District Health System of Dominica
The district health system of Dominica is the organizational backbone of the island’s Primary Health Care (PHC) model, developed in the early 1980s to ensure equitable access to medical services across the entire country. Recognizing the challenges of mountainous terrain, scattered rural communities, and limited financial resources, Dominica adopted a decentralized framework that divided the island into health districts, each anchored by a hospital and supported by health centers and outreach programs. This model remains one of the most cited successes in Caribbean community health delivery.
Historical Development of Dominica’s District Health System
The district health system emerged in the aftermath of independence (1978) and in response to the Alma-Ata Declaration on Primary Health Care (1978). Dominica’s Ministry of Health reorganized services into seven health districts, designed to bring care closer to communities and reduce dependence on the central hospital in Roseau. By the mid-1980s, this approach was fully operational, making Dominica a pioneer in PHC implementation in the Eastern Caribbean.
District Health System Structure in Dominica
The District Health System Structure in Dominica is built around a network of district-based facilities that link village-level clinics to regional hubs and the national referral hospital. This tiered framework organizes services so that common health needs can be met close to where people live, while advanced or specialized care is accessed through higher-level facilities. The system emphasizes both accessibility and efficiency, guiding patients through a clear chain of referrals and ensuring that each of the island’s seven health districts has an anchor institution at its core.
Referral Hierarchy
- Type I Health Centre → Small village clinic, basic outpatient, immunizations, first aid.
- Type II Health Centre → Larger rural clinic, expanded outpatient, maternal & child health, limited lab.
- Type III Health Centre → District-level primary care hub with wider services, coordination, and outreach.
- District Hospital → Provides inpatient care, emergency, surgery, and specialist services (Portsmouth and Marigot).
- Dominica-China Friendship Hospital → National referral hospital, advanced secondary and tertiary care.
Patients from villages first visit Type I or Type II centres. If more care is needed, they are referred to their district’s Type III health centre or district hospital (in Marigot or Portsmouth). Complex or specialist cases are then referred to the Dominica-China Friendship Hospital in Roseau, which is the national referral hospital.
Key Health District Facilities
Each of Dominica’s seven health districts is supported by a central facility that acts as its anchor. These facilities vary in classification, from Type III Health Centres to district hospitals, and provide the core services for their regions. The table below outlines the main facility for each district, its classification, and its role within the broader health system.
| District | Anchor Facility | Classification | Notes |
|---|---|---|---|
| Roseau Health District | Dominica-China Friendship Hospital (Roseau) | National Hospital | Central referral for all districts. Surrounding smaller centres still exist. |
| Portsmouth Health District | Reginald Fitzroy Armour Hospital | District Hospital | Replaced the old Portsmouth Health Centre;covering the island’s north and coastal communities near Cabrits National Park. |
| Marigot Health District | Marigot Hospital | District Hospital | Former Type III Health Centre upgraded;serving the northeast and communities around the Douglas-Charles Airport. |
| Castle Bruce Health District | Castle Bruce Health Centre | Type III Health Centre | serving villages on the east coast, with strong agricultural bases. |
| La Plaine Health District | La Plaine Health Centre | Type III Health Centre | Serves southeast communities including Delices. |
| Grand Bay Health District | Grand Bay Health Centre | Type III Health Centre | Serves southern communities, including farming and fishing villages. |
| St. Joseph Health District | St. Joseph Health Centre | Type III Health Centre | Providing services to west coast villages, including Layou Park and riverine communities. |
Health Teams
District health teams include medical officers, nurses, community health aides, and environmental health officers. Nurses are often the backbone of service delivery, providing outreach in schools, villages, and workplaces.
Achievements of the District Health System
The system contributed to major improvements in public health:
- Infant mortality fell from more than 20 per 1,000 live births in the 1970s to under 12 by the 2000s.
- Skilled birth attendance reached nearly 100%, even in remote villages.
- Maternal and child health indicators improved, with antenatal care coverage rising above 95%.
- Communities gained access to immunization, health education, and chronic disease management services without needing to travel to Roseau.
Challenges
Despite its success, the district health system faces ongoing difficulties:
- Workforce shortages, with migration of nurses and doctors leading to gaps in rural areas.
- Infrastructure damage from natural disasters such as Hurricane Maria (2017), which destroyed health centers and district hospitals.
- Limited resources, including shortages of pharmaceuticals and diagnostic equipment.
- Rising NCD burden, requiring more intensive services than originally envisioned under PHC.
Future Outlook
Reforms are underway to modernize the district health system:
- Rebuilding hospitals and health centers with climate-resilient infrastructure.
- Expanding telemedicine to reduce travel for rural patients.
- Strengthening partnerships with Cuba, China, and PAHO for staffing, training, and equipment.
- Integrating digital health records to link district facilities with the Dominica China Friendship Hospital.
The district health system of Dominica remains a cornerstone of the island’s resilience, ensuring that healthcare is not concentrated in Roseau but reaches communities across the mountains, rivers, and coastlines of the island.