Primary Health Care service delivery in the Health sector in Grenada is public based, meaning, health clinics, emergency room care, general hospital and a National Insurance Scheme (NIS) for insurance, as well as private based, with the provision of private health insurance and private hospitals, such as St. Augustine. As a result it employs the use of both solo and group practice.
o Employment status of Physicians:
The Caribbean in general is experiencing a shortage of medical professionals and Grenada is not immune to this problem. A major contributing factor is that many medical professionals leave to work in other countries, creating a situation of braindrain. It was estimated by the U.N. that around 70% of native born Grenadian physicians leave and work overseas, (UN population statistics, 2010) Grenada has a low physician to population at 8.1 for 10,000 people for comparison Mexico has 20 per 10,000, (PAHO). It is estimated that there are approximately 110 physicians currently working in the health sector in Grenada. A small section of these physicians serve as independent contractors, most of whom are specialist with a few general practioners. A greater majority of those however are in private practice but are still employed in public practice, providing healthcare services at their private establishments and/or the private hospital as well as providing healthcare services through the public health facilities, health centers and hospitals.
o Population Served:
All citizens of Grenada and foreigners, mainly SGU students and visitors are able to get access to the healthcare facilities. The general population of Grenada served, excluding foreigners, is approximately 93,000.
o Types of Hospitals:
Grenada’s health policy aims at ensuring that every Grenadian has access to quality health services. The Grenadian government has embraced the concept of primary health care as the main strategy for improving the population’s health status. As part of its aim to attain ‘health for all by the year 2000’ it has adopted the goals and targets established through the Caribbean Cooperation in Health initiative as the priorities for its health services.
Grenada is divided into seven health districts, six of which have a health center with most services and an additional 30 medical stations. These are major primary care facilities and usually serve as the first point of contact within the Grenadian health system. All health facilities are within easy access of the population and each health district is assigned a District Medical Officer, several categories of nurses, community health aides, dentists and dental auxiliaries, pharmacists, environmental health officers and mental health workers. At some Health Centers, some specialist services, such as pediatrics, and psychiatry are provided.
There is a 240 bed General Hospital, which is the main hospital on island and located in the capital of St. Georges. The General Hospital is a referral hospital offering 24 hour emergency care, specialist, surgical, paediatrics, psychiatric, ophthalmic, obstetric/gynecology, and ENT. Ultrasonagraphy and electrocardiogram are also available. Support services include laboratory, pharmacy, imaging, physiotherapy and rehabilitative services. In addition there are two rural hospitals, the Princess Alice Hospital and Princess Royal hospital, with 60 beds and 40 beds respectively.
As part of their provision of primary health care for all, the Grenadian government, through the health sector also provides specialized Mental Health Services providing treatment, rehabilitation and follow-up care at the Mental Hospital and in the community. The institutions include an 80-bed psychiatric hospital for acute and chronic patients, the Mount Gay hospital, and a geriatric facility at Richman Hill with 120 beds, that is usually filled above capacity. Dorothy Hopkin Home a 16-bed facility offers services for disabled children.
o Prevailing Remuneration of the Health Care Workers:
What currently obtains in Grenada as relates to the prevailing remuneration system for health care workers is that they are primarily salaried workers. The salary of healthcare workers is determined by the negotiation between the Government and the bargaining agent, the Public Service Workers Union. Salary is based on a scale system that is predetermined by the government. Entry into that scale is determined by qualification and the job title held. Private physicians however are paid on a fee for service basis. The fee scale is determined by the Grenada Medical Association.
o Referral Restrictions:
Public hospitals have a restricted referral system, access to specialist care is on the basis of referral from a General Practitioner within the public health sector. This serves as a means of gatekeeping. Home referrals are done by the district medical doctor on advisement from the district health centers. Laboratory and other medical test referrals are also assigned by public health physicians as well as private physicians from the list of preapproved test centers.
Private facilities does not necessarily operate within the boundaries of a referral system as persons using private facilities would have direct access to private specialist care. Home referrals are done by the private physicians whose clinic have been visited or referred to other physicians in different specialties according to the characteristic of the disease. Laboratory and medical tests are referred by private physicians to the test centers, which have agreements with the physicians.
o Level of internal integration between staff:
Within the health system of Grenada both the public and the private sector are integrated. To date, there are about 110 physicians working within the private and public health sector combined. Because of this nurses /midwives and other medical professional that serve both in the private and public sector are allowed a lot of interaction with each other. Within the public sector there is a hierarchy that exists among physicians, there are the senior physicians, followed by the junior doctors. Also within in the nursing system there is a hierarchy. This lends to a flow of authority between members of staff. Though there is this hierarchy, it can be seen from interactions with members of the system that there is a respect that exists between professionals within the different fields that make up Grenada’s very integrated public and private health systems.
o Level of external integration with other services:
The National Strategic Health Plan stated that the community health services had issues with primary care services as it was neither integrated nor coordinated. This is due to limited confidence in community services. It also reported that persons would visit the general hospital or private clinics. There is an increase in private clinics which is seen as the provider of quality care. It should be noted that one of the goals of the National Strategic Health Plan reported that there is an endeavor to improve collaboration between Non-government agencies, public health care, community centers as well as private health care services in an effective and efficient manner. A strategy that was curative in nature was developed to increase collaboration between the Ministry of Health and Regional sectors in aiding with the treatment and diagnosis of Dengue. The formation of strategies that are developed for prevention and promotion aids in the development of partnerships with other ministries to help deal with youth issues. The Ministry of Health was in collaboration with PAHO in Barbados to develop a cost benefit analysis of a National Fluoridation Program.
Level of integration of staff education and training in primary care:
Generally the training in primary care for staff education is a mix between coninous professional development and undergraduate/basic education. In the National Strategic Health Plan for Grenada, the level of integration of staff education and training in primary health care is as follows: for there is in service training provided for community workers. There is also a plan to have training in the screening of cancer, a system of surveillance in communicable diseases, pre and post natal care as well as training in acquiring the proper nutrition for children and their mothers. The training of staff to be sensitive in providing quality care of the elderly, training for hospital staff and the development of the support of clinical service.
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