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Dominican Republic Summary 2024: Common Conditions, Tropical/Neglected Factors & Basic Healthcare System

 

 

Introduction

 

The Dominican Republic, with its rich cultural tapestry and diverse geographical landscapes, faces unique healthcare challenges that are intricately tied to its environment. From the sprawling beaches to the towering mountains, the nation's beauty masks the underlying struggles against vector-borne diseases, waterborne infections, and the impacts of natural disasters. These challenges are further compounded by the socioeconomic conditions and the healthcare system's ongoing efforts to adapt and respond.

 

In recent years, the country has made strides toward improving healthcare outcomes, leveraging both international support and advancements in digital health technologies. Initiatives aimed at strengthening the healthcare infrastructure and enhancing access to care are pivotal in the nation's journey toward achieving Sustainable Development Goals. However, the path is fraught with obstacles, as the healthcare system grapples with limited resources, the need for modernization, and the ever-present threat of climate-related disasters.

 

This summary, drawing from comprehensive sources including the CDC Yellow Book 2024 and WHO reports, offers a snapshot of the Dominican Republic's healthcare landscape in 2024. It underscores the critical need for a multifaceted approach to healthcare, one that encompasses not only medical innovations but also a deep understanding of the socio-economic and environmental determinants of health. The following sections will delve into the specifics of the common conditions, the healthcare system's structure, and the ongoing initiatives aimed at fostering a healthier future for the Dominican Republic.

 

Key Terms:

 

Tropical/Neglected Diseases:

Illnesses prevalent in tropical climates, often overlooked in global health priorities.

Vector-borne Diseases:

Infections transmitted to humans and other animals through vectors such as mosquitoes and ticks.

SDGs:

Sustainable Development Goals set by the United Nations to address global challenges, including health and well-being.

Public Health Care System:

Government-led initiatives and facilities aimed at providing healthcare services to the population.

Digital Health Tools:

Technology-based solutions designed to enhance healthcare delivery and patient care.

 

Key Takeaways:

 

• The Dominican Republic, sharing the island of Hispaniola with Haiti, is distinguished by its language, geography, and healthcare approach.
• The country's geographical diversity and climate expose it to hurricanes and diseases, making healthcare provision challenging.
• Common health concerns include communicable diseases like tuberculosis and HIV, vector-borne diseases like dengue and malaria, and soil & waterborne infections.
• The Dominican Republic's healthcare system is undergoing significant restructuring to meet Sustainable Development Goals (SDGs) by 2030.
• Academic research outlines a two-tier public healthcare system in the Dominican Republic, emphasizing primary healthcare units.

 

Medical & Public Health Report

Vicki L. Moag, February 27, 2024

 

The Dominican Republic (DR) shares the island of Hispaniola with Haiti and is completely separate in terms of language, tourist destinations, geography, there approach to health care, and government. The national language of DR is Spanish, while Haiti speaks French Creole and because DR ranks the most popular vacation destination in the Caribbean during 2018 you may hear plenty of English (CDC, n.d.). You may also come across immigrants from Haiti who sought a better life to work in DR sugar cane fields and live in Dominican Bateys, a shared space for workers (and/or families) that’s equivalent to a dirt floor with left over wood and metal for make shift protection from outside elements (CrownTV, 2023). The gross national income per capita in 2022 is $9,050 (GNI per capita is the total amount of money received by a country (regardless of whether it originates in the country or abroad) divided by the midyear population” (Statista, 2024). 

 

 

The geography of DR begins with the understanding that it covers two thirds of the island. The DR consists of beaches, steep mountains (including the highest point in the Caribbean, Pico Duarte), highlands, and fertile valleys (that contribute to sugar cane, tobacco plantations, and farmland) (CDC, n.d.; WHO & UNCCC, 2021). The DR is susceptible to hurricanes and cyclones that increase the potential for flooding and spreading certain prevalent diseases ranking it 40 out of 192 countries in the 2022 World Risk index for being highly vulnerable to climate disasters (World Bank, 2023). This makes offering health care a challenge considering a majority of DRs population is sprinkled all around it’s coast including its capital city of Santo Domingo (in the south), top tourist destinations of Punta Cana and Bávaro (in the east), and its top three cities (in the north) known for illegal commercial sex workers in Samaná, Sosúa, and Puerto Plata (among other tourist attractions of course) (CDC, n.d.). This chosen activity unfortunately contributes to HIV, syphilis, hepatitis B, and hepatitis C (CDC, n.d.).

 

Common Conditions & Tropical/Neglected Factors

 

Common conditions in the DR include:

• communicable diseases of tuberculosis, COVID-19, and HIV
• soil & waterborne infections such as leptospirosis (especially during flooding) 
• Vector-borne diseases are focused on dengue (it’s widespread, all serotypes have been isolated) and malaria (these could potentially always be a struggle based on the DRs location and climate). Cholera, Chikungunya, and Zika can be an issue with the right environment, but is currently not a major issue (CDC, n.d.; WHO & UNCCC, 2021).

 

The top 10 causes of death in 2019 according to UNAIDS included ischemic heart disease, intracerebral hemorrhage, Alzheimer’s disease, ischemic stroke, HIV/AIDS, motor vehicle road injury (it’s the highest number of traffic deaths per capita in the world at 110 per 100,000 population in 2019), lower respiratory infection, diabetes type 2, prostate cancer, and violence with a firearm (CDC, 2022). “Maternal and neonatal mortality remain a national health priority” (CSS, 2016, para. 2). In direct response to this struggle DR has recently signed an agreement with the World Bank group financing funds via the IBRD (International Bank for Reconstruction and Development) for an approved program to support the strengthening of the National Health System as of November 2023 with a focus on four different components 1) strengthening the capacity to deliver quality public healthcare services, 2) strengthening the stewardship and public health oversight function of the MISPAS, 3) reinforcing health information systems and digital health tools, and 4) project management (World Bank, 2023).

