Primary Health Care

system in Jamaica

Sandra Chsholm-Ford
RN/RM/PHN/MScN Ed
 Background

 Jamaica, the largest English speaking country in the
Caribbean sits in the western Caribbean.
 Its size of 4,411 square miles makes it approximately
the size of the state of Connecticut.
 Background

 The population of Jamaica is predominantly of
African descent (91.2% in 2001 census). There are
European, East Indian and Chinese minorities and
some 6% persons of mixed descent.
 Jamaica is classified as an upper-middle-income
economy by the World Bank.
 Language

 Jamaicans speak English fluently however Patois
(pah'-twa), a blend of English and West African
languages is largely spoken by many Jamaicans,
especially those in the lower socio economic groups.
 Motto

The national motto of Jamaica is “Out of many, One
people" because of the mixture of people who combine
to make up this great nation.
 Counties and Parishes

Jamaica is divided into three historic counties, based on
our British colonialist history:
 Cornwall
 Middlesex
 Surrey
Map of Counties

 Cornwall


 Westmoreland- Savanah –la- Mar
 Hanover - Lucea
 Trelawney - Falmouth
 St. James – Montego Bay
 St. Elizabeth - Black River
 Middlesex


 St. Ann – St. Ann’s Bay
 St. Catherine – Spanish Town
 Clarendon – May Pen
 St. Mary - Port Maria
 Manchester - Mandeville
 Surrey


 Kingston - Kingston
 St. Andrew – Halfway Tree
 St. Thomas – Morant Bay
 Portland- Port Antonio
 Capital

 Kingston is the capital and largest city of Jamaica,
located on the southeastern coast of the island.
Predominantly consists of Downtown Kingston and
Port Royal
 In 1692 the city of Kingston was established as a
parish and has an area of 480 km²
 Has two airports (Norman Manley International and
Tinson Pen Aerodrome)
Parish Capitals

 Primary Health Care

 “Essential health care based on practical, scientifically
sound and socially acceptable methods and technology
made universally accessible to individuals and families
in the community through their full participation and
at a cost that the country and community can afford at
every stage of their development in a spirit of reliance
and self determination”. -- Declaration of Alma Ata 1978
 Primary Health Care

 It is the first level of contact of individuals, the family
and community with the national health system
bringing health care as close as possible to where
people live and work, and constitutes the first
element of a continuing health care process.
 Primary Care

 Primary Health Care essentially means care and
treatment received at a public health facility other
than a public hospital. There are approximately 331
health centres and 21 satellites operating on the
island at this time.
 History of Health Care
in Jamaica

 Between 1658 and 1798, approximately 281,000
slaves were imported to Jamaica
 Epidemics were common on plantations and as
many as half the slaves died. Most common cause
was yaws and dysentery
 Mortality rate among children 0-5 years was as high
as 50%
 Many slave also died from yellow fever, small pox,
TB, worm infestations, maltreatment, over-work and
starvation.
 History of Health Care
in Jamaica

 In 1792, Consolidated Slave Act was passed in
Britain called for the provision of medical care for
slave owners, their families, and their slaves.
 Field slaves were treated at “Hot Houses ” by Vets
 In 1838 slavery was abolished, many plantations
went out of business.
 The majority of doctors migrated, leaving only 50
doctors
 Health and social conditions worsened.
 Epidemic Outbreaks

 Cholera in 1850 caused 32,000 deaths
 Smallpox epidemic in 1852,
 Typhoid fever and Cholera in 1853 resulted in deaths
of a quarter of the population of Kingston, the
victims being buried in mass graves.
 By 1865, conditions were so poor that it led to the
Morant Bay Rebellion.
 Regulations

 In 1867, the Public Health Law was passed and it set up a Central
Board of Health.
 A Parochial (Local) Board of Health was established in the 14
parishes.
 The Central Board was established as an Island Medical
Department with a Government Medical Service coming into
being
 Public medical service was established in 1869

 After the first World War (1920–22) infectious diseases accounted

for four of five death.
 Rockefeller Foundation

In 1918-1928 the Rockefeller Foundation aided in the
control of hookworm, tuberculosis, malaria and yaws.
 They established a Bureau of Health Education
 In 1919 a school for sanitary inspectors was open
 Public health inspectors were employed to guide
sanitary improvements
 Rockefeller Foundation

