The Minister of Health, Hon. Mark Scotland, unveiled the “National Health Policy and Strategic Plan for the Cayman Islands 2012-2017” (NHPP) at the Government’s weekly Press briefing on Thursday (22).

The document is 42 pages long and was developed with technical support of the Pan American Health Organization (PAHO) and the World Health Organisation (WHO) and the financial support of the European Commission through the “Strengthening the Integration of British and Dutch OCTs in the Regional Response to HIV within the PANCAP Framework” Project

 

1.      High blood pressure is the top diagnosis in Cayman, with the HSA treating over 3000 patients.
2.      Diabetes is second most common health problem
3.      Mental health issues are third and Cayman still does not have a proper treatment centre for people suffering with mental health conditions.
4.     A commitment to deal with obesity and non-communicable diseases.

Minister Scotland said Cayman had made some strides in healthcare over the last few years there remained many challenges.

This is what the minister said in his foreword in the NHPP:

“It gives me great pleasure as the Minister of Health, and on behalf of the Government, to present the National Health Policy and Strategic Plan (2012-2017). My vision for a health system that ensures access to the highest quality care at costs that are affordable and sustainable for all residents of the Cayman Islands led me to initiate this process, and I am proud that our efforts have culminated in this Plan.

“While we in the Cayman Islands can certainly say that we have made great strides in securing quality healthcare for our citizens and residents, it remains a fact that providing affordable and accessible health services will be an ever present and infinite challenge. In addition, we are facing many new health issues that have developed over the years, such as the rise in non-communicable diseases including diabetes, obesity and hypertension, as well as the ever-increasing cost of care. The only way to make real progress is to set clear objectives, which is what we have achieved with the completion of the country’s first National Health Policy and Strategic Plan.

“At a time when we face rising healthcare costs and budgetary constraints, it is imperative that we rise to the challenges with a clear vision and a strong sense of direction. An overarching National Health Policy and Strategic Plan will enable us to do just that. With this Strategic Plan, developed in collaboration with public and private sector leaders we have for the first time an overarching, guiding policy that outlines our vision, goals and objectives for our healthcare initiatives. For Government agencies, this means they can now move from strategy to implementation, efficiently and purposefully; and for our private sector health partners, it means they can align their efforts with the national health objectives.

“Apart from giving us strategic direction for the Cayman Islands health system, it is also my hope that this National Health Policy and Strategic Plan milestone will change the perception of our health. To begin with, we must squarely face the enormous problems of obesity and the financial and personal toll of non-communicable diseases. In addition, we have to recognize and promote the notion that health is a national asset and that it should be guarded as such. However, our health is the sum of the health of each of our citizens. Built into the fabric of the Strategic Plan is the notion that each citizen has to be part of the implementation of the Plan. Health is the personal responsibility of every citizen.

“I would like to thank my Chief Officer for her support and assistance throughout this exercise, PAHO for facilitating and guiding the process and preparing this plan, and to my senior policy Advisor of Health for her tireless efforts.

“Finally, I would like to sincerely thank all the public and private stakeholders who committed many hours of their time to help develop this landmark document. The fact that the National Health Policy and Strategic Plan started with a collaborative and inclusive process certainly bodes well for its successful implementation. It is my hope that this National Health Policy and Strategic Plan will channel our energies into a singular focus. It is together that we will address the challenges of becoming a healthier nation.”

Chief Officer of Health, Environment, Youth, Sports and Culture, Jennifer Ahearn, said:

“I want to extend my sincere thanks to everyone who has participated in, and contributed to, the drafting of this document.     Engaging citizens in policy-making is a core element of good governance: It allows government to tap new ideas, resources and information when making policy decisions; but equally important, it serves to build public trust and ensures public ownership and support of government policies.

“As such, we purposefully chose an inclusive method for developing our National Health Policy and Strategic Plan. This choice is also reflective of our Ministry’s commitment to build and strengthen cross-sector partnerships in a bid to answer today’s many challenges, for whether dealing with climate change or public health concerns, our ministry does not – and indeed cannot – function in a vacuum. Progress is only possible if everyone commits to the same goals.

