Transcript British Virgin Islands SUMMARY

Health Systems
and
Services
Profile for
the
British Virgin Islands
BRITISH VIRGIN ISLANDS
Summary




The BVI, an overseas dependent Territory of the United
Kingdom comprises 50 islands, cays and rocks, 15 of which
are inhabited. The 4 largest islands are Tortola, Anegada,
Virgin Gorda, and Jost Van Dyke.
It is self-governed by a democratically elective Legislative
Council.
The Executive Council consists of the Governor, a Chief
Minister, the Attorney General, and four other ministers.
The Governor and Deputy Governor are appointed by His
Majesty, the Queen.
Under the constitution, the Governor is responsible for
foreign affairs, defense, and internal security.
BRITISH VIRGIN ISLANDS
Summary (cont.)
 General elections are held every four years and
are constitutionally due in mid 2007.
 In 2004, the estimated population of the BVI
was 22,053, and the major ethnic group is
black.
 The BVI has one 44-bed public hospital (Peebles
Hospital) and one 8-bed private hospital (the
Bougainvillea Clinic), both located in Road Town.
BRITISH VIRGIN ISLANDS
Summary (cont.)

HEALTH CONCERNS
Obesity, particularly among women.
 Dengue is the most important vector borne
disease in the BVI.
 Since 1985, 50 cases of HIV/AIDS had been
reported, with a total of 25 deaths by the end
of 2004.

HEALTH SYSTEM

PUBLIC SECTOR
 The Ministry of Health and Social Services is the agency
responsible for carrying out the Government’s national health
policy.
 A 2006 Health policy document is currently under review and
consultation.
 In 2005, the BVI Health Services Act was passed establishing
the BVI Health Service Authority Board, which manages all
public health care delivery services.
 The performance of the Authority is to be monitored and
evaluated based on goals and targets as set out in a service
level agreement which is currently being developed
HEALTH SYSTEM (cont.)
The Ministry of Health focuses on the
performance of the Essential Public Health
Functions, standard setting and regulation of
the health sector
 The Government’s health priorities are the
enhancement of hospital services, the
strengthening of public primary health care
services,
and
the
improvement
of
environment health including solid waste
management.

HEALTH SYSTEM (cont.)
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
Government health services are provided free at the
point of use to certain groups. These include fulltime school children, nursing mothers, the elderly,
the mentally ill, health workers, firefighters, the
police, prisoners, and prison officers.
Patients requiring diagnostic and treatment services
beyond the scope of Peebles Hospital are referred to
Puerto Rico, Jamaica, Barbados, the United States,
USVI and the United Kingdom.
HEALTH SYSTEM (cont.)

The BVI does not have a formal health plan, though
incremental health sector development initiatives are
undertaken as part of the budget development
process.
HEALTH SYSTEM (cont.)
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PRIVATE SECTOR
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The territory has a growing private health sector,
encompassing both inpatient and ambulatory care.
Private sector provisions are concentrated in Tortola
the most densely populated island.
There is one private hospital (Bougainvillea Clinic),
which specializes in plastic surgery, two private
dental surgeries, and three private medical
complexes, all located in the capital.
There are 16 physicians practicing in the private
sector.
HEALTH SYSTEM (cont.)

Many residents access services through the private
sector and care abroad, mainly in the US Virgin
Islands or Puerto Rico, either by choice or because
they require specialized care unavailable locally.
HEALTH SYSTEM (cont.)

SOCIAL SECURITY
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A compulsory social security scheme covers all paid
employees, with employees and employers
contributing equally to the premiums. Self-employed
workers are also required to participate in the plan.
The social security benefits include maternity,
occupational injury, unemployment, old-age pension,
sickness, and survivor’s benefits, as well as a funeral
grant.
Discussion on the development and implementation
of a National Health Insurance scheme is ongoing.
HEALTH SYSTEM (cont.)

