Demographics & Economy
There are approximately 10 million inhabitants in the Dominican Republic (DR), of which 40% are under 18 years of age,
43% live in poverty, and 16% live in extreme poverty
[1].
The gap between rich and poor is increasing, and about 80% of
the country’s income goes to urban areas, while 40% goes to the richest families
[1].
Over the past 20 years the economy of the Dominican Republic has experienced continued positive growth,
thanks to the major growth areas of mining, tourism, and commercial exports. Yet the benefits of this
economic growth have been unevenly distributed leading to widening income gaps and inequality.
In their 2008 report, the World Bank cited the Dominican Republic as being among one of the most
inequitable countries in Latin America as indicated by the countries GINI index of 0.52
[1].
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The 2007 per capita GDP was $4,406.40 with an annual growth rate of 8.5% despite recent data indicating that a total of 56%
of the total workforce is informally employed[2].
Low income families have very limited access to healthcare and other basic
services such as potable water, electricity and reliable police and emergency services[3].
Despite concerted efforts on the
part of governmental and non-governmental authorities, recent analysis have determined that it is unlikely that the Millennium
Development Goals set for the country in 2000 will be achieved by 2015[4].
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Health
Improvements in key health indicators in the Dominican Republic have been gradual but remain below regional averages and target values.
Recent reports indicate that MDG health indicators will not be met by 2015. The infant mortality rate in the country is 33.7 per
1,000 (18% above expected rate), while the maternal mortality rate is 159 per 100,000 (twice the expected rate)
[5]. The relatively high maternal mortality rate is concerning considering that over 95%
of all births are attended by health professionals, indicating poor quality of care received in the public health
system
[3]. Infantile malnutrition is a persistent problem; on average 7.2% of
children are malnourished, and up to 12.3% of the poorest children are malnourished
[1].
The government invests approximately 1.8% of GDP in health yearly, a value well below regional averages (3.4%)
[3].
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The control of vector borne diseases such as leptospirosis, malaria, rabies and dengue fever remains an ongoing
challenge to the public health system, and during recent dengue epidemics the observed death rate among children
has been elevated again indicating poor quality of care delivered in public health institutions. Tuberculosis
and HIV/AIDS prevalence in the Dominican Republic are relatively high but within regional values, and
recently implemented programs guarantee access to pharmacotherapy for these diseases.
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Oral Health
In the year 2000, the World Health Organization set a global goal of reducing the number of decayed (D), missing (M), and filled
(F) teeth in 12 year old children (DFMT-12) to less than 3, with a secondary goal stating that 50% of 5-6 year
olds should be caries free6. While some nations have achieved these goals, many others including the Dominican
Republic are still well above the specified caries prevalence
[7].
The most recent national estimate of caries prevalence in the DR comes from a study carried out in 1998
by the Oral Health Department of the Ministry of Public Health8. In the study, 958 children from various
geographic regions were examined in order to produce a caries baseline estimate which would be used to
evaluate the effectiveness of national salt fluoridation initiative.
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The study found that overall
caries prevalence was 72.71%, ranging from a minimum of 42.85% at 6 years old to a maximum
of 93.81% at 15 years old. More than 50% of children examined had a DMFT score greater than 5 (severe),
20% had a score greater than 4, and 30% had a score less than 3.
Recent internal observations in the Smiles dental clinics have confirmed high rates of dental
decay among treatment seeking children. Observations found that of 935 records examined only 1.4%
of 5 year olds and 2.5% of 12 year olds had a DMFT score of 0, while 98.6% and 97.5% of 5 and 12 year
olds respectively were affected by caries. The mean DMFT score for 5 and 12 year olds was found
to be 5.5 and 7.6 respectively. It was also observed that the burden of caries was significantly
higher in 12 year old females than in their male counterparts.
