CONTRIBUTION OF NURSING IN THE REGION
OF THE AMERICAS AND ITS POTENTIAL
towards Universal Access to Health and Universal
Health Coverage
DOMINICA
Caesarina Ferrol
Chief Nursing Officer, Ministry of Health
and Environment Dominica
Objectives of Presentation
 Describe briefly the national context
 Provide basic epidemiological information about the
Commonwealth of Dominica
 Describe briefly the healthcare system in Dominica
 Outline the nursing human resource situation in Dominica
 Explain the contribution of nursing and its potential in
Dominica to universal health coverage
National Context
Geographic Background
National Context
 Largest of the Windward Islands in the Eastern Caribbean,
lying between Guadeloupe to the north and Martinique to
the south with a land space of 751 square kilometers
 Estimated population of 69,665 (2014)
 Average Life expectancy at birth 72.8 years(males). 78.9
years(females)
Economic Background
 Dominica is a middle-income, developing country.
 GDP US$7,175.00 (World Bank Report 2013)
 12.8% of national budget allocated to health
 Dominican economy is based on agriculture with elements of
tourism and manufacturing
Country’s Epidemiological Profile
 Fertility rate of 1.7 in 2014.
 Maternal mortality rate has been 0.0 per 1000 live births (2013
and 2014).
 Infant mortality 19.6 per1000 live births (2014)
(Source: Health Information Unit, Ministry of Health &
Environment)
Leading causes of Death 2010 - 2014
Cerebrovascular diseases
Diabetes mellitus
140
Hypertensive diseases
Ischemic heart diseases
120
Mortality Rate per 100,000 population
Acute respiratory infection
100
Pulmonary heart disease, diseases
of pulmonary circulation
Chronic lower respiratory
diseases
80
Heart failure
Malignant neoplasm of digestive
organs and peritoneum
60
Malignant neoplasm of prostate
40
Septicemia, except neonatal
Assault (homicide)
20
Malignant neoplasm of stomach
Malignant neoplasm of colon and
rectosigmoid junction
0
2010
2011
2012
Year
2013
(Source: Health Information Unit, Ministry of Health & Environment)
2014
Structure of the Health Care System
 Public (Government)
Primary health care, Secondary health care, policy formulation
and health administration
 Private Sector
Doctor’s offices, private hospital, private health center
Nursing Human Resources
 Nurses in Primary Health Care 138(37%)
 Nurses in secondary care 233(63%)
 Nurses in education at the Faculty of Health Sciences 8
 Nurse at policy level
1
 Legislation - Nurse Registration Ordinance Cap 152 of the laws of
Dominica
 General Nursing Council is the regulatory body and maintains a register
of nurses registered and licensed to practice
Profile of Nursing Programs at the Dominica State
College 2016
Type of Nursing Education
Programs
available in country
-
Certificate in Pre Health
-
General Nursing BScN
(Generic)
Number of Nursing
Schools in Country
Approximate number of
students enrolled in Nursing
Programmes in country
Faculty of Health Sciences- 133
Dominica State College
14
-
-
BSc Nursing (RN-BScN)
Bachelor of Science in Nursing;
Midwifery BScM
Certificate in Practical Nursing
Nursing Assistant to Registered
Nurse
14
-
The Nursing Workforce in the Commonwealth of Dominica
Allocation in Public Service
Registered/ Practicing in MOH
Estimated Registered/
Practicing Nurses in Private
Sector
1
1
-
Senior Community Health 2
Nurse
Community Health Nurse1 10
Departmental Nurse
6
2
-
9
-
6
-
Nurse Anesthetist
2
2
-
Nurse Practitioner
(Pediatric/Fam)
9
9
-
Nurse 1
-
-
16 (most officers are also
employed in the public
service
Category
Matron
Clinical
Practitioner
Ward Sister
18
Staff Nurse/ Staff Nurse
Midwife/ Registered
Mental Health Nurse
272
16
257 (included TAC volunteers
with specialized training
Primary Care Nurse
38
15
-
Nursing Assistant
60
50
-
Mental Health Nurse
15
5
-
Total
433
372 (86%)
16
Job Market
 >95% of Nurses are recruited locally
 Employed on a full time basis in public service (temporary
or permanent positions).
 Contractual employment of retired nurses with specialized
skills ( midwives and Family Nurse Practitioners)
 Monthly salaries are based on the classification within the
pay scale level of the public service.