REGULATIONS
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The new Medical Act, passed in 2000, provides for
the registration of medical dental, and allied health
practitioners, and for pharmacists.
It makes
provisions for enforcement of standards and ethical
professional practice.
The Nursing Act, 1976 provides for the regulation of
the nursing professionals.
The Ministry of Health has the mandate to regulate
the health sector including registration, and licensing
of facilities, but does not have effective mechanisms
in place to do so.
SYSTEM’S RESOURCES
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HUMAN RESOURCES
As of 2004, a total of 45 physicians
registered to practice in the BVI. Out of these
29 work in the public sector and 16
physicians in the private sector.
 There are 6 dentist registered to practice in
the BVI, 2 work in the public sector and 4 in
the private sector.
 All non-nationals coming to the territory to
work require a work permit.

SYSTEM’S RESOURCES (cont.)

There are 121 Registered Nurses employed in the
public sector; 24 of these work in Community Health
Services and 97 at Peebles Hospital.
SYSTEM’S RESOURCES (cont.)
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DRUGS & OTHER HEALTH PRODUCTS
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There is no local production of drugs, vaccines or
medical equipment. The Peebles Hospital Pharmacy
is the central purchasing agency for the public health
services.
Drugs are purchased through the Organization of
Eastern Caribbean states pharmaceutical Services
(OECS-PPS). Some drugs not included in the OECSPPS formulary and are purchased directly from
private suppliers. The OECS-PPS formulary is revised
every two years.
SYSTEM’S RESOURCES (cont.)
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Narcotics are not available at district clinics.
A certificate from the Ministry of Health Services is
required for importation of narcotics.
All other drugs used in the private sector are
purchased independently and except for antibiotics
are not regulated by the government.
The
Peebles
Hospital
Pharmacy
supplies
pharmaceuticals to the district health centers
(primary care units).
SYSTEM’S RESOURCES (cont.)
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The Medical Act (2000) requires that a registered
pharmacist be present at both private and public
pharmacies. There are privately owned pharmacies
in Tortola and Virgin Gorda.
Vaccines are purchased through PAHO Revolving
Fund. When urgently needed, some vaccines are
purchased through a vendor in Barbados.
Some vaccines are provided at no cost to the private
sector practitioners as a strategy to boost
vaccination coverage. A limited number of vaccines
are ordered directly by the private sector.
SYSTEM’S RESOURCES (cont.)
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The national blood bank service is located at the
Peebles Hospital medical diagnostic laboratory. The
laboratory uses the Caribbean Regional Standards
for blood banking.
All blood for transfusion is screened for HIV, Hepatitis
B and syphilis.
There is no remuneration offered for blood
donations. All donations are collected on a voluntary
basis.
SYSTEM’S RESOURCES (cont.)
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EQUIPMENT & TECHNOLOGY
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Most of the equipment which includes laboratory, xray, ultrasound and dialysis are located at the public
hospital. CT Scan and mammography are available in
the private sector.
The maintenance staff at Peebles Hospital has had
biomedical technology training provided by the
suppliers and service contracts are maintained with
some suppliers.
There are three private medical diagnostic
laboratories in the private sector.
FUNCTIONS OF THE HEALTH SYSTEM
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STEERING ROLE
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The Ministry of Health and Welfare is responsible for
providing public health and social services, as well as
for monitoring and regulating health sector providers.
The Permanent Secretary is responsible for the
administration of the Ministry headquarters and for
supporting the Minister in his policy role.
The Director of Health Services is the chief technical
adviser on health matters.
FUNCTIONS OF THE HEALTH SYSTEM
(cont.)
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FINANCING & EXPENDITURE
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The Health Ministry of Health is responsible for exercising
supervision and control of financing of the sector.
Public health services are almost entirely financed by the
government
In 2000, the total Ministry of Health and Welfare expenditure
was an estimated US$20.3 million, or approximately 17% of
total government expenditure.
Community Services accounted for approximately US$3.53
million (17%) of the Ministry’s expenditure, and hospital
services for some US$7.7 million (38%).
FUNCTIONS OF THE HEALTH SYSTEM
(cont.)
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The public health services’ overseas medical
expenditure was estimated at US$700,000 in 2003.
User fee generally recover only 8% of the operating
cost of primary and secondary health care services.
HEALTH INSURANCE
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There is no Health Insurance Scheme at present
however a feasibility study for the development of a
National Health Insurance scheme was commissioned
in 2006.
A compulsory social security scheme covers all paid
