The Caribbean State, Health Care and Women: An Analysis of Barbados and Grenada During the 1979-1983 Period

149 Pages·1998·6.183 MB·English

by  Patricia Rodney

THE CARIBBEAN STATE,
HEAiTH CARE AND
WoMEN
•
AN ANALYSIS OF BARBADOS
AND GRENADA DuRING
1979 - 1983
THE PERIOD
PATRICIA R-ooNEY
Africa Wo(r0ld P ress, Inc.
P.O. Box 1892 P.O. Box 48
Trenton, Nj 08607 Asmara, ERITREA
..
-
.
Africa Wo0rld Press, Inc. DEDICATION
P.O. BOll: 1892 P.O. Box 48
Trenton, NJ 08607 Asmara, ERITREA
Copyright © 1998 Patricia Rodney
First Printing 1998
All rights reserved. No part of this publication may be reproduced. stored In a rclrleval
Dedicated to my three children:
system or transmitted In any form or by any means electronic, mcchankal. photocopy
Shaka, Kanini and Asha
ing. recording or otherwise without the prtor wrttten permission of the publisher.
and in loving memory of
Cover and BCooko de-stgn: Jonathan GuUery my mother, Louisa Henry
my mother-in-law, Pauline Rodney
Ubruy of Cataloglna-ln-Publlcatlon Data my dear friend and mentor Dame Nita Barrow.
Rodney. Patrtcta.
The Cartbbean state. health care. and women : an analysis of
Barbados and Grenada durtng the 1979--1983 pertod 1 Patricia Rodney.
p. em.
Includes bibliographical references and index.
ISBN 0-86543-516-2 (cloth). --ISBN 0-86543-517-0 (pbk.: a\k.
paper)
l. Women's health servtces--Government policy--Grenada.
2. Women's health services--Govenunent policy--Barbados. 3. Medical
policy--Grenada. 4. Medical policy--Barbados. 5. Women--Health and
hygiene--Grenada. 6. Women--Health and hygiene--Barbados.
I. Title.
RA564.85.R63 1996
362.1 "98"0972981--dc2l
96-47412
CIP
,
1111
CoNTENTS
. .xi
PREFACE. . ...... .
ACKNOWLEDGEMENTS .................... .x iii
INTRODUCTION .. . ......... . XV
SECTION 1: LITERAn JRE REVIEW .....................1
CHAPTER 1: THE STATE IN CAPITA UST SOCIETIES
FEMINIST PERSPECTNES ON THE CAPITAUST STATE . . . ..3
CHAPTER 2: THE STATE IN THE PERIPHERY .................2 1
INDEPENDENT AND
NATIONAL UBERATION MOVEMENTS IN THE PERIPHERY
THE CONTEXT OF THEIR EMERGENCE . . . . . ..........3 3
THE POST-COLONIAL STATE IN THE CARIBBEAN ..........3 5
CHAPTER 3: WOMEN AND THE CARIBBEAN STATE ...5 3
SECTION 2: THE CARIBBEAN STATE,
HEALTH CARE AND WOMEN . . . . . . . . . . . ..........7 5
CHAPTER 4: EMPIRICAL RESEARCH METHODOLOGY ..........7 7
SELECTION OF RESEARCH AREAS . . . . . . . . . . . . . .. 77
RESEARCH PROCEDURE . . . . . . . . . . . . . . . . .80
METHODOLOGY & METHODOLOGICAL ISSUES ...........8 1
RESEARCH CHALLENGES . . . . . . . . . . . . . . . . . . . . . . .85
CHAPTER 5: HISTORICAL OVERVIEW OF
WOMEN'S HEALTH IN THE CARIBBEAN . . . . . . . . . . . . . . ..8 9
PRE-SLAVERY (1492-1643) . . . . . . . . . . . . . ........9 0
