00% 2003 Hb<10 gms/dl
2004
2005#
Syphillis positive
2006* Immunized for tetanus
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
Figure 5.7: Results of Screening Pregnant Adolescent Women (haemoglobin, syphilis and tetanus immunization) of first antenatal clients: 2003-2006
In 2006, 15.3 percent of hospital births were to adolescent mothers. Caesarian sections per 100 deliveries in government hospitals were 13.8 percent in 2006 [Figure 5.8].
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Ministry of Health Annual Report 2006
25
20
15
10
5
0
2002
2003
2004
2005
2006
% Hopital Births (as a % of total births)
21.6
14.9
13.8
16.4
15.3
C-Section per 100 Deliveries
11.5
12.7
14.2
14.2
13.8
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
Figure 5.8: 2002-2006
Births Among Adolescents Occurring in Public Sector Facilities:
Table 5.24 Postnatal Visits by Adolescent Mothers to Public Facilities: 2004 - 2006 Year 2004# 2005* 2006
Postnatal Visits by Mothers Coverage (as a Percentage of Total visits estimated births) 7,112 20.7 7,261 20.2 6,716 20.1
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
In 2006, postnatal visits made to health centres islandwide by adolescent mothers accounted for 20.1 percent (6,716) of the total postnatal visits. This represents a 7.5 percent decrease in visits from the previous year (7,261) (Table 5.24).
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Ministry of Health Annual Report 2006
Table 5.25 Number of Adolescent Births at VJH, STH, SAB, CRH and Mandeville Hospitals: 2002-2006 Hospitals Victoria Jubilee Spanish Town St. Annâ&#x20AC;&#x2122;s Bay Cornwall Regional Mandeville
Number of Births by Year 2004 2005
2002
2003
2006
2,017
1,938
1,943
1,777
936
1,346
1,135
1,065
1,187
845
723
791
731
653
610
868
814
749#
776
640
664
864
828
969
815
Source: Ministry of Health, Planning and Evaluation Branch #Revised
There was general decrease in the number of births at the five (5) major hospitals above when compared to the figures in 2005. In 2006, Victoria Jubilee Hospital (VJH) had the highest number (936), and this may be due to the fact that it is the only hospital in Jamaica that caters to maternity needs only. In the year 2006, adolescent births at the Cornwall Regional Hospital totalled 640 followed by births at Mandeville Hospital (815) (Table 5.25).
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Ministry of Health Annual Report 2006
CHAPTER SIX 6.0
HEALTH STATUS AND WELLBEING II
6.1
Mental Health and Substance Abuse
The World Health Organization in defining health as “A state of complete physical, social and mental well-being and not merely the absence of disease or infirmity,” acknowledges the importance of mental health as one of the components of healthy well-being. The Mental Health Unit continued to engage in activities towards meeting its objective in contributing to the well-being of the Jamaican populace: •
Facilitated the implementation of the Mental Health Educational Programme with a view to building awareness and reducing stigma. A Communications Specialist was hired and the programme is funded by the National Health Fund. Activities included the following: -
Conducted a joint conference of 350 participants from Ministry of Health and Jamaica Psychiatric Association
-
Held meetings including a symposium on Sexuality and Mental Health during which 210 participants attended
-
Held outside broadcasts and provided information on services available to adults, adolescents and children and on the related mental health problems regarding these populations.
-
Reproduced and distributed 4500 brochures and pamphlets and organised the appearance of four articles in the print media;
-
Prepared copies of three Visual Aides of the Speaker’s Guide for Maternal and Child Health Clinics, Community Meetings and Chronic Disease Clinics.
-
Distributed three video skits on Schizophrenia, Mental Health, Mental Health and the Work place to the Regional Health Authorities.
•
Improved the ability of the police and correctional officers to handle the mentally ill through appropriate training seminars conducted by the Psychiatrist attached to the Constabulary Service.
•
Continued the early identification of challenges and obstacles to ensure the smooth implementation of the Mental Health Strategic Plan throughout
the
Island.
The
major
92
problem
identified was
the
Ministry of Health Annual Report 2006
unavailability of staff such as Mental Health Officers, Psychologists and Psychiatric Aides. Progress reports were submitted and reviews held. •
Facilitated the implementation of plans for the relocation of services from Bellevue Hospital to the four regions by soliciting feedback from stakeholders through the Regional Steering Committees.
•
Conducted 83.3 percent (25) of the thirty (30) monitoring visits that were targeted. Seventy-six (76) Psychiatric Aides have been trained but only thirteen percent have been employed to the Community Mental Health Programme.
•
Completed the draft Policies and Procedures Manual for the Mental Health Programme and also identified funding for duplication.
•
Conducted sensitisation training sessions in all but the North East Region in the use of protocols for the Management of Mental Health patients in order to standardize treatment of common mental health disorders.
A consultant will be hired to train staff in the North East
Region in 2007. •
Conducted a survey to determine the status of public knowledge, attitude and practices regarding mental disorders.
The findings have been
incorporated in the Mental Health Promotion/Education Programme. •
Evaluated the Drug Court facilities of the Cornwall Regional Hospital and Maxfield Park Health Centre in collaboration with the Ministry of National Security and Justice. Recommendations have been submitted to various stakeholders for comments.
•
Conducted a survey through the National Council on Drug Abuse to determine the incidence and prevalence of mental disorders.
Of the
sample, 19 percent met the criteria for major depressive disorder. Findings revealed that there was a strong relationship between substance use and depression. •
Conducted collaborative meetings in relation to the transfer of the training of Mental Health Officers to the University of the West Indies. The decision was taken to continue the six-month training programme under the Ministry of Health as a pre-requisite entry requirement to the University of the West Indies School of Nursing - Nurse Practitioner Mental Health Programme.
•
Morbidity data from the health authorities revealed that 218 new persons were treated for substance abuse recording a reduction of 6 percent from
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Ministry of Health Annual Report 2006
2005 (233); while there were 94 attempted suicides and 675 persons treated for Major Depressive Disorder.
Reports from the Regions also
indicated that Schizophrenia compliance was: South East – 79.57%; Western – 71.5%; North East – 67% and Southern – 56%. Table 6.1 Admission and Average Length of Stay of Clients Seen in Community Mental Health Clinics by Hospitals: 2005-2006 Hospitals
Male
Bellevue Mandeville Black River May Pen C.R.H St. Ann's Bay Annotto Bay JAMAICA
2005 n/a 38 68 97 243 172 37 655
2006 n/a 39 50 86 210 157 84 626
Admissions Female
Total
2005 n/a 43 28 96 162 150 53 532
2005 n/a 81 96 193 405 322 90 1187
2006 n/a 50 52 86 130 167 113 598
Male 2006 n/a 89 102 172 340 324 197 1224
2005 n/a 9.5 13.1 17.9 17 8 8 73.5
Average Length of Stay (days) Female Total 2006 n/a 9.6 9.6 12.1 21 7 7 11.1
2005 n/a 8.3 6.9 15.7 16 8 8 10.5
2006 n/a 9.6 6.6 24.7 18 7 7 12.2
2005 n/a 17.8 20 33.6 16.5 16 16 20.0
Source: Ministry of Health, Mental Health Services; N/a = reports not available
There was a total of 1,224 patients (626 males and 598 females) admitted for mental health care services in 2006. Cornwall Regional Hospital admitted 340 (210 males and 130 females) followed by St. Ann’s Bay with a total of 324 (157 males and 167 females) (Table 6.1). Table 6.2 Visits to Public Primary Health Care Facilities for Mental Health Problems: 2002-2006 Year 2002 2003# 2004* 2005 2006*
Male 13,995 16,795 18,996 21,897 22,048
Gender Female 15,011 18,090 19,728 22,147 21,862
Total 29,006 34,885 38,724 44,044 43,910
Source: Ministry of Health, Planning and Evaluation Branch
There has been a decrease in the number of visits to primary health care facilities for mental health problems between 2005 and 2006. In 2006 a total of 43,910 visits were made while in 2005 there were 44,044. In 2006, there were 22,046 males visiting the facilities, representing 186 more males than female visits for that year (21,862 female visits were made) (Table 6.2).
94
2006 n/a 19.2 16.2 36.8 39 14 14 23.2
Ministry of Health Annual Report 2006
Table 6.3 Source of Referrals of New Patients to Community Mental Health (CMH) Clinics by Regions: 2005-2006 Source of Referrals Street Court/ Security Forces Hospital Health Centre Medical Officer in Private Practice School Children’s Service Division (CSD) Other Total Source: Ministry of * Preliminary data
JAM. 76
SERHA 44
2005 NERHA 21
WRHA 9
SRHA 2
JAM. 45
SERHA 40
2006 NERHA 4
WRHA 1
SRHA 0
287
86
84
64
53
279
118
103
17
41
1,685 718
412 318
451 135
378 166
444 99
1,839 618
425 271
491 120
506 151
417 76
238
119
32
23
64
257
134
44
16
63
253
31
156
15
51
262
22
162
19
59
46
5
21
10
10
40
5
23
7
5
139 866
384 3,630
99 1,127
147 986
49 769
89 748
453 117 121 58 3,745 1,132 1,011 736 Health, Planning and Evaluation Branch
The major source of referrals to Community Mental Health Clinics were hospitals, 1,839 (50.7%) and Health Centres, 618 (17.0%) (Table 6.3). Table 6.4 Major Diagnoses by Gender and Age of Clients Seen in Public Community Mental Health Clinic: 2004-2006 Diagnoses Schizophrenic/ Psychotic Disorder: 2004 2005 2006 Mood Disorder: 2004 2005 2006 Anxiety Disorder:** 2004 2005 2006 Substance Abuse: 2004 2005 2006
Total
Male
Female
0–9
10–14
15–19
Age 20–34
35–44
45–64
65+
7,703 8,175
4,610 4,880
3,093 3,295
11 1
19 32
169 171
2,295 2,453
2,222 2,334
2,464 2,637
523 547
8,002
4,840
3,162
1
27
195
2,427
2,237
2,595
520
3,493
1,007
2,486
28
116
248
1,052
783
956
310
3,462 3,221
1,031 947
2,431 2,274
26 22
95 97
239 200
1,008 987
806 741
990 925
298 249
498 524 499
132 154 126
366 370 373
13 8 4
25 19 15
52 44 52
152 170 171
96 111 120
112 134 111
48 38 26
808 755 716
771 716 682
37 39 34
0 0 1
8 6 2
109 104 84
480 449 405
144 111 145
58 76 75
9 9 4
168 152 141
578 558 531
4,069 3,245 4,080 3,362 3,990 3,243
3,590 3,837 3,706
890 892 799
TOTAL: 2004 12,502 6,520 5,982 52 2005 12,916 6,781 6,135 95 2006 12,438 6,595 5,843 28 Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data ** One of the four mood disorders
From the total of 12,438 Community Mental Health visits in 2006 mentioned above, 6,595 (53.0%) were males and 5,843 (47.0%) were females.
This
represented an overall decrease of 478 clients compared to the number of clients in 2005 (Table 6.4).
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Ministry of Health Annual Report 2006
The
main
condition
for
which
patients
Schizophrenia/Psychotic Disorder (8,002 clients).
were
treated
was
Of this total, 4,840
(60.5%) were males and 3,162 (39.5 %) were females. The 45-64 age group was mostly affected with this diagnosis. The second leading diagnosis was mood disorders comprising 947 males and 2,274 females.
For this
diagnosis, the 20-34 age group was mostly affected (987 cases).
Table 6.5 Client Movement - Patricia House: 2005-2006
M 109 64
2005 F 0 0
T 109 64
M 77 50
2006 F* 0 0
T 77 50
47 20
0 0
47 20
36 22
0 0
36 22
19
0
19
12
0
12
Client Movement Number of Interviews Number of Admissions Number of Graduates Number of Repeaters Number of Premature Departures (Dropouts)
Source: Richmond Fellowship, Drug Rehabilitation Centre - Patricia House #Revised data * No services were offered for females
The number of admissions to Patricia House again fell below the target of 100 due to the reduction in the demand for residential treatment and rehabilitation for drug abusers. Another contributing factor was the inability to effect the kinds of programmes that would facilitate the attraction and retention of the intended number of clients due to limited financial resources.
Therefore of the 77 persons interviewed, 50 were admitted,
registering 21 percent below those admitted for 2005 (64). Again only males were provided with residential services for the entire year. Dropouts were 7 (29.6%) less than 2005. (Table 6.5).
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Ministry of Health Annual Report 2006
Table 6.6 Visits for Attempted Suicide at Public Accident and Emergency Departments In Public Hospitals by Age and Gender: 2004-2006 Age 10 – 19 20 – 29 30 – 44 45 – 64 65+ Not Known Total
Total 140 60 42 7 5 3 198
2004 Male Female Total 63 77 37 22 38 39 22 20 27 6 1 12 3 2 6 1 2 0 69 129 121
2005 Male Female 7 30 10 29 5 22 6 6 4 2 0 0 32 89
Total 52 46 23 7 4 2 134
2006 Male Female 6 46 8 38 9 14 4 3 2 2 1 1 30 104
Source: Ministry of Health, Planning & Evaluation Branch * Preliminary Data
Attempted suicide is an act of deliberate self-harm not necessarily intended to result in death.12
The diagnosis totalled 134 during the year 2006. This
represented 10.7 percent increase when compared to the previous year’s total of 121. The highest incidence of attempted suicide was in the 10-19 years age group where there were 52 cases. Second in rank was the 20-29 age cohort with 46 attempted suicides for the year, while the least number of visits to accident and emergency departments for attempted suicide was found in the 65 and over age group, with 4 cases seen (Table 6.6).
12
World Health Report, 1977, p.64
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Ministry of Health Annual Report 2006
Table 6.7 Suicide by Gender and Method Used: 2002-2006 Gender Male Female Total Method Used Hanging Shooting Poison Drowning Stabbing Burning Cut Self Disembowelled Self Jumped Electrocute Self Total
Total 229 39 268 Total 197 26 27 9 0 4 2 0 2 1 268
2002 50 6 56
2003 55 9 64
Year 2004 33 9 42
2005 48 10 58
2006 43 5 48
2002 44 4 5 2 0 0 0 0 1
2003 46 6 8 2 0 1 1 0 0 0 64
2004 28 4 4 2 0 2 1 0 1 0 42
2005 41 8 6 2 0 0 0 0 0 1 58
2006 38 4 4 1 0 1 0 0 0 0 48
0 56
Source: Police Department, Statistics Division
Suicide is an act, deliberately initiated and performed by an individual in the knowledge or expectation that it will result in a fatal outcome.13 Statistics from the Police Department indicate that there has been a decline in the number of reported cases of suicide in Jamaica between 2005 and 2006. Year 2006 report reflected a total of 48 cases, which represented a decrease of 17.2 percent from 2005.
The most common method continued to be
hanging with 38 cases, followed by Shooting (4 cases) and Poisoning (4 cases) (Table 6.7). The number of male cases between the two-year period (2005 â&#x20AC;&#x201C; 2006) has declined by 5 cases, from 48 (2005) to 43 (2006).
Males continued to
account for most of the cases. The number of female cases decreased from 10 to 5 between 2005 and 2006. (Table 6.7).
13
World Health Report, 1977, p.64
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Ministry of Health Annual Report 2006
6.2
Emergency Care
The Emergency Care Programme has been a stated priority of the Ministry of Health since 2003 and was developed to include all areas of emergency medical care in a continuum from the time of illness or injury until definitive emergency management in the designated hospital. It is therefore one aspect of total patient care that extends until discharge or rehabilitation. The main components of the Emergency Care Programme in the Ministry of Health are: 1.
Pre-Hospital Emergency Care
2.
Hospital Emergency Care
3.
Inter-hospital Emergency Care
6.2.1 Emergency Medical Services The Jamaica Emergency Medical Services (JEMS) was launched in 1996 and represents the pre-hospital emergency care services of the Ministry of Health, in collaboration with the Jamaica Fire Brigade. Services continued to be offered from five (5) Jamaica Fire Brigade sites â&#x20AC;&#x201C; Sav-La-Mar and Negril, Westmoreland; Lucea, Hanover; Ironshore, St. James and Linstead, St. Catherine which was opened in 2005. Two thousand, six hundred and fifty five (2,655) calls were received in 2006, which represented a 46.6 percent increase over the 1,811 calls received in 2005. An average of 221 calls was received each month in 2006, by all sites. Table 6.8 Pre-hospital Emergency Care by Cause and Percentage: 2000-2006 Year
2000 2001 2002 2003 2004 2005 2006
No. of Calls 1,922 2,114 3,094 2,713 2,754 1,811 2,655
Causes and Percentage Medical/ Surgical 58.5 52.7 54.3 57.0 55.6 54.3 58.6
Trauma
MVA
26.1 32.0 29.3 25.5 28.0 28.2 26.4
11.1 10.7 11.3 13.0 12.4 14.2 11.9
OB/GYN 4.3 4.6 5.1 5.5 4.0 3.3 3.1
Source: MOH, Emergency, Disaster Management and Special Services Branch
99
Other 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Ministry of Health Annual Report 2006
The trend continued in 2006, with the majority of calls received (58.6%) being for medical and surgical conditions, with trauma and motor vehicle accidents accounting for 26.4 percent and 11.9 percent respectively. Three point one percent (3.1%) of the calls were for obstetrical and gynaecological cases (Table 6.8 1and Figure 6.).
12%
3%0%
26%
59%
Med & Surg
Trauma
MVA
O&G
False
Source: Ministry Of Health, Emergency, Disaster Management and Special Services Branch
Figure 6.1:
Calls Received by MOH/JFB EMS by Type 2006
The majority of calls (917) or 34.5 percent were received by the Negril Fire Station. Ironshore, Lucea, Sav-La-Mar and Linstead Fire Stations received 574, 545, 481 and 138 calls respectively. Two (2) additional EMS sites will be launched in 2007-8, namely Waterford Fire Station EMS and the hospital-based service operated from the St. Annâ&#x20AC;&#x2122;s Bay hospital. 6.2.2 MOH/Jamaica Defence Force CASEVAC Services The Jamaica Defence Force Air Wing continued to offer inter-hospital CASEVAC services, mainly by helicopter, to transfer critically ill patients to a higher level of care, for specialist medical services.
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Ministry of Health Annual Report 2006
Table 6.9 MOH/JDF CASEVAC Flights: 2001-2006 Year
No. of Flights
No. of Hours Flown
No. of Persons Transported
100 144 143 157 144 184
154.6 226.7 226.0 234.5 212.6 255.6
100 147 144 157 145 186
2001 2002 2003 2004 2005 2006
Source: Ministry Of Health, Emergency, Disaster Management and Special Services Branch
One hundred and eighty four (184) flights were made in 2006, to transfer 186 patients. This represented a 28 percent increase over 2005 (Table 6.9 and Figure 6.2).
300 250 200 150 100 50 0 2001
2002
2003
2004
2005
2006
Year # of Flights
# of Hours
# of Persons
Source: Ministry of Health, Emergency, Disaster Management and Special Services Branch
Figure 6.2:
MOH/JDF CASEVAC FLIGHTS: 2001-2006
The majority of the flights, eighty eight (88), or forty eight percent (48%) continued to be for neurosurgical services in Kingston. Head injury from trauma was the main cause for these services (Figure 6.3). There were thirty six (36) flights (19%) for other surgical interventions and twenty one (21) or eleven percent (11%) for medical emergencies, including eleven (11) flights for myocardial infarctions (Figure 6.3).
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Ministry of Health Annual Report 2006
Respiratory failure, obstetrical and gynaecological complications and the need for imaging services accounted for six percent (6%), one percent (1%) and three percent (3%) of all flights (Figure 6.3).
12% 3% 1% 6% 48% 11% 19%
Neurosurgery
General Surg.
General Med.
Obs & Gynae
Investigations
Other
Resp. Failure
Source: Ministry of Health, Emergency, Disaster Management and Special Services Branch
Figure 6.3:
MOH/JDF CASEVAC Transfers By Service â&#x20AC;&#x201C; 2006
The MOH will seek to upgrade the neurosurgical services in the Western Region with the placement of a neurosurgeon and support staff at the Cornwall Regional hospital, during the period 2008-2009. The CASEVAC services will be augmented in 2007 with the procurement of two (2) new Bell 407 helicopters by the JDF. Special medical equipment will be procured by the MOH over the next two (2) years to enhance in-flight medical care. Emergency Care Training An enhanced training programme for Emergency Care and Emergency and Disaster Management was implemented in 2006, with all objectives met and targets surpassed for the year, as detailed in the table below. The Ministry of Health offered Life Support Courses â&#x20AC;&#x201C; Basic Life Support, Advanced Cardiac Life Support and Paediatric Advanced Life Support - at the standards of the American Heart Association (AHA), with certified trainers (MOH staff). All successful participants receive AHA certification.
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Ministry of Health Annual Report 2006
Two hundred and forty two (242) health care workers were trained and certified in Basic Life Support at nine (9) courses, of which one hundred and three (103) were doctors, one hundred and thirty three (103) were nurses and one (1) was a Medical First Responder. Three (3) Advanced Cardiac Life Support courses were held with one hundred persons trained – seventy seven (77) doctors, twenty two (22) nurses and one Emergency Medical Technician. Support was provided by the National Health Fund for the Life Support Courses. Twelve (12) fire-fighters were trained as Emergency Medical Technicians – basic level and twenty (20) Ministry of Health drivers as Emergency Medical Vehicle Operators. Support was received from the Pan American Health Organisation to conduct training for the mutli-sectoral emergency response team in 2006 – 2007. The courses were Emergency Care and Treatment, Mass Casualty Management and Incident Command Systems. Three hundred and one (301) persons were trained from the health sector, Jamaica Fire Brigade, Jamaica Constabulary Force, Jamaica Defence Force and the Office of Disaster Preparedness and Emergency Management. Training equipment and new manuals were procured for the Life Support courses, with procurement to continue in 2007 - 8. The training programme will continue to be implemented in 2007 – 8, with additional
trainers being certified to ensure
adequate
training and
certification islandwide.
