Health Sector of Dominica

The Health Sector of Dominica stands central to national progress, driving resilience, wellbeing, and productivity. Anchored by the Dominica China Friendship Hospital, complemented by community health centers, and directed by the Ministry of Health, Wellness and Social Services in partnership with PAHO/WHO and UNDP, care reaches towns, villages, and remote valleys. The sector confronts challenges such as non-communicable diseases, natural disasters, and workforce migration, but remains committed to balancing universal access with innovation and resilience planning. Since independence in 1978, Dominica has worked to strengthen its health system through legislation, institutional frameworks, and international partnerships, making health a central pillar in national strategies such as the National Resilience Development Strategy 2030.

Structure and Governance

The Ministry of Health, Wellness and Social Services, is responsible for developing and implementing national health policies, regulating medical practice, and coordinating service delivery. The Ministry supervises both primary and secondary care, ensures the licensing of medical personnel, and manages national public health programs such as vaccination, disease surveillance, and wellness promotion.

Dominica’s governance framework for health is shaped by several important laws and regulations. These include:

• Public Health Act – provides the legal framework for controlling communicable diseases, sanitation, and public health emergencies.
• Hospital and Health Services Act – establishes the structure for hospitals, health centers, and district medical services.
• Medical Practitioners Act – regulates the licensing, registration, and standards of medical doctors.
• Nurses Registration Act – sets professional requirements and practice standards for the nursing labour force (nurses and midwives).
• Labour Standards Act – includes workplace health protections and safety obligations for employers.
• Pharmacy Act – governs the regulation, importation, and sale of medicines.

Oversight also includes collaboration with Cabinet and Parliament, where health funding and sector priorities are debated during the Annual Budget Address. Statutory boards, such as the Medical Board of Dominica and professional associations like the Dominica Nurses Association, play advisory roles.

Infrastructure and Facilities

Dominica’s health system is organized into a tiered structure of hospitals, district facilities, and local health centers.

Dominica China Friendship Hospital

The central referral institution is the Dominica China Friendship Hospital (DCFH), located in Roseau. Built with significant assistance from the People’s Republic of China, it replaced the Princess Margaret Hospital, which had been the island’s main medical facility for decades. The hospital now provides specialized services in surgery, pediatrics, obstetrics, gynecology, cardiology, nephrology, and emergency care.

The DCFH includes an Intensive Care Unit (ICU), diagnostic laboratories, operating theatres, and maternity wards. It has become a symbol of Dominica’s efforts to modernize healthcare infrastructure, with climate-resilient design and capacity to better withstand hurricanes and seismic activity.

District Hospitals

The health network includes seven district hospitals strategically located to provide coverage for rural and semi-urban areas. Key examples are:

• Portsmouth Hospital in the north, which caters to the second-largest urban population and often supports communities near Cabrits National Park.
• Marigot Hospital, which also functions as the island’s designated port health facility for air travel via the Douglas-Charles Airport.
• Grand Bay Hospital, which serves communities across the south, including those engaged in fishing and farming along the St. Patrick Parish coastline.

These district hospitals provide general medical services, minor surgery, obstetrics, and referral links to the Dominica China Friendship Hospital for advanced care.

Health Centers in Rural Communities

Health centers are vital to Dominica’s Primary Health Care model, ensuring that people in remote and mountainous areas have access to services. Notable examples include:

• Calibishie Health Centre, which supports a major fishing and tourism community in the north.
• La Plaine Health Centre, which provides care to farming communities in the southeast.
• Kalinago Health Centre, serving the Kalinago Territory, where cultural sensitivity and community health initiatives are important aspects of service delivery.

Across the island, more than 50 health centers and clinics provide immunizations, antenatal care, chronic disease management, and health education. Outreach programs often extend to schools and workplaces.

Private Clinics and Pharmacies

Private providers play a complementary role. Clinics in Roseau and Portsmouth offer outpatient consultations, while pharmacies distribute medications imported through the OECS Pharmaceutical Procurement Service, which reduces costs by pooling regional demand. Diagnostic labs, including those linked to private practices, provide blood work and imaging services, helping to reduce pressure on the public system.

Health Workforce

Dominica’s health workforce is relatively small compared to larger Caribbean nations, but it is diverse in professional categories. According to available statistics from PAHO, the island has:

• Around 30–35 medical doctors (including specialists).
• More than 200 nurses and midwives in active practice.
• Dozens of allied health professionals, including laboratory technicians, radiographers, and pharmacists.