SLAVERY (1644-1833) ................................9 1
APPRENTICESHIP (1834-1838) .........................9 4
FULL EMANCIPATION (1838-1900) ......................9 6
PRE-INDEPENDENCE (1900-1960) .......................9 7
POST-COLONIAUSM/INDEPENDENCE (1960-1980) ........ 103
CHAPTER 6: BARBADOS . . . . . . . . . . . . . . . . . . . ......... 109
THE POUTICAL SITUATION .......................... 109
THE ECONOMIC SITUATION ...... . .. 114 SECTION 3: BEYOND THE STUDY ..... . . ... 235
THESTATEANDWOMEN ......... . . .. 119
THE HEALTH CARE SYSTEM .... . .. 125 CHAPTER lQ, CONCLUSION AND RECOMMENDATIONS ...2 37
Health Infrastructure . . . . . . . . . . .......... 125 THEORIES ON THE STATE, A SUMMARY . . . . . . . . . . ....2 37
Health Care Financing . . . . . . . . . . ........... 128 BARBADOS AND GRENADA IN THE POST STUDY PERIOD,
Health Policy and Administration .. .. 130 POUCY CHANGES AND REVERSALS . . . . . . . . . . . . ... 240
SUMMARY ..................... . .......... 138 FUTURE DIRECTIONS, RECOMMENDATIONS ............. 240
CHAPTER 7, GRENADA BIBUOGRAPHY ...................................... 245
THE POI..ITICAL SITUATION . . . . . . . . . . . . . . ...... ·145
145
THEECONOMICSITUAllON::::: ....... · · · · · ·
TABLE OF APPENDICES
4
THE STATE AND WOMEN ...... · · · · .15
THE HEALTH CARE SYSTEM .......................... 158
Appendix I: Map of the Caribbean . . . . . . . . . . . . . ....... 259
163
Health Infrastructure · · · · · · · · · · · · · · · · · · · ·
Appendix 2: Health System Components/Elements ........2 60
Health Care Financin~ : : : : : : : : : : : : : : : : : : : : : · · .. 163 Appendix 3: Detailed Demographic Profile of the
166
Health Policy and Administration · · Barbadian and Grenadian Women Interviewed . . . . . . . . . .... 261
SUMMARY · · · · · · · · · · · · · · .169
················· ····· ......... 176
INDEX ..... 263
~~~~b~~~=g~STATE
HEALTH CARE
THE PROFESSIONAL'S PERSPE6JvE
GENDER SENSrnvrry · · · · · · · · · .... 183
ci>.Ri sf:RVicE5 . . . . . . . . . . ...
BARRIERs To HEALTH 184
Middle Class Women · · · · · · · · . . . . . . 189
Ability to Pay for Servi~~~ · · · · · · · · · · · · · · · · · · · .. 190
Attitude of Service Provide~ · · · · · · · · · · · · · · · · · . . . . . . . . 191
Doctor-Nurse Relationships : : : · · · · · · · · · · · · · .... 192
SCotate Hospital Nurse-Polyclinic N~.:.;, ·R~I~ti~~shi·p· . . . .. 194
nsumer Involvement · . . . .195
SUMMARY ..... · · · · · · · · · · · · . . . . . .196
...... . . . . . . . .
. . . . . . . . .199
CHAPTER 9· ASSESSMENT
SYSTEMS IN BARBADos A~6 ~~ATE HEALTH CARE
THE WOMENs PERSPECTIVE ENADA:
EXISTENCE .. . . . . . . . . . . . . . . . . . . . . .
CONDffiONS OF .203
CARE. . . . . . . . . . . . . ........
