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Caribbean Islands HEALTH AND WELFARE
Most Jamaicans enjoyed a relatively high quality of life in the
1980s, in part the result of health services having been a
government priority for decades. The most distinguishing
characteristic of the health system was the dominant role of the
public sector. As early as 1921, government expenditures on healthrelated activities reached 10 percent of the national budget. In
1966 Jamaica became one of the first countries in the world to
establish a national health service. Preventive health services
expanded rapidly in the 1970s as the government's real per capita
spending on health services increased more than 30 percent. Health
expenditures, however, were curtailed sharply in the wake of
Jamaica's financial crisis in the early 1980s, resulting in the
conversion of rural hospitals into health centers, large layoffs of
personnel from the Ministry of Health, and the reintroduction of
hospital fees. In 1985, government health expenditures stood at 2.6
percent of gross domestic product (GDP--see Glossary), down from
3.5 percent in 1980.
The Ministry of Health formulated, implemented, and
administered the health policies of the government. The ministry
was directly responsible for public hospitals, health centers,
dispensaries, family planning, and public health services. In the
early 1980s the Ministry of Health provided inpatient and
outpatient services in 22 general hospitals, 7 specialized
hospitals (1 each for maternity, pediatrics, tuberculosis and
cardiothoracic surgery, physical rehabilitation, mental disorders,
terminal care, and leprosy), a teaching hospital at the UWI, and
more than 150 health centers, clinics, and dispensaries. It was
difficult to estimate the exact number of health facilities during
the mid-1980s, as the ministry was being reorganized.
The country's major public hospitals were Kingston Public
Hospital, the University Hospital in Mona, Cornwall Regional
Hospital in Montego Bay, and Mandeville Hospital, all run by
semiautonomous regional management boards. The total number of beds
provided in public hospitals in 1985 was 5,700, roughly 10 percent
below the 1980 number of 6,300. Compared with other Commonwealth
Caribbean islands, Jamaica had a ratio of hospital beds to
population that was relatively low. General surgery and general
medicine accounted for nearly 44 percent of available hospital
beds. In addition to public hospitals, there were six private
hospitals with nearly 300 beds in the mid-1980s. Private hospitals
were generally small, expensive, service oriented, and affiliated
with religious organizations.
At the local level, each parish council employed a medical
officer of health, public health nurses, public health inspectors,
and district midwives, and three parishes had community health
aides. Three forms of health centers existed. The first offered
only a midwife and perhaps two community health aides. The second
type had a public health nurse and a public health inspector in
addition to the midwife and the aides. The third type included all
the features of the first two as well as a nurse and a medical
doctor, who generally referred patients to either other health
centers or regional hospitals. Community health aides, a position
that was deemphasized in the 1980s, served to educate the public on
nutrition, infant care, family planning, and first aid. Public
health nurses conducted clinics on pregnancy, gave vaccinations,
and visited schools and homes. Public health inspectors examined
the sanitation of food and made certain that slaughterhouses and
food shops were clean; they were also responsible for mosquito
control, the source of most tropical diseases.
Tropical diseases were greatly reduced in the postwar period
through persistent immunization programs and mosquito control.
Deaths from yellow fever, malaria, dengue fever, typhoid, whooping
cough, polio, and other childhood diseases were virtually
eliminated. No vaccinations were needed for most visitors to the
island. Some of the most common diseases reported in 1985 were
gastroenteritis (generally related to malnutrition), measles,
venereal diseases (mostly gonorrhea), tuberculosis, hepatitis,
leptospirosis (transmitted by animals), and a small number of
nonlethal cases of malaria, typhoid, and dengue. As of mid-1987
there were 18 reported cases of acquired immune deficiency syndrome
(AIDS) reported on the island, and 150 persons were reported to
have been infected with the virus. The island also suffered from an
unusually large number of cases of leprosy. Another serious health
problem was mental disorder, especially schizophrenia. More than 50
percent of the island's hospital beds were located on the large
grounds of Kingston's Bellevue Hospital. Although bed occupancy
rates remained high in the late 1980s, little was being done to
alleviate the hospital's growing understaffing problem.
In the mid-1980s the Ministry of Health employed 5,500 people,
but government cutbacks were expected to reduce that number.
Although Jamaica housed a regional medical school, the number of
doctors was insufficient to meet levels recommended by the Pan
American Health Organization (PAHO). With fewer that 500 doctors,
the island had a doctor-to-population ratio of only 1 to 5,240,
whereas PAHO recommended a ratio of 1 to 910. As with professionals
in general, many Jamaican doctors emigrated to earn higher
salaries. The island was even more deficient in the number of
dentists, who were not trained locally. Slightly more than 100
dentists were registered on the island, but many unlicensed
dentists also practiced. The licensed dentist-to-population ratio
was 1 to 20,000, far from the 1 to 2,857 ratio PAHO recommended.
Dental assistants were trained locally through a dental auxiliary
school at CAST. In 1985 Jamaica's nurse-to-population ratio of some
1 to 1,172 was also below the recommended PAHO level of 1 to 769,
as was the 1 to 274 ratio of assistant nurses, compared with the
recommended 1 to 385. Nevertheless, Jamaica's ratio of nurses still
surpassed that in many Latin American and Caribbean countries.
Various professional and regulatory organizations on the island
maintained standards, licensed physicians, and educated the public.
These included the Medical Council of Jamaica, the Medical
Association of Jamaica, the Dental Health Council, the Nursing
Council, the Nurses Association of Jamaica, the Jamaican
Association for Mental Health, the Jamaican Red Cross Society, and
the Pharmaceutical Society of Jamaica.
Since 1966, the government of Jamaica has offered a wideranging , contributory social security service at the national level
called the National Insurance Scheme, operated by the Ministry of
Social Security. Jamaica Blue Cross, an international, voluntary,
nonprofit organization, offered a prepayment health plan and also
served to set standards and control costs. Medical research was
conducted at the central bacteriology laboratory in Kingston and at
the UWI hospital. The Caribbean Food and Nutrition Institute, at
the UWI, also served regional research purposes. A national blood
bank was located in Kingston.
Data as of November 1987
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