Turks and Caicos Islands
Official Name: Turks and Caicos Islands
Capital City: Grand Turk
Official Language: English
Surface: 430 km 2
PAHO Subregion: Non-Latin Caribbean
UN 2 digits Code: TC
UN 3 digits Code: TCA
UN Country Code: 796


PAHO Basic Health Indicator Data Base

This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.

Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.

The data presented is updated annually with the latest country information.


    The Turks and Caicos Islands , a British dependent territory, lie southeast of the Bahamas and north of Hispaniola . The territory comprises eight large islands and many smaller cays and islets, with a total landmass of 430 km2. The Turks group includes Grand Turk , Salt Cay, and some smaller cays. The Caicos group includes East Caicos , Middle Caicos, North Caicos , Providenciales, South Caicos , West Caicos , Pine Cay, and Parrot Cay.

    The total estimated population in 2000 was 17,502. More than 80% of the population lives on Providenciales, Grand Turk , and South Caicos . Providenciales, with 17,000 inhabitants is the only island with an urban center, where most of the territory's commercial and business activities take place. Cockburn Town , on Grand Turk , is the capital and the seat of government. The Governor represents the Queen of England; the Chief Minister, appointed by the Governor, is the head of government. The legislature consists of a unicameral Legislative Council.

    Tourism and related commerce are the main economic activities, accounting for 25% of GDP and more than 50% of employment. Service industries, including public sector services, tourism, banking and insurance, fishing, and agriculture, employ 95% of the labor force. The unemployment rate was 12% in 1999, with a higher rate for women (25%) than for men (17%). Approximately 26% of the population are considered poor, and 3% are extremely poor. Haitians comprise 30% of the population, but accounted for 38% of the poor. In 1999, 30% (US$ 15.8 million) of the national recurrent expenditure (US$ 53 million) was allocated to the social sectors, particularly education, health, youth, and sports. However, the development program is still very dependent on external funding; some US$ 37 million in development aid was received in 1999-2000. Per capita GDP remained fairly steady 1996-1998, at an average US$ 5,973 per year. Total public spending as a percentage of GDP continued its downward trend, falling from 34% in 1992 to 21% in 1999. In contrast, total spending on health as a percentage of GDP increased, rising from 3% in 1996 to over 4 % in 1998. The main problems influencing the health situation and the delivery of health services are poverty, immigration, and increased use of private health services and insurance by Turks and Caicos Islanders. Limited private outpatient services on Providenciales are available for those who can afford them, and some go abroad, particularly to the U.S. , even for primary and routine services.

    There were 306 reported deaths, 1996-2000. Approximately 36% (101) of deaths with defined causes (282) were due to diseases of the circulatory system; 21% (59) to communicable diseases, particularly HIV/AIDS; 7.8 % (24) to signs, symptoms, and ill-defined conditions; 8%(22) malignant neoplasms; and 6% (16) to conditions originating in the perinatal period. The M:F mortality ratio was 0.97:1. The 60 years and older age group accounted for 49% of overall mortality; the 20-59 years age group accounted for 37% of overall mortality, 29% of which was due to HIV/AIDS.

    Analysis by population group
    Children (0-4 years): There were 24 infant deaths, 8% of total deaths, 1996-2000. Conditions originating in the perinatal period accounted for 68% (16) of all infant deaths, to which asphyxia and slow fetal growth contributed 6 deaths and one death due to HIV/AIDS. Intestinal infections and acute respiratory infections accounted for 55% (46 of 84) of hospital discharge diagnoses for infants, 1996-2000. There were six deaths among children aged 1-4 years, 1996-2000: intestinal infectious diseases (2), accidental fire (2), nutritional deficiencies and anemias (1), transport accidents (1). Intestinal infectious diseases and acute respiratory infections accounted for 40% of hospital discharge diagnoses, and injuries, for 8%.

    Schoolchildren (5-9 years): There were eight deaths 5-9 years of age, 1996-2000, transport accidents (3) and HIV/AIDS (2). The leading causes of the 196 hospitalizations in this age group were intestinal infectious diseases (15 %): injuries; appendicitis and hernia; and unspecified bronchitis, emphysema, and asthma.