CRmQUE OF THE HEALTH 204
~-Service Availability ........ SYSTEM · · · · .... 213
· Service Satisfaction · · · · · · · · · · · · · · . . . . . . . . 214
3 Service AcceSSibility : : : : : · · · · · · · · · · · · · . . . . . . . . . 21 7
4 · Service Com b'I· ..... · · · . . . . . . . . . .2 22
SUMMARY para 11ty to Private Health 5;,~~
· ·............ es · ....... 224
..................... . 229
l
II
UST OF TABLES
PREFACE
4.1 Barbados and Grenada: Selected Demographic
and Health Statistics 1979-1983 and 1984-1993 ...... . .79
5.1 Ufe Expectancy at Birth (yrs) by Country, Region and Sex
1965-1975 and 1975-1980 .105
6.1 Rate of Unemployment, 1982: 5,;1~~t~d 6,.jbi,.;~n C~~~;nes. .117
6.2 Breakdown of the Health Budget in Barbados, 1979-1983
to the nearest million (Barabdos Dollars) . . .. 129
6.3 Manpower (Barbados): Health Personnel This book developed from a study designed to examine the lev·
with Population Ratio 1979-1983 .139 els of efficiency and adequacy of state health care policy and ser·
7.1 Grenada Government Revenue and. h~ndit~r~ vice provision with respect to women during the 1979 to 1983
1981 (US Millions) . . . . . . . . . . . . . ' period in Barbados and Grenada, two small post-colonial states
7.2 Health Fadlities in Grenada and its Si~t~; l~lan.d . s. . . . . ....... 156
7 3 G da Sel · · . .167 in the English-speaking Caribbean. These two countries were
· rena • ected Health Economic Indicators 169
selected because of:
7 .4a Manpower (Grenada): · · · · · · · · · · · · ·
Health Personnel with Population Ratio, 1981 ..
7 ·4b Manpower Distribution (Grenada)· . ... 177 1. The different socio-political development paths (and health
Health Personnel Per Health Distrlct 1981 policies) pursued by these two States during the 1979 to
9.1 Barbados and G d p ' · · · · · · · · · · · · · .. 178
Fift y rena a: ercentage Distribution of Population 1983 period;
' . een ears and Over by Educational Attainment 2. The uniqueness of Grenada's revolution experiment; and
(Htghest Level Attended) and Sex, 1980-1982 ·G · · · ·. ' · · · · .208 3. The lessons to be learnt from the two types of health care
9.2 Cntique of State Health Care by Barbad' d
Working Class Women· Co . tan an renadtan models implemented, including the different strategies used
l
1979-1983 and Post mparative Summary Of Findings, in the development of primary health care programs and
983 .......... . . . ' . . . . . . . .... 231 service delivery.
UST OF FIGURES
Primary Health Care (PHC) as advocated by the 1978 Alma
Ata Declaration is "the first level of contact with individuals, the
6.1 Map of Barbados· Loc .
and th H . alton of Polyclinics family and community with the national health system, bringing
o er ealth Fadlities
·H · i
7.1 Map of Grenada· location· j h. · · · · · · · · · · · ............ 127 health care as close as possible to where people live and work,
u· .
and other Health F o eat Centers and constitutes the first element of a continuing health care
ac rties .... . . . . . . .. 165 process."1
The main purposes of this project were to determine the
role of the State in the provision of health care services to work·
ing class women and the impact of these services on the health
of the women. Secondarily, it examined whether in either State,
women participated in all/o r some aspects of health care policy
development.
The results of the data analysis utilizing primary and sec·
ondary sources revealed that the health care services provided to
working-class women in both Barbados and Grenada during the
L
I
~ri?,d1979 to 1983 was neither "holistic" nor "gender sensi
tive, but rather was based on a medical "ill-health" d I d
focus d · ·1 mo e an
both e pn_ma_n Y. on women's reproductive health. Although
feren~or':~~s ~~titu~ed P~mary Health Care (PHC), albeit by dif-
With different outcomes, Grenada seems to
ha ve come closer to real· · th od
cated b th AI A Izmg e m el of health care advo-
t h Yf e rna ta Declaration of 1978. Grenada appeared
o ave ocused (more th Ba b d )
promotion efforts thro an r ~ 0~ on health education and AcKNOWLEDGEMENTS
!ion of th ugh the achve mvolvement and participa-
e consumers the · b ·
system and demysti :ned· ~Im emg to democratize the health
were commendabiZ d Icm~dH owever'. although these efforts
women in general w~~edcfu be considered "progressive,"
responsibilities. They oknger hours and were given more
1 1
institute serious cha a so ac ed the related power necessary to
nge.
