Jamaica is the largest English-speaking and third-largest island in the Caribbean, with an estimated total population of 2.73 million as of 2018 (STATIN, 2018). Between 2002 and 2018, Jamaica’s population saw a steady increase which peaked in 2016 and subsequently declined thereafter. This total population trend is consistent with that of males and females. Most of the population falls between age range 25-59 (47.4%), followed by 0–14-year-olds (21.0%), 15-24 (19.5%) and 60 years and older (13.2%) (STATIN, 2018).

References:

Statistical Institute of Jamaica (STATIN). (2018). Population statistics 2018. https://statinja.gov.jm/Demo_SocialStats/PopulationStats.aspx

Jamaica has a total surface area of 11,424 km² with a population density of 271 persons per square kilometre of land area (Inter-American Culture and Development Foundation, 2011). Jamaica is located 150 km south of  Cuba and 160 km west of Haiti. Volcanic in origin, Jamaica has three landforms: the eastern mountains, the central valleys, and plateaus, and a narrow, discontinuous coastal plain where agricultural production is concentrated. The Blue Mountain Peak, the island’s highest point, has an elevation of 2,256m and is famous for its coffee.

The island is divided into three counties – Cornwall, Middlesex, and Surrey – which are subdivided into 14 parishes (JIS, 2018). Each parish has a capital town, which is typically the centre of commerce. Two parish capital towns, Montego Bay in St. James, and Kingston, have city status. Kingston, located on the island’s southeast end, is Jamaica’s capital (JIS, 2018).

Jamaica’s 2011 population census estimated that approximately 54.0% of the population resides in urban areas, reflecting a growth in urban population rates of 7.2% compared to the previous census conducted in 2001. As of 2018, the largest proportion of the population lived in the Kingston and St. Andrew parishes (24.6%), with St. Catherine (the capital of which is Spanish Town) ranking second (19.0%) (STATIN, 2018). Recently regarded as an archipelagic state by the Maritime Areas Act, Jamaica’s territory extends beyond its coastline to comprise some 66 islands, rocks, and cays (JIS, 2018).

References:

Inter-American Culture and Development Foundation. (2011). Atlas of Cultural Heritage and Infrastructure of the Americas: Jamaica. http://www.jnht.com/documents/atlas_jm.pdf

Jamaica Information Service (JIS). (2018). Parish Profiles, Overview of Jamaica. Available from: https://jis.gov.jm/information/parish-profiles/

Statistical Institute of Jamaica (STATIN). (2018). End of Year Population by Parish. https://statinja.gov.jm/Demo_SocialStats/EndofYearPopulationbyParish.aspx

English is the official language of Jamaica. However, most Jamaicans speak a form of English Creole known as Patois, which is described as a mix between English and a variety of West African languages. Patois is spoken across all segments in Jamaica, but is particularly dominant in rural areas (JNHT, 2011).

The most recent Jamaican Census (2011) identifies the following ethnic/racial groups: Black, Chinese, Mixed, East Indian, White and Other (unspecified). Though the final draft of the questionnaire requested ethnicity information, reports on ethnicity were not published. Several attempts have been made to contact the Statistical Institute of Jamaica to provide the statistics on the distribution on ethnic/racial groups but have been unsuccessful.

Following the eradication of the indigenous Caribbean people, the transatlantic slave trade significantly increased the population with predominantly Africans (Beaubrun, 1992; Edwards, 2013; Hickling, 1988). It is estimated that over 90% of Jamaicans are of African descent. Other ethnic groups apart from Spanish and English settlers arrived on the island remain up to today part of Jamaican society and have contributed to its culture (JNHT, 2011). These groups include Jews, who fled to Jamaica following the Spanish inquisition. Following the British conquest of the island, they practiced openly and today they practice at the only Jewish house of worship in Jamaica, the Shaare Shalom Synagogue. East Indians, Chinese, and Germans  arrived as indentured (working without pay but in exchange for passage to another country) labourers following the emancipation of slavery in English colonies and have had an impact on cultural and commercial sectors.

Today, East Indian and Chinese communities can be seen integrated into African families. In the late nineteenth century, the Syrian/Lebanese community migrated to Jamaica in response to the Turkish oppression and have also made lasting contributions to industry in Jamaica (JNHT, 2011).

It is interesting to note the role of religion in Jamaican society. In 2010, Jamaica held the Guinness World Record for the country with the most churches per square mile. This is reflected in the political cache of the two main overarching religious organisations in Jamaica: the Jamaica Umbrella Group of Churches and the Jamaica Council of Churches.

Another cultural cornerstone of Jamaican culture is the Rastafarian group, an Afro-centric religious and political group which emerged in the 1930’s. Rastafarians (or Rastas) practice select Christian doctrine combined with African tradition. Socially, they have been a controversial and culturally powerful group, contributing to Jamaican art and creating reggae music, popularised by the late, great Rastafarian musician Bob Marley.

The mixing of these various groups gave rise to the country’s motto ‘Out of many, one people’ (JNHT, 2011).

References:

Beaubrun, M. H. (1992). Caribbean psychiatry yesterday, today and tomorrow. History of Psychiatry, 3(11), 371-382. https://doi.org/10.1177/0957154X9200301108

Edwards, D.J. (2013). Psychology bridge building in the Caribbean: A proposal. Interamerican Journal of Psychology, 47(2), 265-276.

Hickling, F. W. (1988). Psychiatry in the Commonwealth Caribbean: A brief historical overview. Bulletin of the Royal College of Psychiatrists, 12(10), 434-436. https://doi.org/10.1192/pb.12.10.434

Jamaica National Heritage Trust (JNHT). (2011). Jamaica National Heritage Trust – Jamaica. http://www.jnht.com/mission_function.php

Jamaica’s growth rate between 2002 and 2016 has gradually declined with a growth rate of 0.36% between 2002 and 2003 and 0.06% between 2015 and 2016. In fact, Jamaica experienced an overall negative population growth of -0.02% for 2016 to 2017 and -0.06% for 2017 to 2018. Important to note, the elderly age range, 60 and over along with age range 25-29, saw a positive growth between 2017 and 2018 (see table 1). Despite the overall negative growth in recent years, Jamaica’s population is projected to increase  from 2.7 million to 3.2 million in 2025 and 3.8 million in 2050 (STATIN, n.d.).

Table 1. Estimated growth rates, 2017-2018

Data Source: Adapted from the Statistical Institute of Jamaica, 2018

Changes in the population growth trends in the demographic structure of Jamaica are being influenced by continuing declines in fertility rates, and by an increase in mortality combined with high levels of external migration. Based on statistical trends, it is projected that by 2050, children will account for 20 per cent of the general population, representing a 57.4 per cent decline from 1970.

Total Fertility Rate:

After years of steady decline, Jamaica’s total fertility rate is now at two children per woman according to the State of the World Population 2018 report (The Gleaner, 2018).

Median age of the population

According to the CIA World Fact Book, the median age of Jamaicans is 28.6 years; for men it is 27.8 years and for women, 29.3 years (CIA World Factbook, 2019).

 References:

CIA World Factbook. (2019). Jamaica. https://www.cia.gov/the-world-factbook/countries/jamaica/

Statistical Institute of Jamaica. (2018). https://statinja.gov.jm/

The Gleaner. (2018, November 9). Two is enough – Ja continues to see steady decline in fertility rate | Lead Stories | Jamaica Gleaner. http://jamaica-gleaner.com/article/lead-stories/20181109/two-enough-ja-continues-see-steady-decline-fertility-rate

The population aged 60 years and over continues to grow. Within this group, there has been an increase from approximately 5.6 per cent in 1970 to 7.7 per cent in 2004 and it is projected to account for 18 per cent of the total population by 2050, which is close to the current size of the under 16 population (STATIN, 2017).

In 2017, it was estimated that 12.4% of Jamaica’s population were aged 60 and older (STATIN, 2017). As it is the case in most ageing societies, older women in Jamaica tend to live longer than their male counterparts (Eldemire-Shearer, 2008). More specifically, between 1995 and 2005, the growth rate of the female population, 65 years or older, was more than double that of males in this age group (UNFPA & HAI, 2011).

Furthermore, between 2013 and 2017, the number of women aged 75 and over outnumbered men aged 75 and over by an average of 25.6% (STATIN, 2017). It is also notable that the largest growth rate among older persons occurred among the 80+ group (Eldemire-Shearer et al., 2012; Eldemire-Shearer, 2008). This is in part due to increases in population life expectancy at birth, which in 2018 was estimated at 74.5 years for the total population- with a lower life expectancy for men (72.7 years) than women (76.5 years). It is therefore evident that Jamaica’s population is ageing and is experiencing an increase in the population of older women.

Total dependency ratio:

Ageing societies are often encouraged to pay attention to their dependency ratios, in order to monitor the potential economic impact of changing age and sex population structures. As of 2018, Jamaica recorded a total dependency ratio (persons younger than 15 or older than 64 compared to the working-age population, 15-64) of 48.25 % (The World Bank, 2019). This represents a minimal decrease from 2015, where the total dependency ratio was estimated at 48.7% (CIA, 2019).

Age dependency ratio:

In contrast, older persons dependency ratio  has steadily increased from approximately 13.1 (2010) to 13.8 (2015) as compared to the decrease in the youth dependency ratio of 41.7% (2010) to 34.9 (2015) (CIA, 2019).

References:

CIA. (2019). Central America: Jamaica — The World Factbook. https://www.cia.gov/the-world-factbook/countries/jamaica/

Eldemire-Shearer, D. (2008). Ageing: The Response Yesterday, Today and Tomorrow. Pp. 577–588.

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

Statistical Institute of Jamaica (STATIN). (2017). Total Population by Broad Age Groups and Parish, 2011. https://statinja.gov.jm/Census/PopCensus/TotalPopulationbyBroadAgeGroupsandParish.aspx

The World Bank. (2019). Jamaica. Available from: https://data.worldbank.org/country/jamaica

UNFPA and HelpAge International. (2011). Desk review: the situation of older persons in Jamaica (Issue July). https://caribbean.unfpa.org/sites/default/files/pub-pdf/Finalized_TheSitOlderPersonsInJamaica_UNFPA_030811-2_0.pdf.

The net population movement between 1965 and 2020 in 5-year intervals is presented below (IOM, 2018).

Table 2. Net Migration Rates (per 1000) in Jamaica

 Source: Adapted from (IOM, 2018). Net migration rates in Jamaica (table 1).

*Estimated

The net migration is calculated as the rate of the number of persons returning to the country (inflow) minus the rate of the number of persons leaving the same country (outflow). Higher levels of outflow than inflow, as indicated in the table above, results in negative rates. Jamaica’s trend indicates a dominant migration movement.

Internal Migration:

The 2011 Population Census revealed that 26.4% of the population lived outside their parish of birth. It also reported that 55% of internal migrants were female, with the majority in the 20 to 29-year age group (STATIN, 2017).

International Migration

Jamaican international emigrants primarily move to the United States of America, the United Kingdom, and Canada, often in search of jobs, higher education or to be with relatives. There are several Caribbean communities in these countries (such as Brixton in the United Kingdom) which are heavily influenced by Jamaican migrants. During 2013, a total of 24,744 persons migrated to these countries, which was 4.4% below the 2012 estimate (STATIN, 2017).

Returning migrants from these countries who return to Jamaica to retire in later life comprise an interesting segment of the local population. While they may bring with them some accumulated wealth and expertise, they may feel isolated having not lived at ‘home’ for several decades and may have difficulties adjusting, which is a common, internationally observed phenomenon among returning migrants (Govia et al., 2012).

The 2018 Migration in Jamaica country profile provided by the International Organisation for Migration (IOM, 2018), presents a thorough account of Jamaican immigration and emigration patterns, both historical and current. The IOM profile details that immigrants in Jamaica are classified either as voluntary returnees (returning residents), forced returnees (deportees), Commonwealth citizens and other foreign nationals or aliens. Between 2007 and 2011, all these categories of migrants totalled 56,508 as compared to 68,201 in the later period, 2012–2016. This reflected a sizeable increase of approximately 11,700 persons arriving in Jamaica for purposes of work and/or residence.

The IOM (2018) also details international and regional emigration patterns of Jamaicans. It notes that, at present, major destinations for Jamaicans are the United States, Canada, and the United Kingdom. Additionally, within the Caribbean region, major emigrant destinations include Trinidad and Tobago, Antigua and Barbuda, the Cayman Islands, the Bahamas, Sint Maarten (Dutch part of the island), Bermuda, and Curacao. The year 2006 saw an unusually high rate of emigration of over 29,000 persons, approximately 25,000 of which went to the United States.

Jamaican migrants to the United States were predominantly persons of working age, and persons under the age of 18, which is considered to contribute to the loss of potential from Jamaica’s workforce. Between this increase in 2006 and 2015, Jamaica saw a decrease in migrants to the United States, Canada, and United Kingdom.

The IOM (2018) report, therefore, reflects the phenomenon of ‘brain drain’ experienced by many Caribbean countries with regular emigration patterns of working aged persons who go abroad for education or better job opportunities and tend to stay there. Their home country then loses out on their economic contributions, expertise which otherwise may support country development and income taxes. This trend may also affect dependency ratios and fertility rates (Mishra, 2006).

For example, traditional migration patterns have resulted in emigration of health professionals to private institutions in Canada and the United States, which have had a  significant impact on the Jamaican health sector’s human resource capacity since the 1990s, creating gaps or deficiencies in the labour market (IOM, 2018).

In July 2019, the Minister of Health and Wellness indicated that Jamaica was in preliminary negotiations with Nigeria to help close the nursing gap, as well as in agreements with China, Cuba, and the UK to help meet the need for nurses and other healthcare professionals. In 2018, Jamaica lost 500 nurses to emigration, and in 2019, there was a need for at least 1,000 nurses across the public health system (Jamaica Observer, 2019).

References:

Govia, I. O. (2012). Angle of View: Heterogeneity within the Caribbean Community in the US, 2005-2007. Social and Economic Studies, 37-68.

IOM. (2018). Migration in Jamaica – A Country Profile 2018. Available from: https://publications.iom.int/books/migration-jamaica-country-profile-2018#:~:text=

Jamaica Observer. (2019). Managed Migration Strategy Needed to Mitigate Effects of Nursing Brain Drain. February 19, 2019. https://www.jamaicaobserver.com/columns/managed-migration-strategy-needed-to-mitigate-effects-of-nursing-brain-drain/

Mishra, P. (2006). Emigration and Brain Drain: Evidence from the Caribbean. IMF Working Papers, 06(25), 1. https://doi.org/10.5089/9781451862850.001

Statistical Institute of Jamaica (STATIN). (2017). Total Population by Broad Age Groups and Parish, 2011. https://statinja.gov.jm/Census/PopCensus/TotalPopulationbyBroadAgeGroupsandParish.aspx

Jamaica has carried out their National Health and Lifestyle Surveys since 2000, which  aim to provide current accurate estimates of Jamaicans’ health status across leading public health issues, including NCDs. Though there is no set schedule for the surveys, it has historically occurred approximately every decade. Much of the information for this section was taken from the third Jamaica Health and Lifestyle Survey (JHLS) (2016-2017) Preliminary Key Findings report (Ministry of Health Jamaica, 2018). The findings of the Jamaica Health and Lifestyle Survey-III were preliminary and as such exact percentages were not provided for all the major health issues Jamaicans face.

Hypertension

When compared to previous surveys, there has been a steady increase in the prevalence of hypertension among Jamaicans over 15 years of age, with 58.3% of males and 57% of females identified as having hypertension, (when defined as BP > 130/80mmHg00). This figure is up by just over 10% from the first JHLS conducted between 2000 and 2001 (Ministry of Health Jamaica, 2018).

