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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Belize is located in Central America. Encompassing a total area of 22,700 km 2, Belize is 274 km (170 miles) long and 109 km (68 miles) wide, with a population density of approximately 30.9 inhabitants per square mile in 2003. The capital is Belmopan City. Belize is the only English-speaking country in Central America. However, due to its location Spanish is widely spoken. The Prime Minister and the Cabinet constitute the executive branch of the government, while a 29-member elected House of Representatives and a 9-member appointed Senate form a bi-cameral legislature, the National Assembly.
Demography:The 2000 census indicated that the total population was 249,800 while the 2004 mid-year estimates reported 282,600 (males 142,700 and females 139,900). The population growth rate was estimated at 2.7%. The percentage of the population over 65 years is 4.3% and that less than 15 years was 40.9%. The dependency ratio is high (estimated at 82.4%). The population is comprised of a mix of ethnicity and cultures. The Mestizos constitute 48.7%, creoles 24.9%, Mayas 10.6%, Garinagu 6.1%, Mennonite 3.6%, and East Indians 3.0%. The remainder of the population (3.1%) is made up of Chinese, Arabs, Africans and white Caucasians. English is the official language of the country but several other languages including Spanish are widely spoken.
Economy: Belize has an open, simply structured economy based primarily on agriculture and services. Since 1976, the exchange rate has been pegged at US $1.00 to BZ $ 2.00. The 1999 per capita income was US $ 2,427 as compared to US$ 1,664 in 1989. In the year 2000 Belize had an unprecedented GDP real growth of 12.3% compared to 1.5% in 1996. Belize’s economy has historically been dominated by agricultural exports which include sugar cane, citrus, bananas, and marine products. Forestry, fishing, and mining are also important sectors.
Mortality: Crude mortality rate in 1999 was 4.9/1,000 pop and 4.7 in 2003. The number of deaths among males (3,907) has remained higher than female (2,637) for the 1999 to 2003 period, with a male female ratio of 1.48:1. It is estimated that over 30% of deaths are not registered. The leading causes of mortality were diseases of the Circulatory System: Hypertensive Diseases (8.0%), Ischemic Heart Diseases (5.8%) and Cerebrovascular Disease (5.5%), which accounted for 27.3% (1,781) of deaths. External injury and poisoning (Transport Accidents 6.0%) whereas Homicide and Injury Purposefully Inflicted (4%) was the second leading cause of death. Five times more males than females died due to external causes. Communicable diseases: Acute Respiratory Infections (5.6%) and HIV/AIDS (4.2%) accounting for a total of 640 deaths. A total of 5.7% (155 males and 216 females) were reported to have died as a result of diabetes. Symptoms and ill-defined conditions with 216 deaths (3.3%), and the rest of residual cause with 85 deaths (1.3%) almost the same for both male and female. Maternal mortality ratio decreased from 68 in 2002 to 40.4/100,000 live births (lb) in 2003.
SPECIFIC HEALTH PROBLEMS (by population group)
Children (0-4 years):The infant mortality rate decreased from 16.9/1,000lb in 1999 to 14.8 in 2003. In this age group, 81.5% (650) of death occurred in the under-1-year population and 18.5% (148) in 1-4 years population. The leading cause of infant mortality, under 1 year, during 1999-2003 was conditions originating in the perinatal period. Of all these deaths among neonates slow fetal growth, fetal malnutrition, and immaturity accounted for 24.5%; hypoxia, birth asphyxia and other respiratory conditions for 14.5%, other conditions originating in the perinatal period for 6%, congenital anomalies for 12.2%, acute respiratory infections 8.5%, nutritional deficiencies and anemia 3.7% and septicemia 3.4%. During 1999-2003 the leading cause of infant morbidity, under 1 year, was Acute Respiratory Infections which accounted for 19.1%, followed by other conditions originating in the perinatal period for 17.9%, intestinal infectious diseases 10.6%, hypoxia, birth asphyxia and other respiratory conditions for 10.6%. Within the 1-4 years old, the highest proportion of deaths (29.7%) was due to external causes. Of these deaths, transport accidents accounted for 11% and accidental drowning accounted for 9.5%. The second leading cause of death was communicable diseases, accounting for 24.3% of deaths. Of these, acute respiratory infections accounted for 8.8% of total deaths and septicemia accounted for 4.7% of total deaths. In the period 1999-2003, 25.2% of all hospitalization among this age group was due to Acute Respiratory Infections, 15.8% intestinal infections diseases, 9.8% bronchitis, chronic and unspecified, emphysema and asthma, 8.6% due to injury, poisoning and certain other consequences of external cause.