Based on its findingsC t h tud The completion of this project would have been more difficult
ment of services for the -~bs Y recommends the develop-
without the love and support of many people. I especially want
tered" and "reality" based an ean th~t are more "women-cen
to acknowedge Shaka, Kanini, Asha, Deily and AI.
of health (as defined by th~ =mpassmg all aspects (influencers)
I am indebted to the Barbadian and Grenadian women who
ented/sensitive and issue/ dOL_O ne concept of consumer ori
willingly shared their time, experiences and gave me permission
the District Health Coun .re:f sed planning can be found in
1 to use their "voices." I appreciate the assistance extended to me
. The District Health~~ m . e operative in Ontario, Canada.
by the health care providers and professionals in both States. To
~mg bodies made up of in:~~s are_ local coordinating and plan
the staff of the libraries and resources centers in Barbados and
mg consumers. Use of a part· _ISCiphnary representatives includ
Grenada: Caribbean Council of Churches, Central Bank of
~ould promo~e internally de~~loat:f' mo?el by Caribbean States Barbados, Caribbean Development Bank, Pan American Health
ocus on the holistic" health p 5eTVIces and programs that
Organization (PAHO), UNICEF, ISER, UWI Cave Hill, WAND
needs of women.
and Marryshow House who assisted me in locating important
documents.
Special thanks to my thesis committee: Professors Nora
Re Notes Ceboratev, Budd Hall, Gordon West (supervisor); George Dei
1.
port of the lntemati °n al (chair); Rudy Grant (external examiner); and Hilary Beckles (field
Alma Ata R . • Conference on Pri
WHO, t9?s~ Alrna-Ata, Primary Health mary J:Iealth Care, advisor).
· Care. Geneva:
Extreme gratitude is due to my original editoral team Kanini
Rodney and Cedric Licorish, and to Pat Winfield for administra
tive support, Abeo Jones, Natalie Kanem and Phyllis-Jones
Changa for assistance with the final corrections and editing.
I was fortunate to receive the assistance of Elias Amare
Gebrezgheir, Staff Editor at The Red Sea Press, and Kassahun
Checole, Publisher of Africa World Press and The Red Sea Press,
who believed in the project.
__ _
-~'-'--"'11---....~1\
•
The Caribbean State, Health Care and Women
last but not least th 1 t · 1
Council (IDRC) Can ' e n ema!ton~ De~elopment Research
ier to do th ahda whose financial assistance made it eas
e researc .
P.R.
Atlanta, GA.
INTRODUCTION
FOCUS OF THE STUDY
This study sought to examine state health policy and its impact
on women's health, specifically that of working-class women
within two Caribbean 1 states with significantly different socio
political development paths: Barbados under the BLP, and
Grenada under the PRG. The period of study selected was from
1979 to1983.
The decision to study Barbados and Grenada during the
1979 to 1983 period was based on a number of reasons. Most
significant was the change in political ideology that Grenada
underwent during the Revolutionary (1979 to1983) period and
the effects this had on the development of socio-economic and
health policies during that time. This transition was compared to
the much smoother one of Barbados. Grenada State refers to
mainland Grenada as well as its sister islands, Carriacou and
Petit Martinique. Both states, recognizing the need to better
serve their respective populations, and in response to other
internal and external influences, adopted Primary Health Care
2
(PHC) in accordance with the Alma Ata Declaration in 1978.
