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Bahamas Healthcare

The public sector operates three hospitals, the two largest of which are located on New Providence. The Princess Margaret Hospital, with 436 beds, provides general acute and specialised services including intensive care, hemodialysis, cardiology and urology. The Sandilands Rehabilitation Centre provides both psychiatric/mental healthcare on an inpatient and outpatient basis (352 beds) and geriatric care (130 beds). The third institution, the Rand Memorial Hospital, is in the nation’s second largest city, Freeport, on Grand Bahama. It provides general acute care as well as basic levels of specialised services, and has a bed complement of 82.

Public health services are delivered through a network of 57 community clinics and 54 satellite clinics in New Providence and the Family Islands. They also encompass community-based programs such as home and district nursing, disease surveillance, and home-based rehabilitation. The management team in this area consists of an Administrator, Medical Staff Coordinator, Principal Nursing Officer, and Medical Officer of Health. There is a unit specifically responsible for coordinating service delivery to the Family Islands. Public health services include general practice, maternal and child health, and dental health.

The private sector provides primary care services, emergency services, secondary inpatient care and specialised clinical, diagnostic, and treatment services in both the medical and dental fields. There are two private hospitals providing secondary care. Doctor’s Hospital has 72 beds and its services include emergency care, specialised medical care (including rheumatology and nephrology), surgery (including cardiovascular and neurosurgery), obstetrics and diagnostic services (including nuclear medicine). The other private hospital, Lyford Cay, has 12 beds. It provides speciality services in cardiology, plastic surgery, urology and podiatry. In addition, a number of private practices have birthing facilities but are not classified as hospitals.

Specialised ambulatory services are available in the areas of cardiology and nephrology. The Bahamas Heart Centre offers a full range of cardiac evaluation techniques, including nuclear stress testing and cardiac catheterisation. Pacemaker implantation is also available. Renal House offers kidney dialysis.

There is no national health insurance scheme, but the National Insurance Board provides medical benefits for job-related injuries and illness. Partial salary replacement is provided during illness, as well as paid medical care for industrial injuries. Other benefit types include maternity, disability, and death. In addition, provision is made for invalidity, retirement, and survivor’s benefits. Several options for health and dental insurance are available through the private insurance system.

The Bahamas is well supplied with physicians and dentists. Doctors increased from 373 (14.13 per 10,000 population) in 1992 to 417 (14.98) in 1995, and dentists from 58 (2.2 per 10,000 population) in 1992 to 80 (2.9) in 1995. In terms of distribution, 235 physicians were in government service and 182 (excluding consultants) were in the private sector. Consultants work in both the private and government sectors. Less than 20% of the physicians in public service are assigned to Community Health Services. Of the 80 dentists in the country, 21 are in government service, 6 to the Community Health Services and 59 in private practice. The number of registered nurses in the government service increased only slightly between 1989 and 1995 (from 623 to 653). 20% of graduate nurses and 15% of the trained clinical nurses (TCNs) are assigned to Community Health Services. There is no medical or dental school in the Bahamas.

Most national doctors and dentists are trained at the University of the West Indies or in North America. As of April 1997 the Bahamas Government entered into an agreement with the University of the West Indies, whereby the Princess Margaret Hospital and community health facilities will provide clinical experience to medical students from the University.

Nursing training is carried out at the College of the Bahamas. The nursing department offers a program in midwifery, an associate of science degree in nursing, a continuing education program, and, since 1995, a bachelor of science degree nursing program for registered nurses. The Health Sciences Department of the College of the Bahamas offers an associate degree in environmental health. An associate of science degree in health sciences, with options in medical technology, pharmacy, occupational health and physiotherapy is presently being developed.

The national health expenditure by the Government has shown a steady increase since 1970, mirroring the increase in the total national recurrent expenditure. The percentage of the total government expenditure devoted to health increased from 10.8% in 1970 to 15.6% in 1986. Since that time, the proportion has fluctuated and has tended to fall; in the 1995-1996 budget it amounted to 13.6%. Nevertheless, because of the strengthening of the national economy, the actual amount spent has increased. The distribution of expenditure between the different divisions of the Ministry has remained fairly constant, with approximately 15% going to administration, 65.5% to hospitals, 8% to environmental health, and 11% to community health services. It is not possible to determine how much is spent on preventive as opposed to curative services, since both types of services are provided through the public health system. The financial resources for health provided by the central government come from the consolidated fund. In addition, limited amounts are obtained from inpatient charges and fees for clinical and diagnostic services.

In addition to medical benefits, the National Insurance Board has provided funding for the construction of 11 health facilities on New Providence and five of the Family Islands, and another 5 are under construction.

The out-of-pocket expenditures of families for physician’s fees, medications, diagnostic services, and private health insurance contribute to private sector resources. The IDB has estimated that private health expenditure amounts to 2.2% of GDP and 45.6% of the total health expenditure in the country.

Several NGOs provide health services of one kind or another. Some of these organisations take an active part in government-sponsored health programs. Notable among these are the Cancer Society, Crippled Children’s Committee, AIDS Foundation, Family Planning Association, Crisis Centre, and Diabetic Association. Other organisations exist in the areas of drug abuse and care for persons living with AIDS.





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