6.2.3 Emergency and Disaster Management The Ministry of Health is responsible to ensure the capability of the health sector – public and private – to respond to all emergencies and disasters, through
the
implementation
of
prevention,
response and recovery policies and programmes.
103
mitigation,
preparedness,
Ministry of Health Annual Report 2006
This mandate was enhanced by maintaining membership on the National Disaster Committee and Executive and chairing of the Health SubCommittee. Collaboration was maintained with the membership which includes, –
Senior Technical Directors
–
Senior Financial and Administrative Directors
–
Director, National Public Health Laboratory
–
Director, National Blood Transfusion Services
–
Medical Association of Jamaica
–
Nurses Association of Jamaica
–
Jamaica Red Cross
–
St. John Ambulance
–
ODPEM – Senior Director, Preparedness
–
Pan American Health Organisation / World Health Organisation representative
Objectives of the National Disaster Committee The main objectives are to: 1. Recommend legislation, policies, strategies and programmes for all aspects of health emergency and disaster management to the MOH and National Disaster Committee and Executive. 2. Develop and adopt norms and standards to ensure best practices. 3. Train/ensure training of the health care workers in priority areas, including emergency care. 4. Collaborate with the donor community to ensure effective resource mobilization and utilization. 5. Maintain linkages with all members of the National Disaster Mechanism and support agreed programmes. 6. Ensure establishment and operations of the health sector Emergency Operations Centres within four (4) hours of advisory of the need to activate. 7. Conduct relevant research to guide the planning process and decision-making for health emergency and disaster management.
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Ministry of Health Annual Report 2006
Overview of Emergency and Disaster Management The preparedness of the health sector to manage emergencies and disasters was improved significantly in 2006/7, through planned upgrading of technical services and in preparation for the International Cricket Council Cricket World Cup 2007 (ICC CWC 2007).
Direction and Coordination of Activities 1. The MOH National Emergency Operations Centre was activated to direct and coordinate the health sector’s response for one (1) event in 2006 – Hurricane Ernesto. Emergency Operations Centres at the regional, parish and hospital levels were also activated according to the Standard Operating Procedures. 2. The MOH remained without a permanent Emergency Operations Centre since its relocation to the Oceana Complex. This continued to require the movement of staff, equipment, furniture and supplies to the temporary Emergency Operations Centre at the Conference Room, Bustamante Hospital for Children. A review of the requirements and a proposal to establish this facility will be finalised in 2007/8. 3. Bi-monthly meetings of the Health Sub-Committee were held, alternating
with
meetings
of
the
MOH
Disaster
Management
Committee. Five (5) training sessions were conducted, with two (2) simulation
exercises.
Topics
included
‘Managing
the
Health
Emergency Operations Centre’ and the ‘Use of Data and Information for Health Decision-Making’. Scheduled meetings were held of the Parish Health Disaster Committees and the Hospital Disaster Management Committees. 4. Written Disaster Management plans are in place and were reviewed for the MOH, Regions and thirteen (13) Health Departments, including the twenty three (23) hospitals and over three hundred (300) Health Centres.
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Ministry of Health Annual Report 2006
5. Collaboration was strengthened with partner agencies, such as the Pan American Health Organisation, the Jamaica Red Cross and the St. John Ambulance. 6.3
Accident and Injuries
Table 6.10 Visits to Public Primary Health Care for Injuries by Gender and Cause: 2003 -2006 Year 2003 2004 2005 2006*
Total 2,956 2,723 2,622 2,740
Intentional Injuries Male Female 1,640 1,316 1,532 1,191 1,488 1,134 1,539 1,201
Unintentional Injuries Total Male Female 22,399 12,878 9,521 20,763 11,727 9,036 20,655 11,572 9,083 20,423 11,336 9,087
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, there were 2,740 and 20,423 visits to primary health care facilities to receive care for intentional and unintentional injuries respectively. There were more males than females visiting for these types of injuries. Visits for intentional injuries comprised 1,539 males and 1,201 females and visits for unintentional injuries comprised 11,336 males and 9,087 females (Table 6.10). The South East Region (1,111) had the highest number of visits for intentional injuries followed by the North East Region (716).
For
unintentional injuries, the South East Region was also first in rank with 7,518 cases followed by the North East Region with 4,829 cases. (APPENDIX C: TABLE C.12)
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Ministry of Health Annual Report 2006
Table 6.11 Utilisation of Accident and Emergency Departments of Public Hospitals for Blunt Injury by Gender and Age: 2004â&#x20AC;&#x201C;2006
Age T <5 299 5-9 510 10-19 2,844 20-29 3,191 30-44 3,372 45-64 1,501 65+ 443 Not Known 43 Total 12,203
2004 M 161 323 1,592 1,510 1,834 951 298 30 6,699
F 138 187 1,252 1,681 1,538 550 145 13 5,504
Blunt Injury 2005 2006 T M F T M F 399 229 170 397 223 174 652 412 240 753 505 248 2,753 1,528 1,225 2,974 1,708 1,266 3,046 1,419 1,627 2,956 1,359 1,597 3,132 1,640 1,492 3,065 1,614 1,451 1,554 966 588 1,457 943 514 430 272 158 447 270 177 61 39 22 81 46 35 12,027 6,505 5,522 12,130 6,668 5,462
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006 there were 12,130 clients attending Accident and Emergency Departments of public hospitals for blunt injury comprising 6,668 males and 5,462 females.
This represents approximately 0.9 percent increase when
compared to the previous yearâ&#x20AC;&#x2122;s total of 12,027.
The 30-44 age group
continue to be the group mostly affected with 3,065 cases. (Table 6.11). Visits made to Accident and Emergency Departments occurred mainly in Western Region where 3,601 clients were seen. This Region accounted for 29.7 percent of the total clients seen for blunt injuries.
The smallest
number of cases was seen in the Southern Region, where 1,946 cases were seen, approximately 16.0 percent of the total cases seen. (APPENDIX C: TABLE C.13)
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Ministry of Health Annual Report 2006
Table 6.12 Utilisation of Accident and Emergency Departments of Public Hospitals for Stab Wounds by Gender and Age: 2003-2006 Stab Wound Age T <5 8 5-9 27 10-19 769 20-29 1,030 30-44 853 45-64 197 65+ 60 Not Known 7 Total 2,951
2003 M 6 15 542 775 678 160 54 7 2,237
F T 2 8 12 43 227 796 255 1,057 175 877 37 256 6 64 0 8 714 3,109
2004 M 5 25 547 759 693 221 57 7 2,314
2005 F T M 3 8 6 18 36 29 249 749 550 298 1,134 862 184 919 743 35 242 216 7 73 61 1 20 19 795 3,184 2,486
F 2 7 199 275 176 26 12 1 698
2006 T M 4 2 38 21 819 598 1,030 736 827 674 211 174 61 57 7 6 2,997 2,268
F 2 17 221 294 153 37 4 1 729
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, there were 2,997 cases treated at Accident and Emergency Departments of public hospitals as a result of stab wounds, of which 75.7 percent (2,268) of the total cases were males.
In 2005, there were 3,184
cases. Thus the 2006 figure represents a 5.9 percent decrease over the year 2005. For both years, the majority of cases were males, 75.7 percent and 78.1 percent for 2006 and 2005 respectively. (Table 6.12). The majority of stab wound cases seen in public hospitalsâ&#x20AC;&#x2122; Accident and Emergency Departments in 2006 was in the South East Region (1,531) which represents 51.1 percent. This was followed by the Western Region (709) where approximately 23.7 percent were seen. (APPENDIX C: TABLE C.13).
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Ministry of Health Annual Report 2006
Table 6.13 Utilisation of Accident and Emergency Departments of Public Hospitals for Gunshot Wounds by Gender and Age: 2004â&#x20AC;&#x201C;2006 Age
2004 M
T <5 5-9 10-19 20-29 30-44 45-64 65+ Not Known Total
5 9 242 677 534 175 120 7 1,769
2 6 211 606 466 146 107 7 1,551
F
Gunshot 2005 T M
3 4 3 13 31 281 71 680 68 518 29 226 13 100 0 5 218 1,827
2 5 229 590 445 189 91 5 1,556
F
T
2 13 8 10 52 243 90 573 73 467 37 127 9 77 0 2 271 1,512
2006 M
F
8 5 7 3 215 28 507 66 414 53 102 25 75 2 2 0 1,330 182
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
There was a decrease of 315 for the number of clients who used public emergency departments for gunshot wounds in 2006 (1,512) when compared to the 2005 (1,827). Of the 1,512 clients visiting for gunshot wounds in 2006, 88.0 percent (1,330) were males and 12.0 (182) percent were females (Table 6.13). Of the 1,512 patients receiving care for gunshot wounds in the Accident and Emergency Departments of public hospitals in 2006, the largest number was from the South East Region (1,021) while the smallest number (41) was from the North East Region. (APPENDIX C: TABLE C.13) Table 6.14 Utilisation of Accident and Emergency Departments of Public Hospitals for Sexual Assault by Gender and Age: 2004â&#x20AC;&#x201C;2006
Age <5 5-9 10-19 20-29 30-44 45-64 65+ Not Known Total
T 94 166 890 214 90 34 18 3 1,509
2004 M 13 19 23 8 8 5 0 0 76
F 81 147 867 206 82 29 18 3 1,433
Sexual Assault/Rape 2005 T M F 72 10 62 155 24 131 877 18 859 212 8 204 90 10 80 31 2 29 19 3 16 5 0 5 1,461 75 1,386
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
109
T 76 170 991 205 93 32 18 4 1,509
2006 M 11 28 30 10 3 7 1 0 90
F 65 142 881 195 90 25 17 4 1,419
Ministry of Health Annual Report 2006
The data indicate that the number of clients seeking care for sexual abuse at Accident and Emergency Departments increased from 1,461 to 1,509 between 2005 and 2006. Between these two years, the number of females increased from 1,386 to 1,419 (2.4 percent). In 2006 the 10-19 age group was mostly affected with 991 cases followed by the 20-29 age group with 205 cases (Table 6.14). Of the total visits to Accident and Emergency Departments for sexual assault, the South East Region had the largest number of clients (479), while the North East Region saw the least number of clients (280). (APPENDIX C: TABLE C.13) Table 6.15 Utilisation of Accident and Emergency Departments of Public Hospitals for Human Bites by Gender and Age: 2004â&#x20AC;&#x201C;2006 Age T <5 607 5-9 909 10-19 1,109 20-29 801 30-44 1,002 45-64 634 65+ 300 Not Known 30 Total 5,392
2004 M 388 515 592 369 474 310 128 13 2,789
F 219 394 517 432 528 324 172 17 2,603
T 541 829 1,167 849 1,080 733 293 30 5,522
Bites 2005* M 332 526 579 399 485 317 144 13 2,795
F 209 303 588 450 595 416 149 17 2,727
T 565 918 1,224 864 1,029 742 273 37 5,652
2006 M 349 550 656 390 477 343 121 19 2,905
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
Human bites as a cause of trauma requiring care at Accident and Emergency Departments had increased to a total of 5,652 cases in 2006 from 5,522 cases in the year 2005. This represented a 2.4 percent increase over the year 2005. In 2006, the data showed that the persons who suffered most were within the 10-19 (1,224) and 30-44 (1,029) age groups (Table 6.15). Of the total number of bites treated at Accident and Emergency departments in 2006, the North East had the largest number of patients seen (1,710) followed by the Western (1,423), the South East (1,387) and the Southern (1,132). (APPENDIX C: TABLE C.13)
110
F 216 368 568 474 552 399 152 18 2,747
Ministry of Health Annual Report 2006
Table 6.16 Utilisation of Accident and Emergency Departments of Public Hospitals for Burns by Gender and Age: 2004â&#x20AC;&#x201C;2006
Age T <5 5-9 10-19 20-29 30-44 45-64 65+ Not Known Total
2004 M
F
T
Burns 2005 M
F
T
2006 M
F
540 301 290 265 297 161 91
327 165 148 146 137 85 44
213 136 142 119 160 76 47
479 206 270 229 248 145 57
272 111 151 111 144 70 33
207 95 119 118 104 75 24
437 227 265 242 244 141 57
237 118 148 122 122 64 26
200 109 117 120 122 77 31
13
7
6
9
6
3
7
4
3
1,958
1,059
899
1,643
898
745
1,620
841
779
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
During the year 2006, there were 1,620 persons who sought care for burns. The table above shows that males continued to be the more affected gender. The data also indicated that the under five-age group was the one mostly affected with 437 cases (27.0%) (Table 6.16). Burns treated at Accident and Emergency Departments ranged between 337 in the North East Region and 547 in the South East Region. (APPENDIX C: TABLE C.13) Table 6.17 Utilisation of Accident and Emergency Departments of Public Hospitals for Accidental Laceration by Gender and Age: 2004-2006 Accidental Laceration Age 2004 2005 T M F T M F T <5 2,004 1,261 743 1,721 1,083 638 1,534 5-9 3,098 2,099 999 2,588 1,803 785 2,380 10-19 4,006 2,878 1,128 3,670 2,642 1,028 3,421 20-29 2,644 1,918 726 2,487 1,834 653 2,461 30-44 2,696 1,866 830 2,575 1,854 721 2,519 45-64 1,399 994 405 1,333 905 428 1,300 65+ 490 330 160 420 292 128 464 67 39 28 81 62 19 87 Not Known Total 16,404 11,385 5,019 14,875 10,475 4,400 14,166
2006 M 965 1,628 2,497 1,791 1,797 907 308 67 9,960
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, a total of 14,166 clients sought care for accidental laceration with a total of 9,960 males and 4,206 females. The age groups mostly affected were
111
F 569 752 924 670 722 393 156 20 4,206
Ministry of Health Annual Report 2006
the 10-19 and 30-44 having a total of 3,421 (24.1%) and 2,519 (17.8%) respectively (Table 6.17). Of the 14,166 clients receiving care for accidental laceration, the North East Region accounted for 3,968 cases (28.0%) the Western Region, 3,522 cases (24.9%), the Southern Region, 3,405 cases (24.0%) and the South East Region 3,271, cases (23.1%). (APPENDIX C: TABLE C.13) Table 6.18 Utilisation of Accident and Emergency Departments of Public Hospitals for Poisoning by Gender and Age: 2004-2006 2004 T M <5 727 399 5-9 145 68 10-19 128 64 20-29 120 60 30-44 134 68 45-64 80 40 65+ 34 19 Not Known 4 1 Total 1,372 728 Age
Poisoning 2005 2006 F T M F T M 328 541 290 251 506 289 77 137 85 52 92 49 64 124 63 61 131 59 60 128 65 63 125 67 66 169 84 8 168 86 40 111 57 54 101 52 15 22 9 13 37 18 3 2 2 0 8 4 653 1,234 579 579 1,168 624
F 217 43 72 58 82 49 19 4 544
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, there were 1,168 clients seeking care for poisoning at Accident and Emergency Departments in public hospitals, comprising 624 males and 544 females. The under-five age group was the largest group that sought care for poisoning, with a total of 506 cases that is, 43.3 percent of those who sought care for poisoning (Table 6.18). Clients seen for poisoning at Accident and Emergency Departments islandwide ranged between 188 (Southern Region) and 345 (North East Region). (APPENDIX C: TABLE C.13)
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Ministry of Health Annual Report 2006
Table 6.19 Utilisation of Accident and Emergency Departments of Public Hospitals for Falls by Gender and Age: 2004-2006 Age <5 5-9 10-19 20-29 30-44 45-64 65+ Not Known Total
2004 T M 2,425 1,379 2,250 1,449 2,917 2,057 1,340 812 1,577 787 1,372 650 1,157 482 24 15 13,062 7,631
Falls 2005 F T M 1,046 2,495 1,436 801 2,348 1,528 860 3,009 2,146 528 1,305 742 790 1,564 826 722 1,514 748 675 1,309 549 9 42 23 5,431 13,586 7,998
F T 1,059 2,494 820 2,340 863 3,098 563 1,266 738 1,550 766 1,465 760 1,201 19 23 5,588 13,437
2006 M 1,403 1,549 2,209 743 815 667 511 15 7,912
F 1,091 791 889 523 735 798 690 8 5,525
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
By the end of the year 2006, 13,437 persons were seen in Accident and Emergency departments in public hospitals for falls of which 7,912 were males and 5,525 were females. (Table 6.19). Patients seen at Accident and Emergency Departments for falls in 2006 ranged between 2,782 in the North East Region and 4,331 in the Western Region. (APPENDIX C: TABLE C.13) Table 6.20 Utilisation of Accident and Emergency Departments of Public Hospitals for Near Drowning by Gender and Age: 2004-2006 Age <5 5-9 10-19 20-29 30-44 45-64 65+ Not Known Total
T 5 6 8 6 1 1 1 0 28
2004 M 5 3 7 4 1 1 0 0 21
F 0 3 1 2 0 0 1 0 7
T 4 5 8 5 5 0 2 0 29
Near Drowning 2005 M F 0 4 3 2 6 2 3 2 5 0 0 0 2 0 0 0 19 10
T 3 5 11 5 2 1 0 1 28
2006 M 2 4 9 4 2 1 0 1 23
F 1 1 2 1 0 0 0 0 5
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In the year 2006, 28 persons received care for near drowning of which 23 were males. While the 10-19 age group was mostly affected with 11 cases, the 65+ age group was least affected with no case. (Table 6.20).
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Ministry of Health Annual Report 2006
Persons seen for near drowning at Accident and Emergency Departments islandwide ranged between four in the Western and 12 in the South East Regions. (APPENDIX C: TABLE C.13) Table 6.21 Utilisation of Accident and Emergency Departments of Public Hospitals for Other Presenting Conditions by Gender: 2004-2006 Condition
T
2004 M
F
2005 M
T
F
2006 M
T
F
97,834 141,527 264,656 109,122 155,534 245,073 101,988 143,085 23,936 Medical Obstetric/ 29,776 29,776 25,828 25,828 26,486 26,486 Gynaecology Genito23,224 13,912 9,312 21,725 13,370 8,355 21,150 12,981 8,169 urinary 3,961 1,937 2,024 4,136 2,042 2,094 4,261 2,209 2,052 Psychiatric 52,287 28,911 23,376 51,465 28,395 23,070 55,526 30,469 25,057 Surgery 12,624 66,971 59,270 102,586 55,878 46,708 120,209 64,420 55,789 Paediatric 500,145 220,853 279,292 450,813 201,673 249,140 466,993 207,913 259,080 Total Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
In 2006, there were 466,993 clients utilizing Accident and Emergency Departments for medical, obstetric/gynaecology, genito-urinary, psychiatry, surgical and paediatric conditions.
The 2006 figure was an increase of
16,180 over the previous yearâ&#x20AC;&#x2122;s figure of 450,813 (Table 6.21). Table 6.22 Utilisation of Accident and Emergency Departments of Public Hospitals for Motor Vehicle Accidents by Cause, Gender and Age: 2004-2006 Motor Vehicle Accident
Age F
2004 M
F
T
2005 M
F
<5 418 249 169 367 214 153 5-9 808 469 339 706 408 298 10-19 2,728 1,473 1,255 2,432 1,354 1,078 20-29 3,850 2,556 1,294 3,519 2,407 11,122 30-44 3,670 2,369 1,301 3,323 2,197 1,126 45-64 1,795 1,141 654 1,633, 1,089 544 65+ 718 491 227 634 428 206 Not 59 47 12 73 48 25 Known Total 14,046 8,795 5,251 12,687 8,145 4,542 Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
T 356 716 2,556 3,660 3,433 1,760 671 30
2006 M
F
202 154 407 309 1,421 1,135 2,479 1,181 2,266 1,167 1,143 617 454 217 16
14
13,182 8,388 4,794
A total of 13,182 cases were seen at Accident and Emergency Departments in public hospitals for motor vehicle accidents. This showed an increase of 495 when compared to the previous yearâ&#x20AC;&#x2122;s figure of 12,687. In 2006, the 2029 age group was mostly affected with 3,660 (27.8%) (Table 6.22).
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Ministry of Health Annual Report 2006
Regionally, South East was first in rank with 4,299 cases seen for motor vehicle accidents and fourth in rank was the North East Region where 2,301 cases were seen. (APPENDIX C: TABLE C.13) Table 6.23 Road Traffic Deaths by Gender and Category of Road Users: 2002â&#x20AC;&#x201C;2006 Gender
TOTAL
Male Female TOTAL
1,464 379 1,843
2002 313 95 408
Category of Road Users Pedestrians Private Motor Car Passengers Private Motor Car Drivers Pedal Cyclists Motor Cyclists Public Motor Car Passengers *C.M.C. Passengers Public Passengers Vehicles Drivers *C.M.C. Drivers Pillion Passengers Other TOTAL
TOTAL 554 306 304 241 174 100 62 38 39 32 3 1,853
2002 126 (1) 68 (3) 72 (2) 41 (4) 41 (4) 26 (5) 13 11 5 5 0 408
2003 316 75 391
Year 2004 284 73 357
2005 263 63 326
2006* 296 75 371
2003 119 (1) 61 (3) 67 (2) 51 (4) 37 (5) 21 12 10 9 4 0 391
2004 94 (1) 70 (2) 67 (3) 46 (4) 29 (5) 19 5 10 6 11 0 357
2005 110 (1) 60 (2) 44 (3) 29 (5) 32 (4) 16 8 12 7 8 9 326
2006 103 (1) 58 (3) 78 (2) 34 (5) 35 (4) 29 12 14 8 6 371
Source: Police Department, Road Traffic Division * Preliminary data ( ) indicates ranked order
Police statistics reveal that in 2006, there were more road traffic deaths (371) than the previous year 2005 (326) with males accounting for 79.8 percent (296 deaths) (Table 6.23). In 2006 the leading road users with fatalities were still pedestrians (103), private motor car drivers (78), and private motor car passengers (58). However, compared to the previous year (2005), there were approximately 6.4 percent less pedestrian fatalities (Table 6.23).