Incentives / Retention Strategies
 Policy to pay nursing sessions
 Policy to provide medical coverage for nurses
 Policy to pay specialist allowance to nurses
 Award of Fellowships / financial assistance for training
 Awards and recognition activities
Challenges for Human Resources in Nursing
 Retention /Migration of staff
 Remuneration
 Professional mobility
 Specialized training
Plans to develop Nursing Human Resources and to address challenges
 Implement five year training plan
 Survey among nurses to inform retention strategies/ retention policy
 Advocate for additional incentives and clinical ladder
 Continued engagement of TAC volunteers/collaborators in
specialized areas
 Engagement/training of assistive nursing personnel to complement
staffing
 Enactment of new nursing legislation
 Audit of nursing education programs
Scope of Universal Health Coverage
UHC is to ensure all people have access to needed
services (prevention, promotion, curative, rehabilitation,
and palliative care) with sufficient quality to be effective,
without exposing individuals to financial hardship and
with access to the social determinants of health.
(Dr. Carissa F. Etienne Director PAHO/WHO)
 Contributions of Nursing to Universal
Access and Universal Health Coverage
Stewardship and Governance
 Support for leadership and management and or public health
training for nurses in supervisory positions
Over 75% nursing supervisors trained at post RN BScN
66% nursing supervisors trained at Master degree level
100% nursing tutors are trained at Master degree level
 Nursing representation at health administration / policy level
 Policies to impact nursing capacity
 Research to inform decision making
Human Resources
 Recruitment process (interviews, orientation)
 Distribution and deployment of nurses and auxiliary staff
 Maintaining competence and quality (in service education,
mentoring/coaching, quality control)
 Performance management
 Specialized training in relation to health priorities
 Compensation for additional duties(Nursing sessions)
Nursing Education
 Collegiate model of training at the Dominica State College
 Collaboration with local training institution
 Upgrade from award of certificate to the Bachelor of Science degree in
general Nursing.
 Entry requirements for training were upgraded
 100% of local tutorial staff trained at Master Degree level
Nursing Education cont’d
 Teaching infrastructure upgraded
 Curriculum upgraded to reflect population needs and regional
recommendations
 Continuous training of nurses to ensure ongoing supply
Contribution of Nurses in Primary & Secondary Health
Care
 Services delivered by nurses at primary care level
include family health, nutrition, health education,
medical care, emergency services, school health,
home and household visits.
 Immunization(90-100% coverage in most vaccines)
 Inpatient and outpatient services in each specialty at
secondary care level.
 Leadership & advocacy
IMMUNIZATION COVERAGE COMMONWEALTH OF DOMINICA
Vaccine
2010
2011
2012
2013
2014
BCG
>100%
>100%
97.6%
96.9%
100%
PENTAVALENT
99%
98%
97.7%
97.9%
94%
99.6%
96.9%
96.2%
97%
99.3%
98.8%
93.1%
100%
2nd MMR
>100%
93.9%
90.6%
100%
1st DPT/POLIO
BOOSTER
100%
96.1%
91.8%
94%
2nd DPT/POLIO
BOOSTER
28%
81.4%
88.3%
88%
ORAL POLIO
1st MMR
>100%
Contribution of Nurses in Primary & Secondary
Health Care cont’d
 Quality Assurance program
 Reducing Health Costs
 Focus on prevention
 Equitable access to care
.
Contribution to Programs in Primary &
Secondary Care cont’d
 Non communicable disease program and activities
 Infection Control program
 Disease surveillance program
 School Health program
 Health outreach programs
 Immunization program
Contribution to Programs at National Level
 National AIDS Response Program / EMCT Program
and Validation(No vertical transmission of HIV &
congenital syphilis since 2001)
 Disaster Management
 Family Health Programs
 Active Ageing
 Adolescent and Youth
 Planned Parenthood
Intersectoral Collaboration to Address the
Social Determinants of Health
 Collaborating/ contributing on boards, committees, national
groups/agencies
 Engaging in health promotion activities involving
communities
 Forging partnerships with other sectors and organizations to
address health problems
Conclusion/ Way Forward
 Reassess gaps in achieving Universal Health Coverage from a
nursing perspective
 Sensitize and raise the awareness of nurses regarding their
contributions towards the achievement of universal health access
/coverage
 Strengthen management & development of nursing human
resources
 Formally launch nursing research committee with agenda in
context of UHA/UHC
Thank You
Thank you for
YOUR
PARTICIPATION
The recording will be available at:
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