Transcript Presentation-on-Primary-Care

NY April 30th2011
 Dr. Barbara Gordon, Ob/gyn
 Dr. Sharon Ogiste-McBain, Pediatrician
 Dr. Wilkins Williams, Internal Medicine
 Dr. Elma Johnson, Emergency medicine
 Rev Wesley Daniel
Grenada General Hospital
Grenada General Hospital
Grenada General Hospital
GRENADA
NATIONAL STRATEGIC PLAN FOR
HEALTH
(2007-2011)
Gov’t of Grenada
The Grenada National Strategic
Plan for Health
designed to involve the
whole country in setting
priorities and a direction
for improving health
status of the population
Steering Committee
Appointed by cabinet in 2004
Financial support from Caribbean Dev. Bank
Technical support from PAHO
Consultation launched in Sept 2005
Ministry of Health
A National Strategic Plan for Health
Guiding principles
Strategies outlined by the
Caribbean Charter for Health
Promotion
Grenada
 Grenada, Carriacou, Petit Martinique
 133 sq miles
 Independent Nation 1974 from the UK
 Westminister- style parliament
 Population 2005 was 106,027
 Growth rate 0.2%
Demographics 2005
 Ages 0-15 …. 34.7%
 Ages 15-65 …54.9%
 Ages 65+
…10.32%
Overview of the population’s
health status
Infant Mortality range 1998-2002
12.5 & 19.6 (deaths /1000 births)
Maternal Mortality rate
0 for 4 years
Death Rate range from 7.0-8.7 /1000 population
Life Expectancy Age 68 for men and women 72
Fertility rate 2004, 2.4 children for women of
childbearing age
Socio-Economic Situation
 The 2005 UNDP- Human
Development Index ranked Grenada
66th of the 177 nations. The ranking
reflect positive changes in infant
mortality rates and adult literacy. Other
indicators include an 18.8 %
unemployment rate and a 31% poverty
rate
Leading causes of death 1998-2002
 Disease of the circulatory system including pulmonary
circulation, cerebrovascular disease other forms of
heart disease
 Malignant neoplasms
 Disease of respiratory system
 Certain infections and parasitic disease
 Accident and injuries increase 4 fold from 1989-2002
Leading causes of morbity 2004
 Diabetes Mellitus
 Hypertensive Disease
 Upper respiratory infections
 Arthritis
 Injuries
 Admissions to hospital greatest in persons in age 45+
Communicable disease review
1980-2004
 Decline in TB from 17 to 6 cases
 No deaths from Dengue ‘03-’04, the number of cases
bet ‘02-’04 were 310,19,8 respectively, cases related to
rainfall an mosquitoes
 Decrease in Sexually transmitted Disease
 Syphilis almost 80% decrease bet ‘96 & ‘02
 Gonorrhea remained stable with 112 cases in ‘96 and
101 cases in ’02
HIV/Aids
 HIV midyear ’05, reported cases 197, male to female
ratio 2.5 : 1
 Cumulative # of deaths from AIDS, 155
 113 males , 42 females
Hospital utilization
 ‘04 Women: 99% delivered in a health facility,75% at
the General hospital, 1% in private
 ‘01-’04 men accounted for higher utilization of
hospitalization (compared to women)for injuries from
work place and road traffic accidents
 Men also had a higher admission to the Carlton House
for drug and alcohol abuse treatment
 ’04 men had 33% first visit to the community health
services
School age children
 A survey for Anemia in 2004 , ages 1-4, 62.1% had
hemoglobin levels below normal
 Dental services at health centers ,2,238 children seen
ages 5-19, 99.3 % were identified with problems
 ‘00 Teenage pregnancies, 21 % of total births
Elderly
 13 homes care for the elderly (gov’t assisted, public,
private)
 An NGO also works in the community for the elderly
 Chronic disease management is a major challenge
 By 2014 , 20-25% of the population will be over 50 years
of age there will be greater demand for chronic disease
care at the community level and hospital level
Health Risks
 Main concern and cause of ill health and death is
related to: poor dietary habits, in particular before and
after pregnancy, poor fetal development, early
childhood nutrition, poor chronic disease
management, accident and injuries, drug and alcohol
use, and (to some extent) unsafe practices
Health Services
 Public facilities- 3 Acute care hospitals
