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Caribbean Islands


Most Jamaicans enjoyed a relatively high quality of life in the 1980s, in part the result of health services having been a government priority for decades. The most distinguishing characteristic of the health system was the dominant role of the public sector. As early as 1921, government expenditures on healthrelated activities reached 10 percent of the national budget. In 1966 Jamaica became one of the first countries in the world to establish a national health service. Preventive health services expanded rapidly in the 1970s as the government's real per capita spending on health services increased more than 30 percent. Health expenditures, however, were curtailed sharply in the wake of Jamaica's financial crisis in the early 1980s, resulting in the conversion of rural hospitals into health centers, large layoffs of personnel from the Ministry of Health, and the reintroduction of hospital fees. In 1985, government health expenditures stood at 2.6 percent of gross domestic product (GDP--see Glossary), down from 3.5 percent in 1980.

The Ministry of Health formulated, implemented, and administered the health policies of the government. The ministry was directly responsible for public hospitals, health centers, dispensaries, family planning, and public health services. In the early 1980s the Ministry of Health provided inpatient and outpatient services in 22 general hospitals, 7 specialized hospitals (1 each for maternity, pediatrics, tuberculosis and cardiothoracic surgery, physical rehabilitation, mental disorders, terminal care, and leprosy), a teaching hospital at the UWI, and more than 150 health centers, clinics, and dispensaries. It was difficult to estimate the exact number of health facilities during the mid-1980s, as the ministry was being reorganized.

The country's major public hospitals were Kingston Public Hospital, the University Hospital in Mona, Cornwall Regional Hospital in Montego Bay, and Mandeville Hospital, all run by semiautonomous regional management boards. The total number of beds provided in public hospitals in 1985 was 5,700, roughly 10 percent below the 1980 number of 6,300. Compared with other Commonwealth Caribbean islands, Jamaica had a ratio of hospital beds to population that was relatively low. General surgery and general medicine accounted for nearly 44 percent of available hospital beds. In addition to public hospitals, there were six private hospitals with nearly 300 beds in the mid-1980s. Private hospitals were generally small, expensive, service oriented, and affiliated with religious organizations.

At the local level, each parish council employed a medical officer of health, public health nurses, public health inspectors, and district midwives, and three parishes had community health aides. Three forms of health centers existed. The first offered only a midwife and perhaps two community health aides. The second type had a public health nurse and a public health inspector in addition to the midwife and the aides. The third type included all the features of the first two as well as a nurse and a medical doctor, who generally referred patients to either other health centers or regional hospitals. Community health aides, a position that was deemphasized in the 1980s, served to educate the public on nutrition, infant care, family planning, and first aid. Public health nurses conducted clinics on pregnancy, gave vaccinations, and visited schools and homes. Public health inspectors examined the sanitation of food and made certain that slaughterhouses and food shops were clean; they were also responsible for mosquito control, the source of most tropical diseases.

Tropical diseases were greatly reduced in the postwar period through persistent immunization programs and mosquito control. Deaths from yellow fever, malaria, dengue fever, typhoid, whooping cough, polio, and other childhood diseases were virtually eliminated. No vaccinations were needed for most visitors to the island. Some of the most common diseases reported in 1985 were gastroenteritis (generally related to malnutrition), measles, venereal diseases (mostly gonorrhea), tuberculosis, hepatitis, leptospirosis (transmitted by animals), and a small number of nonlethal cases of malaria, typhoid, and dengue. As of mid-1987 there were 18 reported cases of acquired immune deficiency syndrome (AIDS) reported on the island, and 150 persons were reported to have been infected with the virus. The island also suffered from an unusually large number of cases of leprosy. Another serious health problem was mental disorder, especially schizophrenia. More than 50 percent of the island's hospital beds were located on the large grounds of Kingston's Bellevue Hospital. Although bed occupancy rates remained high in the late 1980s, little was being done to alleviate the hospital's growing understaffing problem.

In the mid-1980s the Ministry of Health employed 5,500 people, but government cutbacks were expected to reduce that number. Although Jamaica housed a regional medical school, the number of doctors was insufficient to meet levels recommended by the Pan American Health Organization (PAHO). With fewer that 500 doctors, the island had a doctor-to-population ratio of only 1 to 5,240, whereas PAHO recommended a ratio of 1 to 910. As with professionals in general, many Jamaican doctors emigrated to earn higher salaries. The island was even more deficient in the number of dentists, who were not trained locally. Slightly more than 100 dentists were registered on the island, but many unlicensed dentists also practiced. The licensed dentist-to-population ratio was 1 to 20,000, far from the 1 to 2,857 ratio PAHO recommended. Dental assistants were trained locally through a dental auxiliary school at CAST. In 1985 Jamaica's nurse-to-population ratio of some 1 to 1,172 was also below the recommended PAHO level of 1 to 769, as was the 1 to 274 ratio of assistant nurses, compared with the recommended 1 to 385. Nevertheless, Jamaica's ratio of nurses still surpassed that in many Latin American and Caribbean countries.

Various professional and regulatory organizations on the island maintained standards, licensed physicians, and educated the public. These included the Medical Council of Jamaica, the Medical Association of Jamaica, the Dental Health Council, the Nursing Council, the Nurses Association of Jamaica, the Jamaican Association for Mental Health, the Jamaican Red Cross Society, and the Pharmaceutical Society of Jamaica.

Since 1966, the government of Jamaica has offered a wideranging , contributory social security service at the national level called the National Insurance Scheme, operated by the Ministry of Social Security. Jamaica Blue Cross, an international, voluntary, nonprofit organization, offered a prepayment health plan and also served to set standards and control costs. Medical research was conducted at the central bacteriology laboratory in Kingston and at the UWI hospital. The Caribbean Food and Nutrition Institute, at the UWI, also served regional research purposes. A national blood bank was located in Kingston.

Data as of November 1987

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