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6.4
Inpatients
Preliminary data in the year 2005 totalled 153,149 discharges for which diagnoses were available island wide, showed that the leading cause of discharge were obstetric conditions, which represented 30.6 percent of the total discharges and had a discharge rate of 171.9 per 10,000 population. The second leading cause of discharges was Accident and Injuries (8.5%) followed by Diseases of the Circulatory System (7.2%), Diseases of the Respiratory System (6.9%) and Diseases of the Digestive System (5.5 %). (APPENDIX C: TABLE C.14) 6.4.1 Health of Population Groups Under One Year Age Group When the total discharges of 153,149 was disaggregated into age groups, the under one population totalled 27,574. The leading cause of discharge was perinatal conditions which accounted for 22.3 percent of the total under one discharges. This condition had a 1,481.7 per 10,000 discharge rate. The second leading cause of discharge was diseases of the Respiratory System, accounting for 6.9 percent of total discharges while Infectious and Parasitic Diseases was third in rank with 2.3 percent of total discharges. (APPENDIX C: TABLE C.14a)
1 - 4 Years Age Group There were some 7,924 discharges in the 1-4 age group with the major cause of discharges being diseases of the Respiratory System (35.3%), Accidents and Injuries (16.8%), Infectious and Parasitic Diseases (11.6%), as well as Neuro-Psychiatric (4.3%). Diseases of the Respiratory System had a discharge rate of 147.0 per 10,000 population while Accidents and Injuries was 70.0 per 10,000 population. (APPENDIX C: TABLE C.14b)
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5 - 9 Years Age Group From a total of 5,031 discharges, Diseases of Respiratory System was the leading cause among the 5-9 age group. This condition accounted for 27.6 percent of the total 5-9 age group discharges and had a discharge rate of 50.8 per 10,000 population. Second, third and fourth in rank were Accident of Injuries, Infectious and Parasitic Diseases and Diseases of the Digestive System accounting for 21.9 percent, 8.2 percent and 7.0 percent of total discharges respectively. (APPENDIX C: TABLE C.14c)
10 - 19 Years Age Group The total discharge in the 10-19 age group was 16,538. Discharges among this group were mainly due to Obstetric Conditions (55.8%), Accident and Injuries (13.2%), Diseases of the Digestive System (4.9%) and Diseases of the Respiratory System (4.4%). Obstetric Conditions and Accident and Injuries had discharge rates of 168.3 and 39.7 per 10,000 discharges respectively. (APPENDIX C: TABLE C.14d) 20 - 49 Years Age Group In 2005, there were 66,115 discharges in the 20-49 age group. The leading first listed diagnoses were Obstetric Conditions (57.1%) which had a discharge rate of 318.9 per 10,000 population.
Accidents and Injuries
followed, representing 9.3 percent of total discharges and Diseases of the Digestive System (5.3%). (APPENDIX C: TABLE C.14e) 50 - 64 Years Age Group The total discharge in the 50-64 age group was 11,587.
Diseases of the
Circulatory System were the leading cause of discharges and had a discharge rate of 95.9 per 10,000 population. Males who were discharged for this condition had a discharge rate of 81.3 per 10,000 population while females had a discharge rate of 111.3 per 10,000 population. (APPENDIX C: TABLE C.14f)
65 Years and Over Age Group Hospital discharges totalled 18,377 - males in this age group had a discharge rate of 926.0 per 10,000 population and females had a discharge rate of 786.3 per 10,000 population.
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Diseases of the Circulatory System, like the 50-64 age group was the leading cause of discharges. However, for the 65 and over age group, this condition represented 31.2 of the total discharges and had a discharge rate of 265.2 per 10,000 population. (APPENDIX C: TABLE C.14g) 6.5
Mortality
Table 6.24 Reported Deaths in Hospital and in Casualty Departments as a % of Hospital Deaths: 2002-2006 Year
Hospital Deaths
Total
2002 2003 2004 2005 2006
6,738 7,005 7,169 7,508 6,491
797 1,135 1,070 1,089 820
Casualty As a % of Hospital Deaths 11.8 16.2 14.9 14.5 12.6
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data # Revised data
In 2006, total hospital deaths were 6,491 with a total of 820 casualty deaths or 12.6 percent of hospital deaths. In 2005, casualty deaths as a percentage of hospital deaths, was 14.5 percent (Table 6.24). 6.6
Child Welfare
During the period under review (2006) the Child Development Agency continued to focus on the needs of children, prioritizing the consolidation of alternative care programmes and enhancing the quality of residential child care programme. Core activities included planned community outreach and education programmes as part of its primary prevention and intervention initiatives, along with other intervention programming such as counselling and family guidance. The Agency continued its emphasis on family-based programmes as the preferred alternative to residential child care placements. To this end, The Child Development Agency was successful in placing 3,062 children in the Living in Family Environment (L.I.F.E.) programme as at March 2007. This programme comprises children residing in Foster Care, Home-on-Trial and Supervision Order and is 53 percent of the total number of children in the care and protection system.
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The Agency was also involved in the physical rehabilitation of some residential child care facilities. Repairs and renovation were carried out at Muirton Child Care facility, Manning Boys’ Home, Glenhope Place of Safety, Marigold Child Care facility, Homestead Place of Safety, Blossom Gardens Children Care facility, Copse Place of Safety, Granville Place of Safety, Summerfield Boys’ Home and St. Augustine Place of Safety. The Agency emphasises educational development as a critical part of its focus on preparing children in care for re-integration into the wider community. All children of requisite age are required to attend school and the Agency assisted in this process by providing back to school supplies. The Agency also continued its skills based developmental programmes for children ages fourteen and over.
Additionally, a memorandum of
understanding was signed with the Jamaica 4H-Clubs with the intent to establish clubs in the facilities to provide children ages 10 and over with exposure and skills training in areas such as leadership, agriculture, home economics and other general craft activities. Over all, there was successful participation in both the Agency’s programmes and GOJ programmes. There were 134 placements in High schools from the GSAT examinations; 22 in the Grade Nine Achievement Test; 25 in the CXC sittings.
Many who advanced to tertiary institutions were financially
supported by private sector sponsorship. A new internal review process was introduced for all policy instruments, protocols and guidelines. The Child Development Agency also advised the Government on policy regarding child-focused legislation and international protocols on child rights as well as care and protection.
Some of the
protocols and policies introduced into the operations of the Agency during the period were:
•
Medicine Protocol It governs the administration of medication to our children in all facilities irrespective of size and capacities. It covers all medication irrespective of source and includes those dispensed by pharmacy, at a doctor’s office or in-hospital or over the counter.
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•
Complaints Protocol All children or clients within the care and protection system, their parents and/or relatives have the right to indicate verbally and in writing any actions taken by a caregiver or staff member that they feel are not in keeping with the best interests of a child and/or which they feel have violated any rights as set out in the CCPA for children in the care of a fit person.
•
National Plan of Action for Children This policy has been expanded to include children falling within the following categorization: -
Street/working children
-
HIV/AIDS
-
Violence Against Children
-
Child Justice
Other achievements of the Agency included: •
The draft Regulations governing the operations of Children’s Homes are currently with the Parliamentary Counsel and is to be tabled before Parliament shortly.
•
Recreational activities such as: Scouts Jamboree; 4H Clubs; 5-day camp; workshops for adolescents; beach trips and island tours; parent day-open day activities; the completion of a multi-purpose court at the Granville Place of Safety were pursued to promote the overall development and welfare of the children;
•
Two child-friendly versions of the Child Care and Protection Act, 2004 were developed and tested and the responses incorporated into the respective final versions to further educate children about their rights and responsibilities and the responsibility of others to care for them;
•
The protocol for abuse and prevention of abuse and controls in residential care facilities was tested in the field.
•
A brochure entitled: “Child Wise - What You Should Know About – Child Abuse” was developed as part of the primary prevention programming and targets parents and institutions dealing with children.
•
An internal review of the monitoring programme of the homes has been conducted and the findings/recommendations have been compiled into a separate working paper for implementation.
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Ministry of Health Annual Report 2006
•
The Agency collaborated with the Department of Correctional Services in seeking alternatives for housing children in conflict with the law separately from children within the system for care and protection.
•
Medical, dental and psychological care of the children continued.
•
Efforts to maintain and operationalise the Children’s Registry involved the naming of an Acting Registrar, completion and submission of the draft regulations and development of protocols and best practices to guide the overall operations.
•
A protocol governing the selection and establishing the Office of the Child Ambassador has been developed.
Table 6.25 Children in Care by Region: 2005-2006 Region
South East North East Southern Western Total Change
Foster Care ‘05
‘06
Home On Trial ‘05 ‘06
293
311
314
329
910
985
401
654
459
539
65
24
2,442
2,842
215
205
141
123
220
185
99
113
98
154
50
31
823
811
173
171
183
180
305
262
87
105
94
117
68
10
910
845
440
501
161
187
314
305
161
87
202
245
29
12
1,307
1,337
1,121
1,188
799
819
1,749
1,737
748
959
853
1,055
212
77
5,482
5,835
+67
+20
Children’s Home ‘05 ‘06
Places of Safety ‘05 ‘06
Supervision Order ‘05 ‘06
‘05
‘06
‘05
‘06
-12
+211
+202
Other
-135
Total
+353
Source: Child Development Agency *Data as at March 2006
There were a total of 5,835 children in care as at March 2007 representing an increase of 6.4 percent (353) over 2005. Of this amount, 29.8 percent (1,737) were in children’s homes, and 20.4 percent (1,188) in Foster Care. Others were home on trial (799); in places of safety (959) and under supervision order (1,055) (Table 6.25).
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Table 6.26 Number of Child Abuse Cases Reported to the Police: 2002-2006 Year 2002 2003 2004 2005 2006
Carnal Abuse 270 377 413 346 434
Incest
Infanticide
35 27 42 19 40
2 0 4 0 2
Total Cases 307 404 459 365 476
Source: Police Department, Statistics Division
There were 476 cases of child abuse reported to the Police Statistics Department in 2006, when compared with 365 cases in 2005. Carnal abuse which represented the highest incidence (434) had an increase of 25.4 percent over 2005â&#x20AC;&#x2122;s figure of 346 followed by incest reporting 40 cases compared with 19 cases in 2005 and there were 2 cases of infanticide in 2006. (Table 6.26). 6.7
Child and Adolescent Mental Health
The Child Guidance Services continued to contribute to the psycho-social development of children and adolescents with mental health problems despite shortage of staff and increasing problems of crime, violence and the continued escalating incidence of HIV/AIDS. During the year, 261 supervisory sessions took place at the Bustamante Hospital for Children and the St. Jago Park Health Centre with a view to providing technical guidance and support to the regions.
This involved
students ranging from UWI Masters and PhD. Level in Clinical Psychology; University Hospital and Excelsior Community College student nurses; Mental Health Nurse Practitioner students and a Masters Guidance and Counselling student from Northern Caribbean University. A total of 97 Child Abuse Manuals were distributed at four training sessions held for counselling staff and various medical personnel to improve and standardise the management of children who have been abused and/or neglected. In tandem with this strategy three monitoring visits were done to ensure the delivery of the programme in accordance with the standards.
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Efforts were made to improve the quality of services offered to children with the relevant disorders by identifying dedicated mental health beds in selected hospitals (BHC and CRH) and to establish a smooth in-patient service for these patients on the paediatric wards. Where necessary, funding will be sought to refurbish the wards and to train the appropriate number of psychiatric aides. The Mental Health Education and Promotion Campaign spearheaded many opportunities for education of the public and other health professionals. In this regard, 58 parenting sessions were held exceeding the target of 40; the combined Jamaica Psychiatric Association/MOH conference was attended by 350 health professionals and Mental Health Week involved utilising a booth to disseminate information to approximately 300 persons on relevant issues and to patients. Collaboration was maintained with the Child Development Agency through the conducting of three meetings.
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CHAPTER SEVEN 7.0
HEALTH CARE PARTNERS
7.1
Ministry of Health Agencies
7.1.1 Health Corporation Limited During the year 2006, the Health Corporation Limited (HCL) concentrated its efforts on purchasing vital items due to cash flow constraints. Preparations were in place to establish a new Drug Serv pharmacy in Santa Cruz however, after inspection the Pharmacy Council reported that minor modifications were required. A total of nine (9) Drug Serv pharmacies are operational. 7.1.2 National Family Planning Board An
evaluation
of
the
National
Family
Planning
Board’s
(NFPB)
implementation of the 2000-2005 Strategic Framework found that its core quantitative targets of a reduction in both the population growth rate and the fertility rate were achieved.
In 2006, the NFPB implemented the
activities of the Strategic Framework for Family Planning Programme 20062010, focusing on: -
Women who are at risk for unplanned pregnancies;
-
Women of reproductive age who do not desire any more children (limiters) but have an unmet need; and
-
Other underserved groups (e.g. men).
The NFPB’s mission over the next five years is “to enable individuals to achieve good, reproductive health through the provision of high quality voluntary family planning and family life education services implemented efficiently and effectively.” During 2006, NFPB implemented strategies geared toward reducing the number of unwanted pregnancies. The strategies are to: -
Expand access to existing but under-used family planning options;
-
Improve access to reproductive health information and service to adolescents and youth;
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Ministry of Health Annual Report 2006
-
Expand access to reproductive health information and services to men;
-
Promote safe, sexual behaviour, attitudes and practices to reduce the prevalence of STIs and HIV/AIDS.
The total number of public sector family planning users increased marginally in 2006 compared to the previous year and is currently estimated to be 62,022 users. Also, there was a marginal increase in the number of new acceptors during the year (36,035) compared to 35,627 in 2005. This is an improvement since 2003, as there was a downward trend observed.
The
proportion of new acceptors under the age of 20 years remained at approximately 20 percent. Whilst the attendance pattern showed a slight decline in 2006, the number of visits men are making has improved. This is as a result of the integrated strategic approach by the NFPB to expand access to reproductive health information and service to men. The injection, pill and condom are the methods of choice when clients are recruited at public health facilities. The injection remained the most popular contraceptive choice and accounted for 49.8 percent of new clients in 2006. A small proportion (1.7 percent) of new acceptors chose the IUD and the Norplant (implant).
Short-term supply methods (pills and condom)
accounted for 48.4 percent of new acceptors during the year. The NFPB continud to promote the consistent and correct use of supply contraceptives in meeting the fertility goal to reduce unplanned pregnancies and to prevent reproductive tract infections and sexually transmitted diseases. 7.1.3 National Health Fund The National Health Fund (NHF) during the year 2005/2006 achieved tremendous expansion in all its categories: Individual Benefits, Enrolment, Provider Pharmacies, Customer Service, Human Resource and Information Systems. The Individual Benefit Programme had enrolled 218,807 beneficiaries by year end, exceeding the target of 200,000. One strategy which accounted for this success was the support given by the NHF to engage Enrolment Clerks
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Ministry of Health Annual Report 2006
in the Regional Health Authorities.
This resulted in over 33,000 new
beneficiaries. Institutional Benefits aimed at improving the delivery of health services continued to account for the lionâ&#x20AC;&#x2122;s share of NHF funds. Forty-three (43) new projects with grants amounting to $1.66 billion were approved during the financial year bringing the total number of projects approved at the end of the year to eighty-six (86) projects. Of this, a total of twenty-one (21) projects valued at $68.55 million were completed during the year, a four-fold increase over the number of projects completed in the previous year. 7.1.4 National Registration Services The National Registration Services (NRS) continued to engage in activities to facilitate the implementation of a comprehensive national registration system that will register, assign a unique identifier and distribute a multipurpose ID card to all citizens of Jamaica.
Implementation Proposal A multi-agency meeting which included senior management from Tax Administration, Electoral Office of Jamaica (EPJ), Registrar Generalâ&#x20AC;&#x2122;s Department (RGD), National Health Fund (NHF) and Ministry of Health was convened in February 2005 to decide on an implementation path for the National Identification System. An implementation proposal was agreed on by the group and presented to the Human Resource Council of Cabinet in April 2005.
The proposal
included a recommendation for the establishment of a technical team to conduct a requirement analysis and a technical evaluation of the proposed implementation plan; identify the best system design and to provide costing for its implementation.
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Ministry of Health Annual Report 2006
7.2
Government Agencies - Jamaica Social Investment Fund (JSIF)
In 2006, the Jamaica Social Investment Fund had 78 projects in the project implementation portfolio valued at approximately J$471,049,614. The Fund also completed 72 projects during the year at an approximate cost of J$550,705,714. Between April 2005 - March 2006 the JSIF disbursed approximately J$689million on project activities. Between January and December 2006 JSIF completed the Lime Hall Health Centre in St. Ann and the Carron Hall Health Centre in St. Mary in addition to erecting fencing for the Petersfield Health Centre in Westmoreland. JSIF began implementation of the Inner City Basic Services Project (ICBSP) in 2006, which is being funded by a US$29.3 million loan from the World Bank. Under this project the Fund will be working in twelve communities in order to improve basic services, provide public safety and capacity enhancement and give access to micro financing.
JSIF is collaborating with the Ministry of Health (MOH) through its Health Promotion Division to undertake Geographic Information System (GIS) Asset Mapping of ICBSP communities. Mechanisms for building on this database and making information available to other users from the maps are being explored. JSIF undertook a number of Social Services activities in the ICBSP targeted communities, which was intended to build confidence in the Project and encourage beneficiary enthusiasm. The activities included: -
Nine summer camps held in eight Project communities and benefited 1,311 youth at a cost of J$2.34M.
-
Registration of several youth in the High School Equivalency Programme (HISEP)
administered
by
Jamaica
Foundation
for
Lifelong Learning. -
Recruitment of youth for participation in the Ornamental Fishery project being financed by Ministry of Agriculture, which provided training and certification.
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Ministry of Health Annual Report 2006
JSIF continued to finance the Inner City Basic Services Project (ICBSP) and the Basic Needs Trust Fund (BNTF); however some projects have come to an end or are ending in 2007.
One of which is the National Community
Development Project (NCDP), which was very successful with 291 projects at an approximate cost of $1.3 billion. The NCDP assisted communities in the most underserved areas by providing basic services and temporary employment
opportunities.
Also,
there
was
the
Poverty
Reduction
Programme (PRP) which closed in late 2006. Its primary aims were to improve living conditions in deprived communities by providing access to quality basic infrastructure and services, especially in the fields of sanitation, water and health. Under this programme 29 projects were implemented at an approximate total cost of $354M.
7.3
Non-Government Organisations (NGOs)
7.3.1 RISE
Life
Management
Services
(formerly
the
Addiction
Alert
Organization)
During 2006, the RISE Life Management Services offered the following services:
â&#x20AC;˘
National Telephone Lifeline, funded partially by the Ministry of Health. In 2006, the service was expanded by the addition of sixteen telephone counselor volunteers.
The services included telephone
counseling, assessments and referrals between the hours of 8.30 a.m. and 10 p.m., seven days per week. For the period January to December 2006, a total of 1,285 calls were recorded; the highest number of calls received was from females about male abusers; the age group recording the highest abuse was the 25-35 years (44%), followed by the 36-50 age group (29%), the 10-19 age group (19%) and the 51 plus age group (8%); for the one-year period, the most calls received for drug or addiction problems, in order of prevalence were: marijuana with 35%, alcohol 20%, gambling 13.5%, crack cocaine 6%, nicotine 5%, seasoned spliff 3% (combination of crack and tobacco), powder cocaine 2%, prescription drugs 0.3%, undisclosed 15%; the male/female ratio for drug abuse was 84% male and 16% female.
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Ministry of Health Annual Report 2006
â&#x20AC;˘
The Community Drug and Violence Prevention Programme, which is funded by the Ministry of National Security under the name Citizens Security and Justice Programme. It involved over 2,000 hours of remedial education, counseling, life management and parenting skills training, with the aim of reducing the incidence of crime and violence, drug abuse, HIV-AIDS and other STIs, and encourage an improved quality of life. The programme targeted 550 adolescents and 550 adults from the six communities of Allman Town, Parade Gardens, Fletchersland, Drewsland, Tower Hill and Water House. The various interventions which took place in selected communities included: remedial classes for adolescents ages 11-14 years; micro diagnostic reading tests and psycho educational assessments; CXE classes for older adolescents and adults; life skills training
including
drug
and
violence
prevention
programmes;
counseling for adolescents with behavioural and violence-related problems; parenting workshops for parents of participants and other community members, and the formation of parenting support groups; adult Life Long Learning (previously called adult literacy) classes for parents
and
other
community
members;
home
visits
for
all
participants to encourage programme participation and identify referral needs; behaviour modification and incentive programmes to encourage
consistent
attendance,
academic
and
behavioural
improvement. During a six year period, over 48,000 students, parents, guidance counsellors and community members have been educated in drug, HIV/AIDS prevention and life skills topics. Under the Citizens Security and Justice programme, over 1,000 adolescents and adults have received remedial education, parenting skills, life skills training, counselling and home visits over a four year period. The challenges encountered with the Community Violence and Drug Prevention programme included: -
Violence occasionally prevented regular training sessions in the areas.
