Download Suriname

Health System
of
SURINAME
Maltie Algoe
Elly van Kanten
Monitoring and Analyzing Health System Change and Health Reform ,
May 30th – June 1st , 2006 - Belize
Content:

Health System Characteristics

Health System Performance

Health Status and Outcomes

Relevant Trends and Interventions
2
HS Characteristics
Guiding principle:
Health care is the right of every citizen
(Constitution, art. 36, sub 2)
Overall Goal:
To achieve optimal health status
for the majority of the population
through provision of
available, accessible and affordable
health care
3
Main responsibility of the MOH
To promote Public Health through :
1. Improvement of living and working conditions
2. Health education
Main tasks:

Policy Development

Health Planning / Regulation

Coordination / Supervision

Monitoring & Evaluation

Quality Assurance
Demand:
Population
Supply:
MOH
Professionals
NGO’s
Finance:
MOF
MSA
State
Health Ins.
Private Insurance
Out-of-pocket
Population (census 2004): 492 829
by ethnicity:
30000
20000
10000
0
10000
20000
30000
95-99
90-94
Chinese
85-89
Caucasian
Others
80-84
75-79
Indigenous
70-74
Hindustani
65-69
60-64
Mixed
55-59
50-54
45-49
40-44
35-39
Javanese
30-34
25-29
20-24
Creole
15-19
10-14
Maroons
05-09
00-04
Males
Females
6
MOH
CMO
Organization & Management
General affairs:
- Personnel
- Finance
- Maintenance
- Expedition
Planning division
Legislation division
Public Relations
External relations
Inspectorate
Bureau of PUBLIC HEALTH
NAP
STI Clinic Dermatology services
Foundations and Institutions
PHC:
- Regional Health Services
- Medical Mission
HOSPITALS
Psychiatric Center
7
Structure of the MOH

Main Office:
Central Administration
(incl. Planning and Legislation)

Inspectorate

Bureau of Public Health
8
9
Primary Health Care


Coastal area
- RHS (8 districts, 50 clinics, 100,000 clients)
- Private GP’s
Interior
- MM (2 districts, 50 centers, 50,000 clients)
Several NGO’s providing:
 SRH services
 Health Promotion
 (Home) Care & Support
 Research
10
Secondary Health Care
5 General hospitals:
 2 private (one with link to interior)
 3 public (two with ER, one specialized in MCH)
1 Mental hospital
Total # of beds: 1318
# of beds per 1000 pop: 2.7
Occupancy rate: 70 %
11
Human resources (2004)
Number of Physicians
400
Number of General Practitioners
295
Number of Medical Specialists
105
Number of Dentists
42
Number of Non - university trained nursing personnel
1 745
Number of registered nurses
778
Number of midwifes
57
Rates per 10,000 pop (2004)
Physicians per 10,000 population
8. 2
Dentists per 10,000 population
0.9
Non – university trained nursing personnel per 10,000 pop
35.4
Number of registered nurses per 10,000 population
15.8
Number of midwifes per 10,000 population
1.2
12
2000
2002
Gross Domestic Product (GDP)
836.1 mln US $
879.9 mln
US $
GDP per capita
1,915 US $
1,925 US $
National Health Accounts
Total Health Expenditure (THE) 78,763,778 US $ …
THE per capita
180.33 US $
…
THE as % of the GDP
9.42%
…
Public Health expenditure
(PHE)
34.1 mln US $
31.7 mln US
$
PHE per capita
78.1 US $
69.4 US $
PHE as % of the GDP
4.07%
4,97%
PHE as % of THE
43.33%
…
13
Distribution of spending by payer
Donors
14%
Govt
44%
Companies
22%
Households
20%
National Health Accounts, MSH, march 2002
14
Distribution of spending by level of care
Other HC
11%
Primary HC
34%
Secondary HC
55%
National Health Accounts, MSH, march 2002
15
Insurance coverage (Census 2004)
No
insurance /
Do not
know
16%
Other
1%
SZF
21%
Out of
pocket
payment
19%
Insurance
companies
3% Company
Medical
Plan
10%
MSA
24%
Medical
Mission
6%
16
Health Status and Outcomes
Vital Statistics, 2004
Population
492,829
Average Population growth rate
1.4%
Percent of urban population
Total number of registered live
births
59.40%
Total number of registered deaths
Crude birth rate per 1 000 pop
Crude mortality rate per 1 000 pop
Life expectancy at birth (years)
Total fertility rate
9,062
3,289
18.7
6.7
71.5
2
17
10 Leading causes of Hospitalization
(2000)










