JAMAICA’S JAMAICA’S

HEALTH SYSTEMSHEALTH SYSTEMS

TREVOR MCCARTNEYTREVOR MCCARTNEYC.D., J.P., M.B.,B.S., DM (Surg.) UWI, C.D., J.P., M.B.,B.S., DM (Surg.) UWI,

F.R.C.S. (Ed.), F.A.C.SF.R.C.S. (Ed.), F.A.C.SSENIOR MEDICAL OFFICERSENIOR MEDICAL OFFICER

KINGSTON PUBLIC HOSPITALKINGSTON PUBLIC HOSPITAL

JamaicaJamaica, the largest English , the largest English

speaking island in the Northern speaking island in the Northern

Caribbean is 4,441 square miles in Caribbean is 4,441 square miles in

size and has a population of over size and has a population of over 2.6 2.6

millionmillion persons. persons.

–Health Care SystemHealth Care System18 General 18 General

HospitalsHospitals 6 Specialists 6 Specialists

  Primary Care System (Clinics)Primary Care System (Clinics) 331 Clinics 331 Clinics

      (+ 23 satellites)(+ 23 satellites) Public Health SystemPublic Health System

HospitalsHospitals N=18N=18 Type A: 3 multidisciplinary Final Type A: 3 multidisciplinary Final

referral centresreferral centres Type B: 5 Large urban centres (O&G, Type B: 5 Large urban centres (O&G,

Paed med, gen surgery, int medicine, Paed med, gen surgery, int medicine, anesthesiology A&Eanesthesiology A&E

Type C: 10 District hospitals ( gen Type C: 10 District hospitals ( gen medicine, surgery , child health and medicine, surgery , child health and maternity care.maternity care.

Community hospitals/ deliveriesCommunity hospitals/ deliveries

HospitalsHospitals 6 specialists 6 specialists

– Psychiatric and rehabilitative Psychiatric and rehabilitative services for the mentally illservices for the mentally ill

– O & G nationallyO & G nationally– Paediatric carePaediatric care– Oncology and hospiceOncology and hospice– Chest diseasesChest diseases– Physical rehabilitationPhysical rehabilitation

Other National Other National institutionsinstitutions National public Health labNational public Health lab Blood bankBlood bank

Primary carePrimary care Health districts on a demographic Health districts on a demographic

basisbasis Pop 20-30,000 served by health Pop 20-30,000 served by health

centrescentres Type 1. pop 4000Type 1. pop 4000 Type 2: 12,000Type 2: 12,000 Type 3- 5: 20,000Type 3- 5: 20,000

Primary carePrimary care Services offered: Family HealthServices offered: Family Health

– Antenatal and postnatal careAntenatal and postnatal care– Child health E.P.I.Child health E.P.I.– Dental healthDental health– Mental healthMental health– Environmental healthEnvironmental health– Family planningFamily planning– STISTI– NutritionNutrition– Health promotionHealth promotion

Team approach including community Team approach including community

participation.participation.

Integration of preventative and curative Integration of preventative and curative

servicesservices

Government of Jamaica (GOJ) major providerGovernment of Jamaica (GOJ) major provider

Non Government Organizations (N.G.O’s) Non Government Organizations (N.G.O’s)

private practitioners, private clinics and private private practitioners, private clinics and private

hospitals complement the government hospitals complement the government

services.services.

Public Sector predominates in the Public Sector predominates in the

community health and inpatient areascommunity health and inpatient areas

Private sector dominates in terms of Private sector dominates in terms of

primary care, pharmaceuticals and primary care, pharmaceuticals and

diagnostic services.diagnostic services.

  

Health sector reform Health sector reform programmeprogramme

  H.S.R.P. - 1995H.S.R.P. - 1995

–1.1.          PreventionPrevention

–2.2.     T     Treatmentreatment

–3.3.            Severe Resource RestraintsSevere Resource Restraints

  

To accomplish these To accomplish these objectivesobjectives

  Policy Reform requiredPolicy Reform required 1.1.        DecentralizationDecentralization 2.2.        Alternate financingAlternate financing 3.3.        Spending efficiencySpending efficiency 4.4.        Restructuring of Head OfficeRestructuring of Head Office 5.5.    N    New Laws and Regulationsew Laws and Regulations 6.6.        Revision of Information and reporting Revision of Information and reporting

systems systems

DECENTRALISATIONDECENTRALISATION

In 1999, Jamaica decentralized the In 1999, Jamaica decentralized the Administration of its Health Administration of its Health Services.Services.

