St Christopher and Nevis

Health Systems Strengthening SeminarBelize City

May 30 –June 1, 2006

Background

St Christopher and Nevis is an independent twin island federation that is located in the north eastern Caribbean.

St Kitts spans 168km2 and Nevis 93km2

The combined population is 47,313 (2003 est.) The main stay of the economy is tourism with

contributions from agricultural sector and export oriented manufacturing.

Per capita GDP $8600 (2004 est.) Life expectancy at birth 69 years in males and 75 in

females

Public Health System

There are 2 General Hospitals (urban) that offer secondary care.

Two rural district hospitals in St Kitts.

17 Health centers (11 in St Kitts and 6 in Nevis).

Organizational Structure

Ministry of Health

Office of Policy Development and information Management

Community Based Health Services Institution Based Health Services

Administration

Family Health Services

Environmental HealthServices

Health Promotion

Administration and auxiliary services

Clinical and patient care

Health Sector Reform

Since the late 1990’s, the health sector has undergone a series of reforms in an effort to improve efficiency, quality and sustainability.

Discrete examples are illustrated in the following slides.

Establishment of Health Promotion Unit

With the increasing prevalence of lifestyle related disorders, there was recognition of the importance of health promotion strategies and the need to emphasize prevention as part of the holistic approach to care.

A Health Promotion Unit was established in 2000 to coordinate health promotion approaches across government departments and other sectors.

It is staffed by a NCD Coordinator, Nutrition Surveillance Coordinator, Nutrition Officer, National AIDS Programme Coordinator and 2 health educators.

Upgrading of health facilities

The main hospitals on both islands were upgraded.

Several of the primary care facilities were also upgraded to accommodate the operationalisation of the primary health care approach to promote accessibility, community involvement and self reliance.

Human resource strategies

Increased commitment to provide training opportunities for staff through:– Scholarships– In-service Education Department located at

Joseph N France General Hospital• Training of VCT counselors

• Training of Emergency Medical Technicians

• Continuous education for nurses and assistants

Restructuring of the Nursing Services

Training programme for nurses and auxiliaries is now delivered through the Clarence Fitzroy Bryant College.

Restructuring of nursing posts and responsibilities in an attempt to increase the autonomy of managers (the role of the Chief Nursing Officer has been de-emphasized as it relates to the general management of nursing).

Quality Initiatives

There has been an effort to incorporate quality in all care processes.

National Focal Point has been appointed to coordinate these efforts.

Introduction of user satisfaction surveys. There has been some movement towards

achieving accreditation of hospital (preliminary evaluation conducted in 2005)

Health Financing

After almost thirty years, there was an evaluation of user charges in an effort to augment revenue collection (no follow up research to assess the impact on access).

There is keen interest in implementation of a national health insurance scheme to ensure universal access to services.

Privatization

There has been an increased willingness to engage the private sector entities to ensure provision of health services.

CT scan available at Joseph N France through public private partnership.

Plans to establish a haemodialysis unit at the same facility with collaboration from private sector.

Conclusion

We have achieved some successes in our attempts to improve the performance of the health care system through health sector reform.

We must build on these efforts and continue to sustain the momentum that has been created.

The End

Thanks for your attention!