JAMAICA’S HEALTH SYSTEMS TREVOR MCCARTNEY C.D., J.P., M.B.,B.S., DM (Surg.) UWI, F.R.C.S. (Ed.), F.A.C.S SENIOR MEDICAL OFFICER KINGSTON PUBLIC HOSPITAL

Jamaica, the largest English speaking island in the Northern Caribbean is 4,441 square miles in size and has a population of over 2.6 million persons.

Health Care System 18 General Hospitals 6 Specialists  Primary Care System (Clinics) 331 Clinics    (+ 23 satellites) Public Health System

Hospitals N=18 Type A: 3 multidisciplinary Final referral centres Type B: 5 Large urban centres (O&G, Paed med, gen surgery, int medicine, anesthesiology A&E Type C: 10 District hospitals ( gen medicine, surgery , child health and maternity care. Community hospitals/ deliveries

Hospitals 6 specialists Psychiatric and rehabilitative services for the mentally ill O & G nationally Paediatric care Oncology and hospice Chest diseases Physical rehabilitation

Other National institutions National public Health lab Blood bank

Primary care Health districts on a demographic basis Pop 20-30,000 served by health centres Type 1. pop 4000 Type 2: 12,000 Type 3- 5: 20,000

Primary care Services offered: Family Health Antenatal and postnatal care Child health E.P.I. Dental health Mental health Environmental health Family planning STI Nutrition Health promotion

Team approach including community participation. Integration of preventative and curative services Government of Jamaica (GOJ) major provider Non Government Organizations (N.G.O’s) private practitioners, private clinics and private hospitals complement the government services.

Public Sector predominates in the community health and inpatient areas Private sector dominates in terms of primary care, pharmaceuticals and diagnostic services.  

Health sector reform programme  H.S.R.P. - 1995 1.     Prevention 2.     Treatment 3.      Severe Resource Restraints  

To accomplish these objectives Policy Reform required 1.    Decentralization 2.    Alternate financing 3.    Spending efficiency 4.    Restructuring of Head Office 5.    New Laws and Regulations 6.    Revision of Information and reporting systems

DECENTRALISATION In 1999, Jamaica decentralized the Administration of its Health Services. Four Regional Health Authorities were established. South East Southern North East Western

Decentralization Administrative Fiscal Political Process Designed to Improve Health Services through increasing allocation and technical efficiency

Financial Management Financial plans and strategies have determined the pace of decentralization A National Health Insurance Scheme proposed not yet implemented National Health Fund Drugs Institutional Support

Spending efficiency Solar Heating Energy Conservation Energy Monitors Reorganization of Transportation

Restructuring of Head Office Reduction in personnel (600 300) Functions Redefined to reflect Policy Formulation Quality Assurance and Standards Monitoring

New Laws and Regulations Revision of the Health Services Act Public Health Act National Health Services Act

Health Interventions Policy and Procedures Manuals Streamline Activities for efficiency and effectiveness. Development of specialized Services in Rural Institutions Increased Training of health Professionals Equipping of Institutions Increased Access to Specialist Services and Reduced waiting lists.

Health Interventions TRIAGE Programme in Accident and Emergency Department Improved flow to Primary care Clinics Reduced waiting time in Accident and Emergency Department Improved and efficient Service

Ambulatory Care Community Mental Health Clinics Chronic Disease clinics e.g Diabetes, Hypertension, Arthritis Specialist Medical Outpatient Service e.g Asthma High Risk Ante-Natal Clinics Admissions and Maternal mortality decreased Community Mental Health Clinics Decreased inpatients at mental hospitals

SUMMARY Introduction of Primary Care Services has seen an improvement in the control of infections Diseases through a programme of Immunization Decentralization has sought to improve Health Services through increased allocation and technical efficiency Innovative Financing has helped to defray the cost of the decentralization programme and provided increased access to drugs and services

Summary cont’d Health Interventions have improved the quality and quantity of care to the wider population. Emphasis on ambulatory care and the reduction of inpatient services is producing a more efficient and effective service.

Thank you