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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 Grenada lies at the southern end of the Windward Islands
and is a tri-island state: the islands of Grenada , Carriacou and Petit Martinique.
It is about 100 miles north of Venezuela and 90 miles southwest of Barbados
. Land area extends 133 mi2 and is divided into six (6) parishes.
The State has a Westminster style of parliamentary democracy with a bi-cameral
legislature, comprised of the House of Representatives (elected members) and
a Senate (appointed members). Executive powers are vested in a Prime Minister
as Head of Government and a Cabinet. However, the Head of State is the Governor
General, the representative of the British Crown. There are several political
parties.
Demography:
The estimated population in 1999 was 100,703, of which 50.4% were female and
49.6% male. The population growth rate was .06% annually. The population structure
in 1999 was very young, with 47% of the total population less than 20. Life
expectancy was estimated at 68 years for men and 73 for women. Total live births
were 1,791 in 1999 with a crude birth rate of 18.3 per 1,000 population. The
total fertility rate 1996-2000 averaged 2.8 children per woman of childbearing
age.
Economy: Economic
activity in Grenada showed real gross domestic product (GDP) expanding by 6.4%,
following growth rates averaging 5.5% during the period 1996-1999. The GDP at
factor cost in constant 1990 prices was US$ 333 million in 2000 (about US$1,216
per capita). The rate of inflation was 2.5 percent in 2000 . The continued expansion
in economic activity in 2000 reflected strong performances in the construction,
communication manufacturing and banking sectors. The Tourism sector accounted
for 7.5% (US$19 million) in 2000, an increase of 21 % from 1995. In the services
sector, real growth was recorded in the telecommunications, banking, insurance
and wholesale and retail sale sectors. The 1998 labor force comprised 41,015
people, including 23,171 males and 17,844 females. The national rate of unemployment
fell from 12.5 % in 1999 to 11% in 2000. The unemployed rate for men was 11
% and 21 % for women. Total public sector recurrent expenditure in 2000 was
US$ 99 million. Health expenditures were US$ 12.5 million in 2000. In 1998 31%
of the population were poor. Over 64% of the poor have no educational certificate.
Fifty-one percent of the poor are under the age of 20; 40% are less than 5 years
of age, and 38% are school age children.
Literacy:The
adult literacy rate in Grenada was 88.6% in 2000, with similar rates among males
and females.
Mortality: The health situation and delivery
of services is affected by an increasing prevalence of non-communicable diseases,
increasing demands for improved technology and escalating costs. T otal deaths
in 2000 were 712, of which 376 were males and 336 were females. The crude death
rate was 7.9 per 1,000 in 1999. From 1996 to 1998 the leading cause of death
was malignant neoplasms with a rate of 148 per 100,000 population, 1998. In
1999, the leading cause of death was diseases of the circulatory system with
a rate of 130 per 100,000. M ortality by broad groups in 2000 were diseases
of the circulatory system with a rate of 297 deaths per 100,000 population,
neoplasms (104), diseases of the respiratory system (65) and injury, poisoning
and other external causes (31).
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): Between
1997-1999, there were 142 infant deaths, with 61 % occurring within the first
month. Infant mortality decreased from 19.5 per 1000 live births, 1998 to 14.3
in 2000. The leading causes of death were congenital anomalies of the heart
and circulatory system, hypoxia, birth asphyxia, other respiratory conditions,
slow fetal growth and fetal malnutrition. The number of low birth weight babies
decreased from 10% in 1996 to 8% of total births in 2000. Between 1996 - 2000,
a total of 5391 infants visited public clinics at age 3 months. Of those, 1,884
or 34% were solely breast-fed for the first three months.
Schoolchildren (5-9 years): Between
1997-1999, 17 children between the ages of 1 and 4 died with the leading causes
of death being diseases of the nervous system, the respiratory system and the
digestive system. In 2000, 1 child died in this age group, 17 children died
from 1996-1999. There were no deaths in this age group in 2000.
