Universal Health Coverage (UHC)
Universal Health Coverage (UHC) is a core objective of Dominica’s national healthcare development strategy. The country has made steady progress toward achieving UHC through policy reforms, infrastructure upgrades, and international partnerships to ensure that every resident can access essential health services without suffering financial hardship. This goal aligns closely with the country’s broader vision for resilience and equity, especially after the widespread impacts of Hurricane Maria in 2017.
Foundations of Dominica’s UHC Journey
Through the Ministry of Health, Wellness and Social Services, the government of Dominica has actively pursued UHC by restructuring the public health system to emphasise primary health care. Key to this transition has been the Health Systems Transformation initiative, a multi-tiered approach focused on improving service delivery, workforce training, and implementing digital health solutions.
Support from the Pan American Health Organization (PAHO) and the World Health Organization (WHO) has enabled Dominica to formalise policies and invest in health equity. These efforts have strengthened access to preventive, curative, and emergency services, particularly in rural and disaster-prone communities.
Physical and Digital Infrastructure
As part of UHC advancement, several health facilities were either constructed or upgraded to improve access and resilience:
- The Marigot Hospital, completed in 2023, offers modern inpatient, outpatient, and diagnostic services for the northeast of the island.
- Grand Bay Health Centre and La Plaine Health Centre were retrofitted under the Smart Hospitals Initiative, with hurricane-resistant construction, solar energy systems, and rainwater harvesting mechanisms.
- Newtown Health Centre, Roseau Health Centre, and the Bagatelle Health Centre were upgraded with emergency rooms, fencing, improved plumbing, and additional consulting spaces.
Digital infrastructure has also played a central role. The rollout of a Health Management Information System (HMIS) is streamlining patient records, referrals, and service statistics, helping public health managers make timely, data-driven decisions. The island also launched an Electronic Immunisation Registry, improving vaccination tracking and facilitating better community outreach.
Community-Level Services and Workforce Development
Recognising the importance of accessibility, the government trained 27 Community Health Workers (CHWs) to extend health services directly into homes and villages. These workers handle basic diagnostics, wellness checks, referrals, and health promotion efforts in hard-to-reach areas, particularly benefiting the elderly and persons with chronic conditions.
This decentralised approach reduces patient loads at larger facilities while encouraging early intervention and community-based care models.
Policy Support and Global Alignment
Dominica’s reforms are embedded within regional and international frameworks. The country participates in the Universal Health Coverage Partnership, which assists in technical planning, policy development, and healthcare financing strategies. Funded by the European Union, Government of Japan, and coordinated by WHO, this partnership helps countries tailor health reforms to local contexts while meeting global targets.
Another milestone in governance was the creation of the Dominica Hospital Authority, which introduced a Board of Directors and CEO-led management of public hospitals. This shift has led to greater administrative flexibility, improved procurement systems, and enhanced accountability in budget execution and service delivery.
Outlook for Long-Term Impact
While Dominica has made significant headway, challenges persist. Shortages of specialised medical personnel, transportation constraints in interior communities, and gaps in mental health services remain key areas for development. Nonetheless, the UHC agenda has laid a foundation for sustainable progress.
As Dominica deepens its partnerships, invests in local capacity, and embraces technology, the vision of universal health access becomes increasingly achievable. Dominica’s model offers a real-time case study in resilience-driven healthcare transformation for island nations facing climate and economic vulnerability.