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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 The British Virgin Islands (BVI) is an overseas territory
of the United Kingdom in the northeastern Caribbean Sea . The BVI includes over
50 islands and cays, 15 of which are inhabited. The total land mass of 59.3
mi2 is spread over 1,330 mi2. The capital, Road Town ,
is located on the island Tortola . The BVI is self-governed by a democratically
elected Legislative Council. The Government is composed of an Executive Council
consisting of a Chief Minister, the Attorney General, and four other ministers.
Demography: Between 1980 and 1990, the population
increased by approximately 45%, from 11,000 to 16,000; in the 1990s, the rate
of growth decreased to an average of 2%. Approximately, 65 % of the population
growth since 1980 is due to immigration. During the review period, immigrants
accounted for nearly half the population. The population of the BVI increased
from 18,737 in 1996 to 20,254 in 2000. The large influx of immigrants has increased
the working-age population. In 2000, persons under 15 years of age accounted
for 27% of the population, persons age 15-64 years for 67%, and persons 65 years
of age and older for 5%. The dependency ratio in 2000 was 0.46. During 1996-2000,
the crude birth rate averaged 16 births per 1,000 population, and the total
fertility rate averaged 1.9 children per woman. Life expectancy at birth over
the period 1996-1999 averaged 74.5 years (72.2 years for males and 77.8 for
females).
Economy: The economy is driven by tourism,
which contributed 21.1% of GDP in 1999, and financial services, which contributed
some 50.2% of GDP. GDP at current prices was US$ 511 million in 1996 and US$
682.8 million in 2000; the annual growth rate decreased from 10.4% to 4.4% over
those years. The unemployment rate averaged 3.6% from 1998- 1999.
Education: School attendance is compulsory
up to age 15. The average length of school attendance is 9.4 years, most students
complete a total of 12 years (primary and secondary). There are 20 primary schools
(12 public and 8 private), and 5 secondary schools (4 public and 1 private).
Adult literacy rates in 1998-2000 were 98.3% for females and 97.8 % for males.
The H. Lavity Stoutt Community College, located on Tortola , is part of the
University of the West Indies , offers tertiary education.
Mortality: The crude death rate was 5.1 deaths
per 1,000 population in 1997, 4.5 in 1998, and 4.8 in 1999. During 1996- 2000,
there were about 92 deaths per year but no maternal deaths. The leading causes
of death in 2000 were diseases of the circulatory system (33.3%) malignant neoplasms
for (23.7%), and external causes for (7.5%) of total deaths with defined cause
(93 cases). The age group most affected was persons age 65 years and older (59
deaths), followed by persons age 20-59 years (23 deaths), and infants (6 deaths).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): There
were a total of 13 deaths among children under 1 year of age and 16 deaths among
children age 1-4 years from 1996- 1999. The mortality rate for children under
5 years of age was 14.9 deaths per 1,000 live births. There were 47 premature
births from 1996 to 2000. The average incidence of low birth weight was 6.8%
for 1996-2000. Infant mortality rates were over 10 per 1,000 live births during
1997-2000, but there were only 13 recorded infant deaths between 1996- 1999,
with 1 in 1997 and 3 in 1998. Asthma, gastroenteritis, and acute respiratory
infections are important causes of morbidity and hospital admissions among children
age 1-4 years.
Adolescents (10-19 years):Adolescents
accounted for 167 (11%) of the 1,560 births during the period 1996-2000. A 1999
adolescent health survey among 400 students age 11-20 years found that approximately
18% had used marijuana or hallucinogens in the previous year, 16% had smoked
cigarettes, 60% had consumed alcohol, and 13% had attempted or contemplated
suicide, with more than half attempting suicide in the previous year.
Adults (20-64 years):Breast
cancer accounted for five deaths among women age 25-64 years in 1999-2000. Prostate
cancer accounted for one male death in the 45-64 years age group. The 25-44
years age group had the most admissions (23 of 51) due to motor vehicle accidents
from 1997- 1999; the next most affected group was young persons age 15-24 years,
with 16 admissions over that period. The 25-44 years age group accounted for
27 of 192 hospital admissions for heart conditions from 1998- 2000; the 45-64
years age group accounted for 56 admissions, with congestive heart disease (29
admissions) and angina pectoris (11 admissions) predominating. The age groups
25-44 years and 45-64 years accounted for 11 and 25 hospital admissions for
diabetes, respectively, in 1999-2000. There were 10 hospital admissions due
to asthma among the age group 25-44 years in 2000; in addition, 48 patients
in this age group were treated for asthma on an outpatient basis that year.
