Healthcare in Belize
Healthcare in Belize is provided through both public and private healthcare systems. The Ministry of Health (MoH) is the government agency responsible for overseeing the entire health sector and is also the largest provider of public health services in Belize. The MoH offers affordable care to a majority of Belizeans with a strong focus on providing quality healthcare through a range of public programs and institutions.
In contrast to the public health sector, the private health sector provides care to a smaller portion of the population. However, similar to the public sector, private health services are offered at a relatively low cost with a shared emphasis on quality of care and quality improvement.
The need for improved primary healthcare strategies was recognized during the 1980s. A formalized assessment of the health sector was not approved by the Government of Belize (GoB) and the Inter-American Development Bank (IDB) until 1994. Two years later, the MoH launched a National Health Plan, "Quest for Equity", which included an analysis of the major health conditions and determinants of health impacting Belize.
The results revealed a number of problems surrounding the health sector and identified key policy areas and priorities for improving the healthcare system. The issues identified in the diagnostic report laid the foundation for government initiated Health Sector Reform Project (HSRP), which was implemented in 2000. The primary objectives of the reform project included increasing access to care, improving quality of care, and ensuring the efficient and equitable delivery of care across both health sectors.
One of the major accomplishments of the reform project included the establishment of four health regions (northern, central, western, and southern health region) designated to provide health services to distinct geographical areas across Belize. All four health regions offer primary care and secondary care services. Only the Central Health Region, which serves the largest population in Belize, offers tertiary care services [see Health care delivery for description of levels of care]. In addition some progress was made in terms of the organization and management of the health system.
Since the inception of the HSRP, there have been continued efforts focused on reformation of the health sector with the national goal of improving health status through accessible quality care. In line with these goals, the health agenda for the 2007–2011 National Health Plan included a list of essential public health functions that specified minimum performance levels that both the public and private health sector must adhere to in order to maintain and improve health outcomes.
During this time, there was also further expansion of primary care services and an increasing emphasis on mental health. For example, the MoH launched a strategic mental health plan in 2009 aimed at integrating mental health services into primary care. Specifically, the mental health plan aims to achieve greater mental health through increased delivery of community-based care and targeted efforts to improve prevention and management of mental disorders as well as improved psychosocial rehabilitation.
Current Health Initiatives
Current health initiatives include the widespread implementation of a National Health Insurance (NHI) program and further development and implementation of the Belize Health Information System (BHIS).
National Health Insurance: The goal of developing a national health insurance program grew out of earlier health care reform efforts to provide affordable and accessible quality care. A pilot project was established in the south side of Belize City in 2001 and was expanded to the southern region of Belize in 2006.
A separate agency within the Social Security Board has been established to oversee the financing and purchasing duties for the NHI fund, while the MoH remains in charge of the regulatory and policy-making functions. An important component of the NHI program is the implementation of a pay for performance system (P4P), that provides financial incentives for meeting specified quality performance standards. Today, there are continued efforts to expand the NHI program throughout Belize.
Belize Health Information System: A need for a stronger health information system (HIS) was identified during early health reform efforts (1998) and was realized in 2008 with the introduction of the Belize Health Information System. The BHIS is an integrated comprehensive health information system that allows for the collection and dissemination of population-based and record-based health data with the goal of improving health outcomes and health performance.
The BHIS was originally deployed in urban areas in 2008 and was expanded to various hospitals and clinics across the four health regions by 2009. Following a comprehensive assessment of the BHIS, the MoH introduced a National HIS strategic plan (2009) to be carried out across a four-year period (2010–2014). Primary objectives of the plan include: expanding BHIS coverage to rural areas, strengthening the registration system, and improving data security and health information privacy.
While public healthcare in Belize is available to all of the population at no direct cost to the individual, a large portion of funding has been allocated to Belize City. Karl Heusner Memorial Hospital (KHMH), the national and regional referral hospital for Belize, is located in Belize City. Karl Heusner Memorial Hospital is considered to be the premier public healthcare provider in Belize. However, due to funding issues, the hospital has faced many challenges with equipment problems, medical supply shortages, and operation management problems.
Outside of Belize City, there are seven additional hospitals (located within the capitals of each of the seven other districts) that provide public healthcare. Among the seven district capital hospitals there are three regional hospitals: the Southern Regional Hospital in Dangriga, the Northern Regional Hospital in Orange Walk Town, and the Western Regional Hospital in the nation’s capital of Belmopan. Together, these regional hospitals provide more services to the public than the capital hospitals of Corozal and Toledo district.