 Social workers addressed welfare problems as part of the
comprehensive programme
 Venereal Disease control clinics were initiated in four
major towns in 1935
 Establish dispensaries as hospital outposts, forming the
core for community health services, including antenatal
care
 This led to the eradication of malaria and yaws
 Moyne Commission

 Throughout the 1930s there were disturbances in the
British territories in the Caribbean.
 As a result, the British Government appointed the
West Indian Royal Commission to investigate and to
make recommendations on the social and economic
conditions in the various territories.
 This Commission was led by Lord Moyne
 Moyne Commission

 On August 5th 1938 Britain launched a Royal
Commission under the leadership of Lord Moyne to
investigate and make recommendations on the social
and economic life of the British West Indian colonies.

http://www.guyana.org/features/guyanastory/chapt
er108.html
]
 Moyne Commission

 The Moyne Commission exposed the horrible
conditions under which people of the British
Caribbean lived.
 It pointed to the deficiencies in the education system
 Pointed to economic and social problems of
unemployment and juvenile delinquency.
 Sharply criticised the poor health conditions
 Expressed concern over the high infant mortality rate
 Moyne Commission
of sugar workers and
 It was critical of the plight
small farmers
 It condemned unsafe conditions at workplaces.
 It was also very concerned over the use of child
labour and the discrimination against women at
workplaces
 The interests of the workers were unprotected since
there were no collective labour agreements with only
employers deciding on what wages should be.
 The Commission also looked at the political system
operating in all the territories.
 The establishment of a Franchise Commission in 1944
 Moyne Commission

 The Moyne Commission reviewed the health
condition and offered ten recommendations.
 By the late 1940s communities had medical
personnel living in their midst followed by the
addition of District Midwives
 Yaws

 Chronic disfiguring and debilitating childhood

infectious disease caused by Treponema pallidum

subspecies pertenue.

 One of the first diseases targeted for eradication by

WHO and UNICEF in the 1950s. WHO renewed global

efforts to eradicate yaws in 2012.

 Affects skin, bone and cartilage. Humans are currently

believed to be the only reservoir, and transmission is

from person to person.

 Cured with a single oral dose of azithromycin.

 There are 15 countries currently known to be endemic

 Expanded role of the
Midwife

 Before 1972, the role of the Community
Midwife/District Midwife was to provide antenatal
care to women in the community
 This care ended when the baby turned 6 weeks old.
 All subsequent care was given by the PHN or the
Doctor.
 Expanded role of the
Midwife

 In 1972, the community midwife’s role was
expanded to include provision of family planning,
antenatal, post-natal and child welfare services as
well as attending home births

 Members of the Primary Health Care
Team in Jamaica

 Registered Midwife (RM)
 Community Health Aide (CHA)
 Public Health Nurse (PHN)
 Medical Officer (MO)
 Family Nurse Practitioner
 Registered Nurse/Midwife (RN/M)
Members of the Primary
Health Care Team in

Jamaica
 Dental Nurse
 Dental Assistant
 Dentist
 Contact Investigator (CI)
 Laboratory Technical Assistant (LTA)
 Orderlies
 Clerical Staff
 Ministry of Health

South East North East Southern Western

Regional Regional Regional Regional
Health Health Health Health
Authority Authority Authority Authority

Kingston and
St. Thomas St. Catherine
St. Andrew

Zone 1 Zone 2 Zone 3 Zone 4 Zone5 Zone 6

Health Districts in Jamaica

Western Region

 Vision 2030

 Strategic road map to guide the country to achieve
its goals of sustainable development and prosperity
by 2030.
 National Goals

 Jamaicans are empowered to achieve their fullest
potential
 The Jamaican society is secure, cohesive and just
 Jamaica’s economy is prosperous
 Jamaica has a healthy natural environment
 National Outcomes

1.A Healthy and Stable Population
2. World-Class Education and Training
3. Effective Social Protection
4. Authentic and Transformational Culture
 Health Ranking

 Jamaica ranks 53rd out of 190 countries among the
world health systems 2nd only to Barbados in the
Caribbean
 Types of Health Centres

Health Centres are usually named for the community in
which they are found.