The 45-64 years age group accounted for six admissions due to asthma and 9 outpatients
seen the same year. Women age 20 years and over accounted for 1,393 (89%) of
the 1,560 births from 1996 to 2000, yielding an average of 279 births per year.
Elderly (65 years and older): The
number of deaths among males age 65 years and older due to prostate cancer increased
from 9 in 1996 to 17 in 2000. Persons age 65 years and older accounted for 103
of 192 hospital admissions due to heart conditions in 1998-2000. Congestive
heart disease was the most common problem, accounting for 51 admissions.
Analysis by type of health problem Natural disasters: The
BVI suffered four natural disasters during 1996-2000: Hurricane Bertha (1996;
US$ 2 million in damages); Hurricane Georges (1998, US$ 12 million in damages);
Hurricane Lenny (1999, US$ 29 million in damages); and Hurricane Debbie (2000,
damaged the water system). No outbreaks of communicable disease due to these
hurricanes were reported. Vector-borne diseases: Dengue (types 1, 2, and 3)
is the only prevalent vector-borne disease and only sporadic cases were reported
during 1996-2000.
Vaccine preventable diseases: All
children age 0-5 years are immunized. Average rates of coverage for the period
1997-2000 were 98% for DPT3, 97% for OPV3, 99% for BCG, and 98% for MMR. DPT,
polio, and MMR booster shots are given until 11 years of age. The hepatitis
B and Hib vaccines were added to the immunization program in 1999, and pentavalent
vaccine (coverage for diphtheria, pertussis, tetanus, hepatitis B, and meningitis)
was added in 2000. A hepatitis B vaccination campaign (1999-2000) reported particularly
high rates of coverage among students (over 90%), teachers (100%), and fire
officers (100%). A rubella mass vaccination campaign was conducted in January
and June 2000. Out of a target population of 3,220 adults age 22-44 years, 2,910
(90%) were immunized.
Intestinal infectious diseases:Hospital
data for the period 1996-2000 indicates 1 admission for amebiasis, 95 for gastroenteritis,
2 for salmonella, 3 for shigellosis, and 4 for viral intestinal infection. In
the same period, 68 children age 14 years and younger were admitted for gastroenteritis;
of these, 49 (72%) were children age 5 years and younger. There was one death
due to gastroenteritis in 1996. In 2000, there were 134 reported cases of gastroenteritis
among children under 5 years of age, and 281 in the population over 5 years
of age.
Chronic noncommunicable diseases:There
were 30 hospital admissions for diabetes in 2000; the 25-44 years age group,
the 45-64 years age group, and the 65 years and older age group were most affected.
In 2000, there were 42 hospital admissions for asthma, mainly among the 1-4
years age group and the 5-14 years age group. A total of 286 patients were treated
for asthma that year, with 64 patients age 1-4 years and 112 patients age 5-14
years.
Acute respiratory infections: There
were 59 hospital admissions due to acute respiratory infections in 1996; mostly
children under 5 year of age. There were 163 suspected cases of influenza in
2000. Pneumonia accounted for 63 primary hospital admissions in 2000, affecting
particularly the age groups: 1-4 years and 65 years and older.
HIV/AIDS: By
the end of 2000, 30 cases of HIV/AIDS (20 males, 10 females) had been reported,
7 of them since 1997. Only one female case of HIV/AIDS was reported between
1994- 2000. There were 22 deaths due to AIDS by the end of 2000. An HIV seroprevalence
study of 408 pregnant women, revealed no positive cases (1996-97).
Diseases of the circulatory system: From
1998- 2000, there were 50, 78, and 64 hospital admissions due to heart conditions
for each respective year. Congestive heart disease was the main contributor
(39% in 2000). Other important heart conditions during 1998-2000 were angina
pectoris, hypertensive disease, and myocardial infarction. The age groups most
affected by heart conditions were 45-64-years old, and persons age 65 years
and older.