Diabetes

Overall, between 2016-2017, the prevalence of diabetes among Jamaicans 15 years and older stands at 12%, with the most frequent incidence of diabetes occurring among Jamaicans 75 years and older (42 %). In addition, 12% of Jamaicans were found to have pre-diabetes, with a slightly higher prevalence rate found among women than men. The rate of diabetes increased from previous surveys conducted between 2007-2008, indicating an increase of approximately 4% over a ten-year period (Ministry of Health Jamaica, 2018).

Overweight and Obesity

More than half of Jamaicans (54%) were classified as overweight (pre-obese or obese) in 2016-2017. Approximately, two thirds of Jamaican women were classified as pre-obese, and women were disproportionately affected by obesity in comparison to Jamaican males. Jamaicans aged 35-64 years experienced the highest rates of pre-obesity and obesity (Ministry of Health Jamaica, 2018).

Mental Health – Depression

The major mental health measure used in the JHLS-III was depression. According to the survey, the prevalence of depression among  Jamaicans over 15 years of age stands at 14.3% (when depression was defined using the DSM-V criteria: presence of 5 or more depressive symptoms/suicidal ideation). The incidence of depression was highest among urban women (19.2%) and lowest among rural men (7.3%). The highest incidence of depression occurred among Jamaicans 75 years and older at 20.8%, indicating that older, urban women have the highest rates of depression in Jamaica (Ministry of Health Jamaica, 2018).

References:

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Tuberculosis (TB)

There were 1,659 notifications of suspected cases of tuberculosis between 2011 and 2015 in Jamaica. Of these, 32.6% were confirmed, with the highest confirmation rate (51.2%) in 2015. Most of the cases were in young adults (25–34 years old), with the fewest in the 5 to 14-year age group. In 2015, all age groups recorded an increase in cases, with an average of 114.7 new cases per annum from 2006-2015. Non-compliance and inadequate monitoring of Directly Observed Therapy, Short Course (DOTS), a strategy used to reduce TB prevalence, had a negative impact on treatment success rates (PAHO, 2017).

HIV/AIDS

PAHO also estimates Jamaica’s HIV prevalence to be at 1.6% among the general population. It also estimates that 29,000 persons are currently living with HIV in Jamaica, with approximately 16% of those persons being unaware of their status (PAHO, 2017). Between 1982 and 2015, 34,125 cases of HIV were reported to the Ministry of Health. Of these, 9,517 (27.9%) are known to have died (MOH, 2016).

PAHO also notes that Jamaica has improved its HIV prevention program with the adoption of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets and now provides increased access to treatment and care services (PAHO, 2017). However, factors such as inconsistent follow-ups, inconsistent condom use, and poverty have been found to be challenges to combating the epidemic (MOH, 2016).

Malnutrition

The 2016 Global Nutrition Report highlights that Jamaica saw success with only one of the global nutrition targets, reducing wasting in children. However, some progress is being made in meeting the targets of reducing stunting and overweight and achieving exclusive breastfeeding. Unfortunately, the country is yet to see success with reducing anaemia in women of reproductive age (International Food Policy Research Institute, 2016).

Other significant communicable diseases in Jamaica include vector-borne diseases, namely Dengue Fever, Chikungunya (CHIKV) and Zika virus (ZIIKV)

As of October 2019, there were 88 dengue-related deaths for 2019, almost double the amount recorded for 2018. A Dengue outbreak was declared on the island by Prime Minister Andrew Holness in January 2019, with 4,400 confirmed cases being reported by October 2019 (Statement of the Minister of Health Dr. The Hon, 2019).

CHIKV first emerged in Jamaica in 2014. During the JHLS-III between 2016 and 2017, the prevalence rate of CHIKV among Jamaicans was 48.8%; however, 8 out of 10 Jamaicans had a positive serum (blood) test for the disease. Zika emerged in Jamaica in 2016. Only 6% of Jamaicans reported that they had Zika, with the highest rate of self-reporting occurring within the 45-54-year-old age group (Ministry of Health Jamaica, 2018).

The top 3 leading causes of death in the English and Dutch speaking Caribbean between 2000-2016 were cerebrovascular disease, diabetes, and ischemic heart disease, which, collectively, accounted for 29.6% of all deaths over the period (CARPHA, 2017).

References:

Caribbean Public Health Agency (CARPHA). (2017). State of Public Health in the Caribbean Region 2014-2016: Building Resilience to Immediate and Increasing Threats: Vector-Borne Diseases and Childhood Obesity. Port of Spain, Trinidad and Tobago. https://carpha.org/Portals/0/Documents/State-of-Public-Health-in-the-Caribbean-2014-2016.pdf

International Food Policy Research Institute. 2016. Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Washington, DC.

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Ministry of Health Jamaica. (2016). HIV EPIDEMIOLOGICAL PROFILE 2015 , Facts & Figures Ministry of Health. https://moh.gov.jm/wp-content/uploads/2017/05/2015-Epi-Update-Revised-Final.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

Statement of the Minister of Health Dr. The Hon. Christopher Tufton on the Dengue Outbreak in Jamaica Parliament -. (2019, January 8). Jamaica Information Services. https://jis.gov.jm/speeches/statement-of-the-minister-of-health-dr-the-hon-christopher-tufton-on-the-dengue-outbreak-in-jamaica-parliament-8-january-2019/

According to the JHLS-III survey (2016-2017), unintentional injuries were the most common cause of injuries which required medical attention among Jamaicans. As per the universal trend, more men (1.8%) than women (0.4%) reported sustaining major injuries, including those sustained during road traffic accidents, which peaked among the 25–34-year-old age group (Ministry of Health Jamaica, 2018).

However, the prevalence of unintentional injuries not related to road traffic accidents were most prevalent among the 65–74-year-olds at 3.4% and were largely due to falls in both, the workplace and the home (Ministry of Health Jamaica, 2018).

Regarding violence, on average, almost 8% of Jamaicans 15 years or older have witnessed a violent act, with more men (8.8%) than women (6.9%) reporting this. In addition, more than half of Jamaicans 15 years and older had a history of child abuse, with 13% reporting experiences of daily abuse. 7.4% of Jamaicans reported a lifetime history of sexual abuse as well, mainly perpetrated by a neighbour, friend, or acquaintance (Ministry of Health Jamaica, 2018).

Elder Abuse

There is a dearth of information on the prevalence of elder abuse in Jamaica. Though the National Council of Senior Citizen (NCSC) has a toll-free number where individuals may report such cases, it has been reported that gathering this statistics relies exclusively on direct reporting via telephone. Additionally, there has been no consistent publication on elder abuse statistics, apart from what is reported by the NCSC. In 2015, there were 17 reported cases (14 females & 3 males). The actions taken following reported incidents were not reported (Eldemire-Shearer, et al., 2020).

STRiDE Jamaica contacted the NCSC in April 2020 to gather more recent data on elder abuse. It was reported that NCSC currently does not have the jurisdiction to handle cases of elder abuse and are only allowed to record, assess, and report such cases to law enforcement. NCSC outlines the reporting procedures as follows: after a report is made, a social worker arranges to visit the alleged residence of abuse and then completes an Elder Abuse Report form with the requisite information gathered from the assessment and observations made. Should the suspected abuse be confirmed, the social worker refers the case to law enforcement for further investigation. Other recommendations and referrals to other agencies, where applicable, are made to services such as the Victim Support Unit, Medication and Family Counselling, Mental Health Assessment, and inter alia may also be made by the Social worker.

In the event social workers are unable to enter the premises of a suspected victim due to perpetrator refusal, and, among others, the location and/or circumstances are dangerous, the case is automatically handed over to the police.

The STRiDE team anticipates that this injury landscape may have implications for issues like head injury and brain damage among the affected 65-74 year old age group, while the violence and mental health landscape may have implications for mental health of the population as it ages.

References:

Eldemire-Shearer, D., Willie-Tyndale, D., Robinson, C., McKoy Davis, J. (2020). Elder Abuse – An Examination of the situation in Jamaica. In: Shankardass, M. (eds). International Handbook of Elder Abuse and Mistreatment. Springer, Singapore. https://doi.org/10.1007/978-981-13-8610-7_10

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Jamaica’s GDP was estimated at $14.77 billion (official exchange rate), while the GDP – per capita (PPP) for the same year was estimated at $9,200.00 (CIA, 2019). According to the CIA World Factbook (2019), Jamaica’s economic growth reached 1.6% in 2016, but declined to 0.9% in 2017 following intense rainfall, which affected infrastructure and productivity. Economic growth is further impeded by the high unemployment rate which exacerbates the crime problem, along with gang violence fuelled by advanced fee fraud (lottery scamming) and the drug trade. The slow economic growth rate of on average less than 1% per year for the last three decades has also been accredited to high public sector corruption, bureaucracy, and high debt to GDP ratio.

However, the most recent Fiscal Policy Paper 2020-2021, reports that Jamaica has significantly improved under the IMF-supported Extended Fund Facility and Precautionary Stand-by programmes. Notably, Jamaica’s real GDP growth rate by the end of fiscal year 2017/2019 (Government of Jamaica, 2020). Growth is projected to be at .6% in 2020/2021.

Despite this growth and favourable projection, the economy is currently impacted by the COVID-19 pandemic. The Planning Institute of Jamaica (PIOJ) projects that for fiscal year 2019/2020, growth of the Jamaican economy will decline by 0.6% in light of COVID-19 (PIOJ, 2020).

References:

CIA World Factbook. (2019). Jamaica. https://www.cia.gov/the-world-factbook/countries/jamaica/

Government of Jamaica. (2020). Fiscal Policy Paper 2020-2021. Ministry of Finance and the Public Service. Available from: https://www.mof.gov.jm/wp-content/uploads/fiscal-policy-paper-2020-21-140220.pdf

Planning Institute of Jamaica (PIOJ). (2020). The Planning Institute of Jamaica’s Review of Economic Performance, January–March 2020. Media Brief, May 27th, 2020. https://www.pioj.gov.jm/wp-content/uploads/2020/05/DGs_QPB_244-speaking-notes-revised-27-5-20-FINAL_1.pdf

The composition of Jamaica’s economy is described as two main sectors: Goods Producing Industries and Service Industries as illustrated in table 4. The economy is heavily dependent on services, (including government activities, communications, transportation, finance and all other private economic activities that do not produce material goods) accounting for more than 70% of total GDP (CIA World Factbook, 2019). Jamaica also gains most of its foreign exchange from tourism, remittances, and bauxite/alumina.

Economic Performance for the period April to September 2019

The 2020/2021 Fiscal Planning Policy revealed that Jamaica GDP grew by 1.0% for the first half of fiscal year 2019/20. Highlighting a reduction in the pace of growth relative to the 2.1% achieved for the corresponding period of fiscal year 2018/19 (table 4) (Government of Jamaica, 2020). The government attributes the economic expansion to improvements in the Service industries.

The Goods Producing industries contracted by 0.2%. Under this sector, Agriculture, Forestry and Fishing industry declined as a result of adverse weather-related conditions (drought followed by heavy rains), this impacted the island between June and October 2019. Mining and quarrying also declined due to the temporary closure of the JISCO (Alpart) refinery, the construction industry declined in civil engineering activities and infrastructural developments related to road rehabilitation, water supply improvement and power plant construction. An increase in construction of residential and non-residential buildings tempered the fallout.

The Manufacturing industry registered a growth of 4.1%, led by the Food, Beverages, and Tobacco (1.2%) and Other Manufacturing (8.4%) components (Government of Jamaica, 2020).

The Services industry recorded growth of 1.5% with hotels, restaurants and financial services being the lead contributors. Hotels and Restaurants grew by 4.3%, primarily as a result of a 14.1% increase in the number of foreign national visitors, which outweighed a decline in the average length of stay. Finance and insurance services recorded a growth of 3.8% (Government of Jamaica, 2020).

Table 4: Change in Value Added by Industry at Constant (2007) Prices (%)

Source: Fiscal Policy Paper 2020-2021, Ministry of Finance

References:

CIA World Factbook. (2019). Jamaica. https://www.cia.gov/the-world-factbook/countries/jamaica/

Government of Jamaica. (2020). Fiscal Policy Paper 2020-2021. Ministry of Finance and the Public Service. Available from: https://www.mof.gov.jm/wp-content/uploads/fiscal-policy-paper-2020-21-140220.pdf

Jamaica’s public debt-to-GDP ratio has steadily declined. By the end of fiscal year 2018/2019, Jamaica’s debt-to-GDP was at 94.4%, making this the first time in two decades that its debt-to-GDP ratio has fallen below 100% (JIS, 2019). Jamaica’s private debt-to-GDP ratio is not publicly available following literature searches of relevant publications by the Ministry of Finance or publications from the Financial Service Sector.

References:

Jamaica Information Service (JIS). (2019). Debt-to-GDP Ratio to Fall to 96 Per Cent at the End of 2018-2019. Published on the 8^th of March 2019. Available from: https://jis.gov.jm/debt-to-gdp-ratio-to-fall-to-96-per-cent-at-end-of-2018-19/

As of 2017, 19.3% of the Jamaican population lived below the poverty line (see table 5) (STATIN, 2018) with a GINI coefficient of 35- placing Jamaica at a global ranking of 97 for this measure (CIA, 2019). Additionally, Jamaica’s inequality income was reported at 32% in 2018 as compared to the regional average of 34% (UNDP, 2019).

Table 5: Poverty Incidence by Region

Source, Statistical Institute of Jamaica, 2018, https://statinja.gov.jm/living_conditions_poverty.aspx

References:

CIA. (2019). Central America: Jamaica — The World Factbook. https://www.cia.gov/the-world-factbook/countries/jamaica/

Statistical Institute of Jamaica (STATIN). (2019). Living Conditions and Poverty: Table Incidence of Poverty by Region: 1994-2014. Available from: https://statinja.gov.jm/living_conditions_poverty.aspx

UNDP. (2019). Human development Report 2019: Beyond Income, Beyond Averages, Beyond Today: Inequalities in Human Development in the 21^st century. Available from: https://hdr.undp.org/content/human-development-report-2019

The Jamaica Office of Disaster Preparedness and Emergency Management (ODPEM) (2008) acknowledges the island’s vulnerability to environmental disasters such as hurricanes, earthquakes and floods as is the case for many Caribbean islands due to their small size or geographic location in relation to the region’s hurricane belt. The ODPEM also notes that the risk of natural disaster is further compounded by issues such as poverty, environmental degradation and poorly constructed housing and infrastructure. Jamaica’s experience of natural disaster can hinder and undermine its development due to the economic and social impact (PAHO, 1994).

A natural disaster can damage or destroy homes, businesses, schools, hospitals, hotels, and infrastructure like roads and electricity poles. It may impact a country’s rate of homelessness, unemployment, agriculture, imports and exports, and tourism. For example, the PIOJ (2013) report on the economic impact of Hurricane Sandy estimated that the total cost of direct and indirect damage caused was at $107.14 million USD. Banana farmers in 3 parishes lost between 93% and 100% of their crops that year; 8,000 cruise ship passengers were redirected away from scheduled docks on the island and 291 injuries were reported, as well as one fatality, which was an older person.