-
Problems with identifying suitable community locations to keep
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Ministry of Health Annual Report 2006
classes. -
Participants not having the discipline to attend classes on a regular basis.
-
Poor attendance of parents at the scheduled workshops unless refreshments are served.
-
Parents/caregivers of adolescent participants not supervising their childrenâ&#x20AC;&#x2122;s attendance.
-
Community participants require more in depth training including vocational training and job preparation in order to secure employment.
â&#x20AC;˘
Counselling Services, where individual and group counselling was offered, also crisis and family interventions. Company employees are seen
individually
and
through
group
counselling.
Students
suspected, suspended or expelled for drug use or gambling problems are referred for counselling along with their parents or caregivers. An open door policy is in place for the general public seeking drug educational materials, or assistance with accessing drug treatment.
â&#x20AC;˘
Workplace
Programmes,
which
offered
Employee
Assistance
Programmes (EAP) for companies, presently are contracted to provide full EAP services for employees and their family members for one multi-national corporation. Also offered is drug testing for company employees, educational and training workshops for employees and supervisors.
Due to the establishment of random drug testing in
some companies, individual counselling sessions were carried out for employees found positive for marijuana, cocaine or alcohol abuse. As preparations are made for 2007 and beyond, RISE will concentrate its efforts on providing fee-for-service activities, as well as more communitybased interventions, especially in the areas of life skills training, remedial education, parenting skills training, vocational training and counselling.
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Ministry of Health Annual Report 2006
Diabetes Association of Jamaica (DAJ) For the year 2006, the Diabetes Association of Jamaica, continued to offer a variety of services in trying to improve the quality of life for those who are afflicted with diabetes. The Diabetes Association of Jamaica had a very ambitious programme for 2006 because of the various activities that relate to Diabetes Management. One such activity was the training of Foot Care Assistants for some of the rural communities. This programme was made possible by funding from the National Health Fund. Training started in October 2006 and will come to a close in February 2007. Plans are afoot to extend it due to the positive responses. The screening programme has far exceeded its target, and as a result, plans are being made to go beyond 30,000 people. A national diabetes education programme was developed whereby a team of lecturers travelled island-wide to conduct workshops so as to educate and empower communities on the seriousness and management of diabetes. By raising the level of awareness, it is hoped that there will be more support for diabetics from the resource persons in helping them to cope better with the condition and making behavioural changes necessary for its management. This should result in an improvement in the quality of life of persons with diabetes. The DAJ remains committed to continue to work towards providing the best care possible for diabetes and its related complications at an affordable cost to the public. In collaborating with the Ministry of Health, such partnership can only help to improve the quality of life. 7.3.2 Heart Foundation of Jamaica (HFJ) During 2006, the Heart Foundation of Jamaica continued its efforts to reduce the incidence of death from heart disease by placing emphasis on prevention
through
education;
early
detection
through
screening
programmes and rehabilitation through education about healthy lifestyles. The current services include heart screening clinics, pharmacy, CPR courses, nutritional counselling, hypertension clinic, supermarket screening programme, home visiting service, schools health education and tobacco
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Ministry of Health Annual Report 2006
cessation programme. The
tests offered by the
Foundation include
electrocardiogram (ECG), blood sugar, cholesterol and haemoglobin tests, blood pressure check, body mass index and waist circumference. In 2006, 64,748 persons used the services of the Foundation. Of the 17,787 ECGs performed, 3,631 (18.7%) were found to have an abnormality. Of the 43,825 persons who checked their blood pressure, 34,134 (77.9%) persons were found to have readings above the normal range. A total of 23,797 of these persons were seen in the Supermarket Screening Programme. Of the 5,241 persons who checked their haemoglobin, 1,855 (35.4%) were found to be anaemic. In all, 9,927 persons checked their cholesterol and 3,007 (30.3%) were found to have readings above the desirable range. A total of 13,738 persons checked their blood sugar and 1,562 (11.4%) were found to have readings above the normal range. Of the 17,809 who checked their weight, 6,713 (36.7%) were overweight, 4,207 (23.6%) were obese and 282 (1.6%) were morbidly obese. The Foundation, now in its 36th year of service to the community, remains committed to the prevention of cardiovascular disease in Jamaica. 7.3.4 Jamaica Association for the Deaf (JAD) In maintaining its pursuit to reduce the handicapping effects of hearing loss, the Jamaica Association for the Deaf continues to provide a comprehensive range of services for diagnostic hearing assessments and intervention. The JAD currently offers full hearing services at its office in Kingston, but also does hearing testing twice weekly at the ENT Clinic â&#x20AC;&#x201C; UHWI. Table 7.1 Hearing Assessment - 2006 Hearing Assessments Done Adults 792 Children 724 TOTALS 1,516 Hearing Aids Fitted
Persons with Hearing Loss 526 66% 162 22% 688 45% 143
Normal/ Borderline 266 562 828
Mild
Moderate
Severe
Profound
73 50 123
107 29 136
199 46 245
147 37 184
16%
Source: Compiled from data obtained from the Jamaica Association of the Deaf
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Ministry of Health Annual Report 2006
In the year 2006, the Audiological Services Division conducted 1,516 hearing assessments, 792 of which were on adults and 724 on children.
Of the
adults tested, 526 (66%) were found to have a hearing loss, with the most prevalent degree being severe in nature. A total of 22 percent (162) of the assessments conducted on children revealed hearing impairment, with 30.7 percent (50) of the cases experiencing a mild loss. Of the 688 instances of hearing loss, 143 were fitted with hearing aids. There is need for more widespread service delivery in order to cater to the entire country. In line with its effort to provide services nationwide, the JAD in 2006 was able to conduct hearing screening in 11 of 14 parishes. However, the demand is so great that it poses a challenge for the JAD to provide this service on a regular basis. The statistics support the need for more audiologists and audiological services to meet the hearing health care demand of our country. 7.3.5 Jamaica Cancer Society (JCS) During the year 2006, the Jamaica Cancer Society reported an increase in the number of clients accessing the services of the Society. The JCS provided a total of 20,901 screening and clinic contacts across the island, from its Head Office in Kingston, the mobile units and Branches in Manchester and St. Elizabeth. Table 7.2 Breast Cancer Screening - Mammography: 2002-2006 Year 2002 2003 2004 2005 2006
Screening Site Clinic Mobile 4,833 1,579 4,402 1,213 4,575 1,521 4,507 1,205 4,824 1,400
Total 6,412 5,616 6,096 5,732 6,224
Source: Compiled from data obtained from the Jamaica Cancer Society
Overall, nine percent more persons (492) had mammograms done through the Jamaica Cancer Society in 2006, when compared to 2005. The Mobile programme accounted for 22.5 percent of the persons screened.
Of the
4,824 persons who utilized the services in-house, 34 percent were having
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Ministry of Health Annual Report 2006
their first mammogram.
Eighteen percent (18%) of clients seen were
symptomatic, while 27.7 percent of total clients were referred by their doctors.
The total amount of clients seen on the mobile unit was 1,400.
Seventy-two venues were visited. Fifty two percent of the women screened by the mobile unit were having their first mammogram. Women in the age group 40-59 years accounted for 73 percent of the persons having mammograms.
Sixty two clients (62), including nine (9) from the mobile
programme, between the ages of 33 and 93 were provisionally diagnosed with breast cancer. It continues to be of great concern that most persons diagnosed with breast cancer are having their first mammogram as a diagnostic rather than a screening examination despite the increased public awareness.
Cervical Cancer Screening â&#x20AC;&#x201C; Pap smear Island-wide, 13,159 women had Pap smears through the JCS network. This was nine percent more than 2005.
For the year 2006, a total of 10,301
women had pap smear screening done at the JCS Head Office.
This
represented an increase of approximately 10 percent compared to the previous year 2005. Of the 10,301 women screened, 11 percent were doing a Pap smear for the first time, 56 percent were return clients, while 33 percent had done pap smears previously but not at the Society. Seventyfour percent (74%) of the women screened were between the 25-54 age group. The year 2006 saw a 17.5 percent increase in prostate cancer screening. Overall there was a 3 percent decrease in the number of persons utilizing the services of the clinic for the year. 7.3.6 Jamaica Society for the Blind During the period 2006-2007, the Jamaica Society for the Blind (JSB) through the Adjustment to Blindness Programme has seen remarkable improvement on the lives of persons who are blind. Persons are now able to move around on their own independently, and students who had to stop their course of study at the University, were able to continue their education, due to this programme. Training was conducted in Orientation, Mobility and Daily Living Skills; Information Technology and Braille Reading and Writing.
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Under the vision screening programme, seven schools in the parishes of St. Catherine, Clarendon and Kingston and St. Andrew were involved. A total of 3,726 students were screened. Fifty-five (55) students were referred to the Ophthalmologists and six (6) to the Salvation Army School for the Blind. The Jamaica/Cuba Eye Care Progromme saw 1,261 persons who were screened for Cataract, Ptosis, Strabismua and Pterigum.
Approximately
3,073 persons were referred for operation in Cuba.
7.3.7 Richmond Fellowship, Drug Rehabilitation Centre - Patricia House The primary focus of Richmond Fellowship Jamaica was to provide rehabilitation for individuals who have lost control of their lives through the use of drugs and to restore stability to their lives, the lives of their families, and their communities. The focus of the Patricia House programme was drug abuse rehabilitation in a Therapeutic Community setting to clients 18 years and over.
This has
been so since inception in April 1999, at which time the length of residential phase was six to nine months and follow up phase was for one year. While the follow up phase has not changed, the residential component has undergone several adjustments.
The residential phase was two to three
months, which has been the case since 2004.
However, in relation to
previous years this is quite low when compared to three to four months (1994 to 2002) and four to six months (1992 to 1994). Whereas residential care at Patricia House continued to be a substantive function, the range of services has grown to include Harm Reduction (HR) (Street Outreach) and the Youth Development Programme, which is being executed in the Grants Pen – Barbican community. The HR programme was introduced in 2001, where it institutionalized the island’s first Drop-in Centre for drug abusers in 2003.
However, it was
forced to a closure in June 2005, and since then, the RFJ have been searching for an ideal location to no avail. Currently, limited services are being provided through an ongoing relationship with the St. Stephen’s
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Ministry of Health Annual Report 2006
United Church in Cross Roads, Kingston. Throughout 2006, RFJ continued to support the church’s feeding programme. The Youth Development Programme depends on voluntarism and donations. The U.S. Peace Corps has been the core provider of staff members, but this was not the case in 2006, as the Peace Corps had previously withdrawn their volunteers from programmes in Kingston for ‘security reasons.’
This has
had a negative impact on the school-based component and on the Youth Club. Richmond Fellowship Jamaica remains committed to the development of drug abuse prevention, treatment and rehabilitation programmes in Jamaica. 7.4
Private Partners and Sponsors
Various private partners and sponsors have in one way or another complimented the resource pool of medical supplies and equipment of the Ministry during the year 2006. Partnering with various groups such as UNICEF, 3D Projects, UNDP and the Jamaica Foundation for Children facilitated the creation of a supportive environment for the intellectually challenged, leaders, parents, students and teachers.
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Ministry of Health Annual Report 2006
CONCLUSION The Ministry of Health along with its agencies and Non-Government Organizations partners have worked assiduously to support the development and execution of initiatives to improve health. These partnerships have played an integral role in the public health system and have been sustained in the specific health interventions.
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Ministry of Health Annual Report 2006
APPENDIX A RESOURCES FOR THE HEALTH SECTOR (CHAPTER 3)
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TABLE A.1 MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION CAPITAL ‘A’ PROJECTS NATIONAL REGISTRATION (PREPARATORY UNIT)
SOURCE OF FUNDING
DURATION ON-GOING
GOJ
ACHIEVEMENT
A multi-agency meeting which included senior management from Tax Administration, Electoral Office of Jamaica (EOJ), Registrar General’s Department (RGD), National Health Fund (NHF) and Ministry of Health was convened in February 2005 to decide on an implementation path for the National Registration System (NRS).
An implementation proposal was agreed on by the group and presented to the Human Resource Council of Cabinet in April 2005.
In April 2006, Cabinet approved the implementation option which included a recommendation for the establishment of a technical team.
Cabinet also approved the amendments to existing laws and the National Registration Bill. The plan is to withdraw the draft National Registration Bill from Parliament. It will then be redrafted to reflect the concerns that have arisen from all parties.
Objectives: -
Establishment of a reliable and secure database/register of all citizens and persons ordinarily resident in Jamaica.
-
Provide each citizen with a unique national identification number from birth.
-
Issue each citizen and person ordinarily resident in Jamaica with a multipurpose ID card.
-
Provide an effective and convenient system for ID verification.
Component(s): The mandate given to the preparatory unit on formation were as follows: -
To liaise with the relevant sectors in order to determine the best implementation option.
-
To analyse and determine the legislative requirements for the system.
-
To analyse and determine the technical requirements and specification. -
To conduct public education to sensitize the population.
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION NATIONAL REGISTRATION (PREPARATORY UNIT)(Cont’d)
SOURCE OF FUNDING GOJ
DURATION ON-GOING
ACHIEVEMENT
In 2007 the following issues were addressed: (a)
Multi-Agency Technical Team
A multi-agency technical team was established to evaluate the implementation proposal. After several workshops, it was agreed that a technical specialist should be recruited to undertake the following: -
Prepare a detailed user requirement document.
-
Prepare a technical specification document for NRS.
-
Prepare an implementation plan including costing for NRS which will be forwarded to cabinet for approval.
(b) Legislative Amendments
REPAIRS AND MAINTENANCE Objective: - Facilitate general repairs and refurbishing of selected institutions
GOJ
-
The National Registration Bill was withdrawn from Parliament for redrafting.
-
The amendments required for other legislations will be determined after an implementation plan is approved by Cabinet.
ON-GOING
Repairs/refurbishing work:
April 2007
Repairs were effected to the Glenhope Nursery as follows:
Component(s): - Facilitate general repairs and refurbishing of Children’s Homes and Places of Safety
Waterproofing of the Roof of the Administrative Office Total renovation of the bathroom facilities
This project was completed in August at a total cost of $1,057,754.00.
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION PROJECT INNER CITY (FOCUS)
SOURCE OF FUNDING GOJ
DURATION ON-GOING
Objective: - Facilitate the establishment of the necessary infrastructure within 5 urban communities, to develop self-sustained, integrated, demand-reduction programmes in an effort to effectively reduce the demand for harmful substances. Component(s): - Facilitate various workshops in 8 community programmes - Cover administrative expenses
141
ACHIEVEMENT
Montego Bay
Conducted Substance Abuse Prevention Education workshop with youth’s age ranging from 13-15 and 16 – 18 years at the RADA Conference Room, St. James.
Counselling sessions including family counselling offered from the Cornwall Regional Hospital and NCDA Western Office, RADA complex in St. James.
Presentation made in collaboration with the Family Court to 45 clients under the theme “Empowerment through Rehabilitation”.
Facilitated Ministry of Education & Youth’s Region 4 PEP workshop with over 50 counsellors from Hanover, Westmoreland & St. James. .
Conducted Substance Abuse Prevention Training with 26 PLACE (Priorities for Local Aids Control Effort) Officers of the Ministry of Health. Participated in the Quit Smoking Workshop that was organized by the Ministry of Health on February 2, 2007, held in Western Jamaica, the information will assist in the Primary Treatment Programme of Substance Abusers.
Participated in the Acupuncture Workshop was held in
Ministry of Health Annual Report 2006
Montego Bay, St. James. This is to assist in the Primary Treatment Programme of Substance Abusers.
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION PROJECT INNER CITY (FOCUS)(Cont’d)
SOURCE OF FUNDING GOJ
DURATION ON-GOING
Objective: - Facilitate the establishment of the necessary infrastructure within 5 urban communities, to develop self-sustained, integrated, demand-reduction programmes in an effort to effectively reduce the demand for harmful substances. Component(s): - Facilitate various workshops in 8 community programmes Cover administrative expenses ESTABLISHMENT OF DRUG OUTLETS
GOJ
ON-GOING
Objective: - Establish 12 drug windows islandwide, in public health Facilities; - Make available at reasonable cost, drugs and first aid supplies, most of which will be over the counter drugs, along with some prescription drugs; influence the retail costs of pharmaceuticals within the private sector through the forces of competition
142
ACHIEVEMENT Kingston and St. Andrew
Conducted counselling sessions with various persons from Marverley Gospel Hall. Some counselling session is also done at the Agency’s Counselling Room
Focus group sessions were conducted with teachers and students of various schools across Kingston & St. Andrew and information gathered from the session are used to implement a Substance Abuse Prevention Programme in the institution.
Preparations were in place to establish a new Drug Serv pharmacy in Santa Cruz in this accounting period however after inspection the Pharmacy Council advised that minor modifications were required. The opening will take place in the next accounting period. The number of operational Drug Serv Pharmacies remained at nine (9).
Approximately 271,568 prescriptions were dispensed n 2006/2007 through the Health Corporation Limited drug outlets which represented a 15.43% increase over 2005/2006.
Ministry of Health Annual Report 2006
TABLE A.1 (Contâ&#x20AC;&#x2122;d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION IMPROVED REPRODUCTIVE HEALTH OF YOUTH Jamaica Solution To Youth Lifestyle And Empowerment Project
SOURCE OF FUNDING
DURATION
ACHIEVEMENTS
USAID
Objective: To improve health status among adolescents and most vulnerable groups Cross cutting areas:
JA-STYLE received two USAID Prime Time Awards for outstanding efforts in promoting USAIDâ&#x20AC;&#x2122;s visibility and key messages in Jamaica and the Caribbean
Sustainability
Draft sustainability plan drafted and distributed to key stakeholders for feedback
Communications
Communications, Branding and Marking Implementation Plan completed
Awards
Intermediate Result 1.1:
Expanded Access to Youth-Friendly Services in Clinical and Non-clinical Settings to promote healthy lifestyles and improve appropriate sexual behaviour:
Intermediate Result 1.2:
Interpersonal Relations experiential learning curriculum completed, including creation of video clips, aimed at instilling culture of customer service among all health staff; launched September 22, 2006
MOH has assumed responsibility for introducing all primary care staff to the IPR curriculum
Development of job aids for health care workers and young people
Mandeville clinic and Claudia Williams Life Centre identified for strengthening and establishing youth-friendly clinical services; assessments initiated
National Policy and Guidelines Implemented in Support of Healthy Lifestyles Policy Environment Assessment Survey completed to guide policy work in reproductive health, HIV/AIDS, substance abuse, and violence prevention Adolescent Policy Working Group on Reproductive Health reestablished in the MOH Supported stakeholder workshop for the development of the National Parenting Policy Presented policy advice and support to the Office of the Child Advocate on institutional and protocol operations in dealing with children and adolescents at risk based on the provisions of the Child care and Protection Act
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION
SOURCE OF FUNDING
DURATION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH -
ACHIEVEMENT
Four youth advocacy networks established and over 70 youth advocates trained and are active in community, radio, etc.; two advocates appointed to sit on the International Youth Leadership Council
Supported the violence prevention Youth HELP pilot project in Vere Technical High School and sexual reproductive health Sex Ed: Best Said project in Clarendon college
Revised Advocacy Toolkit for youth ready for use
Sponsored two national youth advocates to represent Jamaica at the United Nations Summit on HIV/AIDS in New York; Paper presented on the Feminisation of HIV/AIDS
Finalised partnership with National Family Planning Board (NFPB) to disseminate policy on contraceptives to minors
JAMAICA SOLUTION TO YOUTH LIFESTYLE AND EMPOWERMENT PROJECT (Cont’d) Intermediate Result 1.2 (Cont’d):
Improve knowledge, attitudes and skills related to healthy lifestyles and appropriate sexual behaviour Radio serial drama “Outta Road” first episode aired nationally September 19, 2006 on IRIE FM; now on RJR Youth Advisory Board (YAB) established and operational; coverage and interviews on various radio stations with YAB members
Intermediate Result 1.3:
144
Musical “Curfew” commissioned and DVD production completed Print materials on RH and HIV/AIDS adapted and disseminated; PSAs on drug use/abuse prevention aired Training in behaviour change approaches for grantees Supported activities in schools hosting Healthy Lifestyles clubs
Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2006-2007 PROJECT BRIEF DESCRIPTION
SOURCE OF FUNDING
DURATION
ACHIEVEMENT
IMPROVED REPRODUCTIVE HEALTH OF YOUTH -
JAMAICA SOLUTION TO YOUTH LIFESTYLE AND EMPOWERMENT PROJECT (Cont’d) Increase community support and involvement in promoting appropriate sexual behaviour of adolescent
Intermediate Result 1.4:
145
Thirty-seven SDC officers trained in adolescent healthy lifestyle topics and programs underway in the parishes of St. James, St. Ann, Kingston and St. Andrew
Funding provided to the following youth development organisations: Girls Brigade, Jamaica 4-H
Awarded grants to 17 NGOs to carry out parenting, life skills, healthy sexual behaviour, and violence prevention activities and provided technical assistance for institutional strengthening
Parenting manual developed with support from Family Health International; Good Parenting Calendar for Jamaica ready for dissemination
Community consultations, work plans, and community resource mapping completed in violence prevention communities of Flanker, Rose Town, Brown’s Town, Duhaney Park, Grants Pen
Interventions such as parenting workshops, after-school activities, and sporting competitions completed in Flanker; Performing arts and marching band supported in Browns Town community
Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING
USAID
DURATION
Jan. 2000 Dec. 2004
ACHIEVEMENT
Reorienting of Health Service – To develop comprehensive services for adolescent •
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT Objective: - To improve the reproductive health practices among adolescent youth
Opening of additional adolescent youth friendly service sites
Convened stakeholders meeting with parish and regional representatives to establish and re-establish youth friendly services in each parish. Proposal developed to access funding for these centres. •
Launch of Mental Health Week.
