Bi-national Commission on Health
Guyana Suriname
National Health Care System of Guyana
Dr. Shamdeo Persaud
Chief Medical Officer
Ministry of Health
GUYANA
GEORGETOWN
July 2013
Vision
People of Guyana be among the
healthiest people in the
Caribbean and
the Americas
Ministry of Health, GUYANA
Goals and Targets for Health

Millennium Developmental Goals









Goal 1- Nutritional Disorders, Hunger and Poverty
Goal 4 - Child Health (Morbidity and Mortality)
Goal 5 - Maternal Health and Women’s Health
Goal 6 - Communicable Diseases
Goal 7 - Environment
National Development Strategy
Poverty Reduction Strategy Paper y
Health Sector Strategy (2008-2012)
Health Vision 2020
Ministry of Health, GUYANA
Health Vision 2020 - Framework
Inputs and
Process
• Governance and
Leadership
• Resources
Mobilisation and
Management
• Financing
• Health Workers
• Strategic
Information
• Medical Products
• Service Delivery
through IHSDNs
Outputs
• Strengthened Health
System
• Improved Services:
• Service readiness
• availability
• access
• quality
• safety
• efficiency
Outcomes
• UHC
• Reduced prevalence of
CDs and NCDs and risk
factors
• Reduced health inequities
• Healthier Communities
• Improved Nutrition
• Increased system
responsiveness
• Increased Health Literacy
and Education
Impact
• Increased Life
Expectancy
• Reduced Mortality
• Reduced Morbidity
• Increased financial
protection
• Increased Equity
National Health Authority

Ministry of Health

Policy/Leadership and
Guidance


Functions


Minister of Health

Administration/Accounta
bility




Permanent Secretary
Policy
Regulations
Maintain standards
Human Recourses
development
Technical Leadership



Chief Medical Officer
Skilled Professionals
Other technical

Health/Developmental
Partner
Ministry of Health, GUYANA
Regulatory Functions

Legislation







Food and Drugs Act
Antibiotics, Immunization
Health Professionals (Medical, Nursing, Dental,
Pharmacist, Allied Health Act)
Ministry of Health Act
Regional Health Authority Act
Georgetown Public Hospital Order
Health Facilities Act
Ministry of Health, GUYANA
Minister of Health
Ministerial Secretariat
Permanent Secretary
Finance
Deputy Permanent Secretary
Admin/HR
Chief Medical Officer
GA-FAD/CBH/PPB/
TOP/MC/AHPC
Director
Disease Control
Director
Primary Health Care
Director
Standards and Technical Services
Director
Rehabilitation Services
HIV/AIDS, STI
Maternal and Child Health
Drug Control Authority
Vector Borne Disease
Adolescent and young adult
Laboratory
TB/Chest Disease
Environmental Health
Radiology Unit
Chronic Non Communicable Disease
Nutrition Program
National Blood Bank
Epidemiology and Surveillance
Oral Health
Ministry of Health, GUYANA
Mental Health
Director
Health Sciences Education
Director
Regional Health Services
Coordinator
Hinterland Services
Coordinator
Coastal Services
RHO
(Regions 1,7,8,9)
RHO
(Regions 2,3.4,5,6,10)
Decentralized Health Services

Five Levels of Care (All services Free to public)





Level V – GPHS and other national Referral
Facilities
Level IV – Regional Hospital offering
specialized services
Level III – District Hospital
Level II – Health Centers
Level I – Health Post
Ministry of Health, GUYANA
Agency Programs –
Program 1 Administration


Minister of Health
Permanent Secretary

Deputy Permanent Secretary






General Administration
Accounts/Financing and planning
Personnel/HR
Materials Management Unit
Management Information system
Linden Hospital
Ministry of Health, GUYANA
Program 1 - Administration

Chief Medical Officer






Seven Directors
Chief Nursing Officer



Central Board of Health
Pharmacy and Poisons Board
Intuitional Review Board (Ethics Committee)/Research
All Technical Programs
General Nursing Council
Food and Drug Analysis Department
National Psychiatric Hospital – Administered by RHA
Ministry of Health, GUYANA
Program 2 – Disease Control










