were immunised with one dose of measles. In 2011, 96 per cent of the country’s population was using an improved drinking water source and in 2005, 81 per cent had access to adequate sanitation facilities. Health services within the country are made up of a network of 52 health centres and two district hospitals. The Princess Margaret Hospital is the national referral hospital and provides curative, rehabilitative and other complex medical services. A recent upgrade has reduced the number of people having to seek treatment abroad. There is a smaller hospital at Portsmouth and cottage hospitals at Marigot and Grand Bay. The Ministry of Health is responsible for the provision and financing of health care services. The Dominican government is an active participant in the Eastern Caribbean Drug Service, which is a regional pooled procurement scheme for importing pharmaceuticals and medical supplies. This enables the country to maximise the value of health care services to its citizens through the advantage of collective bulk buying along with neighbouring countries. The pharmaceuticals industry in Dominica remains largely unregulated, except with regard to dangerous drugs. The most recent act relating to mental health in Dominica is the Mental Health Act 1987. There are 19.5 mental health outpatient facilities per 100,000 people (2011). Domi n i c a Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. To achieve MDG 4, Dominica should have reduced under-five deaths per 1,000 live births to six and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 11 deaths per 1,000 live births and measles immunisation at 93 per cent. While the measles immunisation target is relatively close to being achieved, it is unlikely that the under-five mortality target will be met when the 2015 data is analysed. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. Part of this goal stipulates that 100 per cent of births must be attended by a skilled health professional, a target that Dominica met in 2012. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. There has been an overall reduction in estimated TB incidence and estimated mortality (when mortality data excludes cases comorbid with HIV) in the country. Further progress would have had to have been made if Dominica is to achieve this goal. There is insufficient information from international agencies to confirm the country’s progress on this goal with regard to HIV/AIDS. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage Only a third of health care in Dominica (28 per cent) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 5.9 per cent of GDP (2012), of which 72 per cent (US$282 per capita) was covered by the government. Commonwealth Health Partnerships 2015 169 Under-five mortality 1990 1995 2000 2005 2010 2015 Under-five mortality per 1,000 live births 2015 MDG 4 target 20 15 10 5 Mortality by cause of death (% of all deaths), 2008 Other NCDs Communicable, maternal, perinatal and nutritional Injuries Cardiovascular diseases Diabetes Respiratory diseases Cancer Tuberculosis: Incidence and mortality 1990 2000 2010 Mortality excluding cases comorbid with HIV (per100,000 people) Incidence of tuberculosis (per 100,000 people) – including cases comorbid with HIV 35 30 25 20 15 10 5 0
Commonwealth Health Partnerships 2015
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