These numbers translate to a physician density of fewer than 5 per 10,000 people, below the WHO’s recommended threshold, highlighting the sector’s vulnerability.

Professional Associations and Training

The Dominica Nurses Association (DNA) plays a crucial role in professional development, advocacy, and international networking. Nurses are trained at the Dominica State College, while many pursue advanced studies through the University of the West Indies or programs abroad.

Doctors are often trained overseas, with some returning to practice in Dominica after completing medical degrees in Cuba, the United States, or the United Kingdom. Visiting specialists sometimes fill gaps in cardiology, oncology, and nephrology.

International Cooperation: Cuban and Chinese Assistance

Dominica has benefited from strong international health cooperation. The Cuban Medical Brigade has sent doctors, nurses, and specialists to Dominica for decades, supporting both hospitals and rural health centers. Many Dominican doctors also received scholarships to study in Cuba, returning with skills that strengthen the system.

China has also provided significant assistance, not only in constructing the Dominica China Friendship Hospital, but also in sending medical missions and donating equipment, ambulances, and supplies. These bilateral partnerships highlight the importance of diplomacy in sustaining the health workforce.

Challenges: Migration and Retention

One of the greatest challenges for Dominica’s health workforce is brain drain. Nurses and doctors often migrate to the United States, Canada, or the United Kingdom in search of higher salaries and improved working conditions. This leads to shortages at home, particularly in specialized fields.

Retention strategies include offering incentives for rural postings, providing housing, and investing in continuing education. However, limited fiscal space restricts the government’s ability to compete with salaries abroad. As a result, Dominica remains reliant on foreign assistance, visiting professionals, and regional networks to maintain service delivery.

Public Health and Community Care

Dominica has long embraced the Primary Health Care (PHC) model, introduced in the 1980s, which prioritizes preventive care, community health, and equitable access. This model remains the foundation of service delivery and ensures that even the most rural communities receive basic care.

Maternal and Child Health

The island has made major strides in maternal and child health. Skilled birth attendance reaches nearly 100%, reflecting confidence in both district hospitals and health centers. Infant mortality declined from 17.5 deaths per 1,000 live births in 2000 to about 10.7 per 1,000 in 2022. Antenatal coverage improved from 89.6% in 2015 to 95% by 2020, while vaccination programs maintain high coverage rates, though occasional gaps appear during disasters.

Childhood nutrition has also improved, with school feeding programs emphasizing local produce such as green bananas and provisions. NGOs like the Dominica Diabetes Association and Dominica Cancer Society promote early screening, diet education, and chronic disease prevention beginning at the school level.

Non-Communicable Diseases

Like many Caribbean nations, Dominica faces a heavy burden of non-communicable diseases (NCDs). The most common include:

• Diabetes: prevalence increased from 8.4% in 2000 to over 11% by 2014.
• Hypertension: about 22% of adults are affected.
• Obesity: nearly 60% of adults over 15 are overweight or obese.

The government has introduced wellness campaigns, targeting diet, exercise, and smoking cessation. These programs are integrated into schools, workplaces, and rural communities, reflecting the holistic approach of the PHC model.

Communicable Disease Control

Communicable diseases have largely been kept under control. Tuberculosis incidence is low, with no new cases reported in 2022. HIV prevalence is modest, with an estimated incidence of 10.5 per 100,000 people. Dengue, chikungunya, and zika outbreaks pose recurring threats due to Dominica’s tropical climate, but vector control programs, mosquito spraying, water source monitoring, and public awareness, are ongoing.

The Environmental Health Unit monitors water quality, food safety, and sanitation. This unit works closely with village councils in communities like Soufrière and Marigot, where coastal and agricultural activities pose public health risks if not managed properly.

Role of NGOs and Community Organizations

Public health efforts are supported by a network of NGOs and civil society organizations. The Dominica Red Cross is active in disaster preparedness and blood donation drives. The Dominica Cancer Society promotes screenings, particularly for cervical, prostate, and breast cancers. The Dominica Diabetes Association runs education programs and mobile clinics, while smaller community groups organize wellness fairs in villages such as Grand Bay and Castle Bruce.

Together, these initiatives strengthen the social fabric of Dominica’s health response, especially in areas where government resources are stretched thin.

Financing and Partnerships

Dominica spends around 6.5% of GDP on health (2021 figures), with public spending accounting for about 4.1% of GDP. Out-of-pocket payments remain significant at nearly 24% of total health spending, creating a burden for households dealing with chronic illnesses.