Schoolchildren (5-9 years):This age group had mortality rates of 33/100,000 pop in 1999 and 32 in 2003. External causes accounted for 42% of all deaths during 1999-2003 in this specific age group, where transport accidents accounted for 25.4% and accidental drowning and submersion 10.4%. Communicable diseases, including acute respiratory infections (10.4%), HIV/AIDS (4.5%), septicemia (1.5%), meningitis (1.5%), and other infections and parasitic disease (1.5%) all accounted for 19.4% of deaths in this age group. In the period 1999-2003, 19.2% of hospitalization was due to injury, poisoning and certain other consequences of external causes, 10% due to acute respiratory infections, 8.8% appendicitis, hernia of abdominal cavity and intestinal obstruction and 8.3% bronchitis, chronic and unspecified, emphysema and asthma.
Adolescents (10-14 and 15-19 years):The mortality rate for adolescents 10-14 years old varied from 35/100,000 pop in 1999 to 37 in 2003. External injuries were the leading cause of death for this age group (45.3%). Most notable were transport accidents, which made up 20.3% of total deaths. Communicable disease accounted for 11% of all deaths, and this was mostly due to respiratory infections (7.8% of all deaths). Diseases of the nervous system also accounted for 11% of all deaths. Adolescents 10-14 year-olds accounted for 3.1% of all hospitalizations in this period. Leading causes of hospitalization included external injuries (19%), appendicitis, hernia and intestinal obstruction (10.7%), and complications due to pregnancy (9.7%). The mortality rate among adolescents 15-19 years old was 93/100,000 pop and 86 in 2003. Of these deaths, 44.4% were due to external causes, of which transport accidents comprised 18.8% of total deaths for this age group. Complications of pregnancy were the leading cause of hospitalization among 15-19 year olds (69%), followed by external causes (5.7%). During 1999-2003, 35 adolescent males and 76 adolescent females were infected with HIV. 8 suicides occurred in the 10-19 age group during 1999-2003.
Adults (20-59 years): This age group comprised approximately 42% of the total population in 2003. The mortality rates per 100,000 populations were 357 in 1999 and 402 in 2003. The leading cause of death for adults was external injuries, accounting for 32% of all deaths. The second leading cause of death was due to disease of the circulatory system, accounting for 17.8% of all adult deaths. The next leading cause of death was due to communicable diseases, accounting for 16%. The overwhelming majority of these deaths were due to HIV/AIDS. This was followed by malignant neoplasms (9.4%) and diabetes mellitus (3.7%). Complications of pregnancy accounted for 59% of all hospitalization in this group, followed by external injuries (9%), cervical and other cancers (1.5%). Other important causes of hospitalization were diabetes mellitus and diseases of the circulatory system.
Elderly (60 years and older):In 2003, the elderly made up 5.9% of the population as compared to 5.8% (14,105 persons) in 1999. The mortality rate among this age group was 4,431.1 in 1999, and 3,930.1/100,000 pop in 2003, of these, 56.1% were males and 43.9% were females. Between 1999 and 2003, diseases of the circulatory system were the leading causes of death, accounting for 43% of all deaths. This age group accounted for 10.5% of all hospitalizations during this period. Diseases of the circulatory system were the leading cause (34%) of hospitalization, followed by communicable diseases, diabetes mellitus (9%), and malignant neoplasm (5%).
Workers health:According to data from the Social Security Board work related injuries have increased from 1,522 cases in 1995 to 2,580 in 2003. Important to note, however, is the loss of productivity from 35,430 days lost in 1995 to over 70,000 days in 2003.
The disabled: Services for the disabled are provided by the Ministry of Human Development and the Ministry of Education through its Special Education Unit. In 2000, there were 1,991 school-aged children with primary disabilities. 40% (813) of these children were categorized as slow learners, 8.5% had some form of speech or language disorder, 6% had a visual impairment, and 3% had a physical disability. 63% of children with primary disabilities were boys.
Indigenous groups:In Toledo and parts of Stann Creek, where most indigenous people live, access to health care is of concern. Medical personnel offer fixed and mobile services to respond to the districts’ needs. There is one community hospital in the Toledo district and a regional hospital in Stann Creek. Fertility rates in Stann Creek and Toledo districts stand at 5.6 children per woman, while it is 3.7 at the national level.