“Particularly where our nation’s health is concerned, we are facing some tough challenges and even harder decisions. Government is already spending close to one fifth of its entire annual budget on healthcare, with current trends only signaling an increase. The good news is that with a policy document now in hand, we will be able to streamline public, private and volunteer efforts for the greater good.

“Finally, I believe that public participation is necessary in order for government agencies, businesses, and non-governmental organizations to align their efforts. Including individuals in government’s decision-making process has the added potential to change how people think and act, helping to transform our citizens and residents into change agents.

“With that in mind, I am certain that everyone who has been part of our stakeholder meetings will agree with me that it was a worthwhile exercise that resulted in some excellent work.  You have made very valuable contributions so far, and I’m confident with your continued support we will achieve our goal of ensuring health and wellbeing for all.”

In the Document’s Summary it listed the following as the main points:

The constitution of the Cayman Islands affirms the intention to provide a comprehensive healthcare system.

The purpose of the National Health Policy & Strategic Plan (NHPP) is to provide an overarching guiding policy for the Cayman Islands that outlines the vision, values, strategic directions and the objectives with regards to health and the health system.

The vision is “Health and Well-being for All in the Cayman Islands”.

An all-inclusive process led by the Ministry of Health, with the support of PAHO/WHO, brought a broad range of national stakeholders together during a consultation workshop. Participants engaged in a policy dialogue using a realistic approach, including the consideration of the essential functions of public health1, the six building blocks of health systems2, as well as the sector’s capacities, resources, and constraints (in consideration of resource mobilization). Considering the contextual issues of the country, participants analyzed the current situation and forecasted future health concerns. From this meeting the vision, values, and objectives were defined and in a follow up meeting the NHPP were validated.

The analysis of the situation shows a health system with numerous strengths that produces health results that surpasses those of many countries in the region. Yet, there are several growing challenges including among others; an increase in socio-behavioural risk factors resulting in a growing epidemic of non-communicable diseases; shifting needs and health service expectations among the population; the growing burden on health services from chronic illnesses; and rising healthcare costs. These challenges call for a clear policy and strategies for improving the performance of the health system in order to ensure that the new challenges and demands are well addressed.

Pioneering features of the NHPP are the emphasis on the involvement of all sectors in improving health, the planned efforts to work towards a health conscious population empowered in protecting health and the strong commitment for developing broad partnerships within and outside the health sector. These are aligned with strategies to strengthen the building blocks of the health system and various essential functions in public health.

The following strategic directions are identified and for each of these, two objectives are presented in the NHPP.

Strategic Directions

1.   Leadership and Governance: Strengthen institutional capacity for leadership and governance

2.   Health Financing: Implement an equitable and sustainable health financing model

3.   Health Workforce: Enhance human capital to ensure an available, competent, responsive and productive health workforce to improve health outcomes

4.  Inter-sectoral Collaboration for Disease Prevention and Health Protection: Promote the contribution of all sectors to health and well-being

5.   Health   Promotion   and   Social   Participation:  Achieve   an   educated, empowered   health conscious population

6.   Service Delivery and access to medical products, technologies: Further develop accessible, high quality integrated health service delivery networks based on the Primary Health Care approach

7.   Health Information: Develop a robust health information system with multi agency linkages to improve the quality and coverage of health relevant information to be used for decision making

8.   Health Information/Research: Promote increased research for the production, dissemination and utilization of relevant health information, knowledge and scientific evidence for decision making

9.   Emergencies and Disasters: Maintain the capacity to respond to and manage all emergencies and disasters to mitigate the impact on health.

Purpose of the National Health Policy & Strategic Plan

The purpose of the NHPP is to provide an overarching guiding policy for the Cayman Islands that defines the vision, values, strategic directions and objectives with regards to health and the health system.

