NY April 30 th 2011

Dr. Barbara Gordon, Ob/gyn Dr. Sharon Ogiste-McBain, Pediatrician Dr. Wilkins Williams, Internal Medicine Dr. Elma Johnson, Emergency medicine Rev Wesley Daniel

Grenada General Hospital

GRENADA NATIONAL STRATEGIC PLAN FOR HEALTH ( ) Gov’t of Grenada

The Grenada National Strategic Plan for Health designed to involve the whole country in setting priorities and a direction for improving health status of the population

Steering Committee Appointed by cabinet in 2004 Financial support from Caribbean Dev. Bank Technical support from PAHO Consultation launched in Sept 2005 Ministry of Health

A National Strategic Plan for Health

Guiding principles

Strategies outlined by the Caribbean Charter for Health Promotion

Grenada Grenada, Carriacou, Petit Martinique 133 sq miles Independent Nation 1974 from the UK Westminister- style parliament Population 2005 was 106,027 Growth rate 0.2%

Demographics 2005 Ages 0-15 …. 34.7% Ages …54.9% Ages 65+ …10.32%

Overview of the population’s health status Infant Mortality range & 19.6 (deaths /1000 births) Maternal Mortality rate 0 for 4 years Death Rate range from /1000 population Life Expectancy Age 68 for men and women 72 Fertility rate 2004, 2.4 children for women of childbearing age

Socio-Economic Situation The 2005 UNDP- Human Development Index ranked Grenada 66 th of the 177 nations. The ranking reflect positive changes in infant mortality rates and adult literacy. Other indicators include an 18.8 % unemployment rate and a 31% poverty rate

Leading causes of death Disease of the circulatory system including pulmonary circulation, cerebrovascular disease other forms of heart disease Malignant neoplasms Disease of respiratory system Certain infections and parasitic disease Accident and injuries increase 4 fold from

Leading causes of morbity 2004 Diabetes Mellitus Hypertensive Disease Upper respiratory infections Arthritis Injuries Admissions to hospital greatest in persons in age 45+

Communicable disease review Decline in TB from 17 to 6 cases No deaths from Dengue ‘03-’04, the number of cases bet ‘02-’04 were 310,19,8 respectively, cases related to rainfall an mosquitoes Decrease in Sexually transmitted Disease Syphilis almost 80% decrease bet ‘96 & ‘02 Gonorrhea remained stable with 112 cases in ‘96 and 101 cases in ’02

HIV/Aids HIV midyear ’05, reported cases 197, male to female ratio 2.5 : 1 Cumulative # of deaths from AIDS, males, 42 females

Hospital utilization ‘04 Women: 99% delivered in a health facility,75% at the General hospital, 1% in private ‘01-’04 men accounted for higher utilization of hospitalization (compared to women)for injuries from work place and road traffic accidents Men also had a higher admission to the Carlton House for drug and alcohol abuse treatment ’04 men had 33% first visit to the community health services

School age children A survey for Anemia in 2004, ages 1-4, 62.1% had hemoglobin levels below normal Dental services at health centers,2,238 children seen ages 5-19, 99.3 % were identified with problems ‘00 Teenage pregnancies, 21 % of total births

Elderly 13 homes care for the elderly (gov’t assisted, public, private) An NGO also works in the community for the elderly Chronic disease management is a major challenge By 2014, 20-25% of the population will be over 50 years of age there will be greater demand for chronic disease care at the community level and hospital level

Health Risks Main concern and cause of ill health and death is related to: poor dietary habits, in particular before and after pregnancy, poor fetal development, early childhood nutrition, poor chronic disease management, accident and injuries, drug and alcohol use, and (to some extent) unsafe practices

Health Services Public facilities- 3 Acute care hospitals General Hospital-240 beds Princes Alice Hospital- 56 beds Princess royal Hospital (Carriacou ) -40 beds 1 Mental health Hospital (Mt Gay Hospital)

Health Services con’t 1 Rehabilitation center (Carlton House) 1 Home for the elderly ( Richmond Home) 6 Health centers 30 health stations There is limited referral system between community services and hospitals as a result many patients to directly to the Accident and Emergency (A&E) resulting in long waiting time

Hospital Utilization 2004 General Hospital had 8,313 admissions at the Average length of stay 6.6 days, bed occupancy rate 73 % Princess Alice has limited diagnostic services all x-ray and lab services has to go to the General Hospital requiring patients to be transferred. Occupancy rate 60%

Hospital Utilization cont’d Princess Royal Hospital (Carriacou) serves a population of 7000 including Petite Martinique A major constraint is the inability to retain doctors who cover both hospital and community services

Community health services District Medical Officers 10 community health nurses 40 district nurses 5 Family Nurse Practitioners 45 community Health Aides 12 Pharmacists 8 dentists 2 social workers 7 environmental Health officers

Private health services Dominated by single practioners, many of these doctors work for the public health services 2 small private clinics with patient beds A diagnostic facility General hospital Private ward No NGO provide inpatient care, however many participate in health promotion an protection activities

Financial Resources Health sector receives approx 12% of the annual budget in Wages and salaries account for approx 70% of health expenditures

Personnel 1997/ physicians per 10,000 population 19.5 nurses per 10, Dentist per 10, Pharmacist per 10, Nutritionist per 10,000 Key challenges for health personnel in Grenada include the ability to retain medical practioners, nursing staff and medical administrators

Central non-partisan body To coordinate all voluntary health aide efforts made to Grenada with representatives from each parish Develop a website with links Create a central registry for physicians and allied health workers with the services they can provide Governed by an advisory Board efforts coordinated by a core body e.g.. secretary, treasurer and president Set up a central office in Grenada and NY

Education Community education –health information, pamphlets Provide a monitoring system to track the educational materials Have volunteers /paid personnel to ensure reading materials are circulated Maintain statistics of the education materials Quality assurance to ensure materials are distributed to the appropriate parties

Education cont’d Provider education…physicians, nurses, aids and all allied workers those in direct and indirect patient care Mandatory continuing medical education (CME) Incorporate Health education in high school and elementary school…e.g. STD, proper nutrition, dental care etc.

Health Protocols and compliance Review health protocols of hospital and satellite clinics Create a committee of 3-4 physicians/administrative staff to review protocols …are they practical ? are they enforced ? The central board should be involved in the process

NGO and Volunteer services Central Committee …. responsible to coordinate the volunteer services for continuity of care Have a central registry to coordinate the volunteer services e.g. dentists going on different months for continuity of care rather than having all at the same time Have paid staff to coordinate efforts for accountability

Drug Bank Drug assistant bank program to assist patient with unaffordable medication Make arrangement with drug companies and other parties

Weekly Radio and TV health topics Have a calendar, get volunteers to provide health information for different topics

Grenada General Hospital

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