Type of Health Centre Number of health Centres

1 19

2 9

3 15

4 0

5 3
 Type 1


 Serves a population of 4,000
 Offers basic Maternal and Child Health
services, health education, family planning,
immunization, nutrition, home visits and
includes simple dressings
 Staffing – Community Health Aide (CHA)
and Midwife (MW)
 Visiting – Public Health Nurse (PHN) and
Public Health Inspector
 Type 2

 Serves a population of 12,000

 Offers Maternal and Child Health services and

Curative services also includes home visits
 Staffing – PHN, PHI, MW, CHA and Staff
Nurse (SN)
 Visiting- District Medical Officer (DMO),
Nurse Practitioner (NP) and Pharmacist, LTA
 Type 3

 Serves a population of 20,000
 Offers all Type 2 services and also
includes home visits, curative, dental,
environmental health, Sexually
Transmitted Infections (STIs) treatment,
mental health and pharmacy.
 Staffing – PHN, PHI, MW, CHA,
SN,NP,DMO and a clerk Visiting LTA
 Type 4

 Type 4 Health Centre has all the services of
the Type III
 However this type has the Parish
Administrative Office on the same premises
and is usually based at a hospital
 There is only one in the South East Region -
St. Jago Park Health Centre located at the
Spanish Town Hospital
 Type 5
 Health Centre
 Also called a Comprehensive
offers a comprehensive array of services.
 Services offered are similar to those of the
Type III in addition to counselling & contact
investigation and child guidance . Laboratory
facilities are also available at the Type V
Health Centres.
 Located in the urban areas.
 Accepts referrals from all Type 2 and 3
facilities in the area
 Zone 1
Health Centre Type

Windward Road
5

Rollington Town 3

Norman Gardens 2

Harbour View 3

Port Royal 1
Bull Bay 3
VOUCH/Mary Issa 2

Nannyville 3

Lenworth Jacobs Satellite

Salvation Army Satellite

North Street Satellite

 Zone 2
Health Centre
 Type

Glen Vincent 3/Specialist (Paediatric ) Clinic

Comprehensive 5

Operation Friendship 2

Denham Town 3

Chin Loy 2
 Zone 3
Health Centre Type

Maxfield Park

5

Hagley Park 3

Seaview Gardens 3

Olympic Gardens 3

Majesty Gardens 1

Oakglades 2

S Corner Satellite

Whitfield Town Satellite

 Zone 4
Health Centre
Type

Red Hills 2

Sunrise 3

Duhaney Park 3

Drew’s Land 2
 Zone 5
Health Centre

Edna Manley
Type

Stony Hill 3

Lawrence Tavern 2

Parks Road 1

Essex Hall 1

King Weston 1

Mount Charles 1

Bethel Satellite
 Zone 6
Health Centre Type
Gordon Town  3

Mavis Bank 2

Community Health and Psychiatry 2

St. Margaret’s 1

Dallas 1

Hall’s Delight Satellite

Content Gap Satellite

Westphalia Satellite
Immunization Coverage

 The Expanded Programme on Immunization (EPI),

established in Jamaica in September 1977 , has

made significant strides towards attaining universal

immunization coverage for all children and resulted

in the elimination a number of vaccine-preventable

diseases and reducing infant and child mortality.

Vaccine 2013 2019 2020 2022
% % % %

BCG 109 97 99.9 97

MMR 1 95.45

94 91.1 83

DPT 97.33 96 95.6 93

Polio 97.61 96 95.5 89

Hep B 98 96 95.5 93

Hib 98.33 96 95.5 92

COVID 19 21.5

MMR 2 83
 Mortality Rates
Rates

1990 2015 2020
Neonatal 19.85 11.0 9.3
Infant 11.7 10
Child < 5 29.5% 15.5% 13.1
Maternal 120/100,000 89/100,000 80/100,000
 Health successes

 Polio in Jamaica and the Caribbean was in 1982
 Measles in the Caribbean occurred in Jamaica in
1991
 Diphtheria in Jamaica, 1995
 Congenital Rubella in 1998
 Rubella in 2000
 Newborn Tetanus in 2001
 Health successes