    Adolescents (10-14 and 15-19 years): There were two deaths in the 10-14 years age group, 1996-2000: accidental drowning (1), acute respiratory infection (1). In the 15-19 years age group there were two homicides. The 10-14 years age group accounted for 4% of all hospital discharges, 1996-2000, and the 15-19 age group, for 6%. The leading discharge diagnoses were injuries; appendicitis; diseases of the nervous system; and unspecified bronchitis, emphysema, and asthma. Complications of pregnancy accounted for 7% of all discharge diagnoses in the 15-19 years age group. Of all births 10% were to teenagers, 2000.

    Adults (20-59 years): The 20-59 years age group accounted for 37% of deaths, 1996-2000. The leading cause of death in the age group was HIV/AIDS (29%), followed by diseases of the circulatory system (24%). Other important causes of death were homicide (6%), diabetes (4%), and transport accidents (4%). This age group accounted for 57% of all hospital discharges, 1996-2000, of which females were 62%. Main discharge diagnoses were injuries (9%), hypertensive disease (7%), and appendicitis and hernia (7%). Females accounted for 66% of diabetes diagnoses and 65% of hypertension diagnoses. Among females in this age group, complications of pregnancy comprised 11% of hospital discharge diagnoses.

    Elderly (60 years an older): There were 137 deaths 65 years and over, 1996-2000 (45% of all deaths). Diseases of pulmonary circulation (32), cerebrovascular accidents (20), ischemic heart disease (16), and diabetes mellitus (15) were major contributors to mortality in this age group. Malignant neoplasms (12), particularly cancer of the prostate and cancer of the female breast, were important causes of death. Hypertensive disease accounted for 18% (105 of 591) of the hospital discharge diagnoses for this age group, 1996-2000, followed by diabetes mellitus, 15% (90). Other important discharge diagnoses were diseases of pulmonary circulation (36), cerebrovascular accidents (29), other diseases often digestive system (28), injuries (27), appendicitis and hernia (24), and acute respiratory infections (20).

    Analysis by type of health problem
    Vector-borne diseases: No cases of malaria or dengue were reported between 1998 and 2000.

    Immune preventable diseases: No cases of measles or rubella were reported, 1998-2000. There were three cases of hepatitis B in 1998 and four in 2000. There was one case of mumps in 1999.

    Intestinal infectious diseases: Intestinal infectious diseases appeared among the 10 leading hospital discharge diagnoses for all age groups and accounted for four deaths, 1996-2000.

    Chronic communicable diseases: From 1996-2000, there was one death and 28 hospitalizations due to TB. There was no leprosy.

    Acute respiratory infections: Acute respiratory infections accounted for less than 5% (113) of hospital discharge diagnoses 1996-2000. There were 2,309 clinically diagnosed cases of influenza between 1998 and 2000.

    HIV/AIDS: HIV/AIDS is a growing problem, particularly among adolescents and young adults. There were 40 deaths due to HIV/AIDS (13% of total deaths), 1996-2000. From 1998 to 2000, there were 135 new cases of HIV infection. In 2000, 2% of persons tested for HIV (35 of 2,079) were positive.

    Nutritional deficiencies: There were two deaths and 61 hospital discharge diagnoses due to nutritional deficiencies and anemia, 1996-2000. Diabetes accounted for 7% (19) of all deaths, and 3% (113) of all hospital discharge diagnoses, 1996-2000.

    Cardiovascular disease: Cardiovascular disease was 33% (100) of deaths during 1996-2000 and particularly affected adults aged 20-59 and the elderly. Important contributors to mortality due to cardiovascular disease were diseases of pulmonary circulation (44), cerebrovascular disease (26), and ischemic heart disease (22). Diseases of the circulatory system accounted for 13% (428 of 3,428) of all hospital discharge diagnoses from 1997 to 2000; hypertension was the main contributor to this group (65%), with a M:F ratio of 0.41:1.

    Malignant neoplasms: Malignant neoplasms accounted for 7% (22) of deaths, 1996-2000. Important sites were the prostate, the female breast, and the digestive system and peritoneum, which accounted for five deaths each.

    Accidents and violence: External causes accounted for 12% (37) of deaths, 1996-2000, with traffic accidents and homicides (9 each) being the major contributors.

    Health Sector Reform: The Health Sector Adjustment Program was implemented in 1993-1997. A reform agenda includes the transfer of the health services procurement function from the Ministry of Health (MOH) to the Ministry of Finance; completion of a feasibility study for the National Health Insurance Scheme; restructuring of the MOH, including the establishment of a Health Policy and Planning Unit, greater autonomy to health clinic managers, and the design and implementation of management and information systems and infrastructure improvement programs, and development of a communications support and a national mental health program.