Analysis by type of health problem
Natural disasters:In the past few years, Belize has been directly and indirectly affected by natural events, mainly hurricanes and floods. In the wake of Hurricane Mitch, the Government of Belize instituted the National Emergency Management Organization (NEMO), which is responsible for the coordination of disaster preparedness and response activities.
Vector-borne diseases:Malaria continues to be a public health concern, notwithstanding the constant reduction in the number of cases since 1994 from 10,441 cases to 1,319 in 2003. With respect to dengue, there have been outbreaks in neighboring countries of Central America, however the situation in Belize has remained under control with only 8 confirmed cases in 2003. The fact that Belize has had different serotypes of dengue virus makes the population vulnerable to Dengue Hemorrhagic Fever (DHF).
Vaccine preventable diseases:Immunization coverage has remained stable above 95% for each of the immuno-preventable diseases. Hepatitis B vaccine was introduced into the program in 1999.
Intestinal infectious diseases: Cholera was first reported in Belize in January 1992 when 159 cases were reported since then this disease has been kept under control without any cases reported since the year 2000. Diarrhea cases have also been significantly reduced over the past few years from 1645 in 1998 to 227 cases in 2003, especially among children less than 5 years.
Chronic communicable diseases:The number of TB cases reported has increased over the years, from 94 cases in 1995 to 135 in 2002. During 2003, however, the total number of cases was 88. This reduction, especially in the Belize District, is mainly due to improved human resources and coordination of the national program. TB/HIV co-infection, in spite of a reduction in 2002, noted a slight increase in the prevalence rates from 12.39 % in the year 2001 to 12.50 % in the year 2003.
Acute respiratory infections:Acute Respiratory Infections (ARI) continues to be one of the leading causes in the general population. The 1-4 age group data shows an increase from 9.4% of deaths attributable to this condition in 2001 to 13.6% in 2003.
Zoonoses:Rabies in animals is endemic in Belize. No human case has been reported since 1989. Rabies cases have been reported among domestic animals including dogs and cats and wild animals like foxes and bats since 1995. The last canine rabies case was reported in 2001.
HIV/AIDS:The first case of AIDS in Belize was reported in 1986. Up to the end of 2003 a total 2,471 individuals had acquired HIV of which 669 developed AIDS and 464 died. In 2003, HIV/AIDS was ranked as the fourth leading cause of death; second among males and sixth among females. This disease is predominantly affecting the age group between 15-49 years. Among the general population, new HIV infections continue to show an upward trend as the population tested has also greatly increased. The number of HIV infections has increased from 72 in 1995 to 447 in the year 2003. The ratio male to female of new HIV infections decreased from 2:1 in 1996 to an all time low of 1.16: 1 in 2003. The cumulative male to female ratio from 1996 to 2003 is 1.3:1. This ratio is approaching an equal number of males and females infected by this disease, indicating a feminization of the epidemic. This could partially be due to the implementation of the PMTCT Program, which entails HIV testing for females. The HIV prevalence rate among pregnant women tested (87%) was 0.92% in 2003. The districts of Belize and Stann Creek presented the highest rate with 1.74% and 1.44% respectively. Resources made available through the recently approved Global Fund should assist significantly in addressing HIV/AIDS. In addition, there is a multiplicity of agencies working on HIV/AIDS in the country and therefore in order to maximize resources and achieve desired results, effective coordination is critical.
Nutritional metabolic diseases:The only reliable information on the nutritional status of children comes from the 1996 National Height Census of children aged six to nine years old, which shows that 15% of children suffer from growth retardation or low-height- for-age. Most of the stunting was found in the Toledo District (39%) and the lowest levels were in the Belize district (4%). There were higher levels of growth retardation among boys than in girls (18.2 % against 12.5%). Information on iron deficiency anemia among children is non-existent but 52% of women attending prenatal clinics were found to be anemic in 1995.
Diabetes Mellitus is still ranked among the ten leading causes of mortality. In 2003, it was ranked number 6. The number of diabetes cases admitted to hospitals has increased from 319 in 1999 to 536 in 2003. These outcomes are greatly attributed to lifestyle practices. A Diet, Exercise and Lifestyle study conducted in 2003 shows that approximately 15% of the Belizean population between 15 and 64 years has at least one chronic disease; with females more significantly affected than males. Of the total population, 36% was found to be overweight and 27% to be obese.
