Jamaica has had a remarkable track record in the delivery of health care services since 1962.
The development of the sector has been most notable in terms of the training of health care professionals, progress in immunization coverage, and the provision and expansion of health infrastructure.
Jamaica ranks high among developing countries in terms of healthcare and life expectancy at birth increased from 38 years in 1900 to just over 72 years in 2008.
Primary Health care
Jamaica's success in healthcare delivery has its foundation in the creation of a primary health care system, which focuses on prevention services.
The institutional basis for a comprehensive public health service was developed in the 1960's and 1970's with the building of a network of health centres islandwide and the development of a landmark document, which the country took to a meeting on primary healthcare in Alma Ata in the Soviet Union. The outstanding model of primary health care contributed to the vision of health for all by the year 2000, articulated in the World Health Organization (WHO) Alma Ata Declaration of 1978.
The Alma-Ata Declaration emerged as a major milestone of the 20th Century in the field of public health, and it identified primary health care as the key to attaining the goal of health for all.
“That document was developed and put together by our own Jamaican health professionals…and that document actually helped to create the Alma Ata Declaration for the world, which was put out by the World Health Organization (WHO) as the overall goal that countries should follow during that decade,” informs Chief Medical Officer in the Ministry of Health, Dr. Eva Lewis Fuller.
Features of the primary health care system include active community participation in health, provision of health centres island wide, where patients are assessed and appropriately referred to the next layer of the health care system. More than $300 million was provided over the last two years to improve health centres across the island.
It is through this focus on primary health that the country has been successful in implementing a stellar immunization programme, which has resulted in the elimination a number of vaccine-preventable diseases and reducing infant and child mortality.
Through the Expanded Programme on Immunization (EPI), established in Jamaica in September 1977, Jamaica has made significant strides towards attaining universal immunization coverage for all children.
Coverage of tuberculosis (BCG) was 100 per cent in 2011; 92 per cent coverage for polio, diphtheria, pertussis or whooping cough and tetanus (DPT), hepatitis B and haemophilus influenza type B (HIB); and 88 per cent coverage for measles, mumps and rubella (MMR).
The figures represent an improvement over the country’s performance in 2009, which showed 94 per cent coverage for BCG, 91 per cent for polio, DPT, Hep B and HIB and 87 per cent coverage for MMR.
Prior to the introduction of the EPI, the infant mortality rate from infectious diseases, including vaccine-preventable diseases such as measles, polio, neonatal tetanus, tuberculosis, diphtheria, bacterial meningitis and pneumonia, was very high, at some 51 per 1000 live births in the 1960s and 32 per 1,000 live births in the 1970s. The infant mortality rate now stands at 21 per 1,000 live births.
The last recorded case of polio was in 1982, the last case of locally transmitted measles was in 1991, the last case of diphtheria was in 1995 and the last case of rubella (German measles) was in 2000.
Jamaica’s record in immunization is recognised internationally. Manager of Family and Community Health at the Pan American Health Organization (PAHO)
Dr. Gina Tambini, says Jamaica, has been among the most successful in terms of immunization coverage and the programme has been used as a benchmark for other countries.
Jamaica made history in the 1980s when salt fluoridation of the domestic water supply was introduced, become one of the country’s most significant public health achievements. This contributed to a significant reduction in the levels of tooth decay in young children.
PAHO provided technical assistance in the design and implementation of the programme as well as training of local personnel in salt fluoridation techniques.
Over the years, the Ministry of Health has intensified its health promotion campaign by focusing on safe motherhood to achieve a maternal mortality rate of 27 per 100,000 live births by 2015.
Achieving the target is one of the Millennium Development Goals set by the United Nations. The country has lowered the ratio to 78 deaths per 100,000 live births in 2009 from 110 deaths per 100,000 in 2000.
In the year 2011, infant and child mortality rates were 19 and 21 per 1,000 live births, down from 25 and 28, respectively, in 1990.
Jamaica's success in healthcare care has been boosted by the work of professionals serving the sector. Prior to 1962, pioneers such as Nurse Mary Seacole blazed the trail and laid the foundation of high quality service, which was pivotal in advancing Jamaica’s health care system.
The fruits of her endeavours, and those of others, are proudly manifested in the work of doctors, nurses and other medical practitioners and professionals, currently serving the public and private health system, who are carrying the baton of excellence in service delivery.