Conveyed the importance of ensuring an individual’s mental health status to staff of the hospital, high school students, parents and teachers. This took place in St. Ann’s Bay Hospital. October. 10th
Component(s): - Increased use of quality reproductive health and HIV/STI services and preventive practices. - Increased access to quality reproductive health and HIV/STI services. - Improved knowledge and skill related to reproductive health and HIV/AIDSs/STIs. - National policies and guidelines implemented in support of reproductive health (focus on youth)
Creating Supportive Environments - Develop Structured After-School activities in Primary, All-Age and Secondary Institutions targeting Pre-adolescents and Adolescents •
Music Intervention in selected Primary and All Age schools in the North East and Western Regions. Schools include:
Anchovy Primary; Falmouth All Age; Pell River Primary; Salters Hill Primary; Gurney’s Mount Primary; Bounty Hall Primary; Discovery Bay All Age; Lime Hall Age; Hamstead All Age; Preston Hill Primary; Black Hill Primary; Skibo Primary; Caledonia All Age
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING USAID
DURATION
ACHIEVEMENT
Creating Supportive Environments (Cont’d) •
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT (Cont’d)
Music Intervention
School identified Consultant employed Workshop conducted with Principals, Health Educators and Music Teachers Students auditioned and choir selected. Consultant work with music teachers in training the students using all genre of music Healthy lifestyle training conducted by Health Educators. Summer camp activities conducted at Hampton high school in St. Elizabeth. Seventyeight students, thirteen teachers and Ministry of Health staff attended Competition among schools conducted at music festival in November Post evaluation conducted, data being analyzed.
•
Collaboration with The Violence Prevention Team at the Ministry of Health to put forward the Auto Skills Reading programme in inner city community centres
One successful centre is the Rose Town Community Centre. This programme is a self administered programme that asses the reading level of individual pre-adolescent students. Can also be used to improve and enhance a child’s reading and comprehension skills as well as a means of strengthening their command of the English language. Expansion of this programme to other schools is been implemented by the coordinator Ms. Julia Manderson with support from Nadine Tarawali of the ARH Unit.
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING USAID
DURATION
ACHIEVEMENT
Creating Supportive Environments (Cont’d)
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT (Cont’d)
•
Collaboration with The UWI/Change from Within Project in selected schools
Monthly visits to schools Workshops conducted at Jose Marti and the Queens High Schools in healthy lifestyle activities, 60 students attended.
Student Leaders trained as peer links to promote healthy lifestyle activities in schools
Summer camp activities conducted at Runaway Bay HEART Training Institute in August. Eighty students from 40 schools island wide attended.
•
Collaboration with Hope Worldwide to implement a parenting manual to be used at Health Clinics and Training workshops.
Workshops conducted at Jamaica Grand Hotel to sensitize other agencies on the use of the Parenting Manual and the date for its dissemination.
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING USAID
DURATION
ACHIEVEMENT
Capacity Building – Training
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT (Cont’d)
•
Training for Principals, Vice-Principals and Guidance Counsellors
Conducted 3 residential day workshop for 80 Principals, Vice Principals and Guidance Counsellors participating in the MOH/UWI Change from Within Project, March 22-24th in St. Ann. Principals committed to share knowledge with other staff members. Conducted training in Proposal Writing for principals July 5th.
•
Training for National Youth Service Participant
Conducted training for 610 National Youth Service Trainees in March and November at Cobbler and Chestervale Camps respectively. Participants trained as Health Promotion Facilitators and placed in health centres and Hospitals islandwide.
•
Training for Social Development (SDC) – Community Development Officers
Conducted training for 23 SDC Community Development Officers in the North East Region, April 25-28th.
•
Training for Dietetics Interns
Conducted training with Dietetics Interns May 4th, in self-exploration and professional ethics.
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING USAID
DURATION
ACHIEVEMENT
Formulating Healthy Public Policy through Research and Advocacy
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT (Cont’d)
•
Development of National Strategic Plan for Pre-adolescents and Adolescents
Strategic plan completed but has areas of weakness that needs strengthening. Met with JA Style’s Advocacy Officer to identify consultant to refine the plan. •
Analysis done on data collected from the Jamaica Injury Surveillance System
Analysis done on violence towards children under the age of 18yrs. Analysis done on 9 individual hospitals to show the breakdown of ages involved in unintentional, violence related and motor vehicle injuries.
Compilation of data to reflect which health region have the most VRI (violence related injuries) overall for period 2005. Building Partnerships and strengthening existing ones - Improve efficiency through collaborative interaction •
Seven interagency meeting coordinated by The St. Andrew Parish Church Care Centre to formulate policy document which will aid agencies throughout Jamaica to find relevant information pertaining to the target group in question.
So far the recommendations mentioned regarding the policy has allowed agencies to be aware of their limitations as well as capabilities. It also showed how many agencies were actually doing the same interventions simultaneously. Finally with the identification of these factors a guide line will be available soon which will serve as a clear vision to aid in the development of policies that will support the objectives of various agencies.
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING USAID
DURATION
ACHIEVEMENT
Building Partnerships (Cont’d)
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT (Cont’d)
•
Assessing the Level of Validation of Births and Birth Registration in Jamaica
The outcome was a research paper done by Dr. Gordon-Strachan, Kristin Fox and Jessica Dunn which encompassed; -
-
The level of completeness of records from all hospital deliveries in 2003 with the birth registered at the Registered General’s Department for the same period. To use the results to calculate the estimated total number of births for the period. To compare these estimates with official estimates of birth and determine areas with incomplete reporting. Assisted with critiquing the research paper before its dissemination. •
Collaboration with the University of the West Indies-Change from Within Project
Attended Bi-monthly ‘Circle of Friends’ meetings Conduct monthly visit to selected schools in the project Conduct training for Principals, teachers and students
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Ministry of Health Annual Report 2006
TABLE A.1 (Cont’d) MINISTRY OF HEALTH STATUS REPORT OF CAPITAL PROJECTS: 2005-2006 PROJECT BRIEF DESCRIPTION
IMPROVED REPRODUCTIVE HEALTH OF YOUTH
SOURCE OF FUNDING USAID
DURATION
ACHIEVEMENT
Building Partnerships (Cont’d) •
JAMAICA ADOLESCENT REPRODUCTIVE HEALTH PROJECT (Cont’d) -
Collaboration with JA Style Project
Participation in quarterly meetings Participation in workplan development •
Youth and Healthy Lifestyle Workshop
Involvement in the planning and facilitation of workshop, held November 14-17th in St. Ann •
Jamaica Foundation for Children’s Expo
Participation in the Children’s Expo May 11-14th, disseminated information, pamphlets and brochures. Approximately 15,000 parents, children and teachers reached over 4 days. •
Collaboration with the Ministry of Education & Youth – transformation Team
Participation in several meetings designed to establish citizen education programmes in schools. Workplan of activities developed for implementation.
Prepared by:
Ministry of Health, Planning and Evaluation Branch December 2007
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Ministry of Health Annual Report 2006
TABLE A.2 Utilisation of Pharmaceutical Services in Public Hospitals and Primary Health Care Facilities: 2004-2006
NUMBER OF CLIENTS
NUMBER OF ITEMS PRESCRIBED
NUMBER OF ITEMS DISPENSED
YEAR SERHA
NERHA
WRHA
298,132
121,095
137,851
SRHA
SERHA
NERHA
WRHA
SRHA
832,358
317,019
377,399
330,087
SERHA
NERHA
WRHA
SRHA
614,760
220,560
271,763
281,906
2004: Total PHC Hospital 2005: Total
75,865
42,638
16,793
222,267
78,457
121,058
250,872
121,867
163,124
119,974 18,550
223,942
113,158
51,934
57,893
154,132
81,851
101,424
608,416
203,861
325,465
272,194
460,628
138,709
109,829
730,967
291,097
475,366
312,146
570,831
224,328
34,278
41,016
237,485
240,890
360,798
253,573
66,102
50,038
19,220
18,249
200,146
110,079
66,256
57,886
134,070
92,645
Hospital 2006*
184,770
71,829
143,904
91,580
530,821
181,018
409,110
254,260
436,761
131,683
Total
253,369
PHC
52,014
63,657
26,067
26,370
148,182
169,830
81,908
79,469
105,749
141,948
60,361
66,774
201,355
71,878
148,684
92,178
581,887
91,510
451,313
252,733
475,977
142,771
354,899
200,552
PHC
Hospital
15,535
174,751
118,548
730,069
361,340
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data ** No data received for Clarendon, SRHA
153
533,221
332,202
581,726
284,719
39,174
41,714
321,624
211,859
415,260
267,326
Ministry of Health Annual Report 2006
APPENDIX B HEALTH SERVICE PROVISION AND UTILISATION (CHAPTER 4)
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Ministry of Health Annual Report 2006
TABLE B.1 Primary Health Care Visits by Gender and Region: 2002-2006
Number of Visits Region
Total
Male
Female
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
Jamaica
1,543,905
1,586,630
1,535,530
1,514,415
1,525,680
468,562
480,635
463,592
459,921
464,017
1,075,343
1,105,995
1,071,938
1,054,616
1,061,663
South East
680,052
677,531
639,380
613,769
613,808
207,892
205,008
189,515
181,798
183,539
472,160
472,523
449,865
431,971
430,269
North East
233,181
255,173
256,026
263,937
268,746
73,414
80,483
81,883
84,041
84,513
159,767
174,690
174,143
179,896
184,233
Western
289,655
279,896
265,969
272,460
290,666
89,191
85,532
81,331
84,522
89,058
200,464
194,364
184,638
187,938
201,608
Southern
341,017
374,030
374,155
364,371
352,460
98,065
109,612
110,863
109,560
106,907
242,952
264,418
263,292
254,811
245,553
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
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Ministry of Health Annual Report 2006
TABLE B.2 Attendance and Source of Referral to Public Casualty Departments by Region (also UHWI): 2002-2006
Referral by Source
Year
Total Visits
Total Receiving Care
Self
2002
695,239
680,784
2003
746,844
727,977
2004
775,727
2005
694,354
2006*
715,707
2002
Region
Jamaica
UHWI
Private Doctor
Health Centre
Police
Other Hospital
Other
86.9%
1.8%
2.1%
2.3%
1.1%
5.7%
88.3%
1.7%
2.0%
2.0%
1.1%
5.0%
758,835
88.7%
1.8%
1.8%
1.6%
1.0%
5.0%
682,009
87.4%
1.8%
1.8%
1.8%
1.2%
6.0%
702,783
88.0%
1.8%
1.8%
1.8%
1.1%
5.5%
59,028
59,028
n/a
n/a
n/a
n/a
n/a
n/a
2003
53,796
53,796
n/a
n/a
n/a
n/a
n/a
n/a
2004
61,485
61,485
n/a
n/a
n/a
n/a
n/a
n/a
2005
55,524
55,524
n/a
n/a
n/a
n/a
n/a
n/a
2006*
53,872
53,872
n/a
n/a
n/a
n/a
n/a
n/a
2002
205,666
203,260
88.6%
3.3%
3.0%
2.0%
2.4%
0.7%
2003
217,293
213,960
88.6%
2.7%
3.2%
1.7%
2.5%
1.3%
2004
219,378
216,069
88.3%
2.8%
2.9%
1.3%
2.3%
2.6%
2005
202,392
199,520
85.1%
2.8%
2.9%
1.5%
2.5%
5.2%
2006*
195,379
192,808
86.9%
2.7%
3.0%
1.3%
2.2%
3.9%
South East
North East
2002
117,539
116,059
66.6%
1.4%
0.9%
2.0%
0.5%
28.7%
2003
132,821
131,635
72.7%
0.8%
1.4%
1.8%
0.4%
22.9%
2004
141,783
140,301
75.6%
0.7%
1.3%
1.5%
0.4%
20.6%
2005
131,548
130,610
75.7%
0.7%
1.1%
1.8%
0.5%
20.3%
2006*
138,157
137,326
78.5%
0.5%
0.8%
1.3%
0.4%
18.5%
2002
136,649
129,242
91.9%
2.3%
1.7%
2.6%
0.8%
0.8%
2003
143,968
135,105
92.3%
1.7%
2.1%
2.5%
0.6%
0.8%
2004
155,259
148,389
93.1%
1.6%
1.8%
2.2%
0.6%
0.8%
Western
2005
138,168
133,101
92.9%
1.5%
1.8%
2.3%
0.9%
0.7%
2006*
149,773
144,560
93.0%
1.4%
1.7%
2.2%
0.9%
0.8%
2002
176,357
173,195
94.7%
1.0%
1.2%
2.6%
0.3%
0.1%
2003
198,966
193,481
95.3%
1.3%
0.9%
2.0%
0.3%
0.1%
Southern
2004
197,822
192,591
95.3%
1.6%
1.0%
1.7%
0.3%
0.1%
2005
166,722
163,254
94.8%
1.9%
1.0%
1.7%
0.4%
0.2%
2006*
178,526
174,217
92.3%
2.2%
1.5%
2.3%
0.6%
1.2%
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
n/a - not applicable
156
Ministry of Health Annual Report 2006
TABLE B.3 Utilisation of Outpatient Specialty Clinics in Public Facilities by Region (also UHWI): 2002-2006
Number of Cases Region
Number of Clinics
Total
New
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
14,925
15,637
17,154
16,904
15,611
487,692
500,628
594,709
494,752
483,426
88,133
91,083
100,429
94,956
93,435
UHWI
3,777
3,803
4,955
3,983
3,563
94,682
91,246
180,438
96,693
89,036
15,387
15,236
21,822
20,257
16,652
South East
5,977
6,256
6,509
6,260
6,312
219,024
222,730
219,523
202,370
201,259
40,541
39,010
40,214
38,116
40,343
North East
1,296
1,351
1,309
1,306
1,422
27,886
30,882
34,985
33,974
34,921
7,683
9,568
11,954
10,408
8,564
Western
2,428
2,715
2,805
2,968
2,699
94,492
98,552
99,761
98,679
95,989
15,753
17,949
16,622
16,110
16,926
Southern
1,447
1,512
1,576
1,577
1,615
51,608
57,248
60,002
63,036
63,818
8,769
9,320
9,817
10,065
10,950
Jamaica
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
157
Ministry of Health Annual Report 2006
TABLE B.4 Utilisation of Radiography Services in Public Hospitals by Region (also UWHI): 2002-2006
Region
Jamaica
UHWI
Number of Exams
Total
Inpatient
Outpatient
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
208,694
245,936
264,336
243,667
261,688
197,137
223,898
225,991
211,405
216,936
44,156
49,198
47,357
46,387
45,022
152,981
174,700
178,634
165,018
171,914
n/a
n/a
n/a
n/a
n/a
48,993
46,109
45,181
42,383
47,036
13,387
12,490
11,990
13,045
12,237
35,606
33,619
33,191
29,338
34,799
South East
96,816
111,120
117,727
101,585
108,184
66,505
79,336
74,573
67,107
64,406
17,323
20,794
18,657
15,915
15,565
49,182
58,542
55,916
51,192
48,841
North East
28,860
31,911
39,616
38,646
42,322
20,387
24,455
29,929
28,853
28,193
3,567
4,296
4,845
4,483
4,700
16,820
20,159
25,084
24,370
23,493
Western
44,619
52,008
55,778
51,714
53,210
32,079
36,687
38,516
36,931
37,222
4,099
4,069
4,331
5,043
4,656
27,980
32,618
34,185
31,888
32,566
Southern
38,399
50,897
51,215
51,722
57,972
29,173
37,311
37,792
36,131
40,079
5,780
7,549
7,534
7,901
7,864
23,393
29,762
30,258
28,230
32,215
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
n/a - not available
158
Ministry of Health Annual Report 2006
TABLE B.5
Utilization of Public Laboratory Services at Public Hospitals by Region and Examinations Done : 2003-2006 Examinations Done Region & Year
Microbiology Other
Chemistry
Haematology
2003
817,554
859,482
1,232
2004
803,425
948,828
1,427
TB
Histology
Urinalysis
Other
Total
40,810
5,644
17,439
59,281
1,801,442
47,940
5,173
16,673
61,449
1,884,915
Jamaica:
2005
925,619
924,253
1,241
54,933
6,476
15,456
76,076
2,004,054
2006*
917,415
870,782
916
58,123
5,179
13,262
103,155
1,968,832
2003
60,883
94,615
0
19,986
315
1,414
1,856
169,847
2004
65,765
114,578
0
19,986
315
1797
4,549
206,990
2005
54,784
90,568
0
15,399
278
1797
3,861
166,687
2006*
58,199
119,780
0
19,420
319
1402
15,470
214,590
SERHA:
NERHA: 2003
97,704
136,551
100
3,058
746
4,321
12999
255,479
2004
113,532
154,495
155
1,750
353
400
9431
283,717
2005
151,254
157,519
144
5,363
835
3,701
16996
335,812
2006*
174,802
190,205
277
5,695
1344
3,500
20781
396,604
2003
334,505
186,673
1,061
19,826
2,792
4,897
26,728
576,482
2004
326,921
216,869
1,250
18,588
2,410
4,402
21,836
592,276
2005
386,699
243,078
1,010
20,354
3,364
4,331
26,876
685,712
2006*
423,473
239,730
576
20,706
2,187
4,179
40,621
731,472
2003
324,462
441,643
71
7,063
1,890
6,807
17,698
799,634
2004
297,207
462,886
22
7,660
2,095
6,473
25,589
801,932
WRHA:
SRHA:
2005
332,822
433,088
87
13,961
1,999
5,627
28,259
815,843
2006*
260,941
321,067
63
12,302
1,329
4,181
26,283
626,166
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data
159
Ministry of Health Annual Report 2006
TABLE B.6 Utilization of Physical Therapy Services in Public Hospitals by Region: 2005-2006
Region & Year
Total Number of Clients Total Inpatient Outpatient
Total
Total Number of Treatments Inpatient Outpatient
Jamaica: 2005 2006*
28,045 25,914
11,877 10,261
16,168 15,633
242,300 257,377
92,642 85,823
149,658 171,554
UHWI: 2005 2006*
8,018 6,556
3,852 3,137
4,166 3,419
26,929 36,551
14,269 20,866
12,660 15,685
SERHA: 2005 2006*
7,936 8,032
4,481 4,225
3,455 3,807
94,180 91,065
52,441 40,363
41,739 50,702
NERHA: 2005 2006*
2,254 2,118
588 584
1,666 1,534
23,251 25,838
3,881 3,937
19,370 21,901
WRHA: 2005 2006*
5,027 4,864
1,315 1,188
3,712 3,676
58,743 57,483
12,429 11,012
46,314 46,471
SRHA: 2005 2006*
4,810 4,344
1,641 1,127
3,169 3,217
39,197 46,440
9,622 9,645
29,575 36,795
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary Data
160
Ministry of Health Annual Report 2006
TABLE B.7 Discharges and Average Length of Stay by Region (also UHWI): 2002-2006
Region
Discharges
Average Length of Stay
2002
2003
2004
2005
2006*
173,614
179,322
181,983
178,001
UHWI
18,663
18,288
18,959
South East
71,952
73,695
North East
21,602
Western Southern
Jamaica
Bed Occupancy (%)
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
172,697
6.9
6.4
6.8
6.3
6.4
80.2
84.5
66.8
52.5
49.8
16,980
16,159
6.4
6.2
5.7
6.1
6.4
74.7
66.9
61.4
40.9
62.6
74,059
72,279
70,260
9.5
8.3
9.4
8.4
8.4
92.9
102.0
64.7
43.9
39.5
23,164
24,147
23,774
23,822
4.4
4.4
4.3
4.2
4.3
65.2
66.6
65.6
66.6
65.5
29,952
30,776
31,520
32,580
30,647
5.5
5.8
5.6
5.4
5.5
73.4
79.1
79.6
81.0
56.6
31,445
33,399
33,298
32,388
31,809
4.3
4.3
4.3
4.2
4.4
64.7
72.9
69.6
64.4
66.4
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
161
Ministry of Health Annual Report 2006
TABLE B.8 Surgery Workload in Public Hospitals by Region (also UHWI): 2002-2006
Region
Total Operations**
Elective (%)
Emergency (%)
Day (%)
Minor Operations (Outpatients)
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
47,803
52,860
50,238
46,090
52,074
45.9
57.0
42.4
43.5
49.5
29.5
31.3
33.5
32.8
30.9
24.7
27.1
24.2
23.7
19.6
5,855
12,073
15,599
16,092
18,989
5,636
5,126
6,417
4,804
11,005
52.6
69.6
27.3
36.4
69.6
27.6
26.2
41.8
18.9
15.1
19.9
13.8
30.9
44.7
14.9
1,074
1,193
1,031
2,373
4,577
South East
17,390
17,930
18,572
17,254
17,714
45.2
52.7
45.4
42.8
42.8
38.0
37.9
36.8
42.5
43.9
16.8
19.8
17.9
14.7
13.4
3,375
5,005
8,596
8,597
10,043
North East
4,901
5,410
5,572
4,477
5,132
74.0
59.8
53.7
54.1
52.7
21.0
20.1
30.0
23.3
25.4
19.2
21.2
24.3
22.6
21.8
0
131
58
117
124
Western
10,998
12,884
9,399
9,858
9,150
64.3
41.4
46.3
51
48.1
23.0
23.7
29.8
27.8
29.2
35.6
41.7
23.9
21.1
22.7
454
4,814
5,067
4,328
3,441
Southern
8,878
11,510
10,278
9,697
9,073
60.5
40.8
36.7
35.7
38.3
26.6
37.0
31.7
31.7
28.5
32.6
30.8
31.6
32.6
33.3
952
930
847
677
804
Jamaica
UHWI
Source: Ministry of Health, Planning and Evaluation Branch ** excludes minor operations *Preliminary Data
162
Ministry of Health Annual Report 2006
TABLE B.9 Oral Health Visits to Primary Care Facilities by Region: 2004-2006
Year 2004
2005
2006*
Region
<10 yrs
10-14 yrs.