employees, with employees and employers contributing
equally to the premiums; some persons are covered
100% by the government
The social security benefits include maternity,
occupational injury, unemployment, old-age pension,
sickness, and survivor’s benefits, as well as a funeral
grant.
SERVICE DELIVERY
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PRIMARY CARE LEVEL
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The territory has been divided into health districts to
facilitate efficient and effective deployment of
resources to the various communities of the BVI.
There are 5 Zones: Zone 1 (Eastern Tortola); Zone 2
(Central Tortola), Zone 3 (Western Tortola); Zone 4
(Virgin Gorda) and Zone 5 (Anegada).
Public sector primary care services are offered at the
District Health Clinics.
SERVICE DELIVERY (cont.)
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There are a total of 12 health clinics and health
posts in the BVI (10 clinics and 2 health posts) – the
Road Town Health Center and 7 other clinics on
Tortola, two on Virgin Gorda, and one each on Jost
Van Dyke and Anegada
The Road Town Health Center serves as a referral
point for the district clinics.
The clinic in The Valley, on Virgin Gorda, is staffed by
two physicians’ the clinic at North Sound is staffed
by a resident nurse who is supported by the Valley
clinic physicians.
SERVICE DELIVERY (cont.)
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District clinics provide a full range of child health
services, including growth and nutritional monitoring,
development assessment, treatment of common
illnesses, counseling, school health, and screening
for anemia, including sickle cell anemia.
SERVICE DELIVERY (cont.)
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The Community Health Pharmacy Programme was
established in 2002.
The Community Health
Pharmacist although stationed at Road Town Clinic,
also provides services to Virgin Gorda and East End
and West End on Tortola.
In January 2003, the post of Health Disaster
Coordinator was established with responsibility for
coordinating Health Disaster Management activities
within the territory.
SERVICE DELIVERY (cont.)
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The Health Promotion Unit in the Ministry of Health
focuses on the promotion of health and wellness and
emphasized behaviour modification and life style
changes.
Programmes for the prevention and management of
both
communicable
and
non-communicable
diseases are available through the Community
Health Services and Peebles Hospital.
Hypertension and Diabetes clinics are conducted on
Tortola at the Road Town, Iris Smith-Penn (East End),
Cappoons Bay and on Virgin Gorda at North Sound
and Iris O’Neal Clinics.
SERVICE DELIVERY (cont.)
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The BVI’s Expanded Programme for Immunization
(EPI) is a component of the Family Health
Programme. Under the EPI, children under the age
of one year receive BCG, Hep. B, DPT, Hib, OPV
vaccines; at one year of age, children receive MMR
vaccine, DPT Polio, and MMR booster shots are given
according to the immunization schedule until 11
years of age.
The Hepatitis B and Hib vaccines were added to the
immunization programme in 1999, and the
pentavelant vaccine, which provides coverage for
diphtheria, pertusis, tetanus, hepatitis B and
Meningitis, was added in 2000.
SERVICE DELIVERY (cont.)
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No cases or deaths of neonatal tetanus were recorded in
2004.
Adina Donovan Home for the elderly is a senior citizens
home that offers care and protection to the elderly. There is
a similar home in Virgin Gorda.
The Environmental Health Division is responsible for food
hygiene, vector control, water quality surveillance,
institutional hygiene, and investigation of complaints such
as septic tank problems, rodents, and abandoned vehicles.
The Government Dental Services provide oral health
services to the population. There are two Govt. employed
Dentists who are based on Tortola. These officers also visit
Virgin Gorda and Anegada.
SERVICE DELIVERY (cont.)
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The Dental Service Unit monitors primary school
fluoridation and dental health programmes.
The Community Mental Health Center, located in
Road Town, provides mental health ambulatory care
for the Territory through its outreach psychiatric
services.
SERVICE DELIVERY (cont.)
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SECONDARY CARE LEVEL
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Secondary health care is delivered at Peebles
Hospital.
There is an organized Accidents and Emergency
Department which also offers walk-in and scheduled
outpatient services.
A 8 bed unit renal dialysis unit was commissioned in
May, 2000.
SERVICE DELIVERY (cont.)
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Consultant pathology services are now provided onisland.
QUALITY
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TECHNICAL QUALITY
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Quality improvement programmes for all aspects of
health care are in varying stages of development.
There is a Quality Assurance Nurse who has
responsibility for quality standards in the Community
and Hospital Services.
There is no research ethics committee in the
territory.
There is currently no committee on Hospital
Nosocomial Infections, and there is no staff assigned
to deal with this.
QUALITY (cont.)