Four Regional Health Authorities were Four Regional Health Authorities were established.established.

South EastSouth East SouthernSouthern North EastNorth East WesternWestern

DecentralizationDecentralization AdministrativeAdministrative FiscalFiscal Political ProcessPolitical Process Designed to Improve Health Designed to Improve Health

Services through increasing Services through increasing allocation and technical efficiencyallocation and technical efficiency

Financial ManagementFinancial Management Financial plans and strategies Financial plans and strategies

have determined the pace of have determined the pace of decentralizationdecentralization

A National Health Insurance A National Health Insurance Scheme proposed not yet Scheme proposed not yet implementedimplemented

National Health FundNational Health FundDrugsDrugsInstitutional SupportInstitutional Support

Spending efficiencySpending efficiency Energy ConservationEnergy Conservation

Solar HeatingSolar Heating– Energy MonitorsEnergy Monitors

Reorganization of TransportationReorganization of Transportation

Restructuring of Head Restructuring of Head OfficeOffice

Reduction in personnel (600 300)Reduction in personnel (600 300) Functions Redefined to reflectFunctions Redefined to reflect

– Policy FormulationPolicy Formulation– Quality Assurance and Standards Quality Assurance and Standards

MonitoringMonitoring

New Laws and New Laws and RegulationsRegulations

Revision of the Health Services Revision of the Health Services ActAct

Public Health ActPublic Health Act National Health Services ActNational Health Services Act

Health InterventionsHealth Interventions Policy and Procedures ManualsPolicy and Procedures Manuals

– Streamline Activities for efficiency Streamline Activities for efficiency and effectiveness.and effectiveness.

– Development of specialized Services Development of specialized Services in Rural Institutionsin Rural Institutions Increased Training of health Increased Training of health

ProfessionalsProfessionals Equipping of InstitutionsEquipping of Institutions Increased Access to Specialist Services Increased Access to Specialist Services

and Reduced waiting lists.and Reduced waiting lists.

Health InterventionsHealth Interventions

TRIAGE Programme in Accident and TRIAGE Programme in Accident and Emergency DepartmentEmergency Department

Improved flow to Primary care ClinicsImproved flow to Primary care Clinics Reduced waiting time in Accident and Reduced waiting time in Accident and

Emergency DepartmentEmergency Department Improved and efficient ServiceImproved and efficient Service

Ambulatory CareAmbulatory Care Chronic Disease clinics e.g Diabetes, Chronic Disease clinics e.g Diabetes,

Hypertension, ArthritisHypertension, Arthritis Specialist Medical Outpatient Service Specialist Medical Outpatient Service

e.g Asthmae.g Asthma High Risk Ante-Natal ClinicsHigh Risk Ante-Natal Clinics

– Admissions and Maternal mortality Admissions and Maternal mortality decreaseddecreased

Community Mental Health ClinicsCommunity Mental Health ClinicsDecreased inpatients at mental hospitalsDecreased inpatients at mental hospitals

SUMMARYSUMMARY Introduction of Primary Care Services Introduction of Primary Care Services

has seen an improvement in the has seen an improvement in the control of infections Diseases through a control of infections Diseases through a programme of Immunizationprogramme of Immunization

Decentralization has sought to improve Decentralization has sought to improve Health Services through increased Health Services through increased allocation and technical efficiencyallocation and technical efficiency

Innovative Financing has helped to Innovative Financing has helped to defray the cost of the decentralization defray the cost of the decentralization programme and provided increased programme and provided increased access to drugs and servicesaccess to drugs and services

Summary cont’dSummary cont’d Health Interventions have Health Interventions have

improved the quality and quantity improved the quality and quantity of care to the wider population.of care to the wider population.

Emphasis on ambulatory care and Emphasis on ambulatory care and the reduction of inpatient services the reduction of inpatient services is producing a more efficient and is producing a more efficient and effective service.effective service.

Thank youThank you