15-39 yrs.
40+ yrs.
181,052
59,346
42,721
55,087
23,898
South East
82,263
29,648
17,350
23,297
11,968
North East
26,286
8,227
5,144
8,644
4,271
Western
22,205
7,638
5,178
6,481
2,908
Southern
50,298
13,833
15,049
16,665
4,751
171,295
52,100
41,870
53,494
23,831
South East
73,315
24,601
14,952
22,306
11,456
North East
27,127
7,108
6,189
9,028
4,802
Western
19,970
6,260
4,524
5,997
3,189
Southern
50,883
14,131
16,205
16,163
4,384
169,131
51,546
39,369
52,951
25,265
South East
71,602
23,759
14,277
21,685
11,881
North East
26,812
7,903
6,051
7,909
4,949
Western
24,094
7,744
5,080
7,166
4,104
Southern
46,623
12,140
13,961
16,191
4,331
Jamaica
Jamaica
Jamaica
Dental Visits
Source: Ministry of Health, Planning and Evaluation Branch * Prelininary data
163
Ministry of Health Annual Report 2006
TABLE B.10 Home Visits by Region: 2002-2006
Home Visits Region
Jamaica
Total
Maternal
2002
2003
2004
2005
2006*
357,720
359,461
333,697
286,482
294,594
Child Health
Other
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
8.9
8.5
8.2
8.5
7.7
49.0
48.5
50.0
48.3
45.6
42.0
2003
43.0
2004
2005
43.8
43.2
2006*
46.7
South East
126,979
134,404
136,840
116,946
116,724
9.4
7.5
7.2
7.9
7.3
57.6
55.8
54.4
53.8
53.2
33.1
36.8
38.4
38.3
39.5
North East
113,475
120,926
101,154
83,151
75,263
7.2
6.9
6.5
7.0
6.5
37.3
44.6
45.0
44.8
43.5
55.5
48.5
48.5
48.2
50.0
Western
46,262
44,192
40,390
33,646
49,785
10.7
11.0
11.2
10.8
7.4
42.1
41.3
40.2
39.4
29.6
47.3
47.8
48.6
49.8
63.0
Southern
56,580
59,939
55,313
43,196
52,822
12.3
11.9
11.5
12.7
10.4
46.7
45.6
43.3
57.6
47.0
41.1
42.5
45.2
29.7
42.6
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
164
Ministry of Health Annual Report 2006
APPENDIX C HEALTH STATUS AND WELLBEING (CHAPTERS 5 & 6)
165
Ministry of Health Annual Report 2006
TABLE C.1 Trends in Immunization Coverage for Jamaica by Region: 2002-2006
BCG
Region 2002
Jamaica
90.3
2003
89.3
2004
84.9
OPV
2005
94.5
DPT/DT
2006*
2002
2003
2004
2005
90.1
85.8
81.3
74.6
83.6
2006*
89.1
2002
86.5
2003
82.2
2004
78.9
Measles/MMR
2005
87.5
2006*
87.3
2002
85.7
2003
78.7
2004
80.4
2005
84.0
2006*
87.2
South East
88.3
87.8
84.1
100.4
96.2
84.5
79.6
71.3
86.4
95.0
84.6
79.7
77.6
91.4
92.8
86.7
79.2
76.4
86.1
88.5
North East
85.8
84.7
80.4
89.6
85.4
83.6
78.3
75.5
81.9
81.9
83.7
78.2
76.2
82.2
78.6
77.8
71.2
79.5
78.9
85.6
Western
100.0
97.2
91.4
87.5
84.0
90.6
89.5
77.8
78.9
82.9
92.0
89.7
82.7
83.3
81.8
91.9
82.3
91.5
81.5
84.6
Southern
88.2
89.1
84.6
92.5
86.6
84.5
80.4
79.1
83.3
84.6
84.1
80.4
87.3
87.4
83.6
79.4
80.9
85.6
87.9
85.36+2.70
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
166
Ministry of Health Annual Report 2006
TABLE C.2 List of Notifiable Diseases in Jamaica: 2002-2006
DISEASE
2002
2003
2004
2005
2006
Cholera
0
0
0
0
0
Plague
0
0
0
0
0
Yellow Fever
0
0
0
0
0
989
1070
1112
1344
451+
7
9
141
88
8
Acute Flaccid Paralysis
8
23
8
13
13
Poliomyelitis
0
0
0
0
0
Congenital Rubella
0
0
0
0
0
Diphtheria
0
0
0
0
0
262
195
122
115
130
0
0
0
0
0
Pertussis-like Syndrome
2
4
4
8
1
Neonatal Tetanus
0
0
0
0
0
AIDS Malaria (Imported)
Measles (suspected cases) Measles (confirmed)
Tetanus (Excluding Neonatal)
8
4
13
13
8
Tuberculosis
108
120
117
95
87
Accidental Poisoning
371
520
679
625
528
16
19
12
45*
44*
Congenital Syphilis Hansenâ&#x20AC;&#x2122;s Disease (Leprosy)
2
6
8
9
6
Hepatitis B
236
299
307
346
363
Ophthalmia Neonatorum
180
142
150
226
241
4
0
10
3
0
49
30
12
5
1
1
1
0
0
0
103
70
48
27
71
25
13
13
18
16
126
352
307
240
80
Typhoid H. influenzae Meningitis Meningococcal Meningitis Dengue Fever Hepatitis (Viral)* Influenza* Rubella
0
0
0
0
0
420
410
354
-
-
Genital Ulcer Syndrome
1,720
1,371
1,209
-
-
Urethral Discharge Syndrome
8,324
6,057
5,079
-
-
23,181
18,909
19,018
-
-
Syphilis (all stages)
Vaginal Discharge Syndrome
OTHER DISEASES OF NATIONAL INTEREST Febrile Illness Food-Borne Illness Gastroenteritis Mumps
4,655
4,751
3,317
2,891
3,772
32
5
28
33
18
22,230
33,904
39,515
21,202
44,919
11
2
2
3
2
Varicella (Chicken Pox)**
1,822
1,761
2,490
2,480
1,354
Tinea Infections**
9,725
10,247
11,746
9,333
9,658
Conjunctivitis**
1,584
13,708
2,646
2,388
3,123
Scabies**
3,797
4,323
4,116
3,702
3,055
34
0
1
Hepatitis A Source: Ministry of Health, Epidemiology Unit Suspected Cases **Clinical Diagnosis * Suspected Cases +AIDS cases up to June 2006
167
Ministry of Health Annual Report 2006
TABLE C.3 Antenatal Attendance at Public Sector Facilities by Region: 2002-2006 Region
Total Antenatal Visits
Number of first antenatal visits
Average visits per woman
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
138,828
137,723
133,839
133,502
131,797
32,034
30,524
30,014
29,741
29,023
4.3
4.5
4.5
4.5
4.5
South East
53,992
52,781
53,130
50,764
50,701
12,669
11,959
12,071
11,714
11,826
4.3
4.4
4.4
4.3
4.3
North East
21,678
23,350
21,756
22,436
21,247
4,991
5,021
4,650
4,830
4,533
4.3
4.7
4.7
4.6
4.7
Western
27,492
25,640
24,736
26,165
27,067
6,168
5,719
5,716
5,693
5,526
4.5
4.5
4.3
4.6
4.9
Southern
35,736
35,952
34,217
34,137
32,782
8,206
7,825
7,577
7,504
7,138
4.4
4.6
4.5
4.5
4.6
Jamaica
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
168
2002
2003
2004
2005
2006*
Ministry of Health Annual Report 2006
TABLE C.4 Results of Screening (Haemoglobin and Syphillis) and Immunization against Tetanus for First Antenatal Clients by Region: 2002-2006
Number of Visits Region
Hb<10 2002
2003
Jamaica
13.9
47.5
South East
14.0
North East
2004
Syphillis +ve 2005
2006*
51.5
48.2
44.8
54.2
58.8
48.3
38.5
1.3
1.1
1.0
1.3
15.3
60.5
71.3
65.6
69.1
0.9
1.2
0.7
Western
17.6
46.1
37.8
54.1
46.4
2.5
2.9
Southern
10.9
28.6
29.2
28.8
32.6
1.3
1.7
Immunisation against tetanus
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
1.4
1.6
0.9
1.3
1.1
75.5
76.9
63.2
59.7
65.0
0.9
78.1
79.7
63.3
61.8
71.8
0.5
0.5
79.5
83.1
71.8
96.9
95.1
1.4
2.4
2.6
63.6
63.8
55.5
51.7
47.0
0.5
0.9
0.8
78.2
78.1
63.6
38.6
48.7
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
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Ministry of Health Annual Report 2006
TABLE C.5 Postnatal Visits to Public Facilities by Mothers According to Region: 2002-2006
Postnatal Visits by Mothers Region
Total visits
Coverage (as a % of estimated births)
2002
2003
2004
2005
Jamaica
36,018
36,530
34,364
35,906
33,344
69.9
70.9
67.4
74.4
69.1
South East
14,303
14,157
13,411
14,248
13,189
59.1
58.5
56.0
67.9
62.9
North East
5,120
5,598
5,125
5,409
5,028
72.3
79.0
73.1
76.5
71.1
Western
7,973
7,807
7,320
7,540
7,185
88.9
87.0
82.4
78.7
75.0
Southern
8,622
8,968
8,505
8,709
7,942
89.8
79.8
76.4
82.0
74.8
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
170
2006*
2002
2003
2004
2005
2006*
Ministry of Health Annual Report 2006
TABLE C.6 Surgical Intervention for Obstetrics, Gynaecology and Urology by Region (also UHWI): 2002-2006 Obstetrics
Region Jamaica
UHWI
South East
North East
Western
Southern
Gynaecology
Urology
2002 2003 2004 2005 2006* 2002 2003 2004 2005 2006* 2002 2003 2004 2005 2006*
Total 8,466 8,636 8,732 8,312 8,132 197 189 407 42 0 3,544 3,108 3,283 3,546 3,708
Emergency 4,426 4,986 4,992 4,795 4,612 184 162 386 40 0 1,571 1,555 1,586 1,882 1,888
Listed 3,901 3,650 3,740 3,517 3,518 13 27 21 2 0 1,949 1,553 1,697 1,664 1,820
Day 139 262 658 511 362 0 0 405 251 0 24 7 7 4 2
Minor 0 592 702 879 397 0 0 0 0 0 0 42 0 0 0
Total 6,669 5,524 5,825 5,058 5,738 561 461 454 416 588 2,463 2,083 2,323 2,154 2,297
Emergency** 1,591 1,639 2,022 1,631 1,918 52 31 233 156 216 997 1011 1116 1037 1133
Listed 3,954 3,885 3,803 3,427 3,820 407 430 221 261 372 1035 1072 1207 1117 1164
Day 845 1080 1425 1507 1,831 0 240 655 761 950 377 353 303 270 277
Minor 279 343 204 412 1,103 102 0 0 201 834 54 123 204 211 255
Total 2,625 830 904 754 850 308 250 316 187 301 1,079 327 331 253 350
Emergency 94 123 233 140 231 41 43 167 28 52 29 57 4 79 163
Listed 787 707 671 614 619 267 207 149 159 249 318 270 287 174 187
Day 129 213 211 135 96 0 0 62 0 0 69 105 74 63 46
Minor 1,615 3,642 4,286 3,368 3657 0 0 0 0 0 663 1923 2535 2631 2853
2002 2003 2004 2005 2006*
635 705 795 744 887
476 495 605 531 618
157 210 190 213 269
2 16 0 7 17
0 0 0 0 0
1,406 1,135 1,327 1,056 1,226
165 125 215 128 212
1049 1010 1112 928 1014
119 136 145 172 144
73 0 0 0 14
73 84 58 82 31
11 3 4 7 4
45 81 54 75 27
17 53 17 11 6
0 0 0 0 0
2002
2,703
1,290
1,387
26
0
862
98
594
47
123
172
12
138
22
0
2003
2,681
1,497
1,184
49
550
786
136
650
57
220
130
13
117
47
789
2004
2,299
1,239
1,060
61
702
696
108
588
53
0
160
11
149
40
904
2005
2,249
1,239
1,010
51
879
563
70
493
52
0
193
17
176
54
60
2006* 2002 2003 2004 2005 2006*
2,015 1,387 1,953 1,948 1,731 1,522
1,162 905 1277 1176 1103 946
853 395 676 772 628 576
88 87 190 185 198 255
397 0 0 0 0 0
615 1,450 1,059 1,025 869 1,012
103 279 336 350 241 254
512 869 723 675 628 758
69 302 294 269 244 391
0 0 0 0 0 0
153 993 39 39 39 15
4 1 7 7 9 8
149 19 32 32 30 7
42 21 8 18 7 2
0 952 930 847 677 804
Source: Ministry of Health, Planning and Evaluation Branch ** Includes emergency tubal ligations *Preliminary data
171
Ministry of Health Annual Report 2006
TABLE C.7 Utilisation of Outpatient Obstetric and Gynaecology Clinics by Region (also UHWI): 2002-2006
Utilization Region
Year
Obstetric # clinics
Total Cases
Gynaecology New Cases
# clinics
Total Cases
New Cases
. Jamaica
UHWI
South East
North East
Western
Southern
2002
1,144
64,548
13,266
697
28,957
5,564
2003
1,149
59,362
12,308
738
29,203
5,367
2004
1,320
60,060
14,300
883
30,759
5,953
2005
1,097
60,085
13,643
874
30,605
5,642
2006*
1,129
58,387
13,080
902
32,742
5,442
2002
287
16,612
1,388
143
5,414
840
2003
293
17,191
1,520
196
6,882
891
2004
512
16,107
3,117
280
7,481
1,308
2005
285
17,335
2,392
258
7,978
1,469
2006*
274
16,999
1,714
218
7,547
959
2002
300
22,347
6,473
244
11,774
2,541
2003
292
18,747
5,085
214
10,328
1,471
2004
263
20,075
5,181
219
10,746
1,808
2005
277
20,060
5,159
212
9,660
1,289
2006*
298
20,278
5,978
280
11,112
1,684
2002
127
1,880
330
116
2,228
471
2003
116
1,536
515
105
2,190
1035
2004
114
1,860
521
96
2,352
868
2005
111
2,174
773
123
2,519
935
2006*
126
1,954
654
111
2,847
661
2002
195
13,656
2,147
96
6,439
1050
2003
208
11,530
2,032
136
6,511
1207
2004
217
12,221
1,907
140
5,926
914
2005*
225
11,588
1,521
144
5,919
1033
2005*
232
10,794
1,552
155
6,481
1192
2002
235
10,053
2,928
98
3,102
662
2003
240
10,358
3,156
87
3,292
763
2004
214
9,797
3,574
148
4,254
1055
2005
199
8,928
3,258
137
4,529
916
2006*
199
8,362
3,182
138
4,755
946
Source: Ministry of Health, Planning and Evaluation Branch *Preliminary data
172
Ministry of Health Annual Report 2006
TABLE C.8 Total Health Centre Visits for Urinary Tract Infections by Region: 2004-2006 Year 2004
Region Jamaica SERHA NERHA WRHA SRHA
Total 87,655 50,808 11,208 13,266 11,656
STD excluding PID 64,801 38,727 6,453 11,264 7,637
PID 6,300 3,330 1,168 658 1,147
Urinary 16,554 8,751 3,587 1,344 2,872
2005
Jamaica SERHA NERHA WRHA SRHA
85,354 49,724 11,558 11,016 10,667
61,947 37,081 6,780 8,817 6,880
6,488 3,642 1,257 655 934
16,919 9,001 3,521 1,544 2,853
2006*
Jamaica SERHA NERHA WRHA SRHA
84,724 48,066 11,345 13,653 11,660
62,359 36,494 6,961 11,400 7,504
6,246 3,420 1,100 674 1,052
16,119 8,152 3,284 1,579 3,104
Source: Ministry of Health, Planning & Evaluation Branch * Preliminary data
173
Ministry of Health Annual Report 2006
Table C.9
Utilization of Outpatient Urology Clinics: 2002-2006
Year 2002 2003 2004 2005 2006*
Number of Clinics 449 620 671 600 603
Total Cases 16,510 19,765 19,434 19,661 20,122
New Cases 2,437 2,587 2,843 3,079 3,400
UHWI
2002 2003 2004 2005 2006*
143 146 205 142 102
3,279 3,640 3,997 5,110 4,527
675 692 1,089 991 777
South East
2002 2003 2004 2005 2006*
161 154 160 139 142
9,283 9,863 9,658 8,101 6,975
1,259 1,218 1,300 1,064 1,087
North East
2002 2003 2004 2005 2006*
29 77 59 54 79
129 1,288 949 1,660 2,879
17 1 6 559 867
Western
2002 2003 2004 2005 2006*
68 111 130 134 129
3,179 3,552 3,747 3,620 4,322
481 675 441 462 661
Southern
2002 2003 2004 2005 2006*
48 132 117 131 151
640 1,422 1,083 1,170 1,419
5 1 7 3 8
Region Jamaica
Source: Ministry of Health, Planning & Evaluation Branch * Preliminary data
174
Ministry of Health Annual Report 2006
TABLE C.10a Total Family Planning Visits to Health Centres by Females and Percentage New Female Acceptors by Age and Region: 2005-2006 Total Female Visits Region
2005
New Female Acceptors and Visits by Age Groups & Percentage
2006*
2005
2006*
10-19
20-29
30+
10-19
20-29
30+
Jamaica
242,458
241,346
10.1
45.4
44.5
9.9
44.4
45.7
South East
104,907
103,420
10.4
45.6
44.0
10.2
44.6
45.3
North East
33,160
36,097
11.3
45.7
43.1
10.4
45.4
44.2
Western
38,703
41,448
11.4
44.9
43.8
11.1
45.2
43.6
Southern
65,688
60,381
8.4
45.2
46.4
8.3
42.8
48.9
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
175
Ministry of Health Annual Report 2006
TABLE C.10b Method of Contraception Chosen in Public Sector Facilities by Region (Including Postnatal Acceptors): 2002-2006
Pill
Region
Injection
IUD
Condom
Other
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
2002
2003
2004
2005
2006*
Jamaica
29.9
26.9
26.6
26.2
24.9
47.7
48.2
49.1
48.2
49.3
1.4
1.6
1.5
1.3
1.6
20.8
20.9
22.4
23.9
23.3
0.3
0.4
0.4
0.3
0.8
South East
27.4
23.4
23
22.8
21.9
49.9
50.9
51.3
50.9
51.9
1.7
1.6
1.4
1.3
1.6
20.3
20.5
23.4
24.5
24
0.5
0.6
0.8
0.5
0.6
North East
33.7
31.3
29.7
25.4
27.3
42.4
39.4
43.1
39.4
43.0
0.6
1.0
0.9
0.7
1.4
24.4
24.4
26.2
28.3
26.1
0.1
0.1
0.1
0.2
2.0
Western
32.5
29.8
29.3
28.8
27
41.6
43.2
43.5
43.2
44.1
2.2
2.5
3.1
2.7
2.5
24.0
24.2
24.0
25.1
26.1
0.1
0.2
0
0.2
0.3
Southern
30.1
28.9
29.3
27.6
27.6
52.5
52.6
52.8
52.6
53.4
0.8
1.2
0.9
0.7
0.9
16.6
16.6
16.8
18.8
17.2
0.5
0.4
0.2
0.2
0.6
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
176
Ministry of Health Annual Report 2006
Table C.11 Hospital and Home Births as a Percentage of Total Births by Region: 2002-2006 Hospital Region
2002
2003
2004
Home 2005
2006*
2002
2003
2004
2005
2006*
Jamaica
97.3
97.4
98.2
98.0
98.2
2.7
2.6
1.8
2.0
1.8
South East
99.0
98.7
99.2
98.8
98.7
1.0
1.3
0.8
1.2
1.3
North East
98.3
97.9
98.7
98.7
99.1
1.7
2.1
1.3
1.3
0.9
Western
98.1
97.7
98.7
98.6
99.3
1.9
2.3
1.3
1.4
0.7
Southern
92.1
93.8
95.3
98.2
95.4
7.9
6.2
4.7
4.8
4.6
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data
177
Ministry of Health Annual Report 2006
TABLE C.12 Visits to Public Primary Health Care Facilities for Injuries by Gender, Cause and Region: 2004-2006 Year
Region
Intentional Injury
Unintentional Injury
Male
Female
Total
Male
Female
Total
2004
Jamaica South East North East Western Southern
1,590 523 496 301 270
1,262 465 373 183 241
2,852 988 869 484 511
12,151 4,224 2,818 2,945 2,164
9,421 3,791 2,185 1,995 1,450
21,572 8,015 5,003 4,940 3,614
2005
Jamaica South East North East Western Southern
1,488 488 443 235 322
1,134 473 300 153 206
2,622 961 743 390 528
11,572 3,886 3,049 2,624 2,013
9,083 3,475 2,466 1,735 1,407
20,655 7,361 5,515 4,359 3,420
2006*
Jamaica South East North East Western
1,539 586 418 258
1,201 525 298 198
2,740 1,111 716 456
11,336 3,941 2,676 2,711
9,087 3,577 2,153 1,814
20,423 7,518 4,829 4,525
277
180
457
2,008
1,543
3,551