 

Basic Healthcare System

 

The structure and function of the DR healthcare system has and still is undergoing significant changes as they strive to keep up with SDGs targeted for 2030. In 2006-2015 they set up a framework under the Ten-Year Health Plan (PLANDES), in 2014-2019 they worked towards implementing the PAHO Strategic Plan as well and made some changes, they received plenty of aid from outside resources during the COVID pandemic, are participating in the Small Island Developing Initiative on Health & Climate Change, and are now working with the aforementioned IBRD (World Bank) and others for health care restructuring (CCS, 2016; World Bank, 2023; WHO & UNCCC, 2021). This is just to name a few as the list goes on and on… including the decentralization of certain administrative operations (regional health services and Social Security) to form the National Health Service (SNS) (CCS, 2016).

 

Academic research allocates two main levels of public health care for the DR population. 

As of 2023, 1226 first level centers (CPN, Centros de Primer Nivel) constitute 86.7% of the SNS provision system, while 189 specialized level centers (e.g., hospitals) account for 13.3%. In terms of primary healthcare service structures, each CPN includes one or more Primary Health Care Units, which are the basic unit of health care provision for approximately 500-700 families (2,500-3,500 people) within a specific geographical area. These units consist of at least one general practitioner, one nurse, and one or more health promoters (World Bank, 2023, pp. 7).

 

Keep in mind the above mentioned public hospitals do not include medication and can take up to 2 days for care in the ER. There are currently two other known types of medical services offered in the DR: private hospitals (no ins., cash pay, high quality) and private clinics for low income (free, reduced cost, improved quality of care). The healthcare workforce as of 2017 is 15.6 medical doctors per 10,000 persons and 3.1 nurses/midwives per 10 000 persons (WHO & UNCCC, 2021). SDG markers of progress for no poverty is 30.5% living below poverty, good health and well-being at 6.2% for current health expenditures of GDP, 74 on service coverage index for Universal Health Coverage, and 30/1000 live births marking the <5 mortality rate, and last but not least basic sanitation services is 84% while basic drinking water services is marked at 97% (WHO & UNCCC, 2021). A few other issues to consider are the lack of infrastructure, licensing, and occupational hazards for workers that will hopefully be addressed in the very near future (World Bank, 2023). Additional updated information can be found at the Pan American Health Organization Country Profile of the Dominican Republic (2023). 

 

Reflection and Application

 

The Dominican Republic's healthcare challenges and ongoing efforts to reform its system present a rich case study for pre-med and public health students. Understanding the intersection of geography, socio-economic factors, and health in the context of the Dominican Republic offers valuable insights into the complexities of healthcare provision in tropical and developing nations. This case study underscores the importance of a multifaceted approach to health, considering not just the medical but also the environmental and social determinants of health.

 

Students are encouraged to reflect on how the global community can support countries like the Dominican Republic in their health reform efforts. Exploring the roles of international organizations, technology, and policy in improving health outcomes in such contexts can provide practical insights for those aspiring to make a difference in global health.

 

Moreover, this summary highlights the critical role of healthcare workers and the need for infrastructure and licensing improvements. As future healthcare professionals, students can consider the skills and knowledge they need to contribute effectively to global health challenges, especially in vulnerable regions.

 

FAQs

 

What are the primary healthcare challenges in the Dominican Republic?

The Dominican Republic faces challenges such as communicable diseases (tuberculosis, COVID-19, HIV), vector-borne diseases (dengue, malaria), and the impact of natural disasters on health infrastructure.

 

How is the Dominican Republic addressing its healthcare challenges?

Through reforms and programs focusing on improving public healthcare service delivery, digital health tools, and strengthening healthcare system management and oversight.

 

What role do international organizations play in the Dominican Republic's healthcare system?

International organizations provide support through funding, expertise, and programs aimed at strengthening the healthcare system and addressing specific health challenges.

 

Why is the geographic location of the Dominican Republic significant to its healthcare challenges?

Its location makes it susceptible to natural disasters like hurricanes, which can exacerbate health challenges by spreading diseases and straining healthcare resources.

 

What are the SDGs, and how do they relate to the Dominican Republic's healthcare system?

The SDGs are a global agenda for sustainable development, including goals for health and well-being. The Dominican Republic's healthcare reforms are aligned with these goals, aiming to improve health outcomes and access to healthcare by 2030.

 

Resources:

• Centers for Disease Control and Prevention. (n.d.). Dominican Republic | CDC Yellow Book 2024. CDC.gov. [Link]
• Centers for Disease Control and Prevention (2022). CDC in Dominican Republic | Global Health | CDC. [Link]
• Country Strategy and Support (CSS). (2016 May 1). WHO country cooperation strategy at a glance: Dominican Republic. [Link]

• CrownTV. (2023 November 11). Forgotten No More (The Dominican Bateys) | DOCUMENTARY #documentary #dominican #batey] (https://www.youtube.com/watch?v=P9WdJk98WFM)

• Health in the Americas. (2023 August 22). Dominican Republic - Country profile. [Link]

• Nations Online Project. (n.d.). Map of the Dominican Republic - Nations Online Project. Nations Online Project. [Link]

• World Bank. (2023). Dominican Republic - Program to Support the Strengthening of the National Health System (English). Washington D.C. : World Bank Group. [Link]
• World Health Organization and United Nations Convention on Climate Change. (2021 May 14). Health and climate change: country profile 2021: Dominican Republic. [Link]