Diseases of the circulatory system:Cardiovascular diseases accounted for 30% (1,579 deaths) of reported deaths during 1997-2000 from a total of 5,241 deaths. An increase trend was observed during this period from 131/100,000 pop in 1997 to 250/100,000 pop in the year 2000.
Accidents and violence: In the area of violence and injuries, the most significant public health concerns include road traffic accidents, domestic violence and child abuse. Although a decrease is noted in the incidence of Road Traffic Accidents (RTAs) from 33.8 in 2001 to 27.4 in 2003 (per 100,000 pop), RTAs are among the leading causes of death and remain a major public health challenge. These are also contributing to the increase in injuries and related disabilities. Domestic violence continues to increase. In 2003, there were over 1,200 registered cases of domestic violence. Of concern is also the high incidence of sexual violence, especially among young women and the intensity of physical violence.
Oral health:A baseline Caries Index and Fluorosis Survey completed in 1999 demonstrated a continuing reduction of dental decay in the country: 15 year olds had 1.56 DMFT and 6-8 year olds had 2.53 DMFT; 72% of 12 year olds were caries free. In another study done in 1999, high levels of fluoride in drinking water associated with high prevalence of fluorosis were identified in the northern part of the country.
RESPONSE OF THE HEALTH SYSTEM
National health policies and plans:During the past few years the country has developed several policy documents, protocols, guidelines, norms, standards/regulations and other supportive frameworks to advance the public health agenda in Belize. In addition the Government embarked in the reform of the health sector with the purpose to improve efficiency, equity and quality of health care services and promoting healthier lifestyles.
Health sector reform strategies and program:The Health Sector Reform Program has three components: i) Sector restructuring and strengthening the organizational and regulatory capacity of the central and regional level of the public sector, which will strengthen the stewardship and regulatory role of the Ministry of Health ii) Services rationalization and improving the coverage and quality of services of public and private sectors by restructuring public facilities, purchasing selective services from the private sector to support the public supply, and iii) The establishment of a National Health Insurance Scheme.
Institutional organization:The Government of Belize is the main provider of health services. As part of the health sector reform the Ministry of Health has reorganized the health services into four Health Regions (Northern, Central, Western and Southern); each one with a Regional Health Manager, who with the support of a Management Team, is responsible for coordinating the delivery of personal and population-based health services to the communities in the geographical areas under their jurisdiction.
Health provision, insurance and financing: The Ministry of Health is the agency responsible for regulation, financing, health service delivery, sectorial management, and exercise of sanitary authority. Central Government exercises supervision and control over the public financing of the sector. These functions are organized in a centralized and vertical structure, in which the decision making relies at the senior level of the Ministry (Minister of Health, Chief Executive Officer, and Director of Health Services). The Social Security is responsible for the insurance of the employed population based on “job related diseases”. There are no public mechanisms to regulate the different modalities neither of health insurance nor for the supervision, evaluation and control of health services delivery. There are no effective mechanisms for intersectorial coordination at the national level. Defined accreditation procedures/programs for health facilities in Belize do not exist. There are no public or private agencies devoted to health technology assessment in Belize, nor policies.
Private participation in the health system: Private institutions are legally registered as business institutions; there is no legislation at present, which addresses the regulation of the private sector health services. Over the past recent years the private sector has been increasing in size and coverage, mostly in the very urbanized areas. There are five private hospitals with a total of 79 beds offering a wide range of medical and health services at secondary and tertiary levels. However, utilization is constrained by cost.
Health insurance:The Social Security Board is the only public health insurance provider for labor force in the country. Presently, the Social Security has 55,000 contributors, representing 68% of the estimated labor force as of April 1997 (80,940). Private health insurance is limited in Belize but has increased rapidly during the past two decades. Many of the insurance companies are affiliates of large international firms. The benefit packages are fashioned to cover expenses for medical care acquired in and outside of Belize, depending on the premium.
Certification and professional health practice:The following regulatory bodies are established under the laws of Belize: The Medical Board responsible for the registration of medical practitioners, dentists, opticians and nursing homes. The Nurses and Midwives Council, responsible for the registration and regulation of nurses and midwives; and The Board of Examiners of Chemist and Druggists, responsible for the examining and registration of Chemist and Druggists and for carrying out other matters provided for in this Ordinance. The Nursing School participates in an accreditation program within the CARICOM countries.
