Achieving Sustainable Healthcare: The Cayman Islands Experience

1. Ingredients of a Sustainable healthcare SYSTEM– the Cayman islands experience Lizzette Yearwood

2. Our common challenges • increased life expectancy • increasing disease burden (due to age and life styles) • increasing prevalence of mental illnesses • increased public expectations • increased cost of care

3. MINISTRY OF HEALTH NATIONAL STRATEGIC PLAN • Two principles • to build an integrated health service delivery network based on the primary health care approach educating and • empowering a health conscious population. These two fundamental principles propel us to the achievement of the global sustainable development goal set by the United Nations General Assembly of ensuring healthy lives and promoting wellbeing for all at all ages.

4. SUSTAINABLE DEVELOPMENT GOALS • By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births • By 2030, end preventable deaths of newborns and children under 5 years of age, with all countries aiming to reduce neonatal mortality to at least as low as 12 per 1,000 live births and under-5 mortality to at least as low as 25 per 1,000 live births • By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases • By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being • By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being • Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol • Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all • Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States

5. Our progress and Successes • Universal Healthcare • All persons living and working in the country have access to care through health insurance or Government outputs and programmes for vulnerable groups • Non-communicable disease prevention & management • Implementation of a chronic disease management programme, that we branded as “CayHealth” • In the 8th year of our initial pilot and I am pleased to report that among the CayHealth population: • visits to our General Practice for preventive care increased from 44% to 67%. • Specialist visits declined from 37% to 22% during the same period. • Accident & Emergency visits also decreased from 18% in 2010 to 11% in 2018.

6. Our progress and Successes • Health Promotion, Prevention & Treatment • Implemented 18 of the 26 articles recommended for implementation by the World Health Organization Framework Convention on Tobacco Control (FCTC). • Smoking Cessation Programmewith 81% success rate to date. By international standards, a success rate of 20% is acceptable. • Elimination of Mother to Child Transmission of HIV & Syphilis • One of the first 10 countries in the world to achieve the “Elimination of Mother to Child Transmission of HIV and Syphilis” (EIMTCT) and we are currently in the process of request validation for the EIMTCT plus (to include the elimination of the transmission of Hepatitis B. • One Health Initiative

7. Our progress and Successes • Health Workforce • New opportunities for training and development of health workforce through the University College of the Cayman Islands to provide clinical placement for its degree program nursing school. • Partnership with a teaching institution for new medical graduates within the region, and approved by University of the West Indies as a partner in the Doctor of Medicine Programme for Family Medicine.