References:

PAHO. (1994). A World Safe from Natural Disasters: The Journey of Latin America and the Caribbean. Available from: https://iris.paho.org/bitstream/handle/10665.2/34151/9275121141-eng.pdf?sequence=1&isAllowed=y

Planning Institute of Jamaica (PIOJ). (2013). Damage and Loss Assessments: 2013 PIOJ Report Hurricane Sandy. Available from: https://www.pioj.gov.jm/product/damage-and-loss-assessments-2013-pioj-report-hurricane-sandy/

The Labour Force Statistics for October 2019 indicated an unemployment rate of 7.2%, compared to 8.7% in October of 2018. This is a historic low for Jamaica. The unemployment rate for both females (down 2.7%) and males (down 0.4%) showed improvement. Youth unemployment also decreased. In October 2019, most males within the labour force (21.75%) worked within the Agriculture Hunting Forestry and Fishing industry, followed by Wholesale and Retail Repair of Motor Vehicle and Equipment (17.17%), and Construction (14.73%). Within the same time period, the majority of women (22.28%) worked in the Wholesale and Retail Repair of Motor Vehicle and Equipment industry, followed by the Hotel and Restaurant Services industry (11.89%) and Education (9.79%) (see table 6).

Table 6: Jamaican Labour Force by Industry and Gender (October 2018 and October 2019)

Source: Fiscal Policy Paper, 2020-2021; STATIN, 2019

COVID-19 and Employment:

The Government of Jamaica, with assistance from the Private Sector of Jamaica (PSOJ) is responding to the COVID-19 pandemic with the largest stimulus package in the history of Jamaica of 25 billion dollars. Of that amount, a 10 billion spending stimulus is being used to facilitate the novel COVID Allocation of Resources for Employees (CARE-) Programme, a temporary cash transfer programme to individuals and businesses. The programme has 9 components targeting specific industries:

1. SET Cash – Supporting Employees (with) Transfer of Cash
2. BEST Cash – Business Employee Support and Transfer of Cash
3. COVID-19 General Grants
4. COVID-19 Compassionate Grants
5. COVID-19 Path Grants
6. COVID-19 Small Business Grants
7. COVID-19 Tourism Grants
8. COVID-19 Student Loan Relief
9. Other COVID-19 Support Programmes.

The Minister of Finance Dr the Honourable Nigel Clarke reports that since applications opened on April 9, 2020, over 400,000 Jamaicans have successfully applied for one or more of the 9 components by April 20, 2020. Between the announcement of Jamaica’s first COVID-19 case on March 10, 2020 and April, 2020, approximately 46,948  persons reported that they were laid off and subsequently applied for the SET Cash programme. This programme requires employers to verify that employees were laid off (Jamaica Observer, 2020). As suspected and due to incoming flight restrictions, the tourist sector has been impacted the greatest. In fact, the majority of the SET Cash programme applicants were from St. James and St. Ann, Jamaica’s main tourist destinations.

References:

Government of Jamaica. (2020). Fiscal Policy Paper 2020-2021. Ministry of Finance and the Public Service. Available from: https://www.mof.gov.jm/wp-content/uploads/fiscal-policy-paper-2020-21-140220.pdf

Jamaica Observer. (2020, May 14). JHTA working with Gov’t to resolve SET Cash programme delays – Jamaica Observer. https://www.jamaicaobserver.com/news/jhta-working-with-govt-to-resolve-set-cash-programme-delays/

Statistical Institute of Jamaica. (2019). Main Labour Force Indicators. Available from: https://statinja.gov.jm/LabourForce/NewLFS.aspx

Research spearheaded by the Inter-American Development Bank (2006) on the informal economy in Jamaica (the informal economy referring to pure tax evasion, the irregular economy, and illegal activities) found that these activities represented 40% of the official GDP in 2001. This growth  is considered to have contributed significantly to the decline in poverty during that decade.

It is important to note that this growing sector represents a diverse group of enterprises and workers in Jamaica, ranging from small-farm workers, retail sale people, street vendors, domestic helpers, taxi drivers, and local peddlers to fairly sophisticated small to medium entrepreneurs, as well as to illicit drug farmers and transport providers. Persons engaged in this sector often are unable to access pensions, social support, or insurance in later life (Jamaica Gleaner, 2016).

COVID-19 and the Informal Economy

Applicants of the Compassionate Grant programme, who receive a one-time payment of J$10,000.00, accounted for over 83% of the total CARE programme applications. Programme eligibility includes the unemployed (not laid-off due to COVID-19), informally employed, older people and students over 18 (CARE Brochure, 2020). Speaking to the large number of applicants for this component of the CARE Programme, the Minister of Finance, Nigel Clarke asserted that Jamaica’s economy is largely informal, which depends on meeting people physically for goods and service in exchange for cash payment. As a result, physical distancing will disproportionately affect the informal economy (Jamaica Observer, 2020).

Table 7. Summary of Jamaica’s Economic Performance

Source: Ministry of Finance, Fiscal Policy Paper, 2020-2021

References:

Government of Jamaica. (2020). Fiscal Policy Paper 2020-2021. Ministry of Finance and the Public Service. Available from: https://www.mof.gov.jm/wp-content/uploads/fiscal-policy-paper-2020-21-140220.pdf

Jamaica Observer. (2020, May 14). JHTA working with Gov’t to resolve SET Cash programme delays – Jamaica Observer. https://www.jamaicaobserver.com/news/jhta-working-with-govt-to-resolve-set-cash-programme-delays/

Ministry of Finance and Public Service. (2020). CARE: COVID-19 Allocation of Resources for Employees. https://jis.gov.jm/media/2020/04/CARE-Brochure-Ministry-of-Finance-2020.pdf

Brief overview of social protection schemes implemented by the government

The welfare system in Jamaica largely falls under the purview of the Ministry of Labour and Social Security’s (MLSS) Public Assistance Division. The mandate of this division is to provide assistance to Jamaicans who are poor and/or vulnerable, including children, unemployed or underemployed adults, older persons, differently abled persons, pregnant and lactating women and disaster victims (MLSS, 2018).

Public Assistance Programmes constitute 4 types of grants: Rehabilitation Assistance Grant, Compassionate Assistance Grant, Emergency Assistance Grant, and the Education and Social Intervention Grant. These grants are administered through each of the Ministry of Labour & Social Security Parish Offices, while assessment and intervention are required by designated social workers to determine eligibility (MLSS, 2018).

According to a situational analysis by the PIOJ (2018), other social protection schemes include:

• Poor Relief Programme provided by the Ministry of Local Government and Community development, which offers cash and in-kind transfers to Registered Poor persons
• Economic Empowerment Grant provided by the Jamaica Centre for persons with disabilities
• School Feeding Programme provided by the Ministry of Education
• Fee waivers for public secondary school tuition provided by the Ministry of Education
• Fee waivers for public sector health care provided by the Ministry of Health.

Brief overview of social protection schemes implemented by development partners or international

Programme of Advancement through Health and Education (PATH) (provided by the MLSS). According to a summary provided by the Overseas Development Institute (2006), PATH is a Conditional Cash Transfer (CCT) programme providing cash transfers to poor families, who are subject to comply with conditions that promote the development of the human capital of their members. Established in 2001 as part of a wide-ranging restructuring of the Jamaican welfare system carried out by the government in partnership with the World Bank, PATH aims to replace former mechanisms like food stamps, outdoor poor relief (programme that assists persons living in the streets or who have a residence but are experiencing challenges acquiring basic necessities)  public assistance with one CCT programme.

In 2014, 64,355 persons 60 years and older from families deemed eligible for PATH and who were not already in receipt of a National Insurance (NIS) pension were registered for the programme. For the financial year 2011-2012, 57,644 older people benefited from PATH, accounting for 15.5% of the programme’s total beneficiaries, making older persons the second largest category of recipients after children (MLSS, 2018).

The PIOJ developed Jamaica’s Social Protection Strategy with the aim of addressing the various obstacles to population-wide adequate living standards via a Social Protection Floor in order to help provide universally for all citizens while offering safety nets for the most vulnerable (PIOJ, 2018).

For older people, strategies also span transformative, promotive, and protective interventions to encourage social inclusion and economic growth in an environment that facilitates both state support (such as institution of social pensions for a targeted segment of older persons) and market alternatives for social security (PIOJ, 2014).

COVID-19 and Social Protection for the Elderly:

COVID-19 grants announced benefit older persons and carers. Specifically, JMD$150 million was dedicated to the Ministry of Local Government. A portion of this will be used to provide food, medicine, and basic necessities to those living in infirmaries where 90% of its residents are over the age of 65. As of March 25 2020, funds have been used to distribute 2,000 care packages and 1,800 sanitisation packages.

References:

Ministry of Labour and Social Security (MLSS). (2018). National Policy for Senior Citizens (Green Paper) 2018. https://opm.gov.jm/wp-content/uploads/2018/05/Green-Paper-National-Policy-for-Senior-Citizens-1-1.pdf

Planning Institute of Jamaica (PIOJ). (2018). National Policy on Poverty and National Poverty Reduction Programme: Government of Jamaica, 2017. Available from: https://www.pioj.gov.jm/wp-content/uploads/2019/09/NationalPolicyOnPovertyNationalPovertyReductionProgramme

The country is a parliamentary democracy with a bicameral legislature and party system, based on universal adult suffrage (Commonwealth Secretariat, 2019).

According to the Jamaica Information Service (2015), Jamaica’s national policies and programs are directed by its National Development Plan – Vision 2030 Jamaica. The plan has four (4) National Goals, each with several sub-goals. These goals are to ensure that:

• Jamaicans are empowered to achieve their fullest potential.
• The Jamaican society is secure, cohesive and just.
• Jamaica’s economy is prosperous.
• Jamaica has a healthy natural environment (JIS, 2015).

References:

Commonwealth Secretariat. (2019). Constitution of Jamaica. Available from: https://www.commonwealthgovernance.org/countries/americas/jamaica/constitution/

Jamaica Information Service (JIS). (2015). A Vision for Jamaica: National Vision Statement. Available from: https://jis.gov.jm/media/A-Vision-for-Jamaica.pdf

Jamaica’s political system is largely based on that of England, which held colonial rule of the island for over 300 years before Jamaica won its independence in 1962. The system of governance is a constitutional monarchy or limited monarchy under which The Queen, represented by a Governor-General, is head of state (JIS, 2016).

References:

Jamaica Information Service (JIS). (2016). Overview of the Government of Jamaica. Available from: https://jis.gov.jm/features/overview-government-jamaica/

Jamaica has two major political parties – the People’s National Party (PNP) and the Jamaica Labour Party (JLP). There is a history of political violence between supporters of opposing parties. The Hon. Andrew Holness is currently Jamaica’s ninth sitting Prime Minister, following the victory of the Jamaica Labour Party at the polls in 2016. The next general election in Jamaica is due in 2021.

Transparency International (2018) ranks Jamaica as 68^th out of 180 countries and scores Jamaica at 44/100 on the Transparency International scale. (This score indicates the perceived level of public sector corruption, with 0 being highly corrupt and 100 being very clean).

References:

Transparency International. (2018). Corruption perceptions index. Available from: https://www.transparency.org/en/cpi/2018

According to the World Bank 2017 aggregated measures, Jamaica appears to rank within the 50-60^th percentile worldwide on the Political Stability and Absence of Violence/Terrorism scale.

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/

PAHO (2017) also notes that there is a large private health sector in Jamaica with primary and secondary care facilities and diagnostic services, such as radiology. In 2015, there were 10 private hospitals with approximately 200 beds. Referrals between the public and private sector facilities remain a feature of service delivery, particularly for diagnostic and therapeutic care.

As in many other developing nations, higher income persons are more likely to access and utilise private healthcare services, while lower income health care users tend to use the cheaper, public health option via primary health centres or relevant programme, with persons moving between sectors based on the severity of their health status.

For example, research using data from the Jamaica Survey of Living Conditions over a fifteen-year period (1993-2007) showed that wealthier Jamaicans with higher incomes utilised 62.2% more private health facilities than poorer Jamaicans. However, the study also estimated that during this time, private health care demand declined from 54.0% in 1989 to 51.9% in 2007, due to economic downturn experienced in the decade before (Bourne et. al., 2010).

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

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

In the Ministry of Health’s Strategic Business Plan (2015-2018), access to healthcare services is listed as a strategic policy priority, while improving access to specialised health services and appropriate technology in health, including for vulnerable groups, is listed as a strategic objective. Some objectives for improving access to health care, including access to information on key health issues, have been accomplished. For example, the plan reports that sign language training programmes for health centre staff were completed between 2016-2017, along with sensitisation workshops and a project to improve accessibility of health facilities for the differently abled.

Some health programmes, such as JADEP and the NHF Health Card are accessible via registration, and JADEP, for example, has eligibility criteria (persons must be over 60 years old to qualify). However, all persons have access to public health care facilities, although there may be long wait times or delays in services. Nevertheless, those with health insurance coverage are more likely to access health services. Additionally, Jamaican male ‘macho’ culture may impact the higher use of health care services among females than males (Bourne et al., 2010).

The first port of call for persons if they don’t feel well in Jamaica, barring accidents and emergencies for which persons are likely to access the A&E departments of the closest public hospital, may be their private GP (for those accessing private health care), or a nurse at their community health centre (for those accessing public health care) (Bourne et al., 2010).

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

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

The Ministry of Health and Wellness Policy and Procedures Manual (2016) for referrals within the health care system, indicates that there is a bidirectional relationship in referrals between Primary, Secondary, and Tertiary Care. Though most referrals take place from primary upwards, there are occasions when there are referrals from tertiary or secondary care downwards.  Nonetheless, primary care is the first level of contact and acts as a gatekeeper system for access to secondary and tertiary care in the public health system.

References:

Ministry of Health Jamaica. (2016). Policy and Procedure Manual for the Referral and Transfer of Patients. Available from: https://moh.gov.jm/wp-content/uploads/2016/11/Revised-MOH-Policy-and-Procedure-Manual-for-the-Referral-and-Transfer-of-Patients-22.09.16.pdf

Jamaica has moved towards universal healthcare within the last decade, with a focus on health system strengthening and improved access to services. MOHW (2019) notes that the no-user-fee policy, introduced in 2008, reversed the policy of fees for hospital care. However, this policy of universal healthcare is currently under review by the government (MOHW, 2019).

Potential barriers to health care include geographical location, such as living in a rural area with limited access to facilities; the ‘macho ’ culture in Jamaica which may discourage men from accessing or utilising health care services (Ministry of Health Jamaica, 2018), as well as a reluctance to seek help if illness may result in losing one’s job, a reluctance to seek help for highly stigmatised illnesses like HIV/AIDS or mental illness, (particularly in rural areas) and poverty, which may cause situations where even free public health care cannot be accessed due to lack of money to cover transport costs, costs for medication or for referral to the private sector (Bourne et al., 2010).

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

Ministry of Health and Wellness (MOHW). (2019). Vision for Health 2030: Ten Year Strategic Plan 2019-2030. Available from: https://www.moh.gov.jm/wp-content/uploads/2019/05/MOHW-Vision-for-Health-2030-Final.pdf

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. Available from: https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

According to the CIA World Factbook (2019), health expenditure for Jamaica amounted to 5.4% of GDP in 2014. The health system is financed by allocations made within the country’s national budget and the National Health Fund (NHF), which is an agency of the Ministry of Health established in 2003 by the National Health Fund Act. The NHF derives monies from multiple sources, including 20% of Special Consumption Tax charged on Tobacco Products (NHF, n.d.). The health system is also financed via private-public partnerships. In 2011, Jamaica’s private insurance expenditure on health per capita was 11.7% of the total health expenditure per capita in comparison to general government expenditure on health (54%) and out-of-pocket spending on health per capita (32.5%) (Class, et al., 2014). The Regional Health Authorities receive funding allocations from the Ministry of Health and Wellness.

