Mirroring global trends, noncommunicable diseases (NCDs) contribute to high mortality and morbidity in the Caribbean. More than 75 percent of deaths in the Non-Latin Caribbean were due to NCDs in 2016, with cardiovascular diseases, cancer, and diabetes accounting for the highest proportion of those deaths, respectively.
Recognizing the growing burden of NCDs, public and private entities in the Caribbean region have undertaken considerable efforts to address NCD risk factors and strengthen NCD care. The Declaration of Port-of-Spain (2007) represents commitments from Caribbean Community (CARICOM) member states to address the NCD epidemic through efforts such as the standardization of care and policies to encourage healthy behaviors. Progress toward realizing these commitments is ongoing.
To support the development of targeted solutions to the high burden of NCDs, the World Bank, in collaboration with the relevant governments, recently completed NCD care assessments in several upper middle-income Eastern Caribbean countries (including Dominica, Grenada, and Saint Lucia). The findings and recommendations from the assessments in those three countries include actionable insights for policy makers, healthcare professionals, and other stakeholders who are seeking to improve or are investigating NCD care in similar settings.
Dominica
- Dominica, a mountainous Caribbean island nation, faces the burden of noncommunicable diseases (NCDs) as the leading cause of death with the prevalence of hypertension among adults at 22 percent and diabetes at 11 percent. Poor health behaviors and risk factors drive high rates of NCD mortality with 60 percent of the population overweight or obese and 11 percent of the population engaging in tobacco use. In response, the country has committed to the 2030 Sustainable Development Goals to reduce NCD mortality by 30 percent and joined the HEARTS in the Americas initiative, sponsored by Pan American Health Organization (PAHO), aimed at improving cardiovascular health.
- The World Bank in collaboration with the Ministry of Health of Dominica, used a World Bank NCD System Assessment Tool that evaluates health systems via the World Health Organization’s (WHO) Operational Framework for Primary Health Care, which examines 14 strategic and operational levers that drive improved healthcare quality and outcomes. Strategic levers include planning, universal health coverage, and funding. Operational levers include models of care, human resources, health information systems, physical infrastructure, and supply chains. The NCD Assessment Tool also uses the Chronic Care Model (CCM) based on research on the critical success factors common to health care provider groups that are able to achieve the best outcomes for patients with chronic diseases.
- Dominica has a sound model for offering NCD services under the umbrella of Universal Health Coverage which provides services for free, with most patient care provided appropriately within primary care.
- While engaged and committed staff members deliver NCD care, there is an absence of standard protocols to ensure that key services are provided consistently.
- Health Data and Information has room for further strengthening given standard practice is that charts are paper-based, unstructured, and reside with the patient, making it difficult to retrieve health information efficiently or monitor whether best practices are followed.
- Dominica has made progress in adopting WHO-recommended policies on taxation, labeling, and limits to marketing for tobacco, alcohol, and unhealthy foods. It is considering further legislation to expand and enforce these policies.
Grenada
- Grenada’s National Health Sector Strategic Plan (2016-2025) identified NCDs as the leading cause of morbidity and mortality in the country. According to the World Health Organization (WHO) 2022 Progress Monitor, 83 percent of deaths in Grenada are from NCDs and there is a 23 percent probability of premature mortality from NCDs. Given this heavy burden of NCDs, improving NCD care is a critical priority.
- The World Bank in collaboration with the Ministry of Health, Wellness and Religious Affairs of Grenada, conducted a mixed methods study to analyze the care cascades for NCDs – specifically, type 2 diabetes and hypertension – in Grenada.
- Based on data collected from a review of medical records, at least 40 percent of patients in treatment for only hypertension or diabetes did not achieve control. Additionally, approximately 50 percent of patients had more than six months between their last two visits. While almost all patients in the sample with diabetes had their FBG and/or RBG tested, only 7 percent had their A1c tested.
- Focus groups and interviews revealed issues with treatment adherence, related to medication side effects, high costs of medicine, stockouts, preference for traditional remedies, patient complacency, and insufficient patient education. Additionally, while professionals use guidelines for the treatment of diabetes and hypertension, there is no standardized approach.
- Key recommendations focus on strategies to improve the quality of and access to care, strengthen the national health information system, ensure consistent availability of safe and affordable medicines and supplies, and develop a prevention work plan.
Saint Lucia
- The Ministry of Health, Wellness and Elderly Affairs of Saint Lucia (MOHWEA) reports that noncommunicable diseases (NCDs) are the leading cause of illness and death in the country, with NCDs causing 82 percent of deaths and an 18 percent probability of premature mortality.
- In collaboration with the MOHWEA, the World Bank has conducted a study to analyze the care cascades of two major NCDs, type 2 diabetes and hypertension, in Saint Lucia. The mixed methods study used STEPS 2019-20 Survey Data, as well as qualitative data collected from focus groups and interviews.
- Based on national estimates derived from STEPS survey data, about 41 percent of females and 39 percent of males aged 18-69 are hypertensive, and 18 percent of females and 14 percent of males aged 18 to 69 are diabetic. The largest drop in percentage points along the care cascades for hypertension and diabetes was between screening and diagnosis for most individuals. Only 12 percent of adults (18–69 years) with hypertension or diabetes experienced control.
- Based on focus groups and interviews, patients were generally satisfied with provider support and are able to access some services and medications at no cost. However, all providers are not aware, trained on, and/or adhering to the recently adopted national standardized guidelines for diabetes and hypertension care. Challenges with treatment maintenance include medication shortages, insufficient patient empowerment to self-manage, insufficient attention to the gender dimensions of treatment and care, differential prescribing patterns, patients’ high level of alcohol usage, and patients’ frustrations with long-term conditions.
- Key recommendations focus on strategies to improve the quality of and access to care, upgrade and expand the national health information system, ensure consistent availability of safe and affordable medicines and supplies, and coordinate multistakeholder engagement.