Primary care in Caribbean Small Island Developing States

Abstract

Caribbean Small Island Developing States (SIDS) made good process on improving the health of their populations; but concerns exist when it comes to meeting changing health needs. Due to remoteness and limited resources it is difficult to respond to high rates of non-communicable diseases (NCDs). Furthermore, little is known about how primary care (PC) is organised and how this responds to current health issues. This study focused on gaining insights in the organisation of PC of Caribbean SIDS based on currently available literature. This literature review was an explorative multiple case study, where structure of PC and health status of 16 Caribbean SIDS were reviewed using available scientific and grey literature between the years 1997 and 2014. Thirty documents were used to analyse 20 indicators for the dimensions “Structure of Primary Care” and “Health Status”. Results were mapped in order to identify if there is a possible relation between structures of PC to the health of the populations. When reviewing the structure of PC, the majority of information was available for “Economic conditions of PC” (78%) and the least information was available for “Governance of PC” (40%). With regards to health status, all islands show improvements on “Life expectancy at birth” since 2007. In contrast, on average, the mortality due to NCDs did not improve. Saint Lucia performs best on “Structure of PC”. The British Virgin Islands have the best health status. When both dimensions were analysed, Saint Lucia performs best. There is still little known on the responsiveness of PC of Caribbean SIDS to NCDs. There is a need for elaborate research on: (1) If and how the functioning of these health systems relate to the health status; (2) What islands can learn from an analysis over time and what they can learn from cross-island analysis; and (3) Filling the gaps of knowledge which currently exist within this field of research. INTRODUCTION Small Island Developing States (SIDS) made good progress in achieving the Millennium Development Goals (MDGs). However, concerns exist regarding the health of the population of these islands, in particular, the Caribbean SIDS, who have transitioned from high communicable diseases region to an increasing prevalence of non-communicable diseases (NCDs). The prevalence of obesity in the Caribbean is amongst the highest of the world [1, 2]. The five-year evaluation of the Mauritius Strategy of Implementation (MSI+5) for the Caribbean showed that health standards have worsened for NCDs. Patients complain about the deterioration of quality of health services and there is an inability of health administrations to respond to changing needs of patients [1, 2]. In addition, health systems of SIDS face the persistent challenge of limited capacity and skills of health care workers due to emigration, the remoteness, the size and the economic opportunities [1–6]. Health is not solely evaluated within in the MSI and MSI+5. Health system performance and health are assessed and monitored by the Pan American Health Organization (PAHO). PAHO attempts to regionally strengthen health systems of Latin American Countries by assessing Essential Public Health functions and reporting health system performance with the publications of “Health in the Americas” reports [2, 7, 8]. Even though health care systems are assessed regularly, little scientific research was done on the factual organisation and its relation to the health. It is of importance to find out to what extent reforms need to be done in the organisation to meet the “new” needs of the populations. When it comes to the response of prevention and treatment of NCDs, primary care (PC) is the first point of contact. Therefore it plays a pivotal role in the health care system [9–11]. For SIDS a good and efficient organisation of PC is even more so important due to the remoteness and limited resources [1, 12]. SOR-MED