ny april 30 th 2011 dr. barbara gordon, ob/gyn dr. sharon ogiste-mcbain, pediatrician dr. wilkins...
TRANSCRIPT
NY April 30th2011
Dr. Barbara Gordon, Ob/gynDr. Sharon Ogiste-McBain, PediatricianDr. Wilkins Williams, Internal MedicineDr. Elma Johnson, Emergency medicineRev Wesley Daniel
Grenada General Hospital
Grenada General Hospital
Grenada General Hospital
GRENADANATIONAL STRATEGIC PLAN FOR
HEALTH
(2007-2011)Gov’t of Grenada
The Grenada National Strategic Plan for Health designed to involve the whole country in setting priorities and a direction for improving health status of the population
Steering CommitteeAppointed by cabinet in 2004Financial support from Caribbean Dev. BankTechnical support from PAHOConsultation launched in Sept 2005Ministry of Health
A National Strategic Plan for Health
Guiding principles
Strategies outlined by the Caribbean Charter for Health Promotion
GrenadaGrenada, Carriacou, Petit Martinique133 sq milesIndependent Nation 1974 from the UKWestminister- style parliamentPopulation 2005 was 106,027Growth rate 0.2%
Demographics 2005Ages 0-15 …. 34.7%Ages 15-65 …54.9%Ages 65+ …10.32%
Overview of the population’s health status Infant Mortality range 1998-2002 12.5 & 19.6 (deaths /1000 births)Maternal Mortality rate 0 for 4 yearsDeath Rate range from 7.0-8.7 /1000
populationLife Expectancy Age 68 for men and women 72Fertility rate 2004, 2.4 children for women of
childbearing age
Socio-Economic SituationThe 2005 UNDP- Human Development Index ranked Grenada 66th of the 177 nations. The ranking reflect positive changes in infant mortality rates and adult literacy. Other indicators include an 18.8 % unemployment rate and a 31% poverty rate
Leading causes of death 1998-2002Disease of the circulatory system including
pulmonary circulation, cerebrovascular disease other forms of heart disease
Malignant neoplasmsDisease of respiratory system Certain infections and parasitic diseaseAccident and injuries increase 4 fold from
1989-2002
Leading causes of morbity 2004Diabetes Mellitus Hypertensive DiseaseUpper respiratory infectionsArthritis InjuriesAdmissions to hospital greatest in persons in
age 45+
Communicable disease review 1980-2004Decline in TB from 17 to 6 casesNo deaths from Dengue ‘03-’04, the number
of cases bet ‘02-’04 were 310,19,8 respectively, cases related to rainfall an mosquitoes
Decrease in Sexually transmitted Disease Syphilis almost 80% decrease bet ‘96 & ‘02Gonorrhea remained stable with 112 cases in
‘96 and 101 cases in ’02
HIV/AidsHIV midyear ’05, reported cases 197, male
to female ratio 2.5 : 1 Cumulative # of deaths from AIDS, 155113 males , 42 females
Hospital utilization
‘04 Women: 99% delivered in a health facility,75% at the General hospital, 1% in private
‘01-’04 men accounted for higher utilization of hospitalization (compared to women)for injuries from work place and road traffic accidents
Men also had a higher admission to the Carlton House for drug and alcohol abuse treatment
’04 men had 33% first visit to the community health services
School age childrenA survey for Anemia in 2004 , ages 1-4,
62.1% had hemoglobin levels below normalDental services at health centers ,2,238
children seen ages 5-19, 99.3 % were identified with problems
‘00 Teenage pregnancies, 21 % of total births
Elderly
13 homes care for the elderly (gov’t assisted, public, private)
An NGO also works in the community for the elderly
Chronic disease management is a major challenge
By 2014 , 20-25% of the population will be over 50 years of age there will be greater demand for chronic disease care at the community level and hospital level
Health RisksMain concern and cause of ill health and
death is related to: poor dietary habits, in particular before and after pregnancy, poor fetal development, early childhood nutrition, poor chronic disease management, accident and injuries, drug and alcohol use, and (to some extent) unsafe practices
Health ServicesPublic facilities- 3 Acute care hospitalsGeneral Hospital-240 bedsPrinces Alice Hospital- 56 beds Princess royal Hospital (Carriacou ) -40 beds
1 Mental health Hospital (Mt Gay Hospital)
Health Services con’t1 Rehabilitation center (Carlton House)1 Home for the elderly ( Richmond Home)6 Health centers30 health stationsThere is limited referral system between
community services and hospitals as a result many patients to directly to the Accident and Emergency (A&E) resulting in long waiting time
Hospital Utilization 2004General Hospital had 8,313 admissions at the
Average length of stay 6.6 days, bed occupancy rate 73 %
Princess Alice has limited diagnostic services all x-ray and lab services has to go to the General Hospital requiring patients to be transferred. Occupancy rate 60%
Hospital Utilization cont’d
Princess Royal Hospital (Carriacou) serves a population of 7000 including Petite Martinique
A major constraint is the inability to retain doctors who cover both hospital and community services
Community health services 200410 District Medical Officers10 community health nurses40 district nurses5 Family Nurse Practitioners45 community Health Aides12 Pharmacists8 dentists2 social workers7 environmental Health officers
Private health servicesDominated by single practioners, many of
these doctors work for the public health services
2 small private clinics with patient bedsA diagnostic facilityGeneral hospital Private wardNo NGO provide inpatient care, however
many participate in health promotion an protection activities
Financial ResourcesHealth sector receives approx 12% of the
annual budget in 2000-2005Wages and salaries account for approx 70%
of health expenditures
Personnel 1997/20028.1 physicians per 10,000 population19.5 nurses per 10,0001.1 Dentist per 10,000 6.9 Pharmacist per 10,000 0.75 Nutritionist per 10,000 Key challenges for health personnel in
Grenada include the ability to retain medical practioners, nursing staff and medical administrators
Central non-partisan bodyTo coordinate all voluntary health aide efforts
made to Grenada with representatives from each parish
Develop a website with linksCreate a central registry for physicians and
allied health workers with the services they can provide
Governed by an advisory Board efforts coordinated by a core body e.g.. secretary , treasurer and president
Set up a central office in Grenada and NY
Education Community education –health information,
pamphletsProvide a monitoring system to track the
educational materialsHave volunteers /paid personnel to ensure
reading materials are circulatedMaintain statistics of the education materialsQuality assurance to ensure materials are
distributed to the appropriate parties
Education cont’dProvider education…physicians, nurses, aids
and all allied workers those in direct and indirect patient care
Mandatory continuing medical education (CME)
Incorporate Health education in high school and elementary school…e.g. STD, proper nutrition, dental care etc.
Health Protocols and complianceReview health protocols of hospital and
satellite clinicsCreate a committee of 3-4
physicians/administrative staff to review protocols …are they practical ? are they enforced ? The central board should be involved in the process
NGO and Volunteer servicesCentral Committee …. responsible to
coordinate the volunteer services for continuity of care
Have a central registry to coordinate the volunteer services e.g. dentists going on different months for continuity of care rather than having all at the same time
Have paid staff to coordinate efforts for accountability
Drug Bank Drug assistant bank program to assist patient
with unaffordable medicationMake arrangement with drug companies and
other parties
Weekly Radio and TV health topicsHave a calendar , get volunteers to provide
health information for different topics
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