Adolescents (10-14 and 15-19 years):In the age group 10-14 years, 4 children died while
in the age group (15-19), 9 died in 2000. In 1998, teenage mothers accounted
for 13.4% (or 240) of all births.
Adults (20-59 years): It
is estimated that approximately 80% of pregnant women attended prenatal clinics
held in community health facilities and were seen primarily by a nurse. The
Grenada Planned Parenthood Association provided services to 1,266 women in 1996
compared to 1,729 in 1995.
Elderly (60 years and older):
In 1998, seniors made a total of 3,417 first visits to the community health
services. Females accounted for 66% of the visits made. Arthritis was reported
for 54% of adults 65 and older. The elderly suffered 27% of neoplasm, 49% of
circulatory diseases and 45% of cases of diabetes. Also, 14 cases of pneumonia
were reported.
The disabled: Those
with mental and physical disabilities and their families receive support from
the National Council for the Disabled.
Workers' health: There were 272 reported injuries,
1996-1999: construction (95); retail trades (38); restaurants/hotels (35); and
manufacturing (25).
Analysis by type of health problem Vector-borne diseases:
In 2000, 17 confirmed cases of dengue fever were reported. A dengue control
program is actively addressing the matter.
Rabies: Over
7,248 farm and domestic animals were vaccinated against rabies in 2000.
Vaccine-preventable disease:
In 2000, immunization coverage of children under 1 year old was 97% against
diphtheria, tetanus, whooping cough, and poliomyelitis, while measles was 92%.
There have been no reported cases of neonatal tetanus since 1980. In 2000, the
Ministry introduced Hepatitis B and Haemophilus influenza e type B vaccine to
children under 1 year. There were no cases of tuberculosis or leprosy in 2000,
and only 3 cases of leprosy between 1985 and 1999. Between 1997 and 1999, there
were nine cases of tuberculosis.
HIV/AIDS:
From 1996 to 2000, a total of 43 AIDS cases were reported, with a cumulative
total of 121; males (88) and females (33). Of the adult cases, 101 died, and
of 7 paediatric cases, five died. All the paediatric cases have been linked
to vertical transmission.. In 2000, 18 new infected cases were reported and
5 children were born with HIV. In 1997, the ratio of males to females was 1.6.
Other STDs included 47 cases of gonorrhoea, 2000.
Nutritional diseases: The
prevalence of anemia in the antenatal population was 16% and 8% among postnatal
women, 1999. The prevalence of anaemia among one year-olds was 57 % in 1999.
Malignant neoplasms: Malignant
neoplasm of the digestive organs ranked number one (29), prostate (27) and malignant
neoplasm of lymphoid, haematopoietic tissue eleven (11).
Accidents and violence :
In 1997-1998, there were 50 deaths due to external causes, nearly half were
males.
Oral health:
In 1998, the DMF index was 2.7 in 12-year old secondary school children. Malocclusions
is a large problem among young people. It is estimated that more than half of
the population needs orthodontic treatment. At present, no water in the Tri
Island State is fluoridated. Full participation by children in the free dental
care program is not fully utilized, particularly among very young or under privilege
children and in outlying areas.
RESPONSE OF THE HEALTH SYSTEM
National health policies and plans:The Ministry
of Health (MOH) is responsible for policy formulation, regulation, and direction
of health programmes, vital statistics, expenditure control, and personnel matters.
The Permanent Secretary (PS) is the administrative head and the Chief Medical
Officer is the principal Technical Officer.
Health sector reform:
Polyclinics that offer extended hours and a broader range of services, with
the community's active participation in the management of the services, will
be established.
The health system: Institutional
organization: MOH is responsible for overall management of the health sector.
Health services are provided mainly through public facilities but private health
care facilities are increasing. MOH carries out its duties through: administration,
acute care hospitals, mental health, community services, and environmental health.
Central Administration operates through: Registry, Finance, Personnel, Planning,
Health information, Epidemiology, Births and Death, School of nursing, and Procurement.
