Forty years. An introduction to the development of a Caribbean public health

The development of public health and primary care in Jamaica is examined with particular reference to the historical events which paved the way for their development: notably, the collaborative work undertaken by the Rockefeller Foundation (Commissions on hookworm, tuberculosis, malaria, yaws); recommendations of the Moyne Commission (leading to the establishment of the West Indies School of Public Health); and the Irvine Commission which recommended the establishment of the University College of the West Indies. A confluence of political, social and international activity in the 1970s proved catalytic in the development of the current ethos of primary health care, and the Department of Social and Preventive Medicine was instrumental in the training of the most innovative addition to the primary care health team, the community health aide. Undergraduate and postgraduate training programmes of the Department are highlighted as it celebrates its fortieth anniversary.

Patient-flow and waiting times in General Medical and Dental Clinics in Jamaica's primary health care services

Jamaica has implemented primary health care services closely in accordance with the philosophy of the Declaration of Alma Ata. However, resources are scarce and need to be well managed. Ideal patient-flow in health centres (HCs) would achieve both high efficiency in use of staff time and minimum waiting times for patients. this study of 465 patients in 44 general medical clinics served by 34 doctors and 25 nurse practitioners, and 167 patients served by dentists in each of 15 clinics, showed that mean contact time of patients with doctors was 7 minutes, with nurse practitioners 11 minutes, and dentists 4 minutes. Medical patients waited an average of 3 hours 53 minutes, whilst dental patients waited an average of 2 hours 23 minutes. Doctor's, nurse practitioners' and dentists' median times for starting to see patients were 10.00 a.m., 9.35 and 9.48 a.m. respectively. They were able to work without experiencing any delays in patient-flow since many patients were waiting at the HC by 8 a.m., and preliminary processing was short. It is suggested that if they started seeing patients earlier, patients' waiting times would be shorter. The shortage of pharmacists to dispense drugs after medical consultations added to patients' waiting time. The results were a natural outcome of the low supply of personnel and high demand for services situation being experienced in the medical and dental services