Administration
Vector Control
TB/Chest Diseases
Hansens Disease
NAPS-HIV/AIDS/STI
CNCD
Mental Health
VPH
Surveillance/Epidemiology
National Public Health Laboratory
Ministry of Health, GUYANA
Program 3 – Primary Health Care





Family Health (Maternal & Child Health,
Adolescent and Adult Health)
Oral Health
Environmental Health
Food Policy Division
Health Education Division
Ministry of Health, GUYANA
Program 4 – Regional Health Services


Implement in collaboration with RDC/MOLG
Curative services




Regional /District Hospitals/HC and HP
Diagnostic Centers
Medical outreach
Special programs



Eye Care/Miracle Vision
Indigenous programs
Medical Evacuation
Ministry of Health, GUYANA
Program 5 – Health Sciences
Education

Core Training Programs







Nursing
MEDEX
Pharmacy Assistant
Environmental Health Assistant
Lab and X-ray Technicians
CHW
In-service and continuous training
Ministry of Health, GUYANA
Program 6 – Standards and Technical
Services

Quality health care system





Health Facility Licenses
Pharmacy Services
Laboratory Services
Radiology and Imaging services
National Blood Transfusion Services
Ministry of Health, GUYANA
Program 7 – Rehabilitation
Services

Disability Commission

Ptolemy Reid Centre
Cheshire Home
Audiology services
Physiotherapy Services



Ministry of Health, GUYANA
Expanded Clinical Services

GPHC






Curative and specialized services
Medical Training
Berbice Regional Health Authority
Regional Health Departments
Para-stateal – NIS, GUYSUCO
Private


Private Hospital (7), Private Practitioners
Other - Laboratories, Pharmacies, Dialysis, Cancer
treatment
Ministry of Health, GUYANA
Health Manpower/Bed Capacity
Indicato
r
Number of
Physicians
per Ten
Thousand
Population
03
04
05
06
07
08
09
10
4.2
4.2
4.9
4.9
5.1
6.1
6.6
6.8
Cb
59.1
7.9
Cb
61
9
Cb
61
11.2 11.5
12.8
Cb
85
13.3
Cb
78
28
Cb
50
28
Cb
50
Number of
Nurses per
Ten
Thousand
Population
11.5 12.7
Number of
Hospital Beds
per Ten
Thousand
Population
25.0 24.9 24.9 24.1 24.9 24.9 25.1 25.1
11.6 10.8
9.9 10.6
Cb
86
Cb
49
Ministry of Health, GUYANA
11
12
Ministry of Health, GUYANA
Health Situation
Life expectancy




1950’s – Just above 50 years at birth
1990 - 2002 – 64 years at birth
2005 - 2006 – increased to 66 for all at birth
2011



Women – 71.1 years at birth
Men – 66.5 years at birth
Population


2002 – 751,000
2012 Mid year estimate – 768,200
Ministry of Health, GUYANA
Life Expectancy
80
70
60
50
All
Females
Males
40
30
20
10
0
1970
1990
2005*
2007
Ministry of Health, GUYANA
2011
Health Situation
Vital Statistics
 Crude Birth Rate (per 1,000 persons)




2003 – 22.8
2009 – 18
2011 – 17.7
Crude Death Rate (per 1,000 persons)



2003 – 6.6
2009 – 6.1
2011 – 6.1
Ministry of Health, GUYANA
Health Situation
Infant Mortality Rate – The number of deaths of infants
from among all live births of current year




2003 – 17 per 1,000 LB
2009 – 14.1 per 1,000 LB
2011 – 15.1 per 1,000 LB
Most causes are preventable



Premature babies
Respiratory distress
Some unavoidable – congenital deformity, birth defects
Ministry of Health, GUYANA
Infant Mortality
45
40
35
30
25
IMR/1000 Live Births
Under 5MR
20
15
10
5
0
2000
2002
2004
2006
2008
2010
Ministry of Health, GUYANA
Health Situation

Under 5 mortality Rate – deaths of children
under five for all births of current years



2003 - 21.2 per 1,000 live births
200 8– 17.2 per 1,000 live births
Most preventable cause