 General Hospital-240 beds
 Princes Alice Hospital- 56 beds
 Princess royal Hospital (Carriacou ) -40 beds
 1 Mental health Hospital (Mt Gay Hospital)
Health Services con’t
 1 Rehabilitation center (Carlton House)
 1 Home for the elderly ( Richmond Home)
 6 Health centers
 30 health stations
 There is limited referral system between community
services and hospitals as a result many patients to
directly to the Accident and Emergency (A&E)
resulting in long waiting time
Hospital Utilization 2004
 General Hospital had 8,313 admissions at the Average
length of stay 6.6 days, bed occupancy rate 73 %
 Princess Alice has limited diagnostic services all x-ray
and lab services has to go to the General Hospital
requiring patients to be transferred. Occupancy rate
60%
Hospital Utilization cont’d
 Princess Royal Hospital (Carriacou) serves a
population of 7000 including Petite Martinique
 A major constraint is the inability to retain doctors
who cover both hospital and community services
Community health services 2004
 10 District Medical Officers
 10 community health nurses
 40 district nurses
 5 Family Nurse Practitioners
 45 community Health Aides
 12 Pharmacists
 8 dentists
 2 social workers
 7 environmental Health officers
Private health services
 Dominated by single practioners, many of these
doctors work for the public health services
 2 small private clinics with patient beds
 A diagnostic facility
 General hospital Private ward
 No NGO provide inpatient care, however many
participate in health promotion an protection
activities
Financial Resources
 Health sector receives approx 12% of the annual
budget in 2000-2005
 Wages and salaries account for approx 70% of health
expenditures
Personnel 1997/2002
 8.1 physicians per 10,000 population
 19.5 nurses per 10,000
 1.1 Dentist per 10,000
 6.9 Pharmacist per 10,000
 0.75 Nutritionist per 10,000
 Key challenges for health personnel in Grenada
include the ability to retain medical practioners,
nursing staff and medical administrators
Central non-partisan body
 To coordinate all voluntary health aide efforts made to
Grenada with representatives from each parish
 Develop a website with links
 Create a central registry for physicians and allied
health workers with the services they can provide
 Governed by an advisory Board efforts coordinated by
a core body e.g.. secretary , treasurer and president
 Set up a central office in Grenada and NY
Education
 Community education –health information,
pamphlets
 Provide a monitoring system to track the educational
materials
 Have volunteers /paid personnel to ensure reading
materials are circulated
 Maintain statistics of the education materials
 Quality assurance to ensure materials are distributed
to the appropriate parties
Education cont’d
 Provider education…physicians, nurses, aids and all
allied workers those in direct and indirect patient care
 Mandatory continuing medical education (CME)
 Incorporate Health education in high school and
elementary school…e.g. STD, proper nutrition, dental
care etc.
Health Protocols and compliance
 Review health protocols of hospital and satellite clinics
 Create a committee of 3-4 physicians/administrative
staff to review protocols …are they practical ? are they
enforced ? The central board should be involved in
the process

NGO and Volunteer services
 Central Committee …. responsible to coordinate the
volunteer services for continuity of care
 Have a central registry to coordinate the volunteer
services e.g. dentists going on different months for
continuity of care rather than having all at the same
time
 Have paid staff to coordinate efforts for accountability
Drug Bank
 Drug assistant bank program to assist patient with
unaffordable medication
 Make arrangement with drug companies and other
parties
Weekly Radio and TV health topics
 Have a calendar , get volunteers to provide health
information for different topics
Grenada General Hospital
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