Trinidad and Tobago has seen an increase in he population over the period
1990 - 2005. The population pyramid is changing as the under-15 age group is
decreasing, while the 60 years and over age group is increasing.
A review of epidemiological data shows that while maternal mortality is
decreasing, infant mortality is increasing. Mortality from TB, AIDS, malignant
neoplasms, circulatory diseases, etc. are also on the rise.
Some of the determinants of health include political, economic, social and
environmental factors. The country has a parliamentary democracy form of
government and is politically stable. Efforts are underway to attain developed
nation status by 2020, which has led to changes in the health and other sectors.
Public expenditure per capita has been increasing (US$ 1,165.70 in 1990 to
$3,369.80 in 2005). Public expenditure on health as a percentage of GDP has fluctuated from 2.3% in 1990 to 1.6% in 2000 and 2.5% in
Millennium Development Goals indicators show that while strides have been
made in education, with high enrolment ratios for primary education, and in
sanitation, with an increasing percentage of the population having access to
water and water closets at home, the increasing prevalence of chronic diseases
like diabetes and hypertension poses a challenge.
The Ministry of Health is responsible for leading the health sector. The
service provision aspect of public health care has been devolved to newly
created entities, the Regional Health Authorities (RHAs). However, the Ministry of Health is still responsible for some vertical and national
programs. The Ministry of Health is shifting its focus to concentrate on policy
development, planning, monitoring and evaluation, regulation, financing and
research. Citizens can access free health care at public health care facilities
where health insurance is not required. However, the government is developing
the National Health Service in which a package of services is to be determined,
as well as a financing strategy.
Health Sector Reform has affected the functions of the health system in many
ways, e.g. changes in the structure and management of the health sector, new
legislation, rationalization of health care facilities and services, review of
human resources, expansion and development of information technology,
introduction of new services, etc.
There was widespread consensus on the need for health sector reform.
Financial resources to carry out the reform were available both from local and