PERCEIVED QUALITY
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There is no operational programme for improving
user relations. No user satisfaction surveys are
undertaken even though users are encourage to put
their complaints in writing to the Director of Health
Services, Ministry of Health and the Chief Executive
Officer of the BVI Health services authority.
An Employee Orientation Manual and a directory of
service was developed in 2003 to provide
information to staff and clients on the services.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM

MONITORING THE PROCESS
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The BVI undertook a United Kingdom Governmentfunded Health Sector Adjustment Project from 1993
to 1996.
The objectives of the project were to:- implement
new management structures and processes, to
revise planning approaches and systems and to
revise financing strategies and improved quality of
care and optimized health outcomes.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)

The results of the project were as follows:


Agreement and partial implementation of a new
management structure
A number of health sector studies (including
information, health promotion, accident prevention,
mental health, and environmental health), which
were accepted by local health managers as giving
them a sound basis for further planning.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)
- This project had very little success in terms of
achievement of its objectives. Significant progress
was only realized in the redesignation of the post of
Chief Medical Officer to Director of Health Services,
Chief Nursing Officer to Assistant of Director of
Health Services and Hospital Administrator to
Hospital General Manager.
 There was no strengthening of the management
systems and no activities were developed to build
management capacity.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)
The National Health Sector Emergency and
Disaster Management Plan was revised with
the participation of all managers and
representatives from all levels of the health
sector as well as all the health related
sectors in collaboration with the Department
of Disaster Management.
 Every year simulation exercises are held to
ensure that the plan is tested and revised as
necessary.

MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)

INVESTMENT IN HEALTH SERVICE
INFRASTRUCTURE
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The government of the BVI has committed to the
building of a new hospital in 2006 to replace the
present Peebles Hospital. This will result in an
increase in the number of beds available from 44 to
120.
In the area of health care financing, there has been
much discussion about the formation of a National
Health Insurance Scheme.
A feasibility study was commissioned in 2006.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)

SAFEGUARDING
PRACTICE

THE
QUALITY
OF
MEDICAL
A new medical act was passed in 2000. This act
makes provision for the formation of a Medical and
Dental Council and on Allied Health Professions
Council.
 These bodies which will operate independently
of the Ministry of Health will seek to ensure
quality practice of doctors, dentists and allied
health professionals.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)
HUMAN RESOURCE DEVELOPMENT
 In 2000, Sixteen (16) nurses were up-graded
from the certificate/diploma to the
bachelorate BSN level through a special
initiative of the Ministry of Health and the
H.L.
Stoutt
Community
College
in
collaboration with the University of New York
at Sunny Buffalo.

MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)



In 2005 a strategy was implemented in the Community
Health services to strengthen programme planning and
programme management in the areas of;
Maternal and Child Health, Family Planning, Prevention
of Chronic Disease (Diabetes), School and Adolescent
Health, Healthy Elderly and Workplace Health (building
on the Food Handlers and Immigration Clinics) have
targeted for action.
Through this programme, it is expected that the
community and public health programmes, will be better
focused with targeted objectives and improved
monitoring and evaluation.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)


The territory is currently preparing to undertake a
national consultation for the development of a new
national strategic plan to respond to the HIV/AIDS
epidemic.
It is expected that this new plan will have participation
of all relevant sectors and would yield a better
programme of action and response to HIV/AIDS
prevention and control including protection of human
rights and access to ant ratio viral therapy.
MONITORING & EVALUATION OF THE
HEALTH SECTOR REFORM (cont.)

The Health System and Services Profile is currently
updated by the Ministry of Health working closely with
the PAHO/WHO Caribbean Program Coordination office
in Barbados.