The participants at the 1978 International Conference on
Primary Health defined primary health care as "essential care
based on practical, scientifically sound and socially acceptable
methods and technology made universally accessible to individ-
The Caribbean State, Health Care and Women Introduction
uals and families in the community through their full participa
needs that are specific to them as women. "4 For the purpose of
tion ... It forms an integral part both of the country· s health care
this study, health is defined as "a state of complete physical,
system, of which it is the central function and main focus, and
mental and social well-being and not merely the absence of dis
of the overall social and economic development of the commu
ease and infirmity."5 In addition several factors, including race,
nity. It is the first level of contact of individuals, the family, and
age, social and economic status, ideology, geographic or regional
the community with the national health system, bringing health
location, the physical environment, politics and health policies, 6
~re as close as possible to where people live and work, and con
are now known to contribute to the overall health of an individ
sti~tes the ?rst element of a continuing health care process. "3
ual and should be considered in the development of an adequate
Th1s study, m its assessment and comparison of Barbados and
health care system. Accordingly, the study has explored each
Grenada, illustrates how two post-colonial states, with different
state's defined health philosophy and examined fiscal and policy
approaches to their socio-economic, political, ideological and
frameworks that supported their philosophy as well as the extent
cultural development, assumed different aspects of PHC and
to which health policies were incorporated into the broader socio
promoted superficially different (though fundamentally similar)
economic development policies: political will of government in
health care models.
implementing their policies; support of the medical establish
. Policy development in the Caribbean as in most other devel
ment; and political consciousness of the civil society in making
opmg and dev~lo~ed countries, has been'subject to gender, race,
sure that these policies are enacted.
cdla~s and social mequities. Traditionally policies have been
These analyses were amplified by a critique of the system by
es1gned by m 'th 1· 1 '
, en WI Itt e regard for or understanding of a group of professional men and women. These findings were
women s concerns a d th ' '
, n e consequences of these policies on used to examine the differences in policy development in each
;~:~ si~~~th
and well-be.ing. The study highlights this point, state and assess inequities inherent in the system. The develop
with w;me , t~ cases how Inappropriately health policies dealt ments that occurred in the health sector during the 1979 to 1983
ing womenn :i~~~~~ i~ ~ct: the s.tate. was instrumental in mak period were situated in perceptions of Barbadian and Grenadian
t
subsequent implem r Y mvestigatmg the development and working class women who were interviewed about the system's
by the two states a~~ ~~~n ~nd "_Janagement of health policies ability to meet their needs. Working class women in the sample
about the state's pol' . :mg directly on the women's views also gave their views of the policy changes, contrasts and rever
ing inequities. lnclu~~~s.' e study attempts to understand exist sals that occurred after the study period (collapse of the revolu
lion in the political an~ =~ a~~ssm~nt of women's participa tion and death of Maurice Bishop, and the U.S. intervention in
development and im ffii~Istrative processes and in the Grenada in 1983; and after the death of Tom Adams in 1985
1
well-being. In additio~ e~entatio~ of policies that affect their and the subsequent defeat of the BLP in Barbados, in 1986).
ex~ined in the conte~t 0~ t~sulti~g health s~atus of women is
uation of each state 1 ff e SOcio-economic and political sit-
nd · n e ect the tud SIGNIFICANCE OF THE STUDY
a weaknesses of each stat ' . s Y evaluates the strengths
quately service women' ede With regard to their ability to ade- This socio-historical analysis of health care systems in two
. sne s
The re IS a general tend . English-speaking Caribbean countries revealed a number of sim
~ned specifically to issues r~n~for women's health to be con ilarities generated from similar colonial and post-colonial expe
tl~e health (the reproduc~iv to motherhood and reproduc riences.'l In the colonial period, the focus of the health care
e 'klbearing). Although these . e organs, menstruation and system was on curative services provided through predomin~n~ly
encompass , Issues are imp rt t th
health WOmen s entire real'ty "W o an , ey do not urban-based hospitals. People in rural areas were treated at dis
needs, the same as the r:st ~f tho men ha~e both general pensaries" (similar to outpatient clinics) which operated on a
e population, and health
XVI xvii
Introduction
The Caribbean State, Health Care and Women
on curative measures remained. There was a lack of formal and
~e~kly or monthly basis and were designed to treat mainly the
informal health education and promotion programs which
m?tgent. Public health measures were mostly confined to con-
emphasize preventive measures that are gender specific.
tammg and treating 'd · d d .