References:

CIA World Factbook. (2019). Jamaica. https://www.cia.gov/the-world-factbook/countries/jamaica/

Class, D., Cavagnero, E., Rajkumar, S., Ferl, K., & Chao, S. (2014). HEALTH FINANCING PROFILE – JAMAICA, 2–5. Available from: http://documents.worldbank.org/curated/en/360521468283472404/pdf/883420BRI0P1230a0final0January02014.pdf

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

Only 20% of Jamaicans have either private or public health insurance, the majority of which are public sector workers (MOHW, 2019). This leaves 80% of the population, or approximately 2 million Jamaicans totally uninsured (Ministry of Health and Wellness NIHP Green Paper, 2019). It is not surprising then that in 2016, approximately 32% of Jamaicans reported that they were unable to access healthcare when they needed it due to the financial strain (JIS, 2019).

In terms of older Jamaicans, the National Council for Senior Citizens’ National Policy (Green Paper) (Ministry of Labour and Social Security, 2018) noted an improvement in the number of older persons with health insurance, which increased from 4% in 1995 to 23% in 2012, according to results from the Senior Citizens module of the 2012 Jamaica Survey of Living Conditions report (PIOJ, 2012). However, only 10% of persons in the lowest consumption group reported having health insurance coverage. The policy also noted that with 72% of the population having chronic illnesses, there needs to be better coverage of health insurance among older Jamaicans.

Of those who were covered by health insurance, most of this coverage came from the private sector. Only 3.8% of persons with health insurance were covered by the National Insurance (NIS) contributory scheme. Additionally, former Government employees were more likely to have insurance (compared with persons who had been self-employed).

With regards to pension coverage, the 2012 survey data shows that 64,1% of older persons benefitted from NIS pension. this represents a five-fold increase from 13.6 per cent reported in 1995. There was no real difference by gender, region, or age group noted. In 2014, a total of 103,158 persons benefited from NIS with 74 per cent (76,036) categorised as old age pension recipients.

For occupational pension plans, just over 48.0 per cent of older population who received a pension received less than $10,000.00 per month while 13.2 per cent of pensioners received $60,000.00 or more per month. More males than females received pensions of $60,000 or more. The greatest proportion of persons receiving occupational pensions was in the Kingston Metropolitan Area, while the lowest was in the Rural Areas (PIOJ, 2012).

References:

Ministry of Health and Wellness (MOHW). (2019). The Intervention. Available from: https://jis.gov.jm/media/2019/05/Sectoral-2019_Tufton-Speech-version_final.pdf

Ministry of Health and Wellness NIHP Green Paper. (2019). Green Paper on National Health Insurance Plan for Jamaica. Available from: https://www.moh.gov.jm/wp-content/uploads/2019/05/NHIP-Greenpaper-2019-Edited-7_5_19-Final.pdf

Ministry of Labour and Social Security. (2018). National Policy for Senior Citizens (Green Paper) 2018. https://opm.gov.jm/wp-content/uploads/2018/05/Green-Paper-National-Policy-for-Senior-Citizens-1-1.pdf

PIOJ. (2012). Executive Summary: JSLC. In Jamaica Survey of Living Conditions.

According to the Ministry of Health’s Strategic Business Plan (2015-2018), a strategic government priority is a Health Financing Programme which seeks to ensure that ‘while Jamaica is addressing its macroeconomic and fiscal challenges, also promotes policy dialogue on options and best practices in developing health financing systems that support moving towards universal health coverage (UHC) and identifying the main difficulties to guarantee the sustainability of this coverage.’ This may include strategies such as an increase in private-public partnerships including donations and health foundations.

Like many other countries in the region, Jamaica’s health system receives financing from partnership with the InterAmerican Development Bank (IDB). Notably, in April 2019, the Ministry of Health and Wellness received a US$100 million-dollar loan from the IDB to support a programme for the strengthening of the Jamaican health system via upgrades of five hospitals and ten health centres across the island over the next five years, dubbed the ‘Health Systems Strengthening for the Prevention and Care Management of NCDs Programme.’

On May 7, 2019, the Minister of Health and Wellness, Dr. the Honourable Christopher  Tufton tabled the National Health Insurance Plan (NHIP) Green Paper in the House of Representatives (JIS, 2019). The matter of a national health insurance scheme for Jamaica has been on the political agenda for over 50 years and was tabled twice in parliament, once in 1974 and again in 1997, but it was never implemented, partly due to the country’s economic challenges (Jamaica Observer, 2019).

However, with the improved state of the economy and heightened awareness of the value of healthcare, as well as the international evidence-based support for universal health coverage, the Ministry of Health and Wellness, in partnership with the Caribbean Policy Research Institute, has launched a rationale for its implementation over the next few years.

This includes the importance of the scheme in assisting with poverty mitigation, improving national productivity rates, and increasing individual opportunity for investment . The first order of business in ensuring that the NHIP becomes a reality this time around is consensus on key points, including which benefits the scheme will cover, a suitable, sustainable financing mechanism and a decision on which segments of the population will have access to its benefits. These issues will be discussed during a series of Green Paper Consultations (Ministry of Health and Wellness NIHP Green Paper, 2019).

References:

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

Jamaica Information Service (JIS). (2019). Dr. Tufton Tables National Health Insurance Plan Green Paper. Available from: https://jis.gov.jm/dr-tufton-tables-national-health-insurance-plan-green-paper/

Jamaica Observer. (2019). National Health Insurance – a game-changer whose time has finally come? https://www.jamaicaobserver.com/columns/national-health-insurance-a-game-changer-whose-time-has-finally-come/

Ministry of Health and Wellness NIHP Green Paper. (2019). Green Paper on National Health Insurance Plan for Jamaica. Available from: https://www.moh.gov.jm/wp-content/uploads/2019/05/NHIP-Greenpaper-2019-Edited-7_5_19-Final.pdf

Health funding is decided along with the compilation of the country’s national expenditure and revenue estimates, which is presented by the Minister of Finance for parliamentary approval at the start of each financial year (JIS, 2018).

References:

Jamaica Information Service (JIS). (2018). About the budget debate. Available from: https://jis.gov.jm/government/budget-watch/about-the-budget-debate/

The country’s budget is prepared under the direction of the Financial Secretary. This is followed by the Budget Debate, which provides the Government an opportunity to take stock of its performance over the previous fiscal year (April to March of the following year) to measure its progress in relation to targets previously set and to assess the effectiveness of its management of the country’s finances.

After the Minister of Finance has presented the Budget and made his opening address, the House of Representatives create the Standing Finance Committee to study the Budget and make recommendations. When the Debate closes, the House passes an Appropriation Act, which gives the Government the authority to operate the Budget. After the House of Representatives has passed the Appropriation Act, the Act goes to the Senate for approval (JIS, 2018).

References:

Jamaica Information Service (JIS). (2018). About the budget debate. Available from: https://jis.gov.jm/government/budget-watch/about-the-budget-debate/

The government uses revenues from the previous year to fund each fiscal year. Government revenues are earned from taxation, non-tax revenue, capital revenue, grants, and loan receipts (PWC, 2019).

References:

PWC. (2019). Jamaica: 2019/2020 Budget: Pursuing growth with equity. Available from: https://www.pwc.com/jm/en/services/tax/pdf/pwc-jamaica-2019-20-budget-newsletter.pdf

Please refer to 02.02.02.01.

Private insurance markets are regulated by the Insurance Act (2001). This act applies to all insurance intermediaries and all insurers, whether established in or outside of Jamaica that carry on in Jamaica, these include:

1. Ordinary long-term insurance
2. Property insurance
3. Accident insurance
4. Liability insurance
5. Pecuniary insurance
6. Motor vehicle insurance
7. Marine, aviation, and transport insurance
8. Industrial life insurance
9. Sickness and health insurance
10. Other classes of insurance business as may be prescribed by the Minister by order, subject to affirmative resolution.

Regarding sickness and health insurance, eligibility is decided based on the insurance company. However, the Insurance Act stipulates that making or permitting any unfair discrimination between persons will be a violation of the act and deemed as unfair trade practices. Health claims paid are determined by the contract.

Please refer to 02.02.02.01.

Remittances play an important role in financing individual and community health care resources in Jamaica. For example, in 2018, approximately $5 million dollars (JMD) was raised for the Ministry of Health by the Diaspora in the United Kingdom (UK) group, as  part of the High Commission’s Adopt-A-Clinic initiative. The initiative seeks to encourage persons to utilise community health facilities by ensuring that the facilities have necessary personnel and equipment, and are attractively furbished. Other individuals and charities also raised funds and donated equipment under the UK project, which then facilitated the adoption of at least five clinics across the island (Jamaica Observer, 2018).

References:

Jamaica Observer. (2018). Latest News. https://www.jamaicaobserver.com/latest-news/

In October, 2019, ground was broken for the commencement of work to build a $43m US Children’s and Adolescent Hospital; a gift from the People’s Republic of China, set to be the largest facility of its kind in the Caribbean (JIS, 2019).

According to the Jamaica Government Information Service, between 2005 and 2017, Jamaica has been in partnership with countries such as Nigeria, Cuba, and China in order to help support the local healthcare system. For example, in 2005, under a technical cooperation agreement between the Government of Jamaica and the  Republic of Nigeria, the Clarendon health sector received allocation of the services of eight Nigerian nurses (JIS, 2005).

The health sector also benefited from an agreement between the Jamaican and Cuban Ministries of Health aimed at providing improved eye care (JIS, 2012). Over 66,000 Jamaicans received free eye screenings and over 9,000 patients received free eye surgeries under this arrangement. In addition, 45 nurses and 19 specialist doctors from Cuba were deployed throughout the island in 2012 (JIS, 2012). Jamaica extended its country-to-country partnership in eye care in 2017 with its adoption of the Chinese Bright Journey Medical Mission, which was expected to provide hundreds of Jamaicans with free cataract surgery that year (The Gleaner Jamaica, 2018).

COVID-19 and Cuba’s Donation:

As a symbol of the continued support from Cuba during times of crises, on March 21, 2020, 140 Cuban medical professionals arrived in Jamaica to support the island’s national response efforts for COVID-19. The team consisted of 90 specialist nurses, including for critical care, emergency, medical, surgical, and primary care, 46 doctors, including internists and haematologists and 4  therapists.

References:

Jamaica Information Service (JIS). (2005). Clarendon Health Sector Benefiting from the Services of Nigerian Nurses. Available from: https://jis.gov.jm/clarendon-health-sector-benefiting-from-the-services-of-nigerian-nurses/

Jamaica Information Service (JIS). (2012). Jamaica Grateful for Cuba’s Support on Healthcare. Available from: https://jis.gov.jm/jamaica-grateful-for-cubas-support-in-healthcare/

Jamaica Information Service. (2019). Ground Broken for Western Children and Adolescents Hospital. Available from: https://jis.gov.jm/ground-broken-for-western-children-and-adolescents-hospital/

The Gleaner Jamaica. (2018). Hundreds to get free cataract surgery from Chinese medical mission. Available from: https://jamaica-gleaner.com/article/news/20180731/hundreds-get-free-cataract-surgery-chinese-medical-mission

The WHO, in collaboration with PAHO (2013), conducted a study across 16 Caribbean nations which revealed that there is a total of 43 practicing psychologists for more than 17.2 million people. The numbers were described as inadequate and have serious implications for PLWD in the Caribbean, but specifically Jamaica where it has been highlighted that there is a shortage of health care professionals.

According to World Bank Data (2017), Jamaica has a ratio of 1.3 physicians to every 1,000 persons (as compared with, for example, Trinidad and Tobago which has 2.7 physicians per 1,000 persons or Cuba, which has 8.2 physicians to every 1,000 persons).

On March 24, 2020, Jamaica received 150 specialist nurses and doctors from Cuba to assist in meeting the healthcare demand to fight against COVID-19.

References:

The World Bank. (2017). Physicians (per 1,000 people) – Jamaica, Cuba, Trinidad and Tobago. Available from: https://data.worldbank.org/indicator/SH.MED.PHYS.ZS?locations=JM-CU-TT

World Health Organization, & PAHO. (2013). WHO-AIMS: Report on Mental Health Systems in Latin America and the Caribbean. Pan American Health Organization. https://www.mhinnovation.net/sites/default/files/downloads/innovation/reports/WHO-AIMS-REPORT-on-mental-health-systems-in-latin-american-and-the-caribbean.pdf

The Caribbean Commission on Health and Development Report (CARICOM, 2005; as cited in IOM, 2018) reported that there were 2,256 registered nurses in the health sector as well as a vacancy rate of 58.3 per cent. The impact of emigration on the job vacancies gaps recorded was mainly of doctors and nurses, but the gaps in the health system due to emigration also included pharmacists, radiologists, and medical laboratory technologists (IOM, 2018).

In 2016, the Jamaica Ministry of Health detailed the nature of the health sector human resource gap. In some specialised areas of nursing, for example among public health nurses, there is as much as a 74 per cent gap between staffing needs and the number of available staff. There was a 70.7 per cent shortfall of nurse anaesthetists and a 68.1 per cent shortfall for psychiatrists. For many other specialisations, there are significant shortfalls in staffing with an estimated 54 per cent overall shortage (MOH, 2016 as cited in IOM, 2018).

A local psychiatrist who serves as a stakeholder for the STRiDE Jamaica team also explained that there are no neurologists in primary care in Jamaica. These specialists are available at public hospitals (University Hospital of the West Indies and Kingston Public Hospital), which line up with the earlier description of the relationship between primary and secondary care services in Jamaica. He also advises that a newly trained Neuropsychiatrist has joined the Kingston Public Hospital neurology service, but his service is limited, and does not extend to primary care or outpatient care.

References:

Caribbean Community (CARICOM). (2005). Report of the Regional Commission on Health and Development, Caribbean Commission on Health and Development, cited in IOM. (2018). Migration in Jamaica – A Country Profile 2018. Available from: https://publications.iom.int/books/migration-jamaica-country-profile-2018#:~:text=

IOM. (2018). Migration in Jamaica – A Country Profile 2018. Available from: https://publications.iom.int/books/migration-jamaica-country-profile-2018#:~:text=

The Government of Jamaica operates 16 long-term care facilities referred to as infirmaries which provide housing, physical and mental health care to those 18 years and older who are unable to care for themselves. However, the infrastructure and staff capacity to meet the needs of all those eligible is limited. As a result, long-term care is provided primarily by the private sector through nursing homes which are governed by a regulatory body. Unfortunately, most of these homes are unregistered and, therefore, unregulated. Moreover, these residential homes or care home placement and overall long-term care, tend to be costly and are not covered by public or private insurance, thus creating barriers to accessibility. As such, care is usually provided by unpaid carers such as family members, friends and neighbours who are typically unskilled in dementia care and management.

At the launch of the NHIP Green Paper (2019), the Minister of Health and Wellness, the Hon. Dr Christopher Tufton, addressed the question of whether long-term care services were being considered as a benefit under the national health insurance scheme. While the finalisation of particular services that will be covered by this scheme are yet to be determined following upcoming stakeholder consultations and may include not only long-term care facilities, but also services to support in-home care, Minister Tufton noted that the public health system is currently piloting a private-public partnership with private care homes for a residual system to address ‘social cases’ of persons who are abandoned at public hospitals by family members.

