Health System of SURINAME

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Health System ofSURINAME

• Maltie Algoe
• Elly van Kanten

Monitoring and Analyzing Health System Change and
Health Reform , May 30th June 1st , 2006 -
Belize
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Content

• Health System Characteristics
• Health System Performance
• Health Status and Outcomes
• Relevant Trends and Interventions

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HS Characteristics

• Guiding principle
• Health care is the right of every citizen
  (Constitution, art. 36, sub 2)
• Overall Goal
• To achieve optimal health status
  for the majority of the population
  through provision of
  available, accessible and
  affordable health care

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• Main responsibility of the MOH
• To promote Public Health through
• Improvement of living and working conditions
• Health education
• Main tasks
• Policy Development
• Health Planning / Regulation
• Coordination / Supervision
• Monitoring Evaluation
• Quality Assurance

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Demand Population

• Supply
• MOH
• Professionals
• NGOs

• Finance
• MOF
• MSA
• State Health Ins.
• Private Insurance
• Out-of-pocket

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Population (census 2004) 492 829
by ethnicity
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Planning division Legislation division Public
Relations External relations
Organization Management

• General affairs
• Personnel
• Finance
• Maintenance
• Expedition

Inspectorate
Bureau of PUBLIC HEALTH
NAP STI Clinic Dermatology services Foundations
and Institutions

• PHC
• Regional Health Services
• Medical Mission
• HOSPITALS
• Psychiatric Center

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Structure of the MOH

• Main Office
  Central Administration
  (incl. Planning and Legislation)
• Inspectorate
• Bureau of Public Health

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Primary Health Care

• Coastal area
• - RHS (8 districts, 50 clinics, 100,000 clients)
• - Private GPs
• Interior
• - MM (2 districts, 50 centers, 50,000 clients)
• Several NGOs providing
• SRH services
• Health Promotion
• (Home) Care Support
• Research

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Secondary Health Care

• 5 General hospitals
• 2 private (one with link to interior)
• 3 public (two with ER, one specialized in MCH)
• 1 Mental hospital
• Total of beds 1318
• of beds per 1000 pop 2.7
• Occupancy rate 70

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Human resources (2004)
Number of Physicians 400
Number of General Practitioners 295
Number of Medical Specialists 105
Number of Dentists 42
Number of Non - university trained nursing personnel 1 745
Number of registered nurses 778
Number of midwifes 57
Rates per 10,000 pop (2004)  
Physicians per 10,000 population 8. 2
Dentists per 10,000 population 0.9
Non university trained nursing personnel per 10,000 pop 35.4
Number of registered nurses per 10,000 population 15.8
Number of midwifes per 10,000 population 1.2
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2000 2002
Gross Domestic Product (GDP) 836.1 mln US 879.9 mln US
GDP per capita 1,915 US 1,925 US
National Health Accounts
Total Health Expenditure (THE) 78,763,778 US
THE per capita 180.33 US
THE as of the GDP 9.42
Public Health expenditure (PHE) 34.1 mln US 31.7 mln US
PHE per capita 78.1 US 69.4 US
PHE as of the GDP 4.07 4,97
PHE as of THE 43.33
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Distribution of spending by payer
National Health Accounts, MSH, march 2002
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Distribution of spending by level of care
National Health Accounts, MSH, march 2002
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Insurance coverage (Census 2004)
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Health Status and OutcomesVital Statistics, 2004
Population 492,829
Average Population growth rate 1.4
Percent of urban population 59.40
Total number of registered live births 9,062
Total number of registered deaths 3,289
Crude birth rate per 1 000 pop 18.7
Crude mortality rate per 1 000 pop 6.7
Life expectancy at birth (years) 71.5
Total fertility rate 2
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10 Leading causes of Hospitalization (2000)

• 1. Pregnancy, Childbirth and Puerperium
• 2. Gastrointestinal diseases
• 3. Hypertension and Cardiovascular diseases
• 4. Diseases of the respiratory system
• 5. External causes
• 6. Diseases originating in Perinatal period
• 7. Cerebrovascular diseases
• 8. Malign neoplasmata
• 9. Certain Vector-borne diseases
• 10. Urogenital disorders

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10 Leading causes of death, 2000 - 2004

• 1. Cardiovascular diseases
• 2. External causes
• 3. Malign neoplasmata
• 4. Diseases from the perinatal period
• 5. HIV / AIDS
• 6. DM
• 7. Respiratory disorders
• 8. Gastro intestinal disorders
• 9. Diseases of tractus Urogenitalis
• 10. Intestinal disorders

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Achievement of MDGsImmunization Coverage
85PMR , IMR lt5 MR per 1000 of LB
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Maternal Mortality RateDeliveries by skilled
personnel 90
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Performance Strengths Opportunities

• Demand
• Strong NGO involvement
• Increasing awareness for health rights
• Supply
• Independent financing and provision of health
  care
• Financing
• Subsidized health care for the poor
• Social health insurance for civil servants
• Global Fund for HIV/AIDS, TB and Malaria

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Performance Weaknesses Threats

• Demand
• HIV/AIDS (increasing infections)
• Illegal abortions (est. 10,000 /year)
• Supply
• Weak MOH
• Structural migration of nurses
• Unequal access to health care
• Insufficient focus on cross cutting issues
  Gender, Environment, Youth
• Financing
• No correlation between health expenses of 9,4 of
  GDP and quality of care

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HSR Support for HSR(1st project) (1998 2003)

• Series of studies on
• Household Budget Survey
• National Health Expenditures (NHA)
• Performance of PHC
• Actuarial model for the State Health Insurance
• Drug Procurement
• Integration of SHI and MSA
• Payment Systems
• Distribution of medical cards
• Quality Assurance

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HSR Support for implementation of HSR(2nd
project) (2004 2008)

• Project Components
• Improve performance of preventive and primary
  health care services
• Improve access to medicines
• Reduce costs and improve efficiency
• Improve equity
• Strengthen MOH

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Health Sector Plan(2004 2008)

• Strategies
• Strengthening primary care and prevention
• Improving both efficiency and quality of hospital
  care
• Promoting the financial accessibility of health
  care services
• Health care cost control
• Strengthening support systems (procurement,
  logistics, communication, NHIS)
• HRD (quality, quantity, motivation)
• Improving and safeguarding quality

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Multi-annual Development Plan(2005-2010) MOH
policy note (2006 2007)

• Planned interventions (Policy Framework)
• National health costs insurance and financing
• Improve infrastructure
• Basic health care package (focused on prevention)
• Improve management (QA, data acquisition)
• HRD and HRM
• Critical review of health- and environmental
  legislation

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Relevant Trends / Interventions

• Strengthen PHC
• Special attention for deprived areas and
  vulnerable groups
• Community Participation
• Addressing chronic diseases
• Integration of preventive components in PHC
• Emphasis on prevention (? health education),
  early detection (? screening) and secondary
  prevention (?multidisciplinary treatment)

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Relevant Trends / Interventions

• Intersectoral approach
• Recognition of intersectoral influences on health
  (by agriculture, labor, education, housing etc)
• Need for intersectoral cooperation (e.g. in
  HIV/AIDS)
• International commitments
• MDGs (demanding specific attention)
• Global Fund (demanding coordinating mechanism)

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Thank you