The Ministry of Finance allocates health resources during the national budget presentation, with special emphasis on hospital upgrades, district health center repairs, and pharmaceutical procurement. Health funding is also integrated into disaster recovery budgets, particularly after major storms like Hurricane Maria in 2017.

Regional Cooperation

Dominica is a member of the OECS Pharmaceutical Procurement Service, which reduces the cost of medicines through bulk purchasing across the Eastern Caribbean. The Caribbean Public Health Agency (CARPHA) provides laboratory and epidemiological support. Dominica also participates in OECS health harmonization, which sets standards for licensing medical practitioners and sharing health data.

International Partnerships

Bilateral and multilateral partners are essential to Dominica’s health financing and technical assistance:

• China – funded the Dominica China Friendship Hospital, continues to send medical missions, and has donated equipment, including ambulances.
• Cuba – provides scholarships for Dominican medical students and deploys doctors and specialists under the Cuban Medical Brigade.
• PAHO/WHO – supports disease surveillance, vaccination, and data systems.
• European Union (EU) – has financed health system strengthening as part of broader social sector support.
• United Nations Development Programme (UNDP) in Dominica – has assisted in integrating climate resilience into health infrastructure projects.

These partnerships underscore Dominica’s reliance on external collaboration while also reflecting the island’s strategic importance as part of the Caribbean’s health landscape.

Disaster Preparedness and Resilience

The health sector of Dominica is uniquely vulnerable to natural hazards. Hurricane Maria in 2017 devastated hospitals and health centers, destroying roofs, disrupting water supplies, and damaging medical equipment. The Princess Margaret Hospital was left partially incapacitated, with services relocated to temporary shelters.

The destruction highlighted the need for climate-resilient designs in health infrastructure. Since then, new health facilities, particularly the Dominica China Friendship Hospital and district hospitals, have been built or retrofitted to withstand hurricane-force winds and seismic shocks.

National Emergency Planning

Health disaster preparedness is coordinated by the National Emergency Planning Organization (NEPO), which integrates health into national disaster risk management. The Ministry of Health works with NEPO to conduct annual disaster drills, stockpile essential medicines, and train first responders.

Community-level resilience has also been emphasized, with village councils in places like Kalinago Territory and La Plaine participating in health emergency simulations.

Pandemic Response

The COVID-19 pandemic tested Dominica’s resilience in a new way. The first case was recorded on 22 March 2020, prompting immediate border closures and quarantine measures. Though the overall case burden was relatively low compared to larger Caribbean islands, the pandemic strained resources and delayed routine services such as cancer screenings and NCD management.

The crisis also accelerated the introduction of digital health systems, including electronic vaccination registries and data platforms for disease surveillance. Telemedicine consultations became more common, particularly for patients in remote areas unable to travel during lockdowns.

Future of Resilience in Health

Dominica’s vision of becoming the world’s first climate-resilient nation places health at the center of resilience planning. This includes:

• Designing hurricane-proof hospitals and clinics.
• Establishing renewable energy backup systems at health facilities.
• Expanding water storage and purification systems to secure clean supplies during disasters.
• Training health workers in disaster medicine.

The integration of resilience in health not only safeguards lives during crises but also ensures continuity of care for chronic conditions and emergencies in the aftermath of storms.

Health Data and Indicators

Health data provides an essential lens for understanding progress and gaps within Dominica’s system. Over the past two decades, national health indicators show improvement in several areas but persistent challenges in others.

• Life expectancy: As of 2023, life expectancy in Dominica is 74.2 years, an increase from 71 years in 2000.
• Infant mortality: Declined from 17.5 per 1,000 live births in 2000 to about 10.7 in 2022, showing resilience in child health programs.
• Maternal mortality: Data fluctuates, but averages remain below 100 deaths per 100,000 live births, in line with regional trends.
• Non-communicable diseases: Diabetes prevalence increased from 8.4% (2000) to over 11% (2014), while hypertension affects nearly a quarter of the adult population.
• Obesity: Almost 60% of adults are overweight or obese, contributing to cardiovascular disease rates.
• Communicable diseases: HIV incidence sits at 10.5 per 100,000 population. Tuberculosis has nearly disappeared, with no new cases reported in recent years.

Nutrition is also a critical marker. About 20% of Dominican women of childbearing age suffer from anaemia, while school-age malnutrition remains a focus of public health campaigns. These data points highlight why wellness promotion and preventive care remain national priorities.

Emerging Issues and Innovations

The health sector continues to adapt to emerging challenges and opportunities through innovation.