Later in 2019, this partnership was further elaborated on with the announcement of the Ministry of Health and Wellness’ decision to pursue legal action against families of the approximately 200 persons currently in hospital beds across Jamaica who should in fact be in an infirmary or released to their relatives, but their relatives have abandoned them, in some cases for as long as seven years. It is hoped that such court action will compel relatives to ‘take care of their own’ (Jamaica Gleaner, 2010). This challenge indicates the consequences of a lack of a public long-term care system in Jamaica that can adequately meet the needs of older persons.

References:

The Jamaica Gleaner. (2010, November 10). Want to be caregiver | Lead Stories |. https://jamaica-gleaner.com/gleaner/20101109/lead/lead93.html

The  government of Jamaica through the Ministry of Local Government and Community Development provides non-institutional as well as institutional care to adults and children. The Poor Relief Department (embedded in the Ministry of Local Government) was established to relieve poverty and destitution. Non-institutional care refers to Jamaicans who are able to care for themselves or receive assistance from others but  may be destitute and in need of temporary assistance. On the other hand, for institutional care, clients are wards of the state and receive care in infirmaries or golden age homes. As previously mentioned in part 2, the Poor Relief Department also provides provisions to give temporary assistance to all Jamaicans.

In terms of public institutional care, there are 16 infirmaries in Jamaica that provide care for the poor and destitute who are unable to take care of themselves due to mental or physical causes. The exact number of those who utilise this system is unclear. However, the Minister of Local Government, Desmond McKenzie reports that the infirmaries have over 2500 residents and workers such as nurses and community health workers (Jamaica Observer, 2020). In fact, the Minister recently asserted that 90% of its residents are over the age of 65 (JIS, 2020).

 References:

Jamaica Information Service (JIS). (2020). COVID-19 Digital Town Hall Meeting for Senior Citizens March 25, 2020. Available from: https://jis.gov.jm/videos/covid-19-digital-town-hall-for-senior-citizens-march-25-2020/

Jamaica Observer. (2020). Government limits access to infirmaries, golden age homes, May 14, 2020. Available from: https://www.jamaicaobserver.com/news/government-limits-access-to-infirmaries-golden-age-homes/

The Standards and Regulation Division of the Ministry of Health and Wellness has a mandate to ‘lead the process for quality improvement through standard setting and monitoring of the health sector (public and private).’ As part of this mandate, it is responsible for registration and monitoring of private long-term care homes or nursing homes in Jamaica. The publicly available list of registered nursing homes which received certification valid up until 2016-2017 listed 35 such registered homes across Jamaica. The number of nursing homes which received certification valid up until 2020-2021 declined to 14 registered homes with the majority being located in Kingston and St Andrew. No nursing homes were registered in 8 of the 14 parishes.

It is interesting to note that according to a representative at the 2019 Caregivers Seminar in Jamaica, it is estimated that there are over 200 nursing homes in existence, a stark contrast to the rate of registration. These homes are thus operating without monitoring and evaluation.

According to the Guidelines for Community and Private Health Facilities, all facilities should at minimum, provide the following services:

1. Room, meals, and personal services to the residents of the facility, which are commensurate with the needs of the individual residents.
2. Each home shall provide sufficient activities to promote the physical, mental, spiritual, and social well-being of each resident.
3. Each home shall provide as a minimum books, newspapers and games for leisure time activities. Each home shall encourage and offer assistance to residents who wish to participate in recreational, cultural and religious activities available in the home and in the community.
4. The route of the home shall be such that a resident may spend the majority of his or her waking hours out of the bedroom, if he or she chooses.
5. At no time (other than when health and/or safety are jeopardised) may a home restrict a resident’s free access to the common areas of the home or lock the resident into or out of the resident’s bedroom.
6. Adult Day Centres shall provide a place for an individual who may require this during the course of a particular day.

Additionally, care within the home may be supported by paid domestic workers, many of which are represented by the Jamaica Household Workers Association (JHWA), a non-government agency that represents the needs and interest of household workers and provides training. The organisation represents approximately 6,200 of an estimated 58,000 domestic workers. The training includes household management, education on sexual harassment, violence against women and mental health training. Despite working with older persons, the President of JHWA indicated that there is no training provided on dementia care and management, with many members having very little awareness of dementia.

The proportion of persons that utilise the private long-term care facilities is uncertain. However, based on the exorbitant cost (See Part 2) to access this service, it is clear that a significant portion of the population has little to no access.

 References:

Ministry of Health and Wellness (MOHW). (2019). Vision for Health 2030: Ten Year Strategic Plan 2019-2030. Available from: https://www.moh.gov.jm/wp-content/uploads/2019/05/MOHW-Vision-for-Health-2030-Final.pdf

The infirmaries are funded by the Ministry of Local Government and disbursed through each local parish authority. Donations are made periodically by non-governmental organisations, community-based organisations, faith-based organisations, service clubs, and private individuals.

 ^[1] For a “public” long-term care system we mean a system that is designed, regulated, and monitored by the state (or other sub-national government level). For example, in some countries (for example Singapore and Germany) the state sets out the “rules” of a long-term care insurance system, but the actual insurers and care providers are in the private sector.

STRiDE Jamaica intends to seek answers to the following items from 03.02.01.02 to 03.02.01.06 through interviews with policymakers as there is no documented procedure easily accessible to the public on funding mechanisms and timeline.

The National Insurance Scheme (NIS), as previously mentioned is a compulsory funded, social security scheme. A component includes health coverage for pensioners called the NI Gold Health; however, coverage only includes doctor’s visits, prescription drugs, diagnostic services, dental/optical services, surgeon’s fee and hospital room and board. This coverage does not cover residential care costs such as nursing homes or institutional care.

The two leading private insurance companies in Jamaica report that they do not have specific long-term care products and that they do not cover residential care costs such as nursing homes or institutional care.

As previously mentioned, infirmaries within Jamaica are at no cost. However, they are not specific to older persons and house anyone eligible for admission over the age of 18. It is reported that all 16 infirmaries can accommodate over 2500 staff and clients in total. They, therefore, cannot meet the needs of an ageing population. As an alternative, the population is left with private long-term care facilities. At the time of writing this review, the proportion of the population that incurs in out-of-pocket expenditure on LTC or the number of persons incurring these costs is unknown. However, of the 14 registered nursing homes, STRiDE Jamaica was able to make telephone contact with six and found that the average cost of nursing homes is JD$72,500 per month or JD$870,000 per year. This cost is almost 3 times that of the monthly minimum wage (JD$28,000). The disparity in income and expense hinders LTC accessibility for persons from the low to the middle class. Attempts to contact the other registered nursing homes were unsuccessful.

While remittances play an important role in Jamaica’s economy- contributing US$2.18 billion to the economy in 2019– its direct impact on the financing of long-term care is unknown.

According to the Guidelines for Community and Private Health Facilities, all workers should be 18 years and older and of good character. Additionally, all facilities should have as many employees on duty as necessary, and should maintain the safety and welfare of the residents at all times by exercising the following guidelines, including the required staff size:

1. At least one administrator, and on-site manager, or a trained staff person shall be on the premises twenty-four hours per day;
2. Resident shall not be left unsupervised;
3. A minimum on-site staff to resident ratio shall be one staff person per fifteen residents during waking hours and one staff person per twenty-five residents during non-waking hours (not applicable to nursing homes);
4. There shall be one staff person for every four residents.
5. All homes must maintain a written work schedule for all employees, including relief workers, showing adequate coverage for each day and night.

A registered nurse or medical practitioner shall supervise the facility, the registered nurse being on duty at least twelve (12) hours weekly. The remaining hours shall be covered by a registered nurse on call.

The guidelines stipulate that the administrator or on-site manager should be responsible for ensuring that any person working in the facility as an employee receives work-related training acceptable to the Ministry of Health and Wellness within the first sixty days of employment. Such training shall at a minimum include the following:

1. Current certification in emergency first aid except where the staff person is a currently licensed health care professional;
2. Emergency evacuation procedures;
3. Medical and social needs and characteristic of the resident population;
4. Resident’s rights.

At least one staff person who has completed the certification in emergency first aid must be present in the home at all times. All kitchen staff and all staff attending to the physical needs of residents in the home should possess valid food handlers’ permits. All persons, including the administrator or on-site manager, who offers direct care to the residents, should be responsible for maintaining awareness for each resident’s normal appearance and should be capable of intervening if a resident’s state of health appears to be in jeopardy. The administrator, on-site manager, and each employee should have received a physical examination by a licensed physician four weeks before employment to ensure that the employee is free of disease communicable within the scope of employment and is physically qualified to work. A licensed physician should conduct follow-up examinations on each administrator or staff person to determine readiness to return to work following a significant illness or injury.

An active in-service nursing education program should be in effect for all nursing personnel. This program should be developed and conducted by a health care professional.

In February 2004, the Jamaican Government piloted a bill to amend the 1934 Nursing Homes Registration Act, aimed at improving the quality of service provided to residents and working conditions of staff at privately owned Nursing Homeowners.

The Bill introduced requirements for the biennial registration of homes with the Ministry of Health. The registration process was also adjusted to rely on a compulsory inspection and certificate of inspection in order to qualify for registration or renewal of registration. However, according to the regulatory unit at the Ministry of Health, the rate of registration of private care homes is quite low, with less than 20% of all private care homes estimated to be registered (1^st Caregivers Symposium, 2019).

Penalty fees for non-registration were increased from $100 to $30,000JD (approx. $240.00 USD) and registration fees from 50 cents to $5,000JD for homes with a bed capacity of 25 beds or fewer. Registration fees for homes with a bed capacity of 25 beds or more was set at $10,000JD (approx. $80.00 USD) (JIS, 2004).

 References:

1^st Caregivers Symposium (11-12 June 2019). “Supporting your own mental health as a caregiver”. Hosted by the University of Technology, Jamaica.

Jamaica Information Service (JIS). (2004). Nursing Homes Improve Service as Stricter Guidelines. Available from: https://jis.gov.jm/nursing-homes-improve-service-as-stricter-guidelines/

No data was sourced.

Please refer to Part 1 for some context on migration and healthcare workers.

Though there are no documented guidelines on the roles of volunteers, non-government organisations and faith-based groups provide donations in the form of money and kind.

Though dementia falls under portfolio of the Mental Health Unit at the Ministry of Health and Wellness, there is no department or unit which is explicitly responsible for dementia.

Dementia is not specifically addressed in any sector. However, the Ministry of Health and Wellness would assume primary responsibility.

Dementia is not primarily included in any sector in Jamaica. There is much overlap between the social services provided in Jamaica between, for example, the Ministry of Health and Wellness and the Ministry of Labour and Social Security (PIOJ, 2014). There is also overlap between the kinds of services that may be relevant or useful for persons living with dementia.

There are implications for the possible tailoring of policies, programmes, and infrastructure of either NCDs or Mental Health in the health sector, or in either Ageing or Disability in the Social Sector, which do not currently directly address dementia, to become the primary driver of dementia issues.

The question of the primary place for dementia in the governmental framework as of February 2019, requires review and consultation.

References:

Planning Institute of Jamaica (PIOJ). (2014). Jamaica Social Protection Strategy. Available from: https://www.pioj.gov.jm/product/jamaica-social-protection-strategy/

Following the agreement of Jamaica to provide information to the Global Dementia Observatory (GDO), the Director, the Mental Health and Substance Abuse Services, and the Ministry of Health, Jamaica was nominated as the national representative for collation of data to the GDO e-tool, and acts as the dementia-specific representative within the national government. Dr Goulbourne is being supported by the STRiDE Jamaica team in collecting this information from stakeholders via design of Google Forms targeting healthcare and social workers.

This section is prefaced with an outline of the progress of dementia-related regional plans within the Latin America and Caribbean region, in which Jamaica is grouped. It is important to note that although Jamaica, along with many English-speaking Caribbean islands, is often grouped within the wider Latin America and Caribbean (LAC) region in international plans and policies, the regional plans and policies most likely to be relevant to Jamaica are likely to emanate from CARICOM (The Caribbean Community). This is because CARICOM countries speak the same language, share similar histories, are geographically connected, and are faced with similar socio-economic challenges. CARICOM is the oldest surviving regional integration movement in the developing world and consists of twenty countries: fifteen Member States and five Associate Members (all listed below). It is home to approximately sixteen million citizens and focuses on areas of economic integration, coordination of foreign policy, social and human development (including health and culture) as well as security (CARICOM, 2019).

CARICOM full member states:

• Antigua and Barbuda
• The Bahamas
• Barbados (founding member)
• Belize (official language: English)
• Dominica
• Grenada
• Guyana (founding member)
• Haiti
• Jamaica (founding member)
• Montserrat (official language: English)
• Saint Kitts and Nevis
• Saint Lucia
• Saint Vincent and the Grenadines
• Suriname
• Trinidad and Tobago (founding member).

CARICOM associate member states:

• Anguilla
• Bermuda
• British Virgin Islands
• Cayman Islands
• Turks and Caicos.

One key regional dementia-specific plan which exists for the Latin America and Caribbean region is the PAHO Regional Plan of Action on Dementia in Older Persons (2011-2015), coordinated by ADI. This plan aimed at encouraging countries within the region to develop national dementia plans, promote risk reduction strategies; ensure a rights-based approach to the provision of care and support for people living with dementia and better training for health professionals.

The key stakeholders of this plan included PAHO and ADI members. CARICOM members have low representation relative to non-CARICOM/non-English-speaking countries in the LAC region. Specifically, 4 CARICOM members or associate states are full ADI members, whereas there are 22 non- CARICOM/non- English-speaking countries in the LAC region which are full ADI member states. In  October 2015 in Washington DC, the plan was revisited and aligned with the wider PAHO Strategic Plan (2014-2019).

In December of 2015, the Caribbean conference on Ageing, Elder Abuse and the Rights of Older Persons was held in Dominica, a CARICOM country in collaboration with the Economic Commission for Latin America and the Caribbean (ECLAC) and was attended by representatives of CARICOM (including Antigua and Barbuda, Barbados, Dominica, Grenada, Jamaica, Saint Kitts and Nevis, Saint Lucia, and Trinidad and Tobago), Martinique, UNDP, UWI and OAS.

The conclusions of this conference included recommendations which focused on the need for increased priority and funding to be given to policies for older persons; promotion of physical and mental health of older persons, a call for legislation to protect the rights of older persons and to better regulate LTC institutions, pensions, and insurance (Conclusions of the Caribbean conference on Ageing, Elder Abuse and the Rights of Older Persons, 2015).

It also stated that there is an urgent need for improved pension coverage and policies addressing financial abuse of older persons. Universal health coverage was recognised as a key tool for the prevention and management of NCDs and the need to improve human resources in geriatric care, palliative care and LTC was recognised. The importance of inclusivity was also noted. However, there was no mention of dementia or of the PAHO Regional Plan of Action on Dementia in Older Persons.

There was, however, mention of the PAHO plan in 2017 at the Fourth Regional Intergovernmental Conference on Ageing and the Rights of Older Persons in Latin America and the Caribbean, held in Paraguay. Regional states represented included Argentina, Barbados, Brazil, Chile, Colombia, Costa Rica, Cuba, Curacao, Dominican Republic, Ecuador, Germany, Japan, Mexico, Paraguay, Peru, Bolivia, Saint Lucia, and Uruguay. Only two CARICOM member states were represented, likely due to the conference being conducted in Spanish. At this conference, some countries presented reports on the progress of their implementation of the PAHO plan, as they were included as stakeholders during its development (ECLAC, 2017).

These various reports over the past few years demonstrate the various pathways of progress being experienced by different clusters of countries within LAC. Many Spanish-speaking LAC countries which are larger, are full ADI members and have been previously involved with dementia-related research such as the 10/66 study, and today, they have made some progress with national dementia policies and plans, such as Mexico and the Dominican Republic.