Malignant neoplasms: Hospital
data showed 22 deaths due to malignant neoplasms in 2000; mostly among persons
65 years of age and older. Males were more affected than females. In 2000, prostate
cancer accounted for 10 of 22 deaths due to malignant neoplasms, breast cancer
for 3, stomach cancer for 2, and colon cancer for 1.
Accidents and violence:Between
1997- 1999, there were 51 hospital admissions due to motor vehicle accidents;
with a male-female ratio of 2.2:1. The age groups most affected were 15-24-year-olds
and 25-44-year-olds. There was one death due to this cause in 2000.
Mental health: In
1997, there were 65 admissions for mental and behavioral disorders. Of these,
34 were due to alcohol abuse (27 males, 7 females) and 7 (6 males, 1 female)
to other substance abuse. Depression accounted for 6 and schizophrenia for 5
of the remaining 24 admissions for mental disorders. There were only 22 hospital
admissions for alcohol abuse in 1999. In 1999, the Government hired a local
psychiatrist who, in addition to managing psychiatric hospitalizations, also
directs the Mental Health Services Unit.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:The BVI Government provides comprehensive health care,
with special focus on women, children, the elderly, the mentally ill, and the
handicapped. Health promotion is strongly emphasized.
Health sector reform strategies:With
funding from the United Kingdom , the Government undertook a Health Sector Adjustment
Project from 1993- 1996. As a result of the project, a new management structure
was agreed upon and partially implemented, and health sector studies on health
information, health promotion, accident prevention, mental health, and environmental
health were undertaken. Recognizing that the Territory has outgrown most of
its existing health facilities, the Government embarked on a study of the health
system in 1999 to procure high quality and accessible primary and secondary
care services, to monitor and evaluate them, and to develop policies to govern
the health sector.
Institutional organization:The
Ministry of Health and Welfare is responsible for providing public health and
social services, as well as for monitoring and regulating private sector providers.
The 1976 Public Health Act provides the statutory framework for protecting and
promoting the population's health. In accordance with the Public Hospitals Ordinance,
Government health services are provided free at the point of use to certain
groups. Patients requiring health care beyond the scope of Peebles Hospital
are referred to Puerto Rico , Jamaica , Barbados , the U.S. , U.S. Virgin Islands,
and the U.K.
Health insurance: The
BVI has a vigorous private health sector, encompassing both inpatient and ambulatory
care. A compulsory social security scheme covers all paid employees, with employees
and employers contributing equally to the premiums. Self-employed workers are
also required to participate in the plan.
Organization of regulatory actions: The
Government does not monitor or regulate the standards of health care, and as
such, these activities are the responsibility of individual providers and institutions.
The Water and Sewerage Unit government department is responsible for monitoring
and maintaining the public water supply and waste disposal. Food quality is
monitored by the Environmental Health Unit's food hygiene program.
Health promotion:
The three main approaches to health promotion are: the medical approach (breast,
cervical, and prostate cancer screening; immunization; and substance abuse treatment),
the behavioral approach (health education, social marketing, public policies),
and the socioeconomic approach (housing and employment). Other health promotion
strategies include health education, use of the media, and the development of
health policy and legislation.
Disease prevention and control programs: The
Environmental Health Division is responsible for food hygiene, vector control,
water quality surveillance, institutional hygiene, and the investigation of
such complaints as septic tank problems, rodents, and abandoned vehicles.
Laboratory systems:The
only public sector health laboratory is at Peebles Hospital . Samples requiring
testing beyond the laboratory's basic diagnostic capacity are sent abroad for
analysis. The district clinics, the Peebles Hospital Medical Records Unit, and
the Peebles Hospital Laboratory are the system's reporting sites. In 1999, 77%
of the water sampled by the Division was found to be satisfactory. Approximately
90% of the population has a good sewerage system. The Solid Waste Department
is responsible for the collection and disposal of solid waste, and operation
of the incinerator. There are no laws in place to prevent or control air pollution.