1. Pregnancy, Childbirth and Puerperium
2. Gastrointestinal diseases
3. Hypertension and Cardiovascular diseases
4. Diseases of the respiratory system
5. External causes
6. Diseases originating in Perinatal period
7. Cerebrovascular diseases
8. Malign neoplasmata
9. Certain Vector-borne diseases
10. Urogenital disorders
18
10 Leading causes of death, 2000 - 2004










1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Cardiovascular diseases
External causes
Malign neoplasmata
Diseases from the perinatal period
HIV / AIDS
DM
Respiratory disorders
Gastro – intestinal disorders
Diseases of tractus Urogenitalis
Intestinal disorders
19
Achievement of MDG’s
Immunization Coverage 85%
PMR , IMR & <5 MR per 1000 of LB
45
40
35
30
PMR
25
IMR
20
<5 MR
15
10
5
0
1990
1995
2000
2002
2004
2015
20
Maternal Mortality Rate
Deliveries by skilled personnel 90%
Maternal MR (per 100 000 LB)
250
200
150
100
50
0
1990
1995
2000
2002
2004
2015
21
HIV Prevalence
2.00%
1.80%
1.60%
1.40%
1.20%
1.00%
0.80%
0.60%
0.40%
0.20%
0.00%
Incidence of Tuberculosis
25
20
1990
1995
2000
2002
2004
2015
15
HIV-prevalence amoung pregnant women
Est. Adult (15-49 jaar) HIV prevalence
10
5
0
1990
1995
2000
2002
2004
2015
22
API of Malaria
250
40
200
35
150
30
100
25
20
50
15
0
1990 1995 2000 2002 2004 2015
10
5
0
1990
1995
HIV/AIDS death rate
2000
2002
TBC death rate
2004
2015
Malaria death rate
23
Performance: Strengths & Opportunities
Demand:
 Strong NGO involvement
 Increasing awareness for health rights
Supply:
 Independent financing and provision of health
care
Financing:
 Subsidized health care for the poor
 Social health insurance for civil servants
 Global Fund for HIV/AIDS, TB and Malaria
24
Performance:
Weaknesses & Threats
Demand:
 HIV/AIDS (increasing infections)
 Illegal abortions (est. 10,000 /year)
Supply:
 Weak MOH
 Structural migration of nurses
 Unequal access to health care
 Insufficient focus on cross cutting issues :
Gender, Environment, Youth
Financing:
 No correlation between health expenses of 9,4%
of GDP and quality of care
25
HSR
“Support for HSR”
(1st project) (1998 – 2003)
Series of studies on:

Household Budget Survey

National Health Expenditures (NHA)

Performance of PHC

Actuarial model for the State Health Insurance

Drug Procurement

Integration of SHI and MSA

Payment Systems

Distribution of medical cards

Quality Assurance
26
HSR
“Support for implementation of HSR”
(2nd project) (2004 – 2008)
Project Components:

Improve performance of preventive and
primary health care services

Improve access to medicines

Reduce costs and improve efficiency

Improve equity

Strengthen MOH
27
Health Sector Plan
(2004 – 2008)
Strategies
1.
Strengthening primary care and prevention
2.
Improving both efficiency and quality of
hospital care
3.
Promoting the financial accessibility of health
care services
4.
Health care cost control
5.
Strengthening support systems (procurement,
logistics, communication, NHIS)
6.
7.
HRD (quality, quantity, motivation)
Improving and safeguarding quality
28
Multi-annual Development Plan
(2005-2010)
& MOH policy note
(2006 – 2007)
Planned interventions (Policy Framework):

National health costs insurance and financing

Improve infrastructure

Basic health care package (focused on
prevention)

Improve management (QA, data acquisition)

HRD and HRM

Critical review of health- and environmental
legislation;
29
Relevant Trends / Interventions
Strengthen PHC:

Special attention for deprived areas and
vulnerable groups;

Community Participation

Addressing chronic diseases

Integration of preventive components in PHC

Emphasis on prevention ( health education),
early detection ( screening) and secondary
prevention (multidisciplinary treatment)
30
Relevant Trends / Interventions
Intersectoral approach:

Recognition of intersectoral influences on
health (by agriculture, labor, education, housing etc)

Need for intersectoral cooperation (e.g. in
HIV/AIDS)
International commitments:

MDG’s (demanding specific attention)

Global Fund (demanding coordinating mechanism)
31
Thank you