Retired Nurse, Ancillin Morgan, who was trained in the 1960s, and worked in the health care system during the nation’s political transition in 1962, says the sector has grown significantly.
“What really has changed, since Independence, is a further expansion of the role of nursing, in particular. Because, since Independence we have had the nurse practitioner programme and that is an extension of the role of nursing, within the health care system itself. What we had at that time was a hospital administrator, matron and Senior Medical Officer (SMO); that system continued into the 1990s,” she informs.
Facilitating Health For All
Various measures have been implemented to ensure that the most vulnerable Jamaicans can access quality healthcare. Under the no user fee policy introduced in 2008, Jamaicans no longer have to pay for services and public health facilities such as: registration, doctor’s consultation, diagnostic services, hospital admission, surgeries, medications, physiotherapy, ambulance and maternal services.
Jamaicans also have access to programmes, such as the National Health Fund (NHF), which assists with payments on being diagnosed with certain illnesses. The Fund subsidizes the cost of treatment for persons suffering from a range of illnesses including asthma, diabetes, breast cancer, hypertension arthritis and glaucoma. The NHF is also instrumental in funding improvement in health infrastructure and providing necessary equipment.
Through the Jamaica Drug for the Elderly Programme (JADEP), persons over 60 years, suffering from any of 10 chronic illnesses of age can access 72 drugs, free of charge.
The growth of and access to quality hospitals facilities in the island has been another major achievement of the sector since 1962. This is evident in the fact that several facilities have been built over the years, catering to the needs of all Jamaicans, irrespective of their socio economic standing.
The Government, through the Ministry of Health, owns and operates a network of 23 public hospitals, including the semi-public University Hospital of the West Indies (UHWI), which offer varying levels of emergency, curative treatment and rehabilitative services. There are also six specialist hospitals catering to maternity, child care, cancer treatment, rehabilitation, mental health and respiratory disorders.
The hospitals are divided into categories of Type ‘A’; Type ‘B’; Type ‘C’ in terms of the services offered and size of the population served, with at least one facility is found in each parish.
Type A hospitals, including the Kingston Public and Cornwall Regional hospitals, are multi-disciplinary and are the final referral points for secondary and tertiary services, while the Type B Hospitals, situated in the larger urban centres, provide in-patient and out-patient services in general surgery, internal medicine, obstetrics and gynaecology and paediatrics.
The Type C hospitals are basic district hospitals offering in-patient and out-patient services in general medicine, surgery, child and maternity care, basic x-ray and laboratory services.
As for the specialist facilities, the Bustamante Children’s Hospital, which is the only paediatric hospital in the English-speaking Caribbean, was built in 1963. The historic Victoria Jubilee Hospital (VJH), built in 1887, is the largest referral maternity hospital in the region.
Additionally, there are 10 private hospitals and some 350 health centres, which have led to Jamaica’srobust health sector providing an extensive range of services to citizens.
Decentralisation of Health Services
The decentralisation of the health services, to bring responsibility for health care closer to the point of service delivery, are major milestones in the country’s health system.
Through the National Health Services Act of 1997, the Regional Health Authorities (RHA) were created, with the bodies having direct responsibility for managing the public health care networks and the delivery of services, with the Health Ministry having policy making, steering and regulatory roles.
With the creation of the RHA the parishes were grouped into health regions, with the Southeastern Region comprised of the parishes of Kingston and St. Andrew,
St. Thomas and St. Catherine, which account for some 47 per cent of the population.
The Northeastern Region comprises St. Ann, St. Mary and Portland, home to 14 per cent of the population, while the Western Region has 17 per cent of the population and comprises Trelawny, St. James, Hanover, Westmoreland. The Southern Region, with 22 per cent of the island’s population, is comprised of the parishes of Clarendon, Manchester and St. Elizabeth.
Since Independence, Jamaica has had numerous Ministers of Health, who have implemented significant programmes underpinning the sector’s growth and development during their tenures.
These are: Dr. Herbert Eldemire, 1962-1972; Douglas Manley, 1972; Kenneth McNeil, 1972-1974; Dr. Kenneth Baugh, 1980-1989; Easton Douglas,1992- 1993; Desmond Leakey,1993 -1995; Dr. Peter Phillips, 1995-1997; John Junor, 1998-2006; Horace Dalley, 2006-2007; Rudyard Spencer, 2007-2011; and Dr. Fenton Ferguson, 2012 to present.
By Chris Patterson, JIS Reporter