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Health care in jamaica

2. In the past.... Epidemics were seen as punishments for the evil acts of mankind.Cure of illness? - Need to

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Health care in jamaica

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    1. 1 Health care in jamaica Shakeisha Wilson 2/3/09

    2. 2 In the past... Epidemics were seen as punishments for the evil acts of mankind. Cure of illness? - Need to ‘pay’ for sinful acts The consequences of poverty are of often poor housing, overcrowding, unsanitary conditions and poor nutrition, all of which are driving forces of poor health.

    3. 3 Period of Slavery ‘Formal’ healthcare inclusive of hospitalization was noted to exist since the early 15th century. These services were established with the British conquest of the island from the Spanish rule in 1655. KPH established in 1776 with the mandate to “provide medical services to persons unable to afford medical care in and around the island’s capital”.

    4. 4 Period of Slavery Repeated epidemics due to infectious diseases such as smallpox, typhoid, yellow fever and malaria. Health Status of Slaves – Worthy Park Estate (1787 – 92) Stillbirth rate – 20% of babies born dead IMR – 52% of babies did not celebrate 1st birthday CDR – 70/ 1000 population Consolidated Slave Act (1792) mandated healthcare for slaves. This was limited with services being provided by military and naval doctors.

    5. 5 Period of Slavery Maternal Care: Education of Negro midwives Reassignment of pregnant slaves to lighter tasks during 2nd trimester Maternity leave – resumption of work extended to 2-3 months after birth

    6. 6 Full Emancipation: 1838 Did Emancipation (1838) result in improved healthcare? Emancipation resulted in a virtual collapse of the health system. Over 70% of the doctors, particularly those who were employed to the sugar estates migrated after emancipation. Increased dependence on traditional medicine Number of doctors declined from 300 to 75

    7. 7 Emancipation In an effort to improve healthcare provision after this demise, the government implemented the Poor Law System in 1851. This involved a segmentation of the island into health divisions with each being assigned a doctor and a dispensary. Insufficient healthcare professionals meant limited health delivery. Healthcare focused primarily on the sick in hospitals and was concentrated in urban areas

    8. 8 Emancipation Further redress involved: Additional health personnel Establishment of hospitals Public Health Law - 1867

    9. 9 1872 – early 20th century The Medical Council was established in 1872 by the Governor in Privy Council to govern the practice of medicine in Jamaica. Doctors were primarily recruited from Britain but were mandated an initiation at KPH upon their arrival. Mental Hospital Act (1873) The Rockfeller Foundation was instrumental in 1918 in funding the research of health needs of Jamaicans. Research surrounded hookworm disease, school hygiene, dental care and malaria.

    10. 10 Early 20th Century Healthcare provision in the 1920s was very poor resulting in high mortality and morbidity rates. The focus of health services remained that of curative services through hospitals and out-patient type care at dispensaries. Moyne Commission (1938-39): “The emphasis in the past has been placed on the provision of medical relief and the cure of diseases received more attention than was given to prevention”.

    11. 11 Early 20th century There was however marked improvement from period of slavery. IMR (1915-30): 157/ 1000 live births Since this period, mortality has fallen by over 70%. Life expectancy has increased from 57.2 yrs in 1955 to 74 yrs in 1994. How long are you expecting to live in 2009?

    12. 12 1950s Increased pharmaceutical developments Expansion of health services Curative Health Care District medical officer; staff nurse Preventative and Promotional Health Services Medical officer of health; Public health nurse District midwife Public health inspector

    13. 13 1950s Vaccines Polio Eradication efforts Small Pox Yaws Malaria

    14. 14 Health for All Alma-Ata Declaration (1978) Primary health care seen as the “key to achieving an acceptable level of health throughout the world in the foreseeable future as a part of social development and in the spirit of social justice."

    15. 15 PHC: A Background PHC is defined by the WHO to be: “essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and country can afford to maintain at every stage of their development in the spirit of self reliance and self determination.”.

    16. 16 Maxims of PHC

    17. 17 1980s Improvement of physical infrastructure of health facilities. Development of new health centres (372). Emergency wing at KPH opened. Collaborative efforts evidenced through funding from multilateral agencies, the private sector and voluntary organizations.

    18. 18 1980s The devaluation of the Jamaican dollar in 1985 resulted in the development of the Health Service Rationalization Programme: Redistribution of hospital infrastructure (beds) Regionalization of specialist areas Improved quality of care provided Reduction of hospital size and the closing of health centres The reintroduction of user fees

    19. 19 Typology of Health Facilities (Leavitt 1992)

    20. 20 Typology of Health Centres

    21. 21 1990s 23 hospitals; over 350 health centres Decentralization (1997) Primary health and secondary and tertiary health care merged. 4 statutory regional health authorities: South East Regional Health Authority (Kgn, St. And, St. Tho, St. Cath) North East Regional Health Authority (Port, St. Mary, St. Ann) Western Regional Health Authority( Trel, St. Jam, Han & West) Southern Regional Health Authority (St. Eliz, Manch & Claren)

    22. 22 Health Services Disease Surveillance Health Promotion and Education Environmental Health Family Health Services Mental Health and Substance Abuse Diagnostic and Therapeutic Services Public Health Services

    23. 23 21st Century

    24. 24 National Strategic Plan (2006 – 2010) The plan reflects national, regional and international development guidelines, and employs participatory approach in addressing health related issues. Priority areas for the Plan: the need to reduce/control the spread of HIV/AIDS, Maternal and Child Health, eg., reducing maternal mortality, and implementing the Healthy Lifestyle Policy, promulgated in 2004, to control the incidences of Chronic Non-Communicable Diseases (CNCDs) that are lifestyle related. The strategies dictate increased attention to health education and promotion

    25. 25 Vision 2030 A healthy population is seen as critical in achieving development. Specific goals Appropriately managed priority health conditions to decrease early mortality, morbidity and disability Sustainable, equitable and efficient and effective public health financing accessible by all Access to and availability of quality service delivery A social, cultural, economic and physical environment that supports the health and well-being of the society.

    26. 26 Other Health Provisions National Health Fund Healthcare subsidized for persons suffering from a range of illnesses including asthma, diabetes, breast cancer, hypertension arthritis and glaucoma. Programme of Advancement Through Health and Education (PATH) Joint funded by GoJ and WB. Replaces Food Stamp, Poor Relief & Public Assistance Programme Offers cash grants to the most needy in the society.

    27. 27 Other Health Provisions Private Insurance Plans Sagicor Medicus National Insurance Scheme Invalidity Benefit – persons unable to work due to permanent illness (26 weeks or more)

    28. 28 Challenges to Health Care? Health financing Epidemics – HIV/ AIDS, Malaria Human resource mgmt Environmental degradation Social factors Education, potable water, crime and violence Inadequate resources – medication, equipment etc. Strain on health workforce More clients than doctors

    29. 29 Challenges to Health Care? Public’s negative perception of healthcare services Political factors – Varying priorities International Development Agencies Compliance measures may be barriers to success Recommended strategies not culturally suitable Conflicting objectives with joint stakeholders Culture still emphasizes curative measures Inadequate allocation of resources for maintenance of equipment Limited specialized training

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