NY April 30th2011

Dr. Barbara Gordon, Ob/gynDr. Sharon Ogiste-McBain, PediatricianDr. Wilkins Williams, Internal MedicineDr. Elma Johnson, Emergency medicineRev Wesley Daniel

Grenada General Hospital

Grenada General Hospital

Grenada General Hospital

GRENADANATIONAL STRATEGIC PLAN FOR

HEALTH

(2007-2011)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 CommitteeAppointed by cabinet in 2004Financial support from Caribbean Dev. BankTechnical support from PAHOConsultation launched in Sept 2005Ministry of Health

A National Strategic Plan for Health

Guiding principles

Strategies outlined by the Caribbean Charter for Health Promotion

GrenadaGrenada, Carriacou, Petit Martinique133 sq milesIndependent Nation 1974 from the UKWestminister- style parliamentPopulation 2005 was 106,027Growth rate 0.2%

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

Overview of the population’s health status Infant Mortality range 1998-2002 12.5 & 19.6 (deaths /1000 births)Maternal Mortality rate 0 for 4 yearsDeath Rate range from 7.0-8.7 /1000

populationLife Expectancy Age 68 for men and women 72Fertility rate 2004, 2.4 children for women of

childbearing age

Socio-Economic SituationThe 2005 UNDP- Human Development Index ranked Grenada 66th 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 1998-2002Disease of the circulatory system including

pulmonary circulation, cerebrovascular disease other forms of heart disease

Malignant neoplasmsDisease of respiratory system Certain infections and parasitic diseaseAccident and injuries increase 4 fold from

1989-2002

Leading causes of morbity 2004Diabetes Mellitus Hypertensive DiseaseUpper respiratory infectionsArthritis InjuriesAdmissions to hospital greatest in persons in

age 45+

Communicable disease review 1980-2004Decline in TB from 17 to 6 casesNo 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 & ‘02Gonorrhea remained stable with 112 cases in

‘96 and 101 cases in ’02

HIV/AidsHIV midyear ’05, reported cases 197, male

to female ratio 2.5 : 1 Cumulative # of deaths from AIDS, 155113 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 childrenA survey for Anemia in 2004 , ages 1-4,

62.1% had hemoglobin levels below normalDental 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 RisksMain 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 ServicesPublic facilities- 3 Acute care hospitalsGeneral Hospital-240 bedsPrinces Alice Hospital- 56 beds Princess royal Hospital (Carriacou ) -40 beds

1 Mental health Hospital (Mt Gay Hospital)

Health Services con’t1 Rehabilitation center (Carlton House)1 Home for the elderly ( Richmond Home)6 Health centers30 health stationsThere 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 2004General 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 200410 District Medical Officers10 community health nurses40 district nurses5 Family Nurse Practitioners45 community Health Aides12 Pharmacists8 dentists2 social workers7 environmental Health officers

Private health servicesDominated by single practioners, many of

these doctors work for the public health services

2 small private clinics with patient bedsA diagnostic facilityGeneral hospital Private wardNo NGO provide inpatient care, however

many participate in health promotion an protection activities

Financial ResourcesHealth sector receives approx 12% of the

annual budget in 2000-2005Wages and salaries account for approx 70%

of health expenditures

Personnel 1997/20028.1 physicians per 10,000 population19.5 nurses per 10,0001.1 Dentist per 10,000 6.9 Pharmacist per 10,000 0.75 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 bodyTo coordinate all voluntary health aide efforts

made to Grenada with representatives from each parish

Develop a website with linksCreate 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,

pamphletsProvide a monitoring system to track the

educational materialsHave volunteers /paid personnel to ensure

reading materials are circulatedMaintain statistics of the education materialsQuality assurance to ensure materials are

distributed to the appropriate parties

Education cont’dProvider 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 complianceReview health protocols of hospital and

satellite clinicsCreate 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 servicesCentral 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 medicationMake arrangement with drug companies and

other parties

Weekly Radio and TV health topicsHave a calendar , get volunteers to provide

health information for different topics

Grenada General Hospital

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