However, CARICOM/English-speaking islands within the region appear to have not been as closely involved with the PAHO regional plan as one may expect due to barriers in language and variations in resources and preparedness available in smaller island states, for example, with regard to dementia-related research.

Nevertheless, CARICOM member states have pursued for many years various initiatives and plans in NCD prevention and management as well as the rights of older persons. It has been acknowledged  the importance of dementia in the Caribbean Cooperation in Health Phase IV Framework (2016-2025) which emphasises multi-sectoral action to address regional problems. Dementia has been identified as one such challenge facing member states, coupled with high levels of chronic disease. This is promising as, firstly, dementia has been categorised by this framework as a challenge similar to that of NCDs and, secondly, the framework outlines its committee’s goal of enabling policies and policy processes shaped by multi-sectoral input.

References:

Caribbean Community (CARICOM). (2019). Who We Are. Available from: https://caricom.org/our-community/who-we-are/#

Conclusions of the Caribbean conference on Ageing, Elder Abuse and the Rights of Older Persons. (2015). Available from: https://jamaicapoliticaleconomy.files.wordpress.com/2015/12/conclusions-of-the-caribbean-conference-on-ageing-elder-abuse-and-the-rights-of-older-persons_final.pdf

Economic Commission for Latin America and the Caribbean (ECLAC). (2017). Fourth Regional Intergovernmental Conference on Ageing and the Rights of Older Persons in Latin America and the Caribbean. Available from: https://repositorio.cepal.org/bitstream/handle/11362/42239/S1700920_en.pdf?sequence=1&isAllowed=y

Pan American Health Organisation (PAHO). (2015). Strategy and Plan of Action on Dementias in Older Persons. Available from: https://www.paho.org/en/documents/cd54r11-strategy-and-plan-action-dementias-older-persons-resolution-2015

Pan American Health Organization (PAHO). (2014). Strategic Plan of the Pan American Health Organization 2014-2019. Available from: https://www3.paho.org/hq/dmdocuments/2017/paho-strategic-plan-eng-2014-2019.pdf

There is no dementia-specific policy or plan in place. However, Vision 2030 (PIOJ, n.d.) acknowledges an increasing older population, and a need to better incorporate older persons into healthcare policies, including those with disability.

References:

Planning Institute of Jamaica (n.d.). Vision 2030 Jamaica. Available from: https://www.vision2030.gov.jm/about-us/

Not applicable with regards to a dementia-specific national document. However, in line with the increased recognition of senior citizens, the National Policy for Senior Citizens (1997) was revised in 2018 (Ministry of Labour and Security, 2018) to meet the current socio-economic needs.

References:

Ministry of Labour and Security (MLSS). (2018). Green Paper: National Policy for Senior Citizens, 2018. Available from: https://opm.gov.jm/wp-content/uploads/2018/05/Green-Paper-National-Policy-for-Senior-Citizens-1-1.pdf

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

No data was found since there is no dementia-specific national document in Jamaica.

The Mental Health Strategic Plan (MHSP) FINAL DRAFT (2018-2023) was shared with the STRiDE Jamaica team by the Director, Mental Health Unit, Ministry of Health, and Wellness, in May 2019, prior to its public dissemination. Until it is published, or permission is given by the ministry to represent here, this information is embargoed until further notice.

Nevertheless, at the press launch of the ADI 2019 Caribbean Regional Meeting in Kingston, Jamaica, in November 2019, the Director of the Mental Health Unit, Ministry of Health, and Wellness, announced that this strategic plan is due to be in cabinet by 2020 and will be made publicly shortly. The director shared that one of the dementia-specific issues addressed within the plan is the need for more public education programmes, including on how to detect dementia and improving the training of health workers in the early recognition and treatment of dementia. The plan will also address improved training and support of caregivers and options for rehabilitation of patients, which, though not dementia specific, has the capacity to support caregivers of persons with dementia.

He also indicated that the Mental Health Unit has re-organised and expanded its services. One example is a new campaign titled ‘Speak Up, Speak Now,’ aimed at reducing stigma, which was launched on World Mental Health Day in 2019. The campaign is supported by a new Mental Health and Suicide Prevention Hotline.

No data was sourced due to the embargo on the Mental Health Strategic Plan.

No data was sourced due to the embargo on the Mental Health Strategic Plan.

No data was sourced due to the embargo on the Mental Health Strategic Plan.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

No data was sourced due to a lack of dementia policy in Jamaica.

As previously stated, Jamaica does not have a dementia-specific plan, as such, the following questions for this section are not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

Not applicable.

No, there is not. However, Jamaica has a Mental Health Act. Under the Mental Health Bill, provisions have been made for the admissions of patients, whether voluntary or involuntary, and the designation of psychiatric facilities for the mentally ill. The provisions relate to the establishment of the Mental Health Appeal Tribunal, the consent of patients to treatment and the discharge of patients among others. Community care and role of urbanisation on mental health are also discussed. The latest legislation was enacted in 1997 (The Mental Health Act, 1997).

References:

The Mental Health Act. (1997). Available from: https://bellevuehospital.org.jm/pdf/mental_health_act.pdf

While Power of Attorney is accessible in Jamaica via the Ministry of Justice and the Registrar General’s Department, this provision does not apply to persons with cognitive illnesses or reduced cognitive capacity (JIS, 2018). Therefore, there is in fact no current legal provision which promote supported decision making in Jamaica.

References:

Jamaica Information Service (JIS). (2018). Get the Facts – Power of Attorney.

No. In fact, the Caribbean Community of Retired Persons (CCRP) highlighted the vulnerability of older persons, including persons living with dementia, such as financial abuse and neglect from their relatives and caregivers, especially where they had no relatives in Jamaica and were completely dependent on the caregiver (the Jamaica Gleaner, 2019). Currently, legislation is not specific to older persons or persons with dementia and so there is little opportunity for redress for older persons with dementia in these cases.

References:

The Jamaica Gleaner. (2019). Elderly fleeced – Call for special laws to shield vulnerable as families, caregivers plunder the aged, 2 June 2019. Available from: https://jamaica-gleaner.com/article/lead-stories/20190602/elderly-fleeced-call-special-laws-shield-vulnerable-families

No legislation was sourced as part of this desk review which supports the transition of dementia care to community-based services.

Yes, the Standards and Regulation Division of the Ministry of Health and Wellness, described in Part 3, question 03.01.03, provides monitoring and evaluation of registered homes for the aged, where persons with dementia may reside. The division is legislatively supported by the Nursing Homes Registration Act (2004).

References:

Nursing Homes Registration Act. (2004). Available from: https://www.yumpu.com/en/document/read/36302201/nursing-homes-registration-actpdf

According to the Ministry of Health, Strategic Business Plan (2015-2018), Jamaica has established protocols for the use of restraints and seclusion for general and mental health workers.

References:

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

There are no dementia-specific legislative provisions governing anti-discriminatory practices for family carers or people living with dementia beyond what was outlined in the section above, as such the below questions are not applicable. Living wills and Power of Attorney do not apply to persons with cognitive deficiencies in Jamaica.

No data was sourced.

No data was sourced.

The Maintenance Act (2005), part V, section 10.1, states that “every person who is not a minor has an obligation, to the extent that the person is capable of doing so, to maintain the person’s parents and grandparents who are in need of such maintenance by reason of age, physical or mental infirmity or disability” (p.9). Based on the act, the government can take legal actions against the child of the parent or grandparent, if they can be found. Additionally, if there were associated health care costs in the case of extended hospital stays, the government can mandate the child or grandchild to cover the expenses. However, many disagree with the provisions and subsequent consequence of the Maintenance Act. For example, Professor Eldemire-Shearer has asserted that many offspring simply cannot afford or physically provide the care needed to their parents and have strongly advocated for the need for more long-term care options (The Gleaner Jamaica, 2017).

Similarly, Section 29 of the Mental Health Act (1934) “allows the Supreme Court or the Parish Court, on application of the nearest relative or the Attorney-General, to exercise jurisdiction over the management of the property and affairs of a patient if the Court is satisfied by evidence (medical and otherwise) on affidavit that the patient is incapable by reason of mental disorder of managing and administering his property and affairs” (Myers, Fletcher & Gordon Attorneys-at-Law, 2019).

In a blog post on the law firm’s website, it is further explained that according to Jamaica’s Mental Health Act, “a patient is defined as a person who is suffering or is suspected to be suffering from a mental disorder. Diseases such as dementia have been recognised by the Court to be included within the Act’s definition of mental disorder, though it has been held that a person who is comatose and thus unable to have his/her mental capacity assessed is incapable of falling within the Act.”

While the Act allows for some protection of persons who may lack capacity to manage their own affairs, there is a problematic stipulation of the law with regards to who in the patient’s family is delegated with their care or protection and given power over their affairs.

The law in Jamaica does not leave much room for a ‘patient’ deemed lacking in mental capacity to have this kind of input. Thus, the person delegated by the law may not necessarily be the patient’s primary carer or preferred custodian.

“Under the Act, the patient’s ‘nearest relative’ is the only person other than the Attorney-General who may make an application to bring the patient’s affairs within the jurisdiction of the Court. This is only one of the several responsibilities accorded to the ‘nearest relative’ under the Act, another of which is the giving of consent to treatment in a psychiatric facility. In practice, however, problems arise due to the Act’s definition of the term ‘nearest relative’” (Myers, Fletcher & Gordon Attorneys-at-Law, 2019). Section 3(3) of the Mental Health Act defines ‘nearest relative’ a person’s husband or wife; followed by their son or daughter; father, mother, brother or sister, grandparent, grandchild, uncle or aunt and nephew or niece (The Mental Health Act, 1997).

References:

Myers, Fletcher & Gordon Attorneys-at-Law (2019). Challenges in caring for the mentally ill under the Mental Health Act. Available from: https://www.myersfletcher.com/resources/item/challenges-in-caring-for-the-mentally-ill-under-the-mental-health-act.html

The Gleaner Jamaica. (2017). Abandoned with cause? – Senior citizens champion urges caution in condemning those who leave the elderly at hospitals, 13 January 2017. Available from: https://jamaica-gleaner.com/article/news/20170115/abandoned-cause-senior-citizens-champion-urges-caution-condemning-those-who

The Mental Health Act (1997). Available from: https://bellevuehospital.org.jm/pdf/mental_health_act.pdf

While curatorship/power of attorney does not apply to persons with dementia in Jamaica, once the issue of mental capacity is raised before the court by the relative which legally has the right to do so, and this relative is deemed suitable and is appointed by the Resident Magistrate’s or Supreme court over the affairs of the patient, he/she is expected “to do all such things as appear to be necessary or expedient in the interest of and for the maintenance and benefit of the patient; and where it is deemed necessary also for a relative or dependant of the patient” (The Mental Health Act, 1997).

This includes the authority and ability to:

• Transfer, vest, sell, lease, rent or exchange property
• Acquire property in the name of or on behalf of the patient
• Settle property by way of gift
• Execute a will on behalf of the patient
• Fulfil any of the patient’s contractual obligations
• Pay any debts incurred by the patient
• Continue or institute any legal proceeding on behalf of the patient
• Exercise any power of attorney vested in the patient
• Handle all financial affairs of the patient (The Jamaica Gleaner, 2013).

While this ‘guardianship’ of a person lacking mental capacity can be provided by the court to the ‘closest relative,’ it should be explained that in Jamaica, as in Trinidad and Tobago, power of attorney does not apply to a person lacking mental capacity. This is because legally, a person must be capable of understanding the nature and effect of the power of attorney he is purporting to grant, i.e., he must be deemed to have mental capacity. If a person, like a person living with dementia, lacks mental capacity to create a power of attorney, and this is discovered after the power of attorney has already been granted, then the power of attorney becomes invalid and any transaction between the attorney and a third party would be void. The fact that neither the attorney nor any third party was aware of the person’s mental incapacity is irrelevant” (Myers, Fletcher & Gordon, 2014).

References:

Myers, Fletcher & Gordon (2014). Powers of Attorney. Available from: https://www.myersfletcher.com/resources/item/powers-of-attorney.html

The Jamaica Gleaner (2013). Caring for the elderly, 6 May 2013. Available from: https://jamaica-gleaner.com/gleaner/20130506/flair/flair6.html

The Mental Health Act. (1997).  Available from: https://bellevuehospital.org.jm/pdf/mental_health_act.pdf

No data was sourced due to an apparent lack of internal guidelines related to dementia within professional healthcare bodies and the public healthcare system.

No data was sourced due to an apparent lack of internal guidelines related to dementia within professional healthcare bodies and the public healthcare system.

No data was sourced due to an apparent lack of internal guidelines related to dementia within professional healthcare bodies and the public healthcare system.

No data was sourced due to an apparent lack of internal guidelines related to dementia within professional healthcare bodies and the public healthcare system.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

Not applicable due to a lack of an established dementia care pathway in the public health sector.

On January 7, 2020, STRiDE Jamaica’s team lead met with the MOHW to advocate for a National Dementia Plan. STRiDE Jamaica was advised that while a stand-alone dementia policy was not feasible, dementia may be integrated in a wider health policy. It is hoped that as an outcome of Jamaica’s involvement in the STRiDE project (2017-2021), this will be achieved in the next 5 years.

Yes. Jamaica’s commitment to the WHO Global Dementia Observatory (GDO) is indicative of an effort toward baseline evaluation of the local dementia landscape, a result of which is hoped to be a development of policy or commitment to financing for dementia in the future.

During the Alzheimer’s Disease International (ADI) 2019 Caribbean Regional Meeting held in Kingston, Jamaica, in November 2019, the CEO of ADI publicly called upon the Jamaican Minister of Health, Dr. the Honourable Christopher Tufton to take a stand for policy and budget commitment for Jamaica. Minister Tufton responded to this via Twitter, stating his Ministry’s commitment to the issue.

On-going developments around dementia policy are currently being driven by the Jamaica GDO Oversight Committee, which is comprised of the full STRiDE Jamaica project team, the PAHO Advisor for NCDs and Mental Health and the Director of Mental Health at the Ministry of Health, who also serves as the GDO national representative. This group of stakeholders is driven by the goals of the STRiDE project as well as the deliverables of the GDO data collection drive and are motivated by a shared interest in dementia and a need to bring together various silos of dementia-related information or relevant resources in order to have a streamlined, organised and formalised understanding of and a plan on dementia and dementia care.

It is also being driven by the STRiDE JA National Advisory Group, which advises on the feasibility and relevance of work being done on the ground in Jamaica by the STRiDE Dementia Research Project. It also holds researchers accountable for project deliverables and advocates for local dementia-related research and initiatives, including, quite notably, a national dementia policy. The Advisory Group comprises representatives from organisations that are involved in or responsible for national policy; including the National Health Fund; the Inter-American Development Bank; Healthy Caribbean Coalition, the National Council for Senior Citizens as well as key stakeholders including the Jamaica Council of Churches, caregivers of persons living with dementia and a person living with dementia. The Group has agreed to support the public call for a national dementia policy and to use its resources and expertise to contribute to the feasible, sustainable development and implementation of same.

It is yet to be decided whether the expected policy changes are likely to result in either a new National Dementia Plan or with dementia being included in an existing policy.