Belize has a network of approximately 60 public health clinics, with a total of 700 public hospital beds, that provide primary medical and dental care to rural areas. Most of these health clinics suffer from inadequate staffing, lack of financial resources to handle the patient volume, and a lack of equipment and medicine. As a result, there is reduced access to (quality) care. An additional challenge surrounds the tendency for individuals residing in rural areas to utilize non-western medicine for their health needs rather than seeking publicly available health services. This creates problems in fully assessing the standard of healthcare in Belize and thus delays medical statistics requested by the United Nations and other interested parties.
In the 1990s, Belize introduced a program in which psychiatric nurse practitioners were trained and integrated into community-based care. Today, mental health services are available in district hospitals throughout the country. Most inpatient psychiatric services are provided at Rockview Hospital, the national mental hospital based in the Central Region. Mental Health services are also provided in the acute psychiatric ward in Belmopan Hospital, located in the Western Region.
Psychotropic medications are available in all district hospitals as well as in the polyclinic located in Belize City. Availability of psychotropic drugs is intermittent and patients sometimes need to purchase their own medications. In terms of medical staff, there are two psychiatric nurses allocated to provide mental health services in seven of the eight district hospitals. The introduction of psychiatric nurse practitioners has facilitated numerous improvements including: a reduction in the number of admissions to the psychiatric hospital, an increase in outpatient services, and the development of community-based mental health prevention and promotion programs.
The government of Belize, with assistance from the European Union and United Nations, has undertaken a major restructuring of the healthcare system. In 1990, the private sector became an increasingly important player in service delivery, providing services to approximately 15% of the population. Private healthcare for many people in Belize continues to play an increasingly important role.
Today, the private sector provides some additional tertiary care and imaging services not available in the public system. Persons in need of these services can purchase out of pocket from the private sector or the MoH can purchase these services on their behalf. Private institutions also accept medical insurance plans. In addition, P4P contracts have been implemented in Belize, via the NHI program, in order to improve quality care.
Private Hospitals and Clinics
The country has three main private hospitals. La Loma Luz Hospital is a private institution run by the Seventh Day Adventist mission. Belize Medical Associates is a 25 bed private hospital that offers radiology and neurological services. Universal Health Services is also another private healthcare facility in Belize City. In total Belize has 100 private hospital beds. Belize’s private healthcare sector is divided into nonprofit and for-profit facilities. Belize Medical Associates and Universal Health Services are both for-profit hospitals. La Loma Luz Hospital is a non-profit hospital.
In addition, there are over 50 for-profit clinics and four nonprofit clinics spread throughout Belize. Half of these private clinics are located in Belize City. The overlap between private and public is common. Government institutions usually assist private facilities when they lack equipment for a fee. Roughly 14 percent of Belize’s health care staff work in both sectors.
Some key national health priorities include:
- Non-communicable diseases and lifestyle related problems
- Prevention and management of violence (domestic violence and child abuse)
- Health promotion
- Sexual and reproductive health
- Maternal and Child health (Maternal and Infant mortality, EPI)
- Health Information Systems (BHIS, Vital registration, health accounts, WinSig)
- Health sector reform
- Environmental health
- Disaster preparedness and management
There are a number of health conditions prevalent in Belize. The most common conditions include: malaria, dengue fever, gastroenteritis, cholera, and HIV/AIDS. Since Belize is a developing country, many of these conditions are related to issues surrounding, infrastructure, standard of sanitation, and are reflective of the general lack of education and awareness about how these conditions are acquired and transmitted.
Historically, malaria has caused major problems in Belize. Although treatment for Malaria has improved dramatically over the years, there are still concerns about future outbreaks. Similar concerns surround dengue fever, cholera, and HIV/AIDS. Due to the relatively fragile infrastructure and low population, an outbreak of HIV/AIDS or any of the other medical conditions noted above may impact the population size as well as the human resources.
Despite a number of challenges, the Belizean government has made significant changes to the healthcare system. As a result of these changes, Belize has shown marked improvements in a number of areas, including vaccine preventable deaths. For example, there have been no reported cases of measles since 1991 or poliomyelitis since 1987.
