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Caribbean Islands HEALTH AND WELFARE
Based on standard health care indicators, Trinidad and Tobago's
medical system continued to improve in the 1980s. The mortality
rate had been reduced from 18.9 per 1,000 inhabitants in 1930 to 7
in 1980. The infant mortality rate for the same year was 19.7 per
1,000 live births, reduced from 34.4 in 1970. Life expectancy at
birth in 1986 averaged 68.9 years.
Morbidity indicators also improved but were nevertheless below
expectations. In 1983 only 60 percent of children one year of age
and younger had been immunized against measles, poliomyelitis,
diphtheria, pertussis, and tetanus. The implication of the
deficient inoculation programs was evident in the 4.7 percent of
total deaths resulting from infectious and parasitic diseases; this
was significantly higher than on other English-speaking Caribbean
islands.
Despite the fact that 95 percent of the population had access
to potable water in 1984 and 100 percent was serviced by sanitary
waste disposal, communicable diseases were still a problem. In 1983
dengue fever was endemic, venereal diseases were rampant, and
tuberculosis was still a minor threat. As of 1986, there were 134
confirmed cases of acquired immune deficiency syndrome in Trinidad
and Tobago, 93 resulting in death.
Drug addiction and noncommunicable diseases were becoming
increasingly prevalent in the late 1980s. A 1987 government report
named alcoholism as the most serious drug abuse problem and also
pointed to a noticeable rise in the use of marijuana and cocaine.
Abuse of other drugs, however, had not yet become a serious
problem. Drug abuse in general, and alcoholism in particular, was
considered a significant contributor to the relatively high
incidence of motor vehicle fatalities and the increasing suicide
rate. Cancer, hypertension, and heart disease were the most common
noncommunicable health problems.
The government redirected its national health strategy in the
1980s to reflect the Pan American Health Organization's emphasis on
primary health care. The principal goal was to provide basic health
care to all communities, utilizing a decentralized, public
education format, and giving maternal and child health care
priority status.
In the 1980s, the overall public health program was the
responsibility of the Ministry of Health, Welfare, and Status of
Women. It was divided into four divisions responsible for community
services, environmental health, institutional health care, and
epidemiology. Community services oversaw the primary (curative and
preventative), secondary (hospitalization), and tertiary
(specialized and long-term) community health service program. At
the local level, each county had a medical officer responsible for
the health care system, particularly primary health care.
Primary health care revolved around the 102 health centers
located throughout the country. They provided outpatient services
on a daily basis, which included the rotation of medical
specialists. Public health nurses were also available to make house
calls and visit schools. The health centers were the primary
vehicles for extending the immunization programs. Secondary health
care was available at eight district hospitals, as well as two
large government hospitals in Port-of-Spain and San Fernando.
Tertiary health care was available only in Port-of-Spain. The
main facility was the Mount Hope Medical Complex, which housed a
340-bed general-purpose hospital, 200-bed pediatric facility, and
110-bed maternity hospital. Other specialized facilities included
the St. Ann's Hospital for psychiatric care, Caura Hospital for
cardiology and pathology services, and St. James Infirmary for
geriatric, oncological, and physical therapeutic care.
The total number of public hospital beds in 1986 was
approximately 4,900; there were 15 private health institutions that
provided an additional 300 beds. Private sector health services
concentrated primarily on ambulatory care; some publicly employed
physicians maintained separate private practices, however. In 1984
Trinidad and Tobago had 1,213 doctors, or a ratio of 10.6 per
10,000 inhabitants. At the same time, there were 104 dentists and
3,346 nurses, or ratios of 0.9 and 29.6 per 10,000 inhabitants,
respectively.
In spite of noted improvements in health care delivery, serious
deficiencies were still evident in the late 1980s. The ratio of
population to health centers was twice as large as desired,
requiring a long-term commitment to the construction of additional
facilities. There was also a lack of critical medicines and trained
medical personnel, particularly technicians. Physical facilities
and equipment also required attention, as did the lack of dental
care nationwide.
The National Insurance Scheme acted as the equivalent of a
social security system in the late 1980s. Welfare disbursements
went to public assistance programs, food stamps, and retirement
pensions and played a small role in health care by providing
compensation for injuries and diseases acquired on the job.
Data as of November 1987
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