Southern Source: Ministry of Health, Planning & Evaluation Branch * Preliminary data
178
Ministry of Health Annual Report 2006
TABLE C.13 Utilisation of Accident and Emergency Departments of Public Hospitals for Blunt Injury, Stab Wound, Gunshot Wound Sexual Assualt, Human Bites, Burns, Accidental Laceration, Poisoning, Falls, Near Drowning and Motor Vehicle Accident by Region: 2004-2006* Region Jamaica South East North East Western Southern
Region Jamaica South East North East Western Southern
Region Jamaica South East North East Western Southern
Blunt Injury 2004 12,203 4,889 2,199 3,501 1,614
2005 12,027 3,733 2,570 3,810 1,914
Stab Wound 2006* 12,130 3,317 3,266 3,601 1,946
2004
2005
3,109 1,720 290 683 416
3,184 1,703 356 679 446
Bites 2004 5,392 1,259 1,750 1,168 1,215
2005 5,522 1,208 1,875 1,326 1,113
13,062 3,643 2,423 4,020 2,976
2005 13,586 3,391 2,644 4,292 3,259
2,997 1,531 366 709 391
Burns 2006* 5,652 1,387 1,710 1,423 1,132
2004
2005
1,958 711 417 379 451
Falls 2004
Gunshot Wound 2006*
1,643 548 366 367 362
13,437 3,420 2,782 4,331 2,904
2004 28 5 6 3 14
2005 29 10 9 5 5
1,769 1,393 52 206 118
2005
Sexual Assualt 2006*
1,827 1,371 54 255 147
1,512 1,021 41 288 162
2004 1,509 481 258 412 358
Acccidental Laceration 2006* 1,620 547 337 340 396
Near Drowning 2006*
2004
2004 16,404 4,945 4,339 3,134 3,986
2005*
14,166 3,271 3,968 3,522 3,405
Motor Vehicle Accident 2006* 28 12 7 4 5
Source: Ministry of Health, Planning & Evaluation Branch * Preliminary data N/A - Not Available
179
2004 14,046 5,224 2,688 3,128 3,006
2005 12,678 4,238 2,428 3,284 2,737
1,461 460 281 426 294
2006* 1,509 479 280 421 329
Poisoning
2006*
14,875 3,789 4,132 3,506 3,448
2005
2006* 13,182 4,299 2,301 3,681 2,901
2004 1,372 384 330 384 274
2005 1,234 347 314 390 183
2006* 1,168 308 345 327 188
Ministry of Health Annual Report 2006
TABLE C.14 PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY TEN (10) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 TOTAL 2002 FIRST-LISTED DIAGNOSIS ALL CONDITIONS Male Female Obstetrics
1 Male Female
Accidents & Injuries
2
Male Female Diseases of the Respiratory System Male Female Diseases of the Circulatory System Male Female Diseases of the Digestive System Male Female Nutrition/Endocrine Diseases Male Female Diseases of the Genitourinary System Male Female Infectious & Parasitic Diseases Male Female Neoplasms Male Female Perinatal Conditions Male Female
3
4
5
6
8
10
7
9
ALL OTHER CONDITIONS
2003
%
Rate/10,000
discharged
population
100.0
506.9
100.0 100.0 33.7 0.0 51.9 11.0 22.4 4.9 8.0 12.6 5.5 7.7 9.8 6.5 6.2 9.6 4.4 5.3 5.6 4.7 4.3 4.8 4.0 3.9 6.3 2.7 4.4 4.4 4.4 4.1 6.5 2.8
361.9 647.6 170.6 0.0 336.2 55.9 81.1 31.5 40.4 45.7 35.3 38.8 35.5 42.1 31.6 34.8 28.5 26.7 22.9 30.3 21.6 17.4 25.7 19.9 22.7 17.3 22.2 16.0 28.2 20.6 23.4 18.0
11.5
58.4
ALOS 5.8 7.2 5.1 4.2 1 0.0 4.2 8.0 2 8.6 6.9 3.9 3 3.6 4.2 8.9 4 9.8 8.4 6.6 5 6.9 6.3 9.0 6 11.5 9.7 5.4 8 7.5 5.5 11.1 7 11.7 11.1 14.6 9 10.0 11.2 7.3 10 8.6 7.5
2004
%
Rate/10,000
discharged
population
ALOS
Year
Total 2,624,695 2,641,579 2,650,934 2,660,724 2,673,816
Male 1,292,895 1,301,806 1,306,977 1,310,881 1,317,302
Rate/10,000
discharged
population
ALOS
2006*
%
Rate/10,000
discharged
population
ALOS
%
Rate/10,000
discharged
population
ALOS
100.0
523.0
7.6
100.0
570.2
7.2
100.0
561.2
6.4
100.0
461.6
7.0
100.0 100.0 33.5 0.0 51.2 10.4 21.0 4.8 7.9 12.4 5.5 7.7 9.8 6.6 6.2 9.9 4.2 5.1 6.1 4.6 4.4 5.0 4.0 4.5 7.2 3.1 4.3 4.6 4.2 3.7 5.8 2.5
366.0 674.5 175.3 0.0 345.4 54.4 76.7 32.6 41.3 45.5 37.0 40.4 36.0 45.5 32.3 36.4 28.2 26.7 22.2 30.9 22.8 18.2 27.3 23.6 26.2 20.9 22.7 17.0 28.2 19.2 21.4 17.1
8.6 7.5 3.1
100.0 100.0 29.1 0.0 45.7 9.0 17.4 4.2 6.3 9.4 4.5 7.6 9.0 6.7 5.7 8.5 4.1 4.9 5.7 4.5 4.0 4.3 3.9 4.4 5.7 4.5 3.9 3.6 4.0 3.3 5.0 2.3
420.3 715.1 165.7 0.0 326.6 51.4 73.0 30.2 35.9 39.5 32.4 43.1 37.7 48.2 32.5 35.7 29.4 28.2 24.1 32.1 23.1 18.0 27.9 25.0 26.6 23.4 22.1 15.1 28.9 18.6 21.0 16.2
8.7 8.9 3.0
100.0 100.0 30.6 0.0 47.5 8.5 16.8 3.9 6.9 10.7 4.8 7.2 8.8 6.3 5.5 8.6 3.9 4.7 5.5 4.3 3.9 4.0 3.8 3.1 4.7 2.2 3.7 3.1 3.9 4.1 6.3 2.9
404.0 712.6 171.9 0.0 338.3 47.6 67.8 27.7 38.8 43.4 34.2 40.5 35.7 45.2 31.0 34.6 27.5 26.5 22.3 30.5 21.9 16.3 27.3 17.4 22.4 15.8 20.6 12.7 28.1 23.1 25.5 20.3
9.0 8.5 3.2
100.0 100.0 28.2 0.0 49.7 8.5 16.2 4.0 6.1 9.2 4.4 8.4 9.8 7.5 6.0 8.9 4.4 5.4 6.1 4.9 4.1 4.4 4.0 5.0 7.3 3.6 4.3 4.0 1.4 4.2 6.1 3.0
342.2 574.8 130.4 0.0 285.9 39.0 55.3 22.9 28.2 31.4 25.1 38.7 33.7 43.3 27.8 30.3 25.2 24.7 21.0 28.2 18.9 14.9 22.8 22.9 24.8 20.9 19.6 13.6 25.4 19.2 21.0 17.1
9.2 8.7 3.6 0.0 6.3 6.8 12.7 6.2 7.9 6.3 8.2 9.3 9.7 8.5 6.1 7.5 6.3 8.9 8.6 9.7 5.8 6.2 5.5 7.3 10.1 10.1 9.3 10.5 11.4 7.2 5.6 5.9
12.3
64.3
21.9
124.6
21.7
122.0
20.0
92.2
1
4.8 7.0 2 7.3 9.3 5.9 4 7.8 7.9 12.5 3 13.2 8.7 5.3 5 7.0 8.1 13.6 6 12.5 11.2 5.6 8 7.1 6.4 10.7 7 10.4 10.7 10.2 9 13.2 10.8 7.2 10 8.3 6.2
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data ALOS- Average Length of Stay
2002 2003 2004 2005 2006* Source: STATIN
2005
%
Female 1,331,800 1,339,773 1,343,957 1,349,873 1,356,514
180
1
4.2 6.8 2 7.3 7.8 6.8 4 7.9 6.1 15.6 3 10.0 8.9 5.5 5 7.3 7.8 8.9 6 8.4 11.0 6.6 8 5.4 6.1 8.6 10 9.9 8.9 9.7 9 12.5 12.7 7.2 7 5.4 5.8
1
3.7 6.2 2 9.1 8.1 7.4 4 5.9 6.8 8.6 3 9.1 8.5 5.1 5 6.7 5.4 8.8 6 9.0 7.0 5.7 10 6.0 8.3 7.4 7 8.2 9.0 8.5 8 10.2 9.5 6.7 9 6.4 7.2
Ministry of Health Annual Report 2006
TABLE C.14a PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 (Under 1 Age Group) AGE : <1 FIRST-LISTED DIAGNOSIS
% discharged
ALL CONDITIONS
100.0 Male
100.0
Female Perinatal Conditions
100.0
17.3 17.7 16.8
3
9.0 8.8 9.3 3.1 3.5 2.6
4 Male Female
2003 Rate/10,000 population
100.0
2,288.3
2
Male Female Accidents & Injuries
2,046.1
1,798.1 1,051.90 1,158.7 942.4
Male Female Infectious & Parasitic Diseases
% discharged
100.0 51.4 50.6 52.4
1 Male Female
Diseases of the Respiratory System
2002 Rate/10,000 population
2,272.2
100.0
2,488.5
100.0
100.0
1
44.2 43.8 44.8
2,044.8 1,004.6 1,089.7 915.7
354.3 405.3 302.1
2
16.2 17.5 14.5
185.0 201.9 167.7 63.9 77.1 47.5
3
10.6 10.6 10.5 3.0 2.9 3.1
4
% discharged
2004 Rate/10,000 population 5,730.8
100.0
5,927.5
100.0
100.0
1
18.7 19.8 17.4
5,520.3 1,069.1 1,174.5 958.4
367.2 435.9 295.6
2
6.4 7.0 5.7
239.9 262.8 215.3 68.1 71.6 64.1
3
4.2 4.3 4.0 1.0 1.2 0.9
4
% discharged
2005 Rate/10,000 population 6,658.0
100.0
6,857.2
100.0
100.0
1
22.3 23.2 21.2
6,432.0 1,481.7 1,590.0 1,361.5
365.9 415.1 313.7
2
6.9 8.0 5.7
239.1 256.0 219.6 60 68.5 51.3
3
2.3 2.4 2.2 1.2 1.3 1.1
4
2006* % Rate/10,000 discharged population
1
26.8 27.8 25.7
4,427.5 1,243.2 1,323.6 1,136.7
459.1 548.2 366.0
2
5.7 6.6 4.9
266.6 314.7 215.5
155 167.1 141.6 80.1 89.3 69.6
3
4.8 5.1 4.6 1.2 1.4 1.0 0.8 0.9 0.7
224.3 242.9 203.7 55.9 66.6 42.4 39.1 45 31.6
0.8 1.0 0.7
39.1 46.9 30.6
59.8
2777.7
Nutrition/Endocrine Diseases
100.0
4
5 Male Female
Neuro Psychiatric
5 Male Female
2.6 2.7 2.5
53.2 60.6 45.6
Diseases of the Digestive System
5 Male Female
ALL OTHER CONDITIONS
16.5
337.8
2.4 2.8 2.0
55.6 70.8 39.9
23.6
536.8
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data Year 2002 2003 2004 2005 2006*
Total 51,509 50,221 45,833 41,215 41,153
< 1 population Male 26,054 25,421 23,202 20,943 20,875
4,645.8 4,761.7
Female 25,455 24,800 22,631 20,272 20,278
Source: STATIN
181
5
0.9 1.0 0.8
53.9 60.8 46.8
68.8
3942.8
5
1.0 1.2 0.7
66.2 84.5 47.4
66.3
4415.9
5
Ministry of Health Annual Report 2006
TABLE C.14b PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002 - 2006 (1-4 Age Group) AGE : 1-4 2002 FIRST-LISTED DIAGNOSIS
ALL CONDITIONS
2003
2004
2005
2006*
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
discharged
population
discharged
population
discharged
population
discharged
population
discharged
population
100.0
430.6
100.0
472.7
100.0
434.9
100.0
416.7
100.0
Male
100.0
500.1
100.0
533.3
100.0
486.5
100.0
474.6
100.0
381.1 417
Female
100.0
359.5
100.0
409.7
100.0
380.7
100.0
355.2
100.0
342.3
Diseases of the Respiratory System
35.5
152.8
31.5
149.1
28.8
125.2
35.3
147
28.1
107.2
Male
1
35.5
177.6
31.6
168.4
28.7
139.6
25.2
119.6
28.6
119.2
Female
35.4
127.4
31.5
129.1
28.9
109.8
35.5
126
27.7
94.8
16.5
71.1
16.1
76.2
15.2
66.0
16.8
70.0
12.6
48.0
Male
16.4
81.8
16.3
86.8
16.1
78.5
17.1
81.4
13
54
Female
16.7
60.2
15.9
65.3
13.9
52.8
16.2
57.5
12
41.2
Accidents & Injuries
2
Infectious & Parasitic Diseases
3
1
3
2
1
3
2
1
2
3
2
3
15.8
68.1
20.7
97.9
24.3
105.5
11.6
48.5
29.4
112.1
Male
15.7
78.8
19.9
106.1
22.4
108.8
11.0
52.4
1
27.8
115.8
Female
15.9
57.2
21.7
89.0
26.7
101.7
12.5
44.4
31.4
107.5
Diseases of the Skin & Subcutaneous Tissue
4
4.3
18.6
4.1
19.4
4.3
21.3
4.0
22.2
4.4
15.8
4.3
17.6
4.2
17.9
Male
4.1
Female
4.3
Male Female Nutrition/Endocrine Diseases
5
4
4
4.3
18.9
4.1
17.1
4.2
20.4
5
3.6
17.2
4.8
17.1
4.5
17.3
3.8
16.6
4.0
15.3
20.3
3.8
18.5
4.0
16.8
15.5
3.9
14.7
4.0
13.6
5
Neuro-Psychiatric
4
4
4.3
18.0
Male
4.7
22.3
Female
3.8
13.4
Diseases of the Digestive
5
System
3.5
16.5
3.7
14.0
Male
3.7
19.6
3.7
15.4
Female
3.3
13.4
3.6
12.4
24.0
113.5
22.2
84.6
ALL OTHER CONDITIONS
23.7
102.1
Source: Ministry of Health, Planning and Evaluation
Branch * Preliminary data Year
1-4 population Total
Male
Female
2002 2003 2004 2005
213,585 208,002 197,759 188,382
108,056 104,905 99,531 95,985
105,529 103,097 98,228 92,397
2006*
178,221
90,878
87,343
Source: STATIN
182
5
23.6
102.8
27.8
38.3
Ministry of Health Annual Report 2006
TABLE C.14c PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 (5-9 Age Group) AGE : 5-9 2002 FIRST-LISTED DIAGNOSIS
2004
2005
2006*
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
discharged
population
discharged
population
discharged
population
discharged
population
discharged
ALL CONDITIONS
Rate/10,000 population
100.0
175.3
100.0
179.8
100.0
160
100.0
183.9
100.0
138.0
Male
100.0
209.2
100.0
207.0
100.0
186.5
100.0
217.9
100.0
161.2
Female
100.0
140.8
100.0
151.2
100.0
132.9
100.0
149.2
100.0
114.1
24.6
43.1
24.1
43.4
22.2
35.6
21.9
40.2
20.7
28.5
Male
27.8
58.2
27.9
57.7
25.6
47.7
24.8
54.1
24.1
38.8
Female
19.7
27.7
18.9
28.7
17.5
23.3
17.5
26.1
15.9
18.1
27.7
48.6
24.5
44.0
21.6
34.6
27.6
50.8
25.2
34.8
Accidents & Injuries
2
Diseases of the Respiratory
1
2
1
1
2
2
1
2
1
Male
26.0
54.3
23.4
48.3
20.9
39
26.5
57.7
26
41.9
Female
30.3
42.7
26.3
39.7
22.6
30
29.2
43.6
24.1
27.5
6.2
10.8
6.7
12.1
8.0
12.8
7.0
12.8
6.9
9.6
Male
6.3
13.2
6.9
14.3
8.2
15.3
6.8
14.9
5.9
9.5
Female
5.9
8.3
6.4
9.7
7.7
10.2
7.1
10.6
8.4
9.6
7.6
13.3
8.6
15.5
11.5
18.4
8.2
15.0
12.8
17.7
Male
6.4
13.4
7.0
14.5
9.9
18.5
7.7
16.7
11.5
18.5
Female
9.4
13.2
10.7
16.3
13.7
18.2
9.0
13.4
14.8
16.9
Diseases of the Digestive
5
System
2003
%
Infectious & Parasitic Diseases
3
4
3
4
3
Nutrition/Endocrine
4
3
5
4
3
5.7
10.5
6.1
8.5
Male
5.0
10.8
5
5.4
8.8
Female
6.8
10.1
7.2
8.2
29.7
54.6
28.2
38.9
Diseases of the Skin & Subcutaneous Tissue
6.3
11.1
6.1
11.0
6.4
10.3
Male
4
6.4
13.4
6.6
13.7
6.9
12.8
Female
6.2
8.8
5.5
8.3
5.8
7.7
27.6
48.5
29.7
53.5
30.2
48.4
ALL OTHER CONDITIONS
5
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data 5-9 population
Year Total
Male
Female
2002
293,075
148,142
144,933
2003
287,795
145,047
142,748
2004
278,775
140,143
138,632
2005
270,650
135,939
134,711
2006*
266,312
133,409
132,903
Source: STATIN
183
5
Ministry of Health Annual Report 2006
TABLE C.14d PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 (10-19 Age Group) AGE : 10-19 2002 FIRST-LISTED DIAGNOSIS
ALL CONDITIONS
2003
2004
2005
2006*
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
discharged
population
discharged
population
discharged
population
discharged
population
discharged
population
100.0
312.7
100.0
319.6
100.0
303.2
100.0
301.7
100.0
Male
100.0
151.4
100.0
159.5
100.0
156.1
100.0
151.9
100.0
134.3
Female
100.0
475.6
100.0
480.3
100.0
450.7
100.0
450.7
100.0
353.4
56.5
176.9
55.9
178.8
55.0
166.8
55.8
168.3
52.0
127.1
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
74.7
355.4
74.7
358.9
74.2
334.5
74.5
335.8
71.6
252.9
13.7
42.8
14.2
45.3
14.3
43.3
13.2
39.7
13.8
33.7
41.1
62.3
40.6
64.8
39.8
62.2
35.0
53.1
36.8
49.5
4.9
23.2
5.3
25.4
5.4
24.2
4.9
21.9
5.1
17.8
Obstetrics
1 Male Female
Accidents & Injuries
2 Male Female
1
2
1
2
1
2
1
2
244.5
Diseases of the Genitourinary System
4.3
13.3
4.5
14.4
4.3
13.1
4.3
12.9
4.1
10
Male
4
5.4
8.2
4
6.3
10.1
4
5.5
8.5
5
5.7
8.6
5
4.9
6.6
Female
3.9
18.5
3.9
18.7
3.9
17.6
3.8
17.1
3.8
13.4
Diseases of the Digestive System
3 Male Female
4.6
14.3
4.4
14.0
4.9
14.8
4.9
14.8
5.2
12.7
10.7
16.2
3
10.7
17.0
3
10.9
17.1
3
11.5
17.5
3
10.9
14.6
2.6
12.4
2.3
11.0
2.8
12.5
2.7
12.1
3.1
10.8
Diseases of the Respiratory System
3.9
12.1
3.9
12.5
3.7
11.2
4.4
13.1
4.1
10
Male
5
7.7
11.7
5
7.1
11.4
5
7.6
11.9
4
8.7
13.2
4
7.3
9.8
Female
2.6
12.4
2.8
13.5
2.3
10.5
2.9
13.0
2.8
10.1
17.1
53.4
17.1
54.7
17.3
52.6
17.5
52.9
20.8
51
Nutrition/Endocrine Diseases Male Female ALL OTHER CONDITIONS Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data 10-19 population
Year Total
Male
Female
2002 2003 2004 2005
529,479 530,338 534,147 537,393
265,978 266,193 267,724 268,271
263,501 264,145 266,423 269,122
2006*
538,921
268,890
270,031
Source: STATIN
184
Ministry of Health Annual Report 2006
TABLE C.14e PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 (20-49 Age Group) AGE : 20-49 2002 FIRST-LISTED DIAGNOSIS
ALL CONDITIONS
2003
2004
2005
2006*
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
discharged
population
discharged
population
discharged
population
discharged
population
discharged
population
100.0
580.1
100.0
588.2
100.0
570.1
100.0
558.1
100.0
375.5
Male
100.0
265.2
100.0
255.6
100.0
256.9
100.0
231.9
100.0
214.5
Female
100.0
876.0
100.0
901.2
100.0
866
100.0
864.7
100.0
687.2
55.8
323.7
56.3
331.0
54.2
309.1
57.1
318.9
64
240.5
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
71.7
627.9
71.4
643.3
69.5
601.7
71.5
618.7
67.8
466
Obstetrics
1 Male Female
Accidents & Injuries
2 Male Female
1
2
1
2
1
2
1
11.4
66.0
10.3
60.6
10.3
58.7
9.3
52.1
11.6
43.7
39.4
104.6
37.0
94.6
35.5
91.2
35.2
81.7
2
31.5
67.5
3.4
29.6
3.2
28.4
3.2
27.7
2.8
24.0
3.1
21.1
6.8
25.7
Diseases of the Digestive System
3 Male Female
5.7
32.8
5.5
32.3
5.7
32.3
5.3
29.4
13.0
34.4
13.8
35.4
13.3
34.1
13.9
32.2
12.7
27.2
3.6
31.3
3.3
29.3
3.5
30.5
3.1
26.8
3.5
24.2
6.2
23.4
3
3
3
3
Diseases of the Genitourinary System
4.3
24.7
4.4
25.9
4.6
26
4.4
24.4
Male
4
4.9
13.0
4.7
11.9
4.7
12.2
4.6
10.6
4.9
10.4
Female
4.1
35.7
4.3
39.1
4.5
39
4.3
37.4
4.5
30.8
3.8
21.5
Neoplasms
5
4
5
4
5
4
3.8
22.3
3.8
22.5
3.8
21.9
Male
2.5
11.0
2.6
6.8
2.1
5.3
5
2.2
5.0
Female
4.2
37.0
4.1
37.3
4.3
37.6
4.3
36.9 5
Diseases of the Circulatory System
5.1
19.3
Male
6.9
14.8
Female
3.4
23.5
6.1
23
ALL OTHER CONDITIONS
19.1
110.7
19.7
Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data Year
4
20-49 population Male 528,747 539,259
2002 2003
Total 1,091,270 1,110,950
Female 562,523 571,682
2004
1,130,600
549,815
580,775
2005
1,148,605
557,251
591,353
2006*
1,161,087
562,892
598,194
Source: STATIN
185
115.8
21.4
122.2
20.0
111.9
Ministry of Health Annual Report 2006