As mentioned earlier, the strategy on how policy change will be achieved, taking into consideration the length of time it takes for a draft policy to be finalised and proclaimed nationally and the suitability of where in the national governmental framework dementia is likely to receive sufficient resources requires review and evaluation of existing relevant policies, namely:

• National Policy on Senior Citizens Green Paper (MLSS, 2018)
• Persons with Disabilities Draft Sector Plan 2009-2030 (PIOJ, 2009)
• National Strategic and Action Plan for the Prevention and Control Non-Communicable Diseases (NCDS) in Jamaica (MOH, 2013)
• National Mental Health Strategic Plan draft (details not currently available). This document review is currently on-going by members of the GDO Oversight Committee, who will then consult with key stakeholders, including the Mona Ageing and Wellness Centre and the Ministry of Health.

References:

Ministry of Health (MOH). (2013). National Strategic and Action Plan for the Prevention and Control Non-Communicable Diseases (NCDS). Available from: https://ncdip.moh.gov.jm/wp-content/uploads/2021/07/National-Strategic-and-Action-Plan-for-the-Prevention-and-Control-Non-Communicable-Diseases-NCDS-in-Jamaica-2013-2018.pdf

Ministry of Labour and Security (MLSS). (2018) Green Paper: National Policy for Senior Citizens, 2018. Available from: https://opm.gov.jm/wp-content/uploads/2018/05/Green-Paper-National-Policy-for-Senior-Citizens-1-1.pdf

Planning Institute of Jamaica (PIOJ). (2009). Vision 2030 Jamaica National Development Plan Persons with Disabilities Draft Sector Plan. Available from: http://www.caribbeanelections.com/eDocs/strategy/jm_strategy/jm_Persons_with_Disabilities_2009.pdf

The PIOJ (2014) points to government’s on-going revision of the universal, free healthcare policy as well as consideration of a social pensions policy. If there are changes to either of these, dementia care, treatment and support may well be impacted.

References:

Planning Institute of Jamaica (PIOJ). (2014). Jamaica Social Protection Strategy. Available from: https://www.pioj.gov.jm/product/jamaica-social-protection-strategy/

This is yet to be determined.

Key stakeholders who can potentially bring about a policy change in relation to dementia in Jamaica include:

• Prime Minister, Andrew Holness
• Dr Christopher Tufton, current Minister of Health and Wellness and NCD champion
• Shahine Robinson, current Minister of Labour and Social Security
• Ms Cassandra Morrison, Executive Director, National Council for Senior Citizens
• Dr Michelle Harris, PAHO Advisor on NCDs and Mental Health
• Dr Kevin Goulbourne, Director, Mental Health, Ministry of Health
• Dr Tamu Davidson, Director, NCDs and Injuries Prevention, Ministry of Health
• Paola Barbarino, CEO, Alzheimer’s Disease International
• The Mona Ageing and Wellness Centre, UWI, Mona
• Mr Gregory Mair, Chairperson, National Health Fund
• Mr Ricardo Perez, Senior Health Specialist, InterAmerican Development Bank
• Jamaica Council for Pharmacies
• Caribbean Community for Retired Persons.

In September 2019, STRiDE JA ran a public engagement campaign in recognition of World Alzheimer’s Month in keeping with the theme: ‘Let’s Talk About Dementia: End the Stigma, led jointly by ADI and PAHO.’ STRiDE JA researchers made television and radio appearances and gave interviews to help address myths and misconceptions around dementia and encourage help-seeking behaviours.

The team was also invited to deliver lectures at churches and company health days on the topic, including the Jamaica Constabulary Force. STRiDE JA also hosted several information desks at health fairs and conferences, including the Ministry of Health’s and Wellness’ Caribbean Wellness Day event which centred on Healthy Ageing.

This engagement work continued throughout 2019 and into 2020, where the STRiDE JA team, participated in several mental health events, as well as a local conference in November.

In addition to these activities, efforts to increase dementia awareness and stigma reduction are supplemented by a social media campaign on Twitter and through STRiDE Jamaica’s newsletters.

In September 2018, in recognition of World Alzheimer’s Month (WAM), Alzheimer’s Jamaica (AlzJA), led by members of the STRiDE JA team, embarked on a national campaign of public awareness around dementia via traditional media, including television, radio and newspaper appearances, as well as via public outreach events. These included a Dementia Symposium in St. Mary (which is a parish outside of Kingston). Over 140 persons were in attendance, including the Senior Medical Officer for the region.

On World Alzheimer’s Day (September 21^st, 2019), AlzJA also hosted a Dementia Information Desk, at the University of the West Indies Mona campus to engage younger people, university students in this case, in dementia education. These and other events were also supplemented by a social media campaign on Twitter throughout the month of September featuring anti-stigma and dementia awareness posts. As a result of this campaign, during the WAM, AlzJA gained over 200 new followers.

No data was sourced.

No data was sourced.

There is no documented evidence on current or changing perceptions of dementia in Jamaica. However, there is some indication that targeted stigma reduction campaigns of the 1970s and 1980s have shown positive effects, with at least one study revealing that older persons (over 40 years) showed more positive emotions and tolerance to those living with a mental illness (Arthur, et al., 2010). Such evidence provides hope that the current efforts of bring awareness to dementia and reducing stigma will bring favourable results in the years to come.

References:

Arthur C.M., Hickling F.W. Robertson-Hickling H, Haynes-Robinson T, Abel W, Whitley R. (2010). Mad, Sick, Head Nuh Good: Mental Illness Stigma in Jamaican Communities. Transcultural Psychiatry, 47(2):252-275. https://doi.org/10.1177/1363461510368912

The Jamaica STRiDE team has conducted an extensive search online and in-person but was unable to find any published or on-going research or interventions specifically about dementia-related stigma in Jamaica. For the online database component of the literature review, the Jamaica team searched through the following databases/portals but found nothing specific to anti-stigma dementia/Alzheimer’s research in Jamaica:

1. The University of the West Indies UWILinc (University Libraries’ Information Connexion)
2. Google Scholar (particularly in light of the STRiDE Webinar 1)
3. Pubmed/Medline via Ovid
4. Embase
5. Global health on CAB Direct
6. CINAHL (EBSCO) briefly.

In addition to this, discussion with stakeholders from the ToC, the Global Dementia Observatory (GDO), and other experts involved in ageing and dementia research has resulted in no findings of any ongoing anti-stigma research or interventions.

Within the University of the West Indies (UWI), we got into contact with the Mona Ageing and Wellness Centre who have been at the forefront of gerontology research in Jamaica, but they were unaware of any existing initiatives or published research in this area. Also within UWI, we visited the Sir Arthur Lewis Institute of Social and Economic Studies (SALISES) documentation centre where we were unable to locate any relevant literature.

In addition to the above, we got into contact with librarians at the two other major universities in Jamaica: University of Technology, Jamaica (UTech) and Northern Caribbean University (NCU) who searched their archive of published and grey literature and said that nothing on the topic of Alzheimer’s or dementia research in Jamaica was located.

No data found.

No data found.

While there are no known, existing initiatives aimed at directly improving the accessibility of the physical and social environment for persons living with dementia, the Disabilities Act (2014) was passed to protect, promote and ensure “full and equal enjoyment by persons with disabilities, of privileges, interests, benefits and treatment, on equal basis with others and to establish the Jamaica Council for Persons with Disabilities; and for connected matters” (p. 43). The provisions of the act may be applicable and beneficial for persons with dementia, once enforced.

References:

The Disabilities Act. (2014). Available from: https://japarliament.gov.jm/attachments/341_The%20Disabilities%20bill%202014%20No.13.pdf

Part IX, section 36, subsection 2 of the Disabilities Act (2014), stipulates that alterations should be made to public or commercial premises to allow for equal access to a person with a disability. The Act specifies areas such as bathrooms, telephones, drinking fountains and emergency exits. Additionally, the Government of Jamaica Employees Occupational Safety and Health Policy and Guidelines 2002 addressed the issue of access to government buildings. The guidelines discuss the provision and maintenance of ramps for the entry into the buildings but do not extend to access of other facilities within the building.

References:

The Disabilities Act. (2014). Available from: https://japarliament.gov.jm/attachments/341_The%20Disabilities%20bill%202014%20No.13.pdf

Part X, section 40, subsections 1 and 2, stipulates that the Ministry of Transport and Works is responsible for ensuring that public passenger vehicles are accessible to persons with disability. Public passenger vehicles refer to “…any motor vehicle or any other conveyance for transport by road, rail, air or water that provides the general public with a general or special transportation service on a regular or continuing basis” (Disabilities Act, 2014, p.21).

Additionally, the Persons with Disabilities Sector Plan (PIOJ, 2009) states that: “The regular bus system in the capital city, Kingston, is not wheelchair accessible. However, four buses were designated by the Jamaica Urban Transit Company (JUTC) specifically for people with disabilities and [older persons]. These buses run heavily travelled routes and connect places such as hospitals, schools, the main shopping areas, and local residential communities. In October, two additional buses were added to the fleet…The Montego Transit Company provides a similar service in Montego Bay. Reduced fares are offered to [older persons] and people with disabilities travelling on public” p17.

References:

Disabilities Act. (2014). Available from: https://japarliament.gov.jm/attachments/341_The%20Disabilities%20bill%202014%20No.13.pdf

Planning Institute of Jamaica (PIOJ). (2009). Vision 2030 Jamaica National Development Plan Persons with Disabilities Draft Sector Plan. Available from: http://www.caribbeanelections.com/eDocs/strategy/jm_strategy/jm_Persons_with_Disabilities_2009.pdf

Part IX, section 36, subsection 1, stipulates that the owner or agent of the owner of an existing private premises, who has rented or intends to rent, or lease their premises, should, if requested by a person with a disability, make alterations to the premises or specific areas of the premise, to allow easy access to and utility by a person with a disability. Private premise owners and/or public or commercial premises are exempt for modifications if they are structurally impracticable, or the alterations would cause disproportionate or under burden.

Additionally, the National Policy for persons with disabilities (1999) provides guidelines for partnership between the government and civil society in addressing equal opportunities for persons with disabilities. Specifically, the National Housing Trust (NHT), a government-funded agency, reserved a percentage of houses specifically for persons with disabilities. Once a house is assigned to a person with a mobility disability, the NHT modifies the home to allow easy access. The NHT also has a special benefit programme to assist people with disabilities in purchasing or building homes (PIOJ, 2009).

References:

Planning Institute of Jamaica (PIOJ). (2009). Vision 2030 Jamaica National Development Plan Persons with Disabilities Draft Sector Plan. Available from: http://www.caribbeanelections.com/eDocs/strategy/jm_strategy/jm_Persons_with_Disabilities_2009.pdf

No information found.

No information found.

No information found.

The number of people with dementia is not currently routinely monitored in Jamaica. However, in 2011, the Ministry of Health and Wellness, with technical support from PAHO conducted a multi-stakeholder assessment of the National Health Information System (NHIS) which followed the guidelines of the Health Metrics Network (HMN) Framework and used the HMN Assessment Tool version 4.00. The assessment evaluated six key components of the NHIS, Resources, Indicators, Data Sources, Data Management, Information Products and Dissemination, and Use (MOH, 2011).

The assessment report demonstrated that the NHIS’ strengths included its range of sources, including census data, national surveys, and a vital registration system, as well as efficient monitoring of core health indicators (which did not include dementia at that time). Its weaknesses included lack of stakeholder collaboration and participation, lack of adequate infrastructure, human resources, poor reporting mechanisms and limited use of data. Following consultations with various stakeholders, recommendations were produced which continue to be implemented to the present day and which may serve to compliment some of the technical and policy products of the STRiDE project.

For example, it was recommended that private sector health professionals be targeted through their professional associations and that legislation be introduced to ensure private-sector compliance and cooperation in data sharing with the NHIS committee. This recommendation is particularly relevant for dementia data gathering as dementia data may be housed with private sector mental health professionals (due to its stigmatised nature and the ease of accessibility of private sector psychiatrists over public sector ones) and therefore not accessible to the NHIS. It is important to note that the data collected by the NHIS is used to inform national level policy and planning.

Regarding expansion of data sources, it was recommended to explore possibilities of maximising opportunities of current national surveys, which may provide a means to routinely capture dementia-related data as this indicator is not included currently in any of the national surveys or census data collection tools.  Other reported recommendations were to improve health workers ability to diagnose diseases through continuing education and address programme-specific initiatives which could contribute data to the wider NHIS. In the case of dementia, under-diagnosis, or late diagnosis, which is a common issue in LMICs, are due in part to a lack of awareness as well as stigma around dementia and associated myths, such as that it is a normal part of ageing.

Programme-specific initiatives go hand in hand with another recommendation made by the assessment report which calls for better representation among data sources, including adolescent health, mental health, and environmental health assessments. Lobbying for the inclusion of dementia can improve representation of mental health among older persons, as well as the physical and mental health of their carers.

In summary, although information systems focused on dementia do not yet exist within the wider NHIS, other than the data being gathered on a one-time basis for the Global Dementia Observatory, the Ministry of Health and Wellness has made some useful recommendations which provide a promising environment in which STRiDE findings can potentially be integrated, supplemented and complimentary (National Health Information System Assessment Report (MOH with technical support from PAHO), 2011).

References:

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

No data was sourced since data on dementia is not routinely collected in Jamaica.

No data was sourced since data on dementia is not routinely collected in Jamaica.

No data was sourced since data on dementia is not routinely collected in Jamaica.

No data was sourced since data on dementia is not routinely collected in Jamaica.

In Jamaica, an embedded case-control designed study conducted by the Mona Ageing and Wellness Centre at the University of the West Indies, Mona, Jamaica, estimated the dementia prevalence in Jamaica to be at 5.9%, a comparable estimate with other countries in the region. When considering the distribution of dementia types found within the study conducted by Eldemire-Shearer et al. (2018), consistent with additional dementia literature, Alzheimer’s dementia accounted for the majority of the cases (Eldemire-Shearer et al., 2018 ).

References:

Eldemire-Shearer, D., James, K., Johnson, P., Gibson. R., Willie-Tyndale, D. (2018). Dementia among Older Persons in Jamaica: Prevalence and Policy Implications. West Indian Medical Journal, 2018; 67 (1): 1. Available from: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/wimj-iss1-2018_1_8.pdf

No data was found.

This data is not currently available for Jamaica. However, it is notable that in the wider region, according to Parra et al. (2018), in some Latin American countries, dementia leads to a 200% increase in the number of years lived with disability among older persons.

References:

Parra, M.A., Baez, S., Allegri, R., Nitrini, R., Lopera, F., Slachevsky, A., Custodio, N., Lira, D., Piguet, O., Kumfor, F. and Huepe (2018). Dementia in Latin America: Assessing the present and envisioning the future. Available from: https://pure.strath.ac.uk/ws/portalfiles/portal/85132233/Parra_etal_BMCN_2018_Dementia_in_Latin_America_assessing_the_present_and_envisioning.pdf

No data was found due to a paucity of data.

No data was found due to a paucity of data.

No data was found due to a paucity of data.

Eldemire-Shearer and colleagues (2018) found that the female gender (70.6%) was significantly associated with higher rates of dementia than males.

References:

Eldemire-Shearer, D., James, K., Johnson, P., Gibson. R., Willie-Tyndale, D. (2018). Dementia among Older Persons in Jamaica: Prevalence and Policy Implications. West Indian Medical Journal, 2018; 67 (1): 1. Available from: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/wimj-iss1-2018_1_8.pdf

No data was sourced.

No data was sourced.

No data was sourced.

Please refer to Part 5, question 05.01.

The dementia study conducted by the Mona Ageing and Wellness Centre at the University of the West Indies, Mona, Jamaica (referenced in Part 6)  found that “regardless of the dementia type, vascular change was pervasive and suggested that synergistic efforts should be made to address underlying contributory factors. Cardiovascular and cerebrovascular risk reduction should be deliberately pursued as integral adjuncts to dementia risk reduction” (Eldemire-Shearer et al., 2018).