Environmental quality: In relation to preservation and protection of the environment there are two national acts, the Environmental Protection Act and the Public Health Act. The key environmental issues are related to agricultural expansion and agro-processing activities. The main threats to the marine resources (especially the reefs) are effluents from sugar and citrus processing, run-off of fertilizers and pesticides, and untreated sewage from urban areas.
Health Promotion: The Ministry of Health established a Health Education and Community Participation Bureau, which coordinates all health promotion and educational activities in collaboration with other Ministries of Government, municipal governments, NGOs and other agencies to promote and implement health settings initiatives. A national network of community nurse’s aides is in place to facilitate the implementation of these programs at the community level.
Potable water, excreta disposal and sewerage services:Access to safe drinking water in Belize has improved in recent years. In urban areas the coverage increased from 95% in 1990 to 100% in 1999, in rural areas coverage increased from 51% in 1990 to 82 % in 1999. In contrast, the coverage with respect to sanitation remains low, especially the rural areas. According to 1995 data, 59 % of the urban population had access to sanitation services, while in the rural areas the coverage was 22%. In 1999, urban coverage increased to 71%, while rural coverage slightly increased to 25.3%.
Organization of individual health care services:At the Primary Care Level, services are provided through Health Centers and Health Posts in the rural areas. At the Secondary Level the health services are provided through Community and Regional Hospitals with services including emergency, surgery, X-Ray, laboratory, pharmacy and specialized services (only at Regional Hospitals). There is one National Referral Hospital located in Belize City, which provides Tertiary Level Care with some specialized services. Emergency response services are limited to urban areas. A referral and counter-referral system was instituted at all levels in the public sector and between private and public sector. The system is being continuously monitored by a National Committee.
Auxiliary diagnostic services and blood banks:The Central Medical Laboratory provides diagnostic testing for all medical institutions and outpatient facilities. Services provided include Bacteriology, Serology, Chemistry, Cytology, Histology and Hematology. Each public hospital is equipped with basic laboratory services. The National Blood Transfusion Service is responsible for the collection, screening, storing and distribution of blood and blood products country wide. Services depend on voluntary blood donors.
Specialized services: The Ministry of Health provides the following specialized services/programs:
• Health education/promotion
• Maternal Child Health
• Nutrition
• Sexual and Reproductive Health
• HIV/AIDS
• Tuberculosis
• Dental Health
• Mental Health
• Epidemiology
• Pharmacy and medical supplies
• Radiology
• Environmental Health (including vector control)
• Engineering and Maintenance
Health supplies:No pharmaceutical products are manufactured in Belize. There is a National Drug Formulary that is utilized by the public sector. The acquisition of medical supplies is done by the Central Medical Stores of the Ministry of Health through a tendership process. There is no quality control system in place for health supplies imported into the country.
Human resources:According to 2003 data, there were 203 physicians (7.4 per 10,000), 465 nurses (17 per 10,000) and 23 dentists (0.84 per 10,000). The country has one of the lowest coverage of physicians in the region and an average coverage of nurses. There is a large concentration of health personnel in the district of Belize, where more than half of the health staff is employed (54% physicians, 52% practical nurses, and 57% professional nurses). As to the rural and urban areas, the distribution is unequal in all the districts for both, physicians and nurses. Almost 75% of the health personnel work in the public sector with the largest group being the practical and professional nurses (84%). Approximately 14% of health personnel work in both, public and private sector. As part of an agreement with the Cuban Government, there are 67 Cuban doctors involved in the delivery of medical care in rural areas. The Faculty of Nursing and Health Sciences, University of Belize, continues to produce approximately 20 nurses per year.
Health sector expenditure and financing: According to 2003 data Belize's expenditure on health is 2.4% of the GDP with a per capita expenditure of US$ 85.50. The Human Development Report 2002 reports the private expenditure in health at approximately 0.5% (1998). The recurrent expenditures amount to 78.6% of the total budget, while capital expenses constitute 14.1% and 7.34% corresponds to Overseas Economic Co-operations Programs.
External technical cooperation and financing: Belize has developed many bilateral agreements for technical cooperation. The Health Sector Reform project is being financed by the Inter-American Development Bank (54.06%), the Caribbean Development Bank (26.02%), the European Union (8.83%), and the Government (11.09%). There are agreements with the Governments of Cuba and Nigeria for the provision of health professionals to work in Belize. There are four UN Agencies in Belize (UNDP, UNFPA, UNICEF and PAHO/WHO) which continuously support the National Health Agenda.