The Ministry of Finance controls all expenditures. The Department of Human Resource
(DHR) makes all staffing decisions. There is a 240 bed General Hospital , and
two rural hospitals, with 60 beds and 40 beds. There is also a 20-bed psychiatric
unit at the General Hospital. The General Hospital is a referral hospital offering
24 hour emergency care, specialist, surgical, pediatrics, psychiatric, ophthalmic,
obstetric/Gynaecology, and ENT. Ultrasonagraphy, electrocardiogram and mammography
are also available. Support services include laboratory, pharmacy, imaging,
physiotherapy and rehabilitative services. During 1996 - 2000, there were 43,575
admissions at the General Hospital, with an average length of stay of 6 days
and a bed capacity of 56%.
Health insurance: There
are a number of private insurance companies operating, and most of them are
registered and located in the capital. This is a National Insurance Scheme,
through a pension plan that includes certain health benefits. A basic package
of health benefits through a general health plan to which all citizens are entitled,
however, does not exist.
Organization of regulatory actions:
MOH operates under: Hospital Act 1953, Medical Officers Act 1903, Medical Practitioners,
Dentists and Veterinary Surgeons Registration Act 1982, Midwives Act 1954, Mosquito
Destruction Act 1952, Nurses Registration Act 1980, Pharmacy Act 1988, Public
Health Act 1925, Public Health (School Children Immunization) Act 1980, General
Hospital (Fee Rules) 1988, Medical Products Act, and Hospital Authority Act.
Recently an advisory committee for the health system was appointed to achieve
greater efficiency and improve the quality of care. There is a well-developed
relationship between the private entities and the public institutions. Private
facilities are mainly located in the capital and include five acute hospitals,
thirteen nursing homes, two maternity units and several offices to provide care.
Health care service is available on the three island states. The MOH has direct
control of the public health system, and the private sector is regulated by
MOH through legislation. A Medical Board chaired by the Chief Medical Officer
is responsible for granting medical licenses. Nurses must register with the
Nursing Council. Physicians are not obligated to pursue continued education,
or prove to be physically fit to practice. A pharmacy council monitors the importation
and distribution of pharmaceuticals to the public and private sectors and registers
pharmacists and pharmacies on an annual basis.
Health promotion: Consultants
conduct specialist clinics in pediatrics; ear-nose-and throat; and mental health
at the district level. Patients seeking care in other specialties are referred
to the General Hospital , but there are long delays. Referrals for admission
to the General Hospital are also made through the Accident and Emergency Department.
Community services functions are carried out through: community nursing, pharmacy,
district medical officers, dental health, health education and HIV/AIDS.
Laboratory and surveillance:Between
1995 and 2000, with the Epidemiology and the Health Information Units were merged.
Data s is collected from public and private health facilities and practitioners.
Laboratory data is accessed on a weekly basis and some data from electronically
transmitted on a weekly basis to CAREC.
Water, sewerage and food safety: The
National Water and Sewage Authority manages public water supply and sewage.
The Environmental Health Division of the MOH administers on-site sanitation.
About 97% of water is disinfected in urban areas and slightly less in rural
areas. More than 95% population have adequate sanitation. The MOH's Environmental
Health Department is responsible for controlling water pollution; improving
waste water treatment; ensuring that the population has access to safe drinking
water, improving systems for disposal of excreta and other harmful substances,
and improving the country's food safety. Grenada has no national policies or
organized programs to combat coastal pollution, but in 2000, over 200 itinerant
vendors attended MOH sponsored workshops on food safety.
Ambulatory emergency and inpatient services:
Grenada is divided into seven health districts,
six with a health center with most services and an additional 30 medical stations.
All facilities are within easy access of the population. Each health district
is assigned a District Medical Officer, several categories of nurses, community
health aides, dentists and dental auxiliaries, pharmacists, environmental health
officers and mental health workers.