Diarrheal disease and dehydration
ARI and Pneumonias
Other infections
Ministry of Health, GUYANA
Health Situation
Maternal Mortality Ratio
 Direct causes Critical indicator
 Most preventable cause



2003 – 168/10,000
2006 – 115/10,00
Main causes include post partum hemorrhage,
sepsis and anemia
Ministry of Health, GUYANA
Maternal Mortality
200
180
160
140
120
100
MMR/10,000 Live
births
80
60
40
20
0
2000
2002
2004
2006
2009
2011
Ministry of Health, GUYANA
Nutritional Status
9
8
7
6
5
Moderate
severe
Overweight
4
3
2
1
0
2004
2005
2006
2007
2008
2009
Ministry of Health, GUYANA
2010
Nutritional Status

Low birth-weight babies (<2500g.) as a % of live births




Severely malnourished




2003 – 0.6 % of all under 5
2007 - 0.3 % of all under 5
2010 – 0.3 % of all under 5
Moderately malnourished



2003 – 11.9
2006 - 10.8
2010 – 9.1
2003 – 8.8% of all under 5
2010 – 4.1 % of all under 5
Overweight – 2.8% (2003) - 6.9%(2007) – 8.1% (2010)
Ministry of Health, GUYANA
Communicable Disease

Morbidity

Major causes of Illness




ARI – 84,000
Gastroenteritis/ADD – 38,421 cases
Unspecific fevers – 62,321 cases
Other specific Causes



Malaria – 31,876 cases (185,000 smears in 2012)
TB – 93/100,000 (725 cases 2012)
HIV – 1.1 % (8,263 cases, 106,492 tested )
Ministry of Health, GUYANA
Non Communicable Disease






Diabetes
Cardiovascular diseases, heart diseases,
hypertension
Cancers
Chronic Lung Diseases, GI and Liver Disease
Accidents, violence and injuries (MVA etc)
Mental Illnesses
Ministry of Health, GUYANA
Cancers
Ranking of top cancers
 Prostate (male)
 Breast (female)
 Cervical (female)
 Stomach, Colon and other bowel (both sex)
 Liver
 Lung
Ministry of Health, GUYANA
Diabetes

Diabetes –




Estimated Prevalence – 6.2% of population
Average of 4.8 % of population over 30 years
Incidence – 4,000 new cases annually
Types of Diabetes


Type 1 (Insulin Dependant) – 8%
Type 2 (non-Insulin Dependant) - 92 %
Ministry of Health, GUYANA
Hypertensive Diseases



Prevalence – 9% of the Population over 30
years
Incidence – 16,000 new cases reported
annually
Major contributing cause of



Strokes in persons over 40
Heart Attacks
Disability and under productivity
Ministry of Health, GUYANA
Cardiovascular and heart disease

Strokes




Hemorrhagic – 1,901 cases annually
Thrombo-embolism (Clots) – 896 cases annually
Heart Attacks – 2,012 cases
Blood vessel disease


Atherosclerosis – 3,129 reported
Aneurysms
Ministry of Health, GUYANA
Morbidity
Main Causes
1999
2000
2001
2002
2003
2004
2005
Heart
Diseases
796
1001
936
963
1056
1176
Infectious*
HIV
TB
565
302
45
753
312
47
683
405
61
753
475
97
661
374
84
644
358
118
670 4729(14.3%)
359 2585(54.7%)
96
548(11.6%)
Cerebro
Vascula
r
Diseases
392
545
494
574
633
558
585
3781(11.5%)
Cancers
348
394
431
396
423
426
452
2870(8.7%)
Endocrine
(Diabetes)
367
377
345
395
370
385
411
2650 (8.0%)
All Causes
3749
4227
4629
5003
4986
5141
5232
32,983
Ministry of Health, GUYANA
1128
Total
7056
(21.4%
)
New Priority Areas







Health in the life cycle (Family health - child,
adolescence, women, men, elderly)
Non communicable disease (CNCD and Mental
Health) and their risk factors
Communicable Disease (Priority, neglected, emerging
and remerging disease)
Violence, accidents and injuries
Health Environments or settings (health communities,
city, hospital, workplace and homes)
Nutrition and food security
Frontier, migrant, remote and vulnerable population
Thank You!
Ministry of Health, GUYANA