TABLE C.14f PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 (50-64 Age Group) AGE : 50-64 2002 FIRST-LISTED DIAGNOSIS
ALL CONDITIONS
2003
2004
2005
2006*
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
discharged
population
discharged
population
discharged
population
discharged
population
discharged
population
100.0
440.0
100.0
451.9
100.0
472.3
100.0
413.7
100.0
398
Male
100.0
438.6
100.0
441.9
100.0
456.1
100.0
385.8
100.0
380.2
Female
100.0
441.5
100.0
461.5
100.0
488.2
100.0
442.6
100.0
415.9
23.2
92.5
Diseases of the Circulatory System
22.8
100.2
22.2
100.4
23.2
109.5
23.2
95.9
Male
1
20.0
87.8
20.4
90.0
21.3
97.1
21.1
81.3
21.8
82.7
Female
25.6
113.0
24.1
111.1
25.1
122.4
25.1
111.3
24.7
102.6 52.2
Nutrition/Endocrine Diseases
2
1
2
1
2
1
2
1
13.7
60.4
13.6
61.3
13.7
64.8
13.6
56.4
13.1
Male
10.3
45.3
10.4
46.2
11.2
51.1
11.0
42.3
10.4
39.5
Female
17.2
76.0
16.7
77.0
16.2
79.1
16.1
71.3
15.8
65.8
49.9
Diseases of the Digestive System
12.3
54.2
12.6
56.9
11.7
55.1
12.3
51.1
12.5
Male
4
14.5
63.6
14.6
64.4
13.5
61.6
14.7
56.7
14.9
56.5
Female
10.1
44.5
10.6
48.9
9.8
48
10.1
44.8
10.3
42.7
Neoplasms
3
3
12.6
55.4
12.0
54.4
12.0
56.8
11.7
48.5
12.3
48.8
10.6
46.6
10.5
46.5
9.9
45.2
9.0
34.8
10.0
37.9
Female
14.6
64.6
13.5
62.5
14.1
68.9
14.2
63.0
14.5
60.4
9.8
43.0
9.2
41.4
8.7
41.2
8.3
34.3
8
31.8
5 Male
50-64 population Total Male
5
62.4
12.7
56.3
12.4
56.5
12.1
46.7
11.5
43.9
5.2
22.9
5.6
25.8
5.1
24.8
4.8
21.1
4.5
18.5
28.8
126.8
30.4
137.6
30.7
145
30.8
127.5
30.9
122.8
* Preliminary data Year
5
4
14.2
Female ALL OTHER CONDITIONS Source: Ministry of Health, Planning and Evaluation Branch
5
3
3
Male
Accidents & Injuries
4
4
Female
2002
245,397
124,593
120,804
2003
251,081
128,425
122,656
2004 2005 2006*
258,129 266,740 275,121
132,789 137,811 142,412
125,340 128,930 132,709
Source: STATIN
186
Ministry of Health Annual Report 2006
TABLE C.14g PERCENTAGE INPATIENTS DISCHARGED FROM PUBLIC HOSPITALS AND UHWI PER 10,000 POPULATION BY FIVE (5) LEADING FIRST-LISTED DIAGNOSIS : 2002-2006 (65 and over Age Group) AGE : 65+ 2002 FIRST-LISTED DIAGNOSIS
ALL CONDITIONS
2004
2005
2006*
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
%
Rate/10,000
discharged
population
discharged
Population
discharged
Population
discharged
Population
discharged
Population
100.0
841.1
100.0
890.0
100.0
923.0
100.0
851.3
100.0
772.3
Male
100.0
925.5
100.0
975.1
100.0
997.9
100.0
926.0
100.0
826.7
Female
100.0
770.4
100.0
817.1
100.0
858.7
100.0
786.3
100.0
722.9
29.9
251.4
29.7
264.5
30.7
283.3
31.2
265.2
31.3
241.6
30.2 33.1
247.0 255.0
26.4 33.0
257.4 269.7
27.4 33.9
273.7 290.7
10.7 34.0
98.7 267.5
27.5 35.0
227 253.3
13.5
113.4
12.6
112.3
13.4
123.5
13.4
113.8
10.4
96.2
9.7
94.2
10.6
106.2
10.9
100.6
16.0
137.5
9.6
89
Diseases of the Circulatory System
1 Male Female
Nutrition/Endocrine Diseases
2 Male Female
Diseases of the Digestive
4
System
2003
%
Male Female
Diseases of the Respiratory
5 Male Female
Neoplasms
3 Male Female
16.6
127.7
10.3
86.3
10.9
1
2
1
2
15.6
127.1
10.0
88.6
101.0
10.6
103.5
10.3
9.6
74.0
9.3
75.8
8.4
70.9
9.5
84.4
9.3
86.3
10.1
98.5
7.5
58.0
10.4
87.3
12.1 8.6
27.6
4
5
8.9
72.5
10.3
91.9
112.3
12.6
66.4
8.1
231.9
27.9
3
3
5
1
2
1
2
13
100
10.8
89.6
15.0
108.4
10.5
81.1
15.8
124.0
10.2
86.9
103.1
10.7
98.7
11.1
92
9
77.1
9.8
76.8
9.9
71.3
8.6
79.6
9.1
77.9
9.7
96.6
10.1
93.2
3
4
65.0 73.6
7.8
60
9.1
74.9
7.6
65.2 83.4
122.4
10.6
106.2
9.4
86.6
11.1
91.6
66.4
7.5
64.1
7.9
62.4
8.5
61.4
248.2
28.6
264.2
27.5
233.9
27.7
214.1
5
8.3
5
9.0
4
8.6
3
4
6.5
47.1
9.8
75.4
Accidents & Injuries Male Female ALL OTHER CONDITIONS Source: Ministry of Health, Planning and Evaluation Branch * Preliminary data Year
65+ population Total
2002
200,379
91,324
109,055
2003
203,192
92,547
110,645
2004
205,701
93,774
111,927
2005
207,739
94,650
113,089
2006*
213,002
97,946
115,058
Male
Female
Source: STATIN
187
Ministry of Health Annual Report 2006
APPENDIX D HOSPITALS BY REGION, PARISH, TYPE, BED COMPLEMENT AND SERVICES 2006
APPENDIX E REGIONAL HEALTH AUTHORITIES
188
Ministry of Health Annual Report 2006
TABLE D HOSPITALS BY REGION, PARISH, TYPE BED COMPLEMENT AND SERVICES: 2006 REGION/PARISH
ADDRESS & TELEPHONE
NAME
TYPE
NO. OF BEDS
B
238
C
44
A
455
Specialist
215
Specialist
244
A Quasi Public
481
Specialist
100
Specialist
54
Specialist
26
Specialist (Psychiatry)
977
Private
46
Private
39
Private
24
C Public
131
SOUTH EAST Spanish Town Hospital St. Catherine Linstead Hospital
Kingston & St. Andrew
Kingston Public Hospital (KPH) Victoria Jubilee Hospital (VJH) Bustamante Hospital for Children (BHC) University Hospital of the West Indies (UHWI) National Chest Hospital (NCH) Sir John Golding Rehabilitation Centre Hope Institute Bellevue Hospital (BVH)
Andrews Memorial Hospital
Nuttal Memorial Hospital
St. Joseph’s Hospital
St. Thomas
Princess Margaret Hospital
189
Burke Road 984-3031-2 984-4670-2 Rodney Hall Road 985-2241 985-2359 North Street, Kingston 922-0227-9 922-0530-1 North Street, Kingston 922-1700 Arthur Wint Drive 926-5721-5 968-0300-6 Mona, Kgn. 6 927-1620 36½ Barbican Road, Kgn 6 977-7071/7131 7 Golding Avenue, Kgn 7 927-2504 977-1458 Elletson Flats, Kgn. 7 927-2111/2887 16 ½ Windward Road Kgn 2 928-1380-1 938-1562-3 27 Hope Road 926-7401 926-7402 929-3821 6 Caledonia Avenue 926-2139 926-8770 22 Deanery Road 928-4955-9 928-1080 928-1083 54 Lyssons Road 982-2304 982-1093
Ministry of Health Annual Report 2006
TABLE D (Cont’d) HOSPITALS BY REGION, PARISH, TYPE BED COMPLEMENT AND SERVICES 2006 REGION/PARISH
ADDRESS & TELEPHONE
NAME
TYPE
NO. OF BEDS
C Public
93
C Public
95
C Public
59
B Public
203
C Public
58
A Public
342
Specialist Private
5
C Public
38
B Public
138
C Public
97
B Public
205
Specialist Private
19
C Public
114
C Public
159
C Public
49
NORTH EAST Portland
Port Antonio Hospital Annotto Bay Hospital
St. Mary Port Maria Hospital
St. Ann
St. Ann’s Bay Hospital
Naylor’s Hill 993-2646 Annotto Bay 996-2222 996-2314 Trinity 994-2228 994-2277 St. Ann’s Bay 972-2272 972-0150-2
WESTERN Trelawny
Falmouth Hospital
Cornwall Regional Hospital (CRH) St. James Doctor’s Hospital
Hanover
Noel Holmes Hospital
Westmoreland
Savanna-la-mar Hospital
Golden Grove 954-3250 954-3255 Mount Salem 952-6683 940-4086 940-5297-8 Fairfield 979-8665 979-8874 Fort Charlotte Drive 956-2733 956-2731 Barracks Road 955-2133/ 955-2533
SOUTHERN St. Elizabeth
45 High Street 965-2212 965-2224 32 Hargreaves Ave. 962-2067 962-8198 32 Hargreaves Ave. 962-2040 962-2070 Christiana 964-2322 964-2222 Muirhead Avenue 986-2528 986-6307 Vere 986-3226
Black River Hospital
Mandeville Hospital
Manchester
Hargreaves Memorial Hospital Percy Junor Hospital
May Pen Hospital Clarendon Lionel Town Hospital Source: Ministry of Health, Planning and Evaluation Branch
190
Ministry of Health Annual Report 2006
TABLE E REGIONAL HEALTH AUTHORITIES South East Region Parishes: Kingston and St. Andrew, St. Catherine & St. Thomas Address:
South East Regional Health Authority (SERHA) The Towers, 2nd Floor 25 Dominica Drive Kingston 5
Telephone: Fax:
754-3340/3441/3443 926-4019
North East Region Parishes: St. Ann, St. Mary & Portland Address:
North East Regional Health Authority (NERHA) Shop #34-37, Ocean Village Shopping Centre Ocho Rios St. Ann
Telephone: Fax:
795-3107/0102/7758 795-2747
Western Region Parishes: Westmoreland, St. James, Trelawny & Hanover Address:
Western Regional Health Authority (WRHA) C/o Cornwall Regional Hospital Montego Bay St. James
Telephone: Fax:
952-1124/3678 952-4074
Southern Region Parishes: Manchester, Clarendon & St. Elizabeth Address:
Southern Regional Health Authority (SRHA) 3 Brumalia Road Mandeville Manchester
Telephone: Fax:
625-0612/0613 962-8233
191
Ministry of Health Annual Report 2006
GLOSSARY
AFP AIDS ALOS ANC ARH ARV BCH BCG BMI BNTF BSE BVH CAPP CAREC CARICOM CARIMAC CCC CCPA CDA CDC CFNI CIC CIDA CIRAD CODAC CPC CPR CRH CRS CSW CVD DAJ DAS DFID DMFT DPT/DT EAP ECG EHU EOJ EPI FDA ESSJ GIS GOJ HATS HbsAg HCL HCV HEART Hep B
Acute Flaccid Paralysis Acquired Immune Deficiency Syndrome Average Length of Stay Ante Natal Clinic Adolescent Reproductive Health Anti retroviral Busatmante Hospital for Children Bacille Calmette-GuĂŠrin Body Mass Index Basic Needs Trust Fund Bovine Spongyform Encephalopathy Bellevue Hospital Certification of Agricultural Produce and Project Caribbean Epidemiology Centre (PAHO) Caribbean Community Caribbean Institute of Media and Communication Caribbean Conference of Churches Child Care Protection Act Child Development Agency Centres for Disease Control Caribbean Food and Nutrition Institute Caribbean Informaiton Committee Canadian International Development Agency Caribbean Institute of Research and Development Community Development Action Committees Chief Parliamentary Counsel Cardio-pulmonary Resuscitation Cornwall Regional Hospital Congenital Rubella Syndrome Commercial Sex Workers Cardiovascular Disease Diabetes Association of Jamaica Dental Auxiliary School Department of International Development Decayed, Missing, Filled Teeth Diphtheria, Pertussis and Tetanus/Diphtheria Tetanus Employee Assistance Programme Electro-Cardiogram Environmental Health Unit Electoral Office of Jamaica Expanded Programme on Immunization Food and Drug Act Economic Social Survey of Jamaica Geographic Information System Government of Jamaica HIV/AIDS Tracking System Hepatitis B Surface Antigen Health Corporation Limited Hepatitis C Virus Human Employment and Resource Training Hepatitis B
192
Ministry of Health Annual Report 2006
HFJ HFMU HIA Hib HISEP HIV HMSR HPP HRM HTLV I H5N1 ICC IDB ICBSP ISSA IUD JAD JADEP JAMAL JAMALCO JAS JA-STYLE JCS JICA JN Plus JPS JSIF JSB JSLC KAPB KPH KSA KSAC KSN LAC LIFE MICS MMR MOH MSM MVP NAC NAP NBTS NCDP NERHA NFPB NGOs NHF NPHL NRS OPV PAHO PALS
Heart Foundation of Jamaica Health Facilities Maintenance Unit Health Information Assessment Haemophilus Influenza Type B High School Equivalency Programme Human Immuno-deficiency Virus Hospital Monthly Statistical Report Health Promotion and Protection Human Resource Management Human T Lymphotrophic Virus (Type 1) Highly Pathogenic Avian Influenza Subtype International Cricket Council Inter-American Development Bank Inner City Basic School Project Inter-Secondary Schoolsâ&#x20AC;&#x2122; Association Inter-Uterine Device Jamaica Association for the Deaf Jamaica Drugs for Elderly Programme Jamaica Adult Literacy Programme Jamaica Aluminium Company Jamaica AIDS Support Jamaica Solution to Youth Lifestyle and Empowerment Project Jamaica Cancer Society Japan International Cooperation Agency * Jamaica Network of Seropositives Jamaica Public Service Jamaica Social Investment Fund Jamaica Society for the Blind Jamaica Survey of Living Conditions Knowledge, Attitude and Practice Kingston Public Hospital Kingston and St. Andrew Kingston and St. Andrew Corporation Kingston School of Nursing Latin America and the Caribbean Living in Family Environment Multiple Indicator Cluster Survey Mumps, Measles and Rubella Ministry of Health Men who have Sex with Men Mentors for Violence Prevention National AIDS Committee National AIDS Programme National Blood Transfusion Services National Community Development Programme North East Regional Health Authority National Family Planning Board Non-Government Organizations National Health Fund National Public Health Laboratory National Registration Services Oral Polio Vaccine Pan-American Health Organisation Peace and Love in Schools
193
Ministry of Health Annual Report 2006
PCA PCO PCR PHC PIOJ PLACE PLWHA PMI PMTCT PRP RFJ RHAs RHS RISE SERHA SLA SRHA STATIN STIs Tb TFR UHWI UN UNEP UNICEF UNITAR USAID UTECH UWIDEC VCT VDRL VJH WHO WPRC WRHA
Pesticide Control Authority Pest Control Operators Polymerase Chain Reaction Primary Health Care Planning Institute of Jamaica Priority for Local AIDS Control Effort Persons Living with HIV/AIDS Peace Management Initiative Prevention of Mother-to-Child Transmission of HIV Poverty Reduction Programme Richmond Fellowship of Jamaica Regional Health Authorities Reproductive Health Survey Reaching Individuals through Skills and Education South East Regional Health Authority Service Level Agreement Southern Regional Health Authority Statistical Institute of Jamaica Sexually Transmitted Infections Tuberculosis Total Fertility Rate University Hospital of the West Indies United Nations United Nations Environment Programme United Nationsâ&#x20AC;&#x2122; Children Fund United Nations Institute for Training and Research United States Agency for International Development University of Technology University of the West Indies Distance Education Centre Volunteer Counselling and Testing Venereal Disease Research Laboratory Victoria Jubilee Hospital World Health Organisation Whole Person Resource Centre (Bethel Baptist Church)* Western Regional Health Authority
_________________________ * Added April 2011
194
Ministry of Health Annual Report 2006
BIBLIOGRAPHY
Ministry of Health:
Hospital Monthly Statistical Reports (2002-2006) Hospital Utilisation Data (2002-2006) Jamaica Basic Indicators, 2000 Ministry of Health Annual Report, Planning and Evaluation Branch, Kingston, Jamaica (2003), (2004), (2005). Ministry of Health Agencies, Branches, Divisional & Regional Health Authorities Reports Monthly Clinical Statistical Reports (2002-2006)
Planning Institute of Jamaica:
Economic and Social Survey, Jamaica, PIOJ (2006).
PAHO:
Annual Report of the Director: Advancing the People’s Health, Chapter 5, Health Systems and Services Development, p83 Promoting Health in the Americas – Annual Report of the Director, 2001, Chapter 4, Health Services and Systems Development, PAHO, Pan American Sanitary Bureau, Washington D.C. Annual Report of the Director: Advancing the People’s Health, Chapter 5, Health Systems and Services Development, p83 Promoting Health in the Americas – Annual Report of the Director, 2001, Chapter 4, Health Services and Systems Development, PAHO, Pan American Sanitary Bureau, Washington D.C.
Publications:
Glossary, commonly used health care terms accessed from http://www.health.state.mn.us/clearinghouse/glossary.htm Michael O'Donnell, editor of the American Journal of Health Promotion accessed from http://www.healthpromotionjournal.com/
195
Ministry of Health Annual Report 2006
Reports:
NGOs Summary of Achievements/Challenges (2006) Police Department (Statistics and Traffic Divisions) (2006) Jamaica Estimates of Expenditure for year ending March 31, 2007 Jamaica Estimates of Expenditure for year ending March 31, 2005 and 2006 and Ministry of Healthâ&#x20AC;&#x2122;s Finance Division Access to Care and Maternal Mortality in Jamaican Hospitals 1993-1995
STATIN:
Demographic Statistics, 2006
WHO:
WHO/FAO, 1999 Conference on Veterinary Public Health The World Health Report 2000, Health Systems: Improving Performance WHO Geneva Switzerland World Health Report, 1977, p.64 Adapted from Glossary of Terms used in Health for All series, WHO, Geneva, 1948 accessed from http://www.who.int/hpr/NPH/docs/hp_glossary_en.pdf Glossary of Terms used in Health for All series. WHO, Geneva, 1984, accessed from http://www.ldb.org/vl/top/glossary.pdf
196