Trinidad and Tobago - 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.
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