. ept emtc an en emtc diseases such as
1 Consequently, women continue to suffer high morbidity rates
rna ana, tuberculosis, hookworm and other communicable dis
eases. from preventable diseases such as hypertension, anemia and
obesity9 As will be shown, women's health has been jeopardized
Diund'ng the colonial period, the development of policy was
us uaiY one extra-regionally d h d . . by diverse influences such as legal rights, education, employ
Is h an a very 1ttl 1e mput from nation-
ment, housing, social class, occupation, food and nutrition and
~l~y ~a~~~u:l~~~~:d with_in the system. As such, the public environmental factors. Some of the underlying causes of
majority of th C 'b~he pnmary health care needs of the vast women's health problems and factors that influence the extent
Stockdale the ~r tan ean working class people. Sir Frank
and the nature of morbidity are malnutrition, poverty, home
the West i d' 5 Comp~oller for Development and Welfare in lessness, fatigue, overwork, stress, violence and exploitation; 10
n tes, may be vtewed a · ·
the system, in his 1 _ s ~stonary since he challenged yet, women's health care programs continue to ignore these fac
940 42
whole population while core~o~, to promote the health of the tors and continue to be tied mainly to their reproductive/pro
sick. "8 Prior to inde d ntinumg to adequately care for the ductive roles. 11
for the developmenf~7 h~~~~ there was still no coherent policy Interestingly enough, although many health problems plagu
government appeared t t k~re servtces m the region. Each ing women are preventable and although these facts are well
needs by responding to 0 ac e the problem of basic human known by the health experts and political and economic powers
whether they involved ~~s 1~ different sectors of the economy, within the region, eradication of the root causes has not been
employment The ad' ~ ac of health or housing facilities or adequately addressed and solutions have not been conveyed to
were based, ~ot onl/: th::~:ad: to ~e health care systems the public at large. In effect, these institutions seek to maintain
but on the priority each t ntry s socto-economic situation their control and protect their interests and these concerns take
and the political will of ths ate placed on health and health care'
priority over resolving women's health issues.
torical attitude to health odsehWith power· Despite the state's his: This study specifically addressed two states in the Caribbean
w h · . an ealth care th 1·
ere eavtly mlluenced and cond· . • e po tcy structures built and refrains from drawing broad conclusions about other
the dominant metropolitan tbon~d by the relationship with Caribbean countries or developing nations even though there
economic and political d ~wer gtven the continued socio- may be some common themes. It is an innovative project in that
After independence ::-~r ~nt status of the colonies. it investigates, analyzes and compares state health policy in
health sector. These w:rre tJt tril~provements were made in the Barbados and Grenada (before and during the 1979 to 1983
strong but complementa uted, in part, to the following period) and is supported by both qualitative and quantitative data
governments by Caribb:no rces: polit!cal pressures put on the from primary and secondary sources which highlight the impact
played by individual 'lOcal' puJ.e~I:eas;: I mportant lobbyist roles of these policies on women and their health. The research leads
~-ton; and subsequent chan tc ealth s~ecialists throughout the to the formulation of a number of suggestions and future policy
(s~~~fi~~-made in areas s~~~ ~n pu~lic health policy. directions to address women's health needs, and to improve
positive chatn ~~unization and nutritio~r~ and child health their overall health status. It is contended that such an under
reduction inn~e: I_n ;ocio-economic condi~ tch, co~bined with taking would require structural changes in the societies in ques
tion. These changes would require long term political
expectancy at b·r:h a~t ~ortality rates and ns, ~ontnbuted to a
HOWever,~ wtthm the region. an mcrease in life commitment backed by public persistence to keep the issues
alive. As an original study, it provides a basis for further discus
at the ri ough definite Strid
P mary health care level) thes were ~e in health (some sion, research and development. Hopefully, it will contribute to
--'_ere remams a definite focus
xix
Xlllti