The Ministry of Health and Wellness (MOH, 2014) is responsible for health care delivery island-wide. Headed by the Minister, the Ministry provides policy and strategic guidance on public health and regulatory matters and has the mandate to develop policy guidelines and supporting legislation in keeping with the overall goal and objectives of government.

Jamaica’s public health sector was de-centralised in 1997 under the effect of the Health Services Act, which led to the establishment of four Regional Health Authorities across the island to more efficiently and effectively deliver health care to the entire population (MOH, 2014):

• The South-East Regional Health Authority (SERHA)
• The North-East Regional Health Authority (NERHA)
• The Southern Regional Health Authority (SRHA)
• The Western Regional Health Authority (WRHA).

The Ministry of Health describes its public sector as being comprised of a range of health services which are delivered through a network of primary, secondary, and tertiary healthcare facilities. There are 25 hospitals, of which 23 are designated according to specialty, bed capacity, and the services offered. The remaining two are quasi-public sector hospitals that operate within a private sector health care market. Primary health-care services are provided through a network of 317 health centres located island-wide (MOH, 2014).

The Pan American Health Organisation notes that utilisation of public health service in Jamaica is quite high (PAHO, 2017). There is a paucity of research on exact and recent data on the utilisation of public health services in Jamaica. Most recent data revealed that public health care demand by Jamaicans increased from 38.0% in 1989 to 40.5% in 2007, and there was a peak of 57.8% regarding utilisation in 2002 (Bourne et al, 2010).  In assessing the health information system components in Jamaica, data management received a score of 48, indicating data management strategies relating to the health care and systems where present but not adequate (MOHW & PAHO, 2011).

Notable services provided via the public health care sector as an initiative of the National Health Fund (NHF), (which provides financial support to Jamaica’s national healthcare system), is the Jamaica Drugs for the Elderly Programme (JADEP) and the National Health Fund Card. JADEP provides a specific list of medications that are 100% subsidised for chronic illness for beneficiaries aged 60 years and older. However, JADEP cardholders are still required to pay pharmacy-specific dispensary fees.

The NHF Card provides subsidies to any person of any age living in Jamaica diagnosed with any of 16 specified chronic illnesses, including diabetes, hypertension, and major depression. Dementia is not included as one of these illnesses and dementia medication is not subsidised under this programme (The National Health Fund, n.d.).

However, one study showed that only a small percentage of older persons participate in these programs. For JADEP, only 30 per cent of older persons were registered. Participation among persons in the higher socio-economic status groups was 170% higher than those in lower socio-economic groups. Likewise, only 39% of older persons utilised the NHF card.

There was also found to be significant disparity by education and socio-economic status among older persons who had a card versus those who did not. Older persons who were university-educated had a 220% higher likelihood of having an NHF card, even though the service is available to persons of all socio-economic status groups (Eldemire-Shearer et al., 2012).

There are several reasons that may account for this disparity to include the lack of awareness of such benefits, and lack of service providers in different communities. Though the NHF has reported an increase in NHF (2.6%) and JADEP (7.9%) enrolment for fiscal year 2017/18, there is an uneven distribution of pharmaceutical providers across the country. In fact, the Kingston Metropolitan Area and St. Catherine, which are mainly urban, had almost 50% of JADEP providers, with some parishes having only one provider.

References:

Bourne, P., Denise, E.-S., Paul, T. J., LaGrenade, J., & Charles, C. A. (2010). Public and private health care utilization differences between socioeconomic strata in Jamaica. Patient Related Outcome Measures, 81. https://doi.org/10.2147/prom.s11868.

Eldemire-Shearer, D., James, K., Waldron, N., Mitchell-Fearon, K. (2012). Older Persons in Jamaica. Available from: https://www.mona.uwi.edu/commhealth/sites/default/files/commhealth/uploads/EXECUTIVE%20SUMMARY.pdf

Government of Jamaica, Ministry of Health. (2014). Strategic Business plan 2015-2018. Available from: https://moh.gov.jm/wp-content/uploads/2015/07/Ministry-of-Healths-Strategic-Business-Plan-2015-2018.pdf

MOHW & PAHO. (2011). National Health Information System Assessment 2011, Jamaica. Available from: https://moh.gov.jm/wp-content/uploads/2015/07/FinalNHISAssessJAMReport.pdf

PAHO. (2017). Salud en las Américas+, Edición del 2017. Resumen: panorama regional y perfiles de país. Available from: https://iris.paho.org/handle/10665.2/34322.

The National Health Fund. (n.d.). In The National Health Fund. https://www.nhf.org.jm/