Proportion of time used productively by staff in Jamaica's primary health care services

The primary health care system in Jamica offers extensive preventive and curative services to the public though a system of health centres, ranging from small centress with basic services to large centres with more sophisticated services. At a time of severe constraints in terms of financial and human resources, it is important to have a management system which will make the best use of these resources. The present survey was undertaken as part of management exercise initiated by the Ministry of Health, Jamica. The aim of the study was to describe what proportion of their working day was spent productively by various categories of personnel. A sample of 96 health centres was taken from the 375 providing services in Jamica. At each health centre selected, 1 of each type of staff category was randomly chosen and observed during 1 day, and 504 days' observations were so male. The work being done by the staff member was recorded and was classified as 'productive', 'other essential' or 'umproductive'. It was found that productive time ranged from over 60% to under 40%, according to category of worker. It varied very little between large and small health centres. the results indicate that there is much scope for improvement of time and staff management in the primary health care services. At present, based on findings reportd her and on a model developed in a collaborative project, a new system of scheduling of clinics and of staff allocation to these clinics is being planned in two districts in Western Jamaica

Maternal mortality in Jamaica.

A confidential inquiry into all maternal deaths in Jamaica during 3 years (1981 to 1983) was carried out. 192 maternal deaths were identified by a variety of means. The maternal mortality rate of 10.8 per 10 000 live births was considerably higher than the official rate of 4.8. The most common causes of death were hypertensive diseases of pregnancy (26%), haemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. The lowest rates were for women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. The largest groups of avoidable factors were: non-use of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of women at high risk; and delays in taking action when signs of complications developed before, during, and after delivery.

PIP: This article reports the results of a review of all maternal deaths occurring in Jamaica in 1981-83. A total of 192 maternal deaths were identified, yielding a maternal mortality rate of 10.8/10,000 live births, which was considerably higher than the official rate of 4.8. 15% of these deaths were associated with abortion or ectopic pregnancy. The most common causes of death were hypertensive diseases of pregnancy (26%), hemorrhage (20%), ectopic pregnancy (10%), pulmonary embolus (8%), and sepsis (8%). Maternal mortality was closely related to both age and parity. Lowest rates were noted among women of para 2-4 aged 20-24 years and para 3-4 aged 25-29 years. Avoidable factors were judged to be present in 68% of the deaths. The largest categories of avoidable factors were: nonuse of and deficiencies in antenatal care; inadequacy in ensuring the delivery in hospital of high-risk women; and delays in taking action when signs of complications developed before, during, and after delivery. In response to these findings, the Ministry of Health's Maternal Mortality Committee has called for the following actions: measures to encourage women to seek antenatal care early in pregnancy; improvements in antenatal monitoring; the referral of high-risk women for hospital delivery; the definition of standard procedures for dealing with specific complications of pregnancy, e.g., eclampsia and hemorrhage; regionalization of obstetric services and criteria for referring patients to hospital; and review of provision of blood and plasma for emergency transfusions.