Health and Welfare

The Bahamas in general had a healthy population in the mid1980s . Substantial progress had been made in the country's health care over the previous two decades, as indicated by several life expectancy indicators. By 1984 the crude death rate had declined to a low of 5.1 per 1,000 inhabitants, and life expectancy at birth was estimated at 69 years. The infant mortality rate in 1985 was measured at a low 27.5 per 1,000 live births. Specific healthrelated data revealed a 9.5-percent increase in the number of hospital beds from 1974 to 1983; the ratio of population to hospital beds also improved from 260 to 1 to 234 to 1 over the same period. From 1970 to 1983, the ratios of population to doctors and nurses improved from 1,630 to 1 to 1,018 to 1 and from 260 to 1 to 234 to 1, respectively.

The Ministry of Health was responsible for setting national health policies and for implementing health programs. A tiered network of private and public health facilities made up the national health sector; referral linkages existed among the different facilities. The country's three government run hospitals were the Princess Margaret Hospital in Nassau, a 484-bed general hospital; the Sandilands Rehabilitation Centre on New Providence, consisting of a 158-bed geriatric facility and a 259-bed psychiatric facility; and the Rand Memorial Hospital on Grand Bahama, a 74-bed general hospital. In addition, Rassin Hospital, in Nassau, was a privately run general hospital with twenty-six beds. In the Family Islands, primary health care was delivered through a network of public health centers and clinics staffed by physicians, dentists, community nurses, midwives, and health aides. In 1984 the Family Islands' nineteen health districts contained twelve health centers, thirty-four main clinics, and forty-six satellite clinics staffed by nineteen physicians, three dentists, and eighty-three nurses. Patients in the Family Islands requiring additional medical assistance were flown to Princess Margaret Hospital. Most Bahamian doctors and dentists received their degrees from schools in Britain, Canada, or the United States.

In 1982 the major causes of death in the Bahamas were, in descending order of incidence: cancer, heart disease, accidents and violence, bronchitis, emphysema and asthma, cerebrovascular diseases, and diseases originating in the perinatal period. A comprehensive system of inoculation was responsible for the nonoccurrence of many infectious and parasitic diseases, including typhoid, poliomyelitis, diphtheria, pertussis, and tetanus. Some cases of tuberculosis, hepatitis, and malaria were reported among Haitian refugees living in close quarters, but no major outbreaks had occurred in the general population. According to a 1986 World Bank (see Glossary) report, no major malnutrition problems were recorded. The report also indicated that the country had begun to experience diseases normally associated with developed countries, such as diabetes and hypertension. The Ministry of Health reported fifty-six cases of acquired immune deficiency syndrome in 1985 and thirty-four cases in the first half of 1986.

Most of the islands had potable drinking water from underground wells. Access to piped water was highly uneven. Estimates in 1976 indicated that all urban residents, but only 13 percent of the rural population, had access to such a service. New Providence experienced particular difficulty in satisfying its fresh water needs. It supplemented its ten underground well fields with distilled sea water and received fresh water shipped from nearby Andros Island. Nearly 20 percent of New Providence's fresh water in 1983 was barged in from Andros Island. Septic tanks and drainage pits required waste water removal in some lowland areas.

In the late 1980s, the country faced a growing housing shortage. A 1986 World Bank study noted that "new housing production over the past decade has been below required levels, creating a backlog of housing demand, particularly for the lower income groups." The report also noted that considerable rehabilitation on existing dwellings was needed. Forty percent of all housing was in average to poor condition, and two out of three households did not have water piped into the dwelling. The government became increasingly involved in housing via this rehabilitation effort, new construction of urban public housing, private construction incentive grants, and construction loans.

In 1974 the government introduced the country's first national social insurance program; the system provided benefits to qualified contributors for retirement, disability, sickness, maternity, funeral expenses, industrial benefits, and survivor's assistance. Noncontributory assistance was available for old-age pensions, survivor's benefits, and disability. Total contributions rose steadily from a low of US$700,000 in 1975 to an estimated US$11.3 million in 1982. Most of these benefits were paid out for noncontributory old-age pensions.