Specialized services: Some
specialist services - pediatrics, and psychiatry are provided at some Health
Centers. The Health Education Unit collaborates with the MOH and other departments:
Ministry of Education, the Government Information Service, and NGO's. The
Grenada Planned Parenthood Association conducts a youth outreach program to
speak on family life and sex education. There are specialized Mental Health
Services providing treatment, rehabilitation and follow-up care at the Mental
Hospital and in the community. The institutions include an 80-bed psychiatric
hospital for chronic patients, and a geriatric facility of 120 beds, usually
filled above capacity. Carlton House (16 beds) also provides rehabilitative
care for substance abuse patients and the Dorothy Hopkin Home (16 beds) offers
services for disabled children.
Health supplies:All
high technology equipment of the public health sector is located at the General
Hospital in the capital; it also has a biomedical technology maintenance unit.
Ultrasonograms, electrocardiogram and mammograms are available in both the public
and private sectors. Grenada procures most of its pharmaceuticals and medical
supplies through the Eastern Caribbean Drug Service. There is a national drug
list with 273 drugs included on the list and the list is revised every year.
The whole population has access to those drugs.
Human resources: In
1998, there were 59 physicians in the public health sector; many with private
practices. About 21 doctors work exclusively in the private sector. There are
8 physicians per 10,000 population. There were 242 registered nurses with a
ratio of 1 per 413 population. In addition, there are 40 community health aides
and 84 nursing assistants. The public sector employs 22 pharmacists, the private
sector 47. There are 6.9 pharmacists per 10, 000 populations. Pharmacists are
trained in the T.A. Marry show Community College. In 1998 there were 15 dentists,
seven in the public sector - all have private practices. There are 1.5 dentists
per 10, 000 population, and 5 dental auxiliaries. Training: The St. George's
University School of Medicine (SGUSOM) offers an undergraduate program with
majors in Basic Medical Science and Medical Technology. Five scholarships are
provided annually to Grenadian nationals. There is a local school of pharmacy
and nursing.
Sectoral financing:Financing
of health expenditure is confined to the public sector. The MOH receives its
funding from general taxation through the Ministry of Finance. International
funding agencies also assist in funding some health projects and programs. Supervision
and control over public financing of health are the responsibility of the Ministry
of Finance and the MOH is under the direction of Parliament/Cabinet. Health
Insurance: There is no system of public health insurance. Except for a minimal
user fee at the General Hospital and the community services, health care services
are generally provided at no cost to the public.
Health expenditure: Total
public sector recurrent expenditure in 2000 was US$ 98.9 million. Health expenditures
were US$ 12.5 million in 2000. For the year 2000 health, education and housing,
and social services consumed 11%, 17% and 7 % respectively of the total recurrent
budget. In 1998, per capita recurrent health expenditure was US$ 118. The Government
funds hospital services. A grant of US $ 100,000 is provided by the St. George's
University School of Medicine to purchase medical equipment.
External technical cooperation and financing:
PAHO/WHO, UNICEF, Caribbean Development Bank
(CDB) (BNTF), and Cuba, China and Taiwan, and France provided assistance. In
2000-2001, significant financial assistance of the CDB provided for the refurbishment,
rebuilding and maintenance of community health facilities. PAHO provided technical
and financial assistance for Health Sector Reform, Environmental Health and
Health Promotion and Disease Prevention. Through UNICEF the work on the Breast-Feeding
program was intensified and pilot projects were implemented in anemia and School
Health. China and Taiwan have provided grants of US$ 100,000, 1997-2000. Cuba
provided nurses, doctors and other health professionals. Through the bilateral
work with France , eight nurses have been trained in Intensive Care Nursing;
bio-medical technicians were also trained. The French have provided equipment
for two-bed intensive care unit and physiotherapy equipment. An agreement is
also in place for the transfer of patients for treatment to Martinique and Guadeloupe
. MOH also received donations from many Grenadian organizations abroad. The
St. George's University School of Medicine provides US$ 100,000 for medical
equipment and five medical scholarships annually.