The food hygiene program inspects food-handling premises and provides training
for food handlers. The food handlers clinic, given by the inspector of the Environmental
Health Division, offers weekly sessions on food handling techniques.
Ambulatory, emergency, and inpatient services:
Public sector primary care services are offered
at the district health clinics (13 health clinics , 2 are satellite clinics).
The BVI has one 44-bed public hospital, Peebles Hospital , and one 8-bed private
hospital, the Bougainvillea Clinic. Peebles Hospital offers inpatient, pediatric,
general surgery, neonatal intensive care services and renal dialysis among others.
Basic diagnostic services are also available at the hospital. Total admissions
to Peebles Hospital increased from 1,824 in 1997 to 2,206 in 2000 (excluding
the nursery), average length of stay is 5 days. The Bougainvillea Clinic specializes
in general and reconstructive surgery among others. Three private medical complexes
and several private medical practices also offer primary care and basic diagnostic
services.
Blood banks: The
BVI's only blood bank is located at Peebles Hospital . All blood for transfusion
is screened for HIV. The Red Cross also screens blood donors.
Specialized services: The
Community Mental Health Centre provides most of the ambulatory mental health
care for the Territory through its outpatient psychiatric services. At the end
of 1999, 236 clients were enrolled at the Centre. The mental health service's
approach emphasizes treating individuals in their community, including monitoring
and administering medication, providing family counseling, and promoting self-care.
Mental health officers also travel on a regular basis to clinics to follow up
on patients. Physical therapy and rehabilitation services are based at Peebles
Hospital , and clinic and home visits are provided on the four main inhabited
islands. The Government's dental service provides basic routine care. Treatment
is free for schoolchildren, the poor, persons over age 70 years, prison inmates,
the severely handicapped, firefighters, and police; other adults are charged
modest fees. Preventive, screening, and educational services are also offered.
The dental service is staffed by a dental surgeon, two dental nurses/therapists,
a dental hygienist, and a dental assistant. Vision care is provided by Pearle
Vision Centre, a private sector franchise. Vision screening for children and
adolescents is done periodically as part of the school health program, and when
students leave high school. Audiological services were established in 1999.
Health supplies: No
drugs, vaccines, or medical equipment are produced in the BVI. The Peebles Hospital
pharmacy is the central purchasing agency for the national public health services.
Drugs are purchased through the Eastern Caribbean Drug Service (ECDS). Narcotics
are not available at district clinics. Vaccines are purchased through the PAHO
Revolving Fund for Vaccine Procurement. When urgently needed, some vaccines
are purchased through a vendor in Barbados . Some vaccines are provided at no
cost to private sector practitioners. A limited number of vaccines are ordered
directly by the private sector.
Human resources: The
BVI has difficulty attracting and retaining health personnel due to the high
cost of living, uncompetitive salaries, and limited opportunities for professional
growth and development. Overall reliance on foreign-born and trained medical
personnel remains high. Non-nationals usually receive two-year contracts, and
turnover is high among foreign staff. There are 15 physicians and 3 dentists
in the private sector. Through a health human resources initiative, 16 registered
nurses began an intensive program at H.L. Stoutt Community College in March
2000, leading to a Bachelor of Science degree in nursing from SUNY at Buffalo.
Health sector expenditure and financing: Public
health services are almost entirely financed by the Government. In 1996, the
total expenditure of the Ministry of Health and Welfare accounted for approximately
US$ 12.46 million (12%) of total Government expenditure. By 2000, the total
Ministry of Health and Welfare expenditure was an estimated US$ 17.18 million,
or approximately 17% of total Government expenditure (some US$ 99 million).
Community services accounted for approximately US$ 2.88 million (17%) of the
Ministry's expenditure, and hospital services for some US$ 6.6 million (38%).
The public health services' overseas medical expenditure was US$ 92,263 in 2000.
Data on expenditure on private sector health services are unavailable.
External technical cooperation and financing:
Expanded Program on Immunization received technical assistance from PAHO during
the review period, and financial assistance for the 2000 rubella vaccination
campaign. The National Youth Council's AIDS Youth Project was funded by PAHO/CAREC
during the review period.