References:

Eldemire-Shearer, D., James, K., Johnson, P., Gibson. R., Willie-Tyndale, D. (2018). Dementia among Older Persons in Jamaica: Prevalence and Policy Implications. West Indian Medical Journal, 2018; 67 (1): 1. Available from: https://www.mona.uwi.edu/fms/wimj/system/files/article_pdfs/wimj-iss1-2018_1_8.pdf

Please refer to Part 1, questions from 01.02.01 to 01.02.03.

In 2009, it was estimated that over 27,000 people experience hearing loss. As of 2009, it was reported that Jamaica has 12 deaf schools and two vocational schools across the country (the Joshua Project, 2009).

References:

The Joshua Project. (2009). The Deaf of Jamaica: The Jamaican Sign Language Community. Available from: https://joshuaproject.net/assets/media/profiles/text/t19007_jm.pdf

The Jamaica Health and Lifestyle Survey III (Ministry of Health Jamaica, 2018), reports that 26% of men and 5% of women, 15 years and older use tobacco. Of the lifetime smokers, 27% report consuming more than 100 cigarettes. Additionally, by age 19, 50% of lifetime smokers had initiated cigarette smoking and by age 11, 10% initiated the act. Marijuana use was reported by 29% of male Jamaicans and 5% of Jamaican females. The highest prevalence estimates (21%) were among the 15 to 24 age group.

References:

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Please refer to Part 1, question 01.02.01.

The Jamaica Health and Lifestyle Survey III (Ministry of Health Jamaica, 2018) estimated that 82% of Jamaicans engage in low physical activity, 16% engage in moderate activity (minimum WHO recommendations) and 2% in high level activity. The survey did not find a significant age or gender difference. However, younger persons (below 60 years) within urban communities were more likely to make attempts to exercise.

References:

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Please refer to Part 1, question 01.02.01.

In Jamaica, alcohol use was reported by 41% of Jamaicans, 15 years and older. Alcohol consumption was highest among the 25 to 34 age group. Additionally, 8% of Jamaicans reported having six or more drinks on one occasion at least monthly (Ministry of Health Jamaica, 2018).

References:

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

The 2016-2017 Jamaica Health and Lifestyle Survey published preliminary findings that do not include the prevalence of high cholesterol (Ministry of Health Jamaica, 2018). However, the survey conducted between 2007 and 2008, though dated, estimated that 12% of Jamaicans, between 15 and 74 years old, had high cholesterol. Females have higher levels of cholesterol than their male counterparts (JHLS-II, 2008). Additionally, only 14% of those with high cholesterol were aware of their condition.

References:

JHLS-II. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

Ministry of Health Jamaica. (2018). Jamaica Health and Lifestyle Survey III: Preliminary Findings. https://www.moh.gov.jm/wp-content/uploads/2018/09/Jamaica-Health-and-Lifestyle-Survey-III-2016-2017.pdf

A local psychiatrist and STRiDE Jamaica stakeholder provided a brief overview of the diagnostic and post-diagnostic process for patients living with Dementia in Jamaica:

In terms of diagnostic tools used, he explains that patients are diagnosed using a history often obtained from collateral informants such as family, friends, or peers, along with a physical examination and mental status examinations, including the use of the Mini Mental Status Examination, which is often supported by brain imaging.

In terms of which mental health professional usually makes a diagnosis, he says that usually psychiatrists make the diagnosis of dementia, however he acknowledges that competent General Practitioners have also made the diagnosis and that in some cases, Mental health Nurse Practitioners have also assisted in diagnosing cases. He also notes that a dementia clinic exists at the University Hospital of the West Indies and is run by an assigned Consultant Psychiatrist and operated by a Psychiatry Resident.

[It was later learned that the services for the dementia clinic at University Hospital of the West Indies are available once a week, on Tuesdays between 12.30 p.m. to 4.00 p.m. An initial appointment with the General Psychiatry Clinic at the hospital is required, then followed up by regular visits at the Dementia Clinic. There is a cost attached of $2,500.00 JMD for the initial appointment and $1,200.00 JMD per visit to the dementia clinic.]

After diagnosis, it is explained that many patients are followed up by mental health nurses (in the Community mental health service ) and are followed up annually by the psychiatrist. Sometimes referrals are made by the psychiatrist for additional nursing assistance/housing. However, no psychological or social workers are available to the Kingston St Andrew or St Thomas Health Departments, which serve the most populous areas in Jamaica. Other Health Departments, on the other hand, may provide some psychological and/or social support (such as nursing assistance/housing). Our source notes that family support groups for persons with dementia exist in Jamaica, but these are poorly attended and ad-hoc referrals consequently diminish their momentum and critical mass.

No data was sourced due to a lack of data on dementia diagnosis rates and services in Jamaica.

No data was sourced due to a lack of data on dementia diagnosis rates and services in Jamaica.

No data was sourced due to a lack of data on dementia diagnosis rates and services in Jamaica.

Please refer to item 07.01.01 above.

No data was sourced.

No data was sourced.

No data was sourced.

No data was sourced.

There is no dementia-specific monitoring system in Jamaica. However, preliminary findings gathered from the STRiDE Jamaica team indicate that people living with dementia experience out-of-pocket expense to access care. Specifically, dementia care is not subsidised by the public sector, therefore individuals either access care through private insurance or pay-out-of-pocket.

No data was sourced.

There is no known empirical study conducted in Jamaica on the direct or indirect costs of dementia. However, STRiDE Jamaica, through telephone and email correspondence with pharmacies, diagnostic facilities and insurance companies found that, for a newly diagnosed dementia patient, care may cost on average J$56,321.90 to over $120,000 per month. This cost includes primary care visit, medication, and diagnostic cost.

Please refer to Part 3, question 03.01.01.

No data was found.

Please refer to item 07.01.01.

Please refer to Part 2, item 02.01.

No estimates available on the number of people who receive dementia-specific community-based care.

These mechanisms do not exist in Jamaica.

Family and other unpaid carers are not formally recognised as part of dementia-specific diagnostic services.

Please refer to item 07.01.01.

Please refer to item 07.01.01 above.

Yes, the local Alzheimer’s Association is Alzheimer’s Jamaica (AlzJA).

AlzJA does not have a national office, but it has a secretariat located at the Caribbean Institute for Health Research, University of the West Indies, Mona.

All of the staff are volunteers, including the Board of Directors.

The association has a website with useful information related to dementia. It also has some materials on dementia and a telephone contact. The Association runs Dementia Friends sessions, modelled after the UK based Dementia Friends programme. It has also launched a memory club in St Mary and has hosted a local conference on dementia in Kingston (See Part 5, question 05.01.02).

No data has been sourced, as there is no dementia-specific policy, and the only dementia-specific NGO does not have a national office.

No data has been sourced, as there is no dementia-specific policy, and the only dementia-specific NGO does not have a national office.

No data has been sourced, as there is no dementia-specific policy, and the only dementia-specific NGO does not have a national office.

No data has been sourced, as there is no dementia-specific policy, and the only dementia-specific NGO does not have a national office.

No data has been sourced, as there is no dementia-specific policy, and the only dementia-specific NGO does not have a national office.

Despite requests made to the Mental Health Unit at the Ministry of Health and Wellness as well as to the Medical Association of Jamaica, no data has been sourced for this question.

Despite requests made to the Mental Health Unit at the Ministry of Health and Wellness as well as to the Medical Association of Jamaica, no data has been sourced for this question.

Despite requests made to the Mental Health Unit at the Ministry of Health and Wellness as well as to the Medical Association of Jamaica, no data has been sourced for this question.

The Mona Ageing and Wellness Centre at the University of the West Indies, Mona, intermittently provides some short courses targeted at caregivers, family members of older adults, older adults and persons interested in providing care for older adults (UWI, 2019). These have included Older Adult Caregivers’ Training, Diabetes Mellitus Management, and practical hands-on training on checking vital signs, insulin administration and nutrition.

Plans are underway at the centre to develop new courses: Understanding Mental Health and First Aid and CPR. In partnership with PAHO, MAWC conducted a one-off ageing workshop for health care workers in the North-East Regional Health Authority (NERHA) which focused on issues such as nutrition, communication, health services and the built environment.

The Human Employment and Resource Training Trust National Training Agency (HEART) also provides training for ‘untrained’ workers as it is a key provider of technical and vocational training targeting school leavers (who passed at least 2 of their 6-8 subjects at the CXC examination level) and employed persons who wish to secure certification or further their career options. The Heart Trust operates 27 training centres island wide and aims to promote the development of human resource capital in Jamaica and improve the lives of citizens seeking training. Programmes provided by HEART include year-long courses in Allied Health- Geriatric Care, which may be a training option for ‘live-in carers’ or ‘caregivers’ who are otherwise ‘untrained’ (Heart NSTA Trust, 2019).

References:

Heart NSTA Trust. (2019). Programmes: Allied Health Geriatric Care. Available from: https://ndar.heart-nta.org/programmes.aspx

University of the West Indies. (2019). Mona Ageing and Wellness Centre. Available from: https://www.mona.uwi.edu/sites/default/files/uwi/reports/wellness.pdf

Despite requests made to the Mental Health Unit at the Ministry of Health and Wellness as well as to the Medical Association of Jamaica, no data has been sourced.

Private residential long-term care facilities, hospices, and adult day centres  are available in Jamaica. Some outpatient services are also available via public health centres in Jamaica.

As reported by the Ministry of Health and Wellness (2019), there are currently 14 facilities registered under the Nursing Homes Registration (1934). The nursing homes are required to register every two years. There are other private nursing homes in operation that are not currently registered under this act and, as such, pose a challenge in providing an accurate estimate.

References:

Ministry of Health and Wellness. (2019). Facilities currently registered under the Nursing Homes Registration Act 1934. Available from: https://www.moh.gov.jm/wp-content/uploads/2019/04/2019-gazette-list_final.pdf

Nursing Home Registration. (1934). The Nursing Homes Registration Act. Available from:     https://www.yumpu.com/en/document/read/36302201/nursing-homes-registration-actpdf

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

No data was sourced as there is no dementia-related tracking system.

Based on telephone enquiries made with local pharmacies by the STRiDE Jamaica team and leading psychiatrist who provides dementia care, antidementia medications available in Jamaica as of April 2020, include:

Acetylcholinesterase inhibitors:

1. Donepezil (Aricept)
2. Galantamine (Exelon)
3. Rivastigmine (Reminyl)

Anti-psychotic, Anti-depressants or anti-anxiety:

1. Haloperidol
2. Risperdal
3. Escitalopram
4. Lorazepam

Aricept (5mg & 10mg), and Palixid (5mg and 10mg) are frequently carried, while Reminyl (8 mg) and Exelon (3mg, 4.5mg, 5mg & 10mg) are also approved for sale in Jamaica but are not as widely available.

Yes, Palixid is available as generics.

The government of Jamaica partners with International Non-Profit Organisations such as Free Wheelchair Mission and the Starkey Hearing Foundation to help provide free or partially subsidised assistive technology to vulnerable groups in Jamaica, including older persons and persons with dementia (JIS, 2019). Other NGOS like Food for the Poor also provide adult hygiene products and housing adjustments upon request in vulnerable groups in the areas in Jamaica which they serve (Food for the Poor, 2019).

References:

Food for the Poor. (2019). Food for the Poor website. Available from: https://www.foodforthepoorja.org

Jamaica Information Service (JIS). (2019). Hundreds in Western Jamaica Get Free Hearing Aids, 20 June 2019. Available from: https://jis.gov.jm/features/hundreds-in-western-jamaica-get-free-hearing-aids/

No. STRiDE Jamaica is currently advocating for subsidisation of dementia-related medication to be covered by the National Health Fund. On April 20, 2020, STRiDE Jamaica presented their argument. For additional information, please refer to Part 2.

No data was sourced.

No data was sourced.

Eleven pharmacies across nine parishes were contacted. Table 9 provides the average monthly and tab costs of dementia-related medication:

 Table 9. Average Costs (JMD$) of Anti-dementia Medication

No data was sourced as there is no known organised body or data source on informal care workers for persons with dementia (or any condition) in Jamaica.

There is currently no government provided support specifically available to family/unpaid carers in Jamaica.

The Jamaica Gleaner (2017) reports that female-headed households represent the majority of mean household size compared to male-headed households. Additionally, female-headed households were also represented in the poorest quintiles (exact figures were not reported). Traditionally, parenting responsibilities and family care lies heavily on the female. In recent years, the female role has expanded to include meeting the financial needs of the family as well as the source of emotional support. Similarly, demographic profile from STRiDE Jamaica’s work package 4 of participants thus far and consistent with global literature, carers who participated were predominantly females (78.9%).

References:

The Jamaica Gleaner. (2017). Poverty climbed back to 21% in 2015. Available from: https://jamaica-gleaner.com/article/business/20171008/poverty-climbed-back-21-2015

No data was sourced for this question.

No data was sourced for this question.

No data was sourced for this question.

No data was sourced for this question.

No data was sourced for this question.

Please refer to Part 1, question 01.03.

Jamaica does not appear to currently have such a policy.

No data was sourced for this item as it is unclear whether work around dementia being conducted at the Mona Ageing and Wellness Centre was funded by the Jamaican government within the last year.

No data was sourced for this item as it is unclear whether work around dementia being conducted at the Mona Ageing and Wellness Centre was funded by the Jamaican government within the last year.

The STRiDE Dementia project happening in Jamaica is funded by the Global Council Research Fund, UK. Funding is used to directly support its research team and partners at the Caribbean Institute for Health Research University of the West Indies, Mona and Alzheimer’s Jamaica.

The STRiDE Dementia Project includes a work package on Training to help build capacity of early career researchers, NGO liaisons and associated professionals involved with the project in each of the developing country sites.

For many years, the government has identified the need to improve, streamline and computerise information systems in the public Jamaican health system, however this has not yet been achieved. Because information on dementia is aggregated with other mental health data, there is currently no direct, specific way in which to collect or analyse the performance of the public healthcare system for persons with dementia. It is also worth noting that there is no mandatory system currently in place to collect data on dementia from the private healthcare system. Efficient information systems are missing. Without a clear, regular, nuanced means of collecting relevant data on how the public and private healthcare systems are currently serving persons with dementia, there is no real way to identify what works or where the needs lie.

A national policy on dementia is needed in Jamaica. This has been the sentiment of the STRiDE Jamaica National Advisory Group as well as the STRiDE Dementia Project partner Alzheimer’s Disease International, in order to ensure committed prioritisation of and funding for dementia specific investment. However, the Ministry of Health and Wellness is yet to commit to the support of the development of such a policy and while dementia has been recognised as important by the Ministry, as well as the Pan American Health Organisation and the Ministry of Labour and Social Services, no local entities have yet publicly committed to the development of a national policy.

Direct service provision for dementia in the public sector appears to be limited to one weekly dementia clinic at the University Hospital of the West Indies, in the country’s capital of Kingston. Based on the limited data gleaned for this desk review, it appears that there is no clear care pathway enacted for dementia in the public sector. This has implications for timely diagnosis; adequate treatment, social support and the ability of families to manage care; considering the lack of a public long-term care system.

Evidence is needed on the public sector’s current view of dementia and how this may affect diagnosis and care; as well as on diagnosis rates; prevalence, the costs and consequences of dementia on family carers and the wider cost to the state. This evidence can support more efficient and effective approaches to dementia on a national scale and be used to inform recommendations for a national policy, which can in turn feed back into improving information systems and service provision for dementia in Jamaica.