The last case of neonatal tetanus was reported from Stann Creek District in 1997 and the last case of non-neonatal tetanus was in a three-year-old from Orange Walk District in 1998. The last case of Congenital Rubella Syndrome was reported in 1997. The Measles-Mumps-Rubella (MMR) vaccine was introduced in 1996 and the pentavalent formulation (DPT/Hep/Hib) in 2002. In 2005, MMR coverage was 95%; BCG, DPT, OPV-3 and Hepatitis B coverage were 96%.
Some key areas of national concern include:
- High prevalence of communicable diseases such as malaria, respiratory diseases and intestinal illnesses.
- High mortality rate from non-communicable diseases. Cardiovascular diseases appear as a significant cause of death not only in the elderly but also in the productive age population of 20–49.
- An increase in health problems related to human behavior and lifestyle such as injury, road traffic accident, violence adolescent pregnancy, abortions, STI’S HIV/AIDS and suicide.
- Anaemia, malnutrition, growth retardation, and diabetes.
- Limited equity in terms of access to health care and distribution of resources.
- Inefficient health care delivery system.
- Limited capacity for policy formulation and regulation of the health sector.
- Absence of a human development policy and plan.
- Limited quality assurance.
- Outdated legislations and areas of health care delivery not yet regulated.
- Limited clinical protocols for patient management.
- Limited technical operational manuals for program implementation.
- Health Systems Profile Belize (2009). Area of Health Systems and Services HSS-SP Pan American Health Organization/World Health Organization. Retrieved from: http://www.paho.org/blz/index.php?option=com_docman&task=doc_view&gid=64&Itemid=237
- Ministry of Health, Belize: Health Agenda 2007 – 2011. Retrieved from: https://www.healthresearchweb.org/files/National_Health_Policies-Belize_2007-2011.pdf. Specifically, the MoH’s mission is to deliver quality primary, secondary, and tertiary health services with an increasing emphasis on primary and preventative care
- Ministry of Health, Belize. Retrieved February 2nd, 2014 from: http://health.gov.bz/
- Belize: Nationwide district-based mental health care. Retrieved February 3rd, 2014 from: http://www.who.int/mental_health/policy/services/Belize.pdf
- NHI: a gateway to better health for all. Retrieved February 3rd, 2014 from: http://www.socialsecurity.org.bz/download/handbooks/NHI.pdf Archived 2014-02-28 at the Wayback Machine
- Ministry of Health, Health Initiatives, National Health Insurance. Retrieved February 3rd, 2014 from: http://health.gov.bz/www/health-projects/national-health-insurance
- Bowser, D.M., Figueroa, R., Natiq, L., & Okunogbe, A. (2013). A preliminary assessment of financial stability, efficiency, health systems, and health outcomes using performance-based contracts in Belize. Global Public Health: An International Journal for Research, Policy and Practice, DOI: 10.1080/17441692.2013.829511.
- Diagnostic Study of the National Health Information System of Belize (2008). Ministry of Health. Retrieved February 5th, 2014 from: http://health.gov.bz/www/attachments/413_NHIS%20Final%20Diagnostic%20Study.pdf
- Belizean Innovation: The Belize National Health Information System. Retrieved February 3rd, 2014 from: http://www.who.int/healthmetrics/library/countries/Belizean_Innovation_-_The_Belize_National_Health_Information_System_BHIS.pdf
- Belize: National Health Information System, Strategic Plan 2010–2014 (2009). Ministry of Health. Retrieve February 5th, 2014 from: http://health.gov.bz/www/attachments/305_National%20Health%20Information%20System%20Strategic%20Plan%202010-2014.pdf
- Medical Care in Belize: Retrieved February 4th, 2014 from: http://www.belize.com/medicalcareinbelize[permanent dead link]
- Killion, C., & Cayetano, C. (2009). Making mental health a priority in Belize. Archives of Psychiatric Nursing, 23(2), 157–165.
- Belize Medical Associates: Retrieved February 4th, 2014 http://www.belizemedical.com/about-us.html Archived 2014-02-22 at the Wayback Machine
- Global AIDS Country Progress Report: Belize. Retrieved February 5th, 2014 from: http://www.unaids.org/en/dataanalysis/knowyourresponse/countryprogressreports/2012countries/ce_BZ_Narrative_Report.pdf