Health System of SURINAME

1. Health System ofSURINAME Maltie Algoe Elly van Kanten Monitoring and Analyzing Health System Change and Health Reform , May 30th – June 1st , 2006 - Belize

2. Content: • Health System Characteristics • Health System Performance • Health Status and Outcomes • Relevant Trends and Interventions

3. 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

4. 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

5. Demand: Population Supply: MOH Professionals NGO’s • Finance: • MOF • MSA • State Health Ins. • Private Insurance • Out-of-pocket

6. 30000 20000 10000 0 10000 20000 30000 95-99 90-94 85-89 80-84 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 05-09 00-04 Males Females Population (census 2004): 492 829by ethnicity:

7. 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

8. Structure of the MOH • Main Office: Central Administration (incl. Planning and Legislation) • Inspectorate • Bureau of Public Health

10. Primary Health Care • Coastal area - RHS (8 districts, 50 clinics, 100,000 clients) - Private GP’s • Interior - MM (2 districts, 50 centers, 50,000 clients) Several NGO’s providing: • SRH services • Health Promotion • (Home) Care & Support • Research

11. 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 %

14. Distribution of spending by payer National Health Accounts, MSH, march 2002

15. Distribution of spending by level of care National Health Accounts, MSH, march 2002

16. Insurance coverage (Census 2004)

17. Health Status and OutcomesVital Statistics, 2004

18. 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

19. 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

20. Achievement of MDG’sImmunization Coverage 85%PMR , IMR & <5 MR per 1000 of LB

21. Maternal Mortality RateDeliveries by skilled personnel 90%

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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;

30. 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)

31. 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: • MDG’s (demanding specific attention) • Global Fund (demanding coordinating mechanism)

32. Thank you