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JAMAICA’S JAMAICA’S
HEALTH SYSTEMSHEALTH SYSTEMS
TREVOR MCCARTNEYTREVOR MCCARTNEY
C.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.S
SENIOR 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) 331 331 Clinics 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 Reduced waiting time in Accident
and Emergency Departmentand Emergency 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 control of infections Diseases through a programme of Immunizationa programme 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