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Social Programming & Education
Historically, public investment in the sectors of health and education has been well below regional values and the
government currently invests 2.1% of GDP in education yearly, the second lowest investment in the region
[3]. Although
the percentage of children enrolled in primary education (92.6%) is above the regional average, secondary
school completion rates (21.3%) and achievement on standardized testing are well below regional averages
[3].
The quality of education delivered in public schools is generally poor in comparison to regional values,
only around one third of students are enrolled in public institutions
[3]. In a 2007 study comparing 16
Latin American countries, 90.5% of Dominican 3rd grade students were in the bottom percentile of math,
while 78.1% were in the bottom percentile in reading. Overall scores were 15 to 20% below the expected
values having taken into account the income level of the country
[3].
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In the area of health care coverage, great advances have been made since the introduction of social
security reforms introduced in 2001. Included in the reformed Dominican Social Security System are
three main products, an old-age and disability pension, employment insurance, and a family health
insurance plan[9]. Although the benefits of all of these plans are minimal, they represent an
important step towards reducing social inequalities, and have introduced a great number of low
income individuals and families in to a social safety net. However the system has been slow to
roll out and to date approximately 3.5 million users are enrolled in the health plan.
A second major challenge is related to funding, considering that the 56% of the population with
informal employment are not able to access the publicly funded program. The publicly provided
plan provides little dental coverage and out of pocket payments for dental services are an
estimated 6% of families total spending on health[10]. Coverage for the elderly who are unemployed
is scant, and in 2007, less than 10% of individuals 50 years of age and over had health insurance
[10].
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References:
- The World Bank. (2008). Dominican Republic Poverty Assessment: Achieving More Pro-Poor Growth. Report No. 32422-DO.
Accessed from the World Bank Website, July 3, 2007.
- Banco Central de la Republica Dominicana. (2010). Monthly Brief, 25/06/2010.
http://www.bancentral.gov.do/noticias/avisos/aviso2010-06-25.pdf
- The United Nations Development Program Dominican Republic. (2010). Politica social: capacidades y derechos. http://odh.pnud.org.do/politica-socialcapacidades-y-derechos
- Listin Diario. (2010). LF dice RD no cumplirá con los Objetivos del Milenio.
http://www.diariolibre.com/noticias_det.php?id=261656&l=1
- Pan American Health Organization. (2009). Indicadores Básicos de Salud, 2009. http://new.paho.org/dor/images/stories/archivos/indicadores_salud_2009b.pdf
- The World Health Organization. (2003). The World Oral Health Report 2003. Accessed October 23, 2009, from WHO website.
- Pan American Health Organization. (2007). Health In the Americas, Volume I – Regional. Accessed June 3, 2008, from PAHO website.
- Garcia, A., Guzman, F., Montes de Oca, F., Ruiz, O. (1998). Estudio Epidemiológico de Caries y Fluorosis en Escolares de 6,7,8,12 y 15 Años de Educación Básica de Republica Dominicana. Retrieved May 23, 2009, from the Oral Health Division of Public Health Archives.
- Consejo Nacional de Seguridad Social. (2010). http://www.cnss.gob.do/
- Oficina Nacional de Estadisticas. (2007). Resultados Generales Encuesta Nacional de Ingresos y Gastos de los Hogares 2007.
In the area of health care coverage, great advances have been made since the introduction of social security reforms introduced in 2001. Included in the reformed Dominican Social Security System are three main products, an old-age and disability pension, employment insurance, and a family health insurance plan[9]. Although the benefits of all of these plans are minimal, they represent an important step towards reducing social inequalities, and have introduced a great number of low income individuals and families in to a social safety net. However the system has been slow to roll out and to date approximately 3.5 million users are enrolled in the health plan. A second major challenge is related to funding, considering that the 56% of the population with informal employment are not able to access the publicly funded program. The publicly provided plan provides little dental coverage and out of pocket payments for dental services are an estimated 6% of families total spending on health[10]. Coverage for the elderly who are unemployed is scant, and in 2007, less than 10% of individuals 50 years of age and over had health insurance [10].