 Jamaica and the rest of the Caribbean was the first
region in the world to eradicate poliomyelitis and
measles.
 The end of 2006 an outbreak of malaria was swiftly
and successfully managed.
 Health successes

 High levels of immunization and an antenatal care
programme which includes high risk antenatal care and
ensures that over 98% of mothers have at least one antenatal
visit and over 87% have four .
 More than 90% of women attending antenatal clinics are
now tested for HIV. Mother to child transmission rate was
brought below 10% by 2007.
 Health successes

Vertical transmission of HIV from mother to infant
reduced to 1.2 % in 2020

Immunization has eradicated

 Small Pox
 Poliomyelitis (Polio)
 Measles
 Rubella
 Congenital Rubella
 Health successes

 Family planning programmes have successfully
reduced the fertility rate from 4.5 children per
woman of child-bearing age in 1975 to the present
1.93 in 2022.
 UN agencies such as PAHO, UNICEF and UNFPA
have provided critical support in health areas related
to women and children, the latest being the joint Safe
Motherhood Programme
 Challenges

The system is severely short of public health nurses and
midwives, at 53% and 54% of the cadre, respectively
with an annual attrition rate of 15%, as well as of
pharmacists and community health aides. Registered
nurses are 74% of the cadre
 Challenges
Disease Condition

2000 2008

Diabetes 7.2% 7.9%

Hypertension 20.9% 25.2%

Obesity 19.7% 25.3%

 MOH Position

 The Ministry of Health has established four Centres
of Excellence at the primary care level, one in each of
the four Regional Health Authorities.
 Has refurbished over 80 health centres island-wide
to better equip them to provide optimal service in
keeping with the needs of their respective
communities.
 Centres of Excellence
Health Centre
 Region Parish

Claremont Health North East St. Ann

Centre

Isaac Barrant Health South East St. Thomas

Centre

Santa Cruz Health Southern St. Elizabeth

Centre

Darliston Health Centre Western Westmoreland

 Summary

 Jamaica is an English speaking Caribbean country
whose economical status is classified by the world
Bank as:
a) Lower-middle-income country.
b) Upper-middle-income country.
c) Lower-lower-income country.
d) High-middle income country.
e) Middle-middle income country.
 Summary

 Primary Health Care refers to care and treatment
received at a public health facility other than a public
hospital.
 True
 False

 The Consolidated Slave Act was passed in Britain

made provision for medical care for slave owners,
their families, and their slaves.
 True
 False
 Summary
 Commission and The
 The Rockefeller, The Moyne
Expanded Role of the Midwife, were important
implementations utilized to improve health care in
Jamaica.
 True
 False

 Jamaica ranks 108 out of 190 countries among the

world health systems .
 True
 False
 Summary
 Type 1 primary health 
centre provides basic
maternal and child health services while a Type 5
primary health care facility offers a comprehensive
service include laboratory service.
 True
 False

 Primary health care facilities in Kingston and St

Andrew are divided in four zones.
 True
 False
 References

 Common Wealth online (2014). Health in
Jamaica .Retrieved from
http://www.commonwealthhealth.org/americas/ja
maica/
 McCaw-Binns, A.(2005).Safe motherhood in Jamaica:
from slavery to self-determination. Retrieved from
http://content.ebscohost.com.rproxy.uwimona.edu.j
m/ContentServer.asp?T=P&P=AN&K=1
 References

 Macrotrends, (2022.) Jamaica Fertility Rate 1950-2022.

https://www.macrotrends.net/countries/JAM/jam
aica/fertility-rate
 References

 Sinha,D.,Rojas-Aleta,I., Diloreta, A.,Gutmore-Lowe,
I.& Murray, J. (1984). Primary Health Care in Jamaica-
Parish Level (Situational analysis of parish health
department the distributive (intermediate) level of
primary health care and areas of development.
PAHO/MOH;GOJ
 WHO, 2020. Jamaica: WHO and UNICEF estimates of
immunization coverage: 2019 revision.
https://www.who.int/immunization/monitoring_s
urveillance/data/jam.pdf?ua=1