Digital Health and Telemedicine

The COVID-19 pandemic accelerated investments in digital health systems. The electronic immunization registry now allows real-time monitoring of vaccine uptake, and telemedicine pilots enable consultations for rural communities in Layou, Castle Bruce, and Kalinago Territory. Plans are underway to expand electronic health records across district hospitals, linking them to the Dominica China Friendship Hospital.

Mental Health Services

Mental health has emerged as an area of renewed focus. The Acute Psychiatric Unit at the Dominica China Friendship Hospital provides inpatient care, but community-based services remain limited. NGOs have called for more counseling in schools and workplaces, especially following trauma from Hurricane Maria and the pandemic.

Wellness Tourism

Dominica’s reputation as the “Nature Island” has spurred interest in wellness tourism, connecting health services with eco-tourism. Some private clinics now collaborate with resorts in Portsmouth and Soufrière to offer health packages that combine relaxation, herbal medicine, and spa treatments with conventional medical care.

International Cooperation and Technical Support

Bilateral agreements remain a cornerstone of innovation. The Cuban Medical Brigade continues to provide doctors and training, while Chinese missions regularly bring specialists in cardiology, ophthalmology, and oncology. Memoranda of Understanding (MOUs) with countries like Venezuela and regional OECS agreements also provide technical and pharmaceutical support.

Challenges and Reforms

Despite progress, Dominica’s health sector faces persistent challenges requiring reform.

Workforce Retention

The migration of nurses and doctors is perhaps the greatest long-term threat. Many trained professionals leave for the United Kingdom, United States, or Canada, where salaries and conditions are more favorable. This brain drain has left shortages in critical specialties such as nephrology, oncology, and emergency care.

Financing Sustainability

While 6.5% of GDP is spent on health, out-of-pocket costs remain high. Patients with chronic diseases such as diabetes or hypertension often face significant financial strain. Discussions on introducing a national health insurance scheme have surfaced repeatedly but remain unrealized due to fiscal limitations.

Access to Rural Communities

Rural Dominica, with its mountainous terrain, creates barriers to equitable access. Patients in Delices, Petite Savanne, or remote Kalinago Territory villages may still travel long distances to access specialist services. Expansion of mobile clinics and telemedicine may help, but geographic barriers remain.

Pharmaceutical and Equipment Shortages

Supply chain challenges, exacerbated by disasters, create shortages of essential medicines and diagnostic equipment. While the OECS Pharmaceutical Procurement Service mitigates costs, timely delivery remains inconsistent.

Legislative Updates

Some health laws, such as the Public Health Act and Hospital and Health Services Act, are decades old and require updating to reflect modern standards, data management, and patient rights. Proposals for a Patients’ Rights and Responsibilities Act have been discussed but not yet enacted.

Natural Disasters and Climate Change

Climate-related disasters like hurricanes and tropical storms remain an existential challenge. Hurricane Maria in 2017 destroyed nearly every health facility, forcing Dominica to rethink its infrastructure strategy. While new facilities are climate-resilient, the risk of service interruption in future disasters remains a constant threat.

Path Forward for the Health Sector of Dominica

The future of Dominica’s health sector lies in a vision of resilience, equity, and innovation. Strengthening primary health care remains the foundation, with district hospitals and health centers like Calibishie, Grand Bay, and La Plaine positioned to deliver accessible community care.

At the secondary and tertiary level, expanding services at the Dominica China Friendship Hospital is vital, with plans to grow specialties in oncology, cardiology, and renal care. Partnerships with China and Cuba will continue to provide training and visiting professionals, but strategies must prioritize training and retaining local talent.

Technology is poised to reshape service delivery. Telemedicine, digital health records, and surveillance systems can overcome geographic barriers and improve efficiency. Mental health integration and wellness tourism present opportunities to broaden the sector’s reach while contributing to economic diversification.

Policy reforms are also crucial. Updating health legislation, exploring options for universal health coverage, and investing in sustainable financing models will ensure equity and long-term stability.

Finally, Dominica’s role as a climate-vulnerable small island state makes resilience central to its health future. Every hospital, clinic, and pharmacy must be built to withstand storms, with renewable energy and water systems ensuring continuity during disasters.

Health Sector of Dominica therefore stands not just as a service provider but as a guardian of resilience, a driver of development, and a partner in national well-being. The coming decades demand integrated approaches, linking health with education, environment, and the economy, to ensure that every Dominican can thrive in a system prepared for both everyday needs and extraordinary challenges.