    Organization of the health sector: The MOH is responsible for the provision of efficient and effective preventative and curative care through the Health Department. This is carried out in partnership with the community, and with private and overseas providers. Decision-making is very centralized. The Permanent Secretary chairs the Senior Management Team, which is comprised of the Undersecretary, the Chief Medical Officer, the Chief Nursing Officer, and senior program managers. Private sector activity is limited to outpatient care and is focused on general practice. Residents have total access to healthcare throughout the country and at public health care facilities, clients are treated regardless of their ability to pay.

    Health Insurance: Employed persons pay a premium to receive benefits. Social Security covers the cost of medical expenses for occupational injuries; however, most employees are also enrolled in private insurance schemes. An estimated 20% of population has private health insurance; the remainder are covered by the MOH. Premiums for private insurance are paid jointly by the employer and the employee.

    Organization of regulatory actions: The MOH is responsible for regulating the health sector, but there are no mechanisms in place to regulate private health insurance. It is also responsible for the supervision, evaluation, and control of health service delivery by public and private providers. Intersectoral activity is promoted, but there are no formal mechanisms for collaboration or community participation. The Health Practitioners Board Ordinance is responsible for the establishment of health facilities and for the regulation and control of health professionals and allied health workers. The Board is also responsible for the accreditation of public and private sector health facilities. The Department of Environmental Health is responsible for vector control; monitoring of food and water supplies; inspection of food establishments and other buildings; and solid waste collection and disposal. Environmental health officers are stationed throughout the islands. Most of their activities are performed in close collaboration with the Department of Primary Health. The Public Environmental Laboratory is the main laboratory within the National Public Health Laboratory System. Its primary role is to monitor food sanitation and environmental quality. The Department of Primary Health is responsible for the prevention and control of communicable and noncommunicable diseases. It also implements various public health programs, including health education activities, through clinics. Health information n is not available on a timely basis: there is no coding system and data are processed manually.

    Organization of the health care services: The public hospital network is comprised of the main facility, Grand Turk Hospital (35 beds), and the Myrtle Rigby Health Clinic (10 beds), located on Providenciales. These facilities provide general acute care and specialized services, as well as mental health, geriatric, and rehabilitative care on an inpatient and outpatient basis. Some secondary level services are offered in county, and others may be procured abroad; all tertiary level services must be procured abroad. There are two clinical laboratories in the public sector, located on Grand Turk and Providenciales, and two private clinical laboratories on Providenciales. The National Blood Bank Service is based at Grand Turk Hospital.

    Health supplies: The procurement of pharmaceuticals and monitoring of public sector pharmacies is conducted by the Chief Pharmacist. All persons seeking health services in public institutions have access to prescribed drugs, when available. Equipment distributed among the two public hospitals includes two ultrasound, two X-ray, and four dialysis machines. The private sector does not have high technology equipment.

    Human resources: The number of health staff has increased since 1995, but shortages continue. Most personnel are foreign nationals, which is particularly critical, since they often hold senior managerial positions (e.g., Chief Medical Officer), and there is a high degree of temporary staff. The Government is seeking to employ more nationals, and the Community College has begun to train clinical nurses.

    Sectoral expenditure and financing: The total national expenditure on health in 1998 was estimated at US$ 16.5 million: public expenditure on health was estimated at US$ 7.5 million (45%) and private expenditure at US$ 9 million (55%). Annual Government spending per capita is approximately US$ 310, and individuals spend at least US$ 375 per year out-of-pocket. Therefore, the minimum per capita health expenditure was estimated at US$ 685 in 1998. Private insurance accounted for 21% of national health expenditure. Services provided in Turks and Caicos accounted for 48% of total expenditure, and services procured abroad accounted for 52%. A user fee system is in place at public facilities, though those deemed unable to pay are exempt. Other excluded categories include elderly pensioners, welfare recipients, prisoners, and children under 18 years of age. The Government pays for some overseas care for individuals on a case by case basis. There are no public financing modalities for private health insurance. The Institute for Health Development reported a 7% increase in the health budget in 1997 and a 39% increase in 1998. The latter increase is mainly for the strengthening of primary care, including the Myrtle Rigby Health Clinic, medical treatment overseas, and the integration of the HIV/AIDS Program in the MOH.

    External health technical cooperation: DFID and PAHO/WHO provided technical cooperation and financial assistance to the Turks and Caicos Islands during the review period.