A national policy and strategic framework is vital to health development, because health is known to be a broad and complex issue and the health system has many components with many stakeholders, both within the health sector and outside. The NHPP will serve as a critical instrument in providing direction and coherence for stakeholders and the public to improve the health status of the population in the Cayman Islands.

Health Status of the population

Population Data

The total population count of the Cayman Islands was 55,456 in 2010 (including an institutional population of 420) reflecting a 41.0% increase since the 1999 census. From this, 50.5% are female (27,817), 49.5% (27,219) are male in the non-institutional population. The majority of the population (95.8%) resides in Grand Cayman, largely in the capital city George Town. The remaining Sister Islands (Cayman Brac and Little Cayman) account for approximately 4.2% of the total population3.

Health Data

Overall, the general health status of the population is very good and there are many positive points to be noted including the fact that:

The incidence of vaccine preventable disease is negligible (Table 1)

•          Vector borne diseases are not endemic to the Cayman Islands

•          The infant mortality is very low (Table 2)

•          There has been no maternal death in the last five years.

Health care is provided by the Health Services Authority (a Crown corporation) and the private sector.

The Chrissie Tomlinson Memorial Hospital is an 18 bed hospital and is privately owned; there are approximately 40 private doctors’ offices/clinics with specialist doctors and/or general practitioners.

The Health Services Authority is the sole provider of healthcare services in the public system. It has a defined organizational structure (Figure 3) and consists of the following facilities and services:

•          104-bed Cayman Islands Hospital on Grand Cayman

•          15-bed Faith Hospital on Cayman Brac

•          Primary Health Care & Public Health Services are delivered through:

–           Faith Hospital in Cayman Brac

–           5 District Health Clinics in Grand Cayman

–           1 District Health Clinic in Little Cayman

–           School Health Clinics

•          Dental services are delivered on site at the Cayman Islands Hospital and the Faith Hospital as well as through the schools and district clinics in Grand Cayman and Little Cayman.

•          Ophthalmology services are delivered on site at the Cayman Islands Hospital and through visiting specialists on Cayman Brac.

The Cayman Islands Hospital and Faith Hospital offer inpatient and outpatient services, including some specialist services. While some tertiary care can be provided locally, a significant number of tertiary care patients are sent abroad (overseas).

Health System Strengths and Challenges

The SWOT analysis led to the identification of strengths to build upon and opportunities to utilise in addressing challenges faced in health.

Numerous strengths were identified within the health system.

Leadership and Governance:

Legislation in many areas of health

Regulatory bodies for licensing of healthcare practitioners and facilities

Public Health functions; the surveillance system for example, and public health programmes demonstrate their strengths by achieving excellent results in controlling communicable diseases. Immunization coverage is high (98%), surpassing many countries and there is an outstanding disaster management system with collaboration between the public and private sector and the population is kept well informed.

Health Workforce:

Practitioners committed to delivering quality healthcare

Health Service Delivery:

The health service infrastructure facilities are in good shape and well equipped

Facilitating measures for access to care:

– A Health Insurance Law aiming to have the total population covered

– CayHealth expresses recognition of Primary Health Care (PHC) as the basis of the health system and structures supply of close-to-client care with referral systems to secondary care and increasing utilization of services at the primary level.

In addition to the strengths, several opportunities were identified to strengthen the existing and evolving health system; the opportunities for partnerships with the private sector and with other national government institutions, advances in health technologies, interaction with regional and international agencies and capacity building opportunities and research grants offered by these agencies. The size of the population was recognized as both an opportunity to achieve health outcomes, as well as a threat. The small size of the population is a challenge to the sustainability of specialist health services and does not offer sufficient volume of cases to maintain the necessary skill levels of certain practitioners (e.g. open heart surgery). Medical tourism was mentioned as an opportunity in terms of exploring the affordability of tertiary care services in the Islands for visitors as well as for residents.

Identification of internal weaknesses as well as threats from outside the system led to a realistic view on the challenges that need to be addressed.

Leadership and Governance: There are some gaps in legislation e.g. in the area of environmental health and food safety. Some existing laws require updating. Due to resource limitations and court scheduling issues, the enforcement of the health insurance law is not optimal. While there is collaboration among agencies and across sectors, there is a need for improving coordination which should be governed by the Ministry of Health.

Health Workforce: It was recognized that a structure is needed for higher learning and to train future healthcare practitioners as well as an appropriate credentialing process for practitioners. The loss of skilled healthcare practitioners due to high turnover and the need to harmonize a workforce with many members from outside were concerns, which are currently not well addressed.

Health Information: Insufficient sharing of data across institutions, the lack of a national health research agenda and funding were concerns demanding attention.

Health Financing: The current trend of rapidly increasing costs of healthcare is having serious consequences for the government. There is a need to address escalating costs and arrive at a sustainable health-financing model to ensure the future viability of the healthcare delivery system.

Service delivery: While several measures are already in place for quality improvement in care, there is need for a programmatic approach for all service providers. Duplication of services due to lack of communication and coordination of actors in service delivery, including NGOs, was recognized.

Some identified threats to the health system are the ageing of the population, the widely available information on new medical technologies resulting in unrealistic expectations of the public and high costs of healthcare. The influence of multinational healthcare providers could become a threat to the national system. The threats of nuclear, bio and hazmat emergencies and increased frequency of natural disasters may become realities.

In relation to the NCD epidemic, a number of threats were identified that facilitate the increase in socio-behavioural illnesses:

Economic downturn results in poor eating habits

Children exposed to social media, which glamourizes unhealthy eating and unhealthy lifestyles

Public not well informed about healthy food choices

Lack of national guidelines for physical activity

Infrastructure needed to encourage outdoor physical activity and alternate means of transportation

Lack of incentivized wellness programs

Inaccessibility of personal health data

Linkages with Operational plans and budgets

This National Health Policy and Strategic Plan will be followed up by operational plans, linked to the government’s annual budgets.  As operational plans and their budgets are subsets of the NHPP, alignment is paramount. A review of existing operational plans will be conducted to ensure this association. Similarly, all new operational plans will need to be developed with the NHPP in mind. Further, operational plans will include a wider number of performance indicators particularly regarding access and service readiness, intervention quality, safety, measures for health determinants, health system inputs, processes, and outputs, use of healthcare services, mortality, morbidity, and health system responsiveness.

Likewise, disease or population-specific policies and strategies will need to be aligned with the NHPP. Presently, some policies such as the Government Policy on AIDS and the Strategic Plan of the Cayman Islands Health Services Authority are available. In reviewing and updating existing policies and strategies the NHPP will serve as the guiding framework, as will be the case in developing any new health related policy.

Monitoring and Evaluation Plan

Monitoring and Evaluation (M&E) are key functions assisting in achieving the expected results of the NHPP. The purpose is to track changes and explain why change may or may not be occurring. Therefore, it provides information for the improvement of objectives and activities and as such it is a powerful tool in decision-making processes during the implementation of the NHPP.

Monitoring is a routine function that collects data routinely and systematically, and reports on how the planned actions are progressing.

Evaluation is a selective function comparing baseline data with data collected in a later stage to determine the outcomes and impact of the plan and implemented activities.

A set of core indicators will be required for the nine strategic directions; one process indicator will measure the progress towards the expected result and one results based indicator will measure the results achieved in each of the strategic directions by the end of the five year implementation period. These core indicators will be developed when the action plans for each Strategic Direction are formulated in the next stage of the process. At that time, the baselines for the indicators, the result indicators and means of verification will be established. Once confirmed, the indicators will be incorporated within a comprehensive M&E Plan that will be developed for the NHPP and its subsequent detailed and costed operational plans.

The M&E plan will present the performance framework for the NHPP and selected indicators for all objectives in the strategic directions building as much as possible on existing performance assessment mechanisms. The collection of data and analysis of the indicators will be described as well as the dissemination strategy of findings to national stakeholders as well as for meeting reporting requirements to regional and international organizations for comparability with other countries and to track progress on global commitments.