Belize

The shared responsibilities among the three ministries
involved in occupational health should be clearly defined.
Industrial hygiene and safety should be under the purview
of the EHD, and a physician or PH nurse should oversee
occupational medicine. Objectives and priorities in occupational
health must be evaluated to establish guidelines
to protect workers' health.
Organization of the Health Sector
"Emphasis on preventive care, improvement of the
environment, rural health centres and health education have
proven to be effective in reducing child death and illness
among children. Belize's thrust has been more effective
than the strategies of some countries that have chosen to
put their resources into costly and technologically sophisticated
institutions and buildings that benefit a small portion
of the population." (A Kayayan, GIS 1984, p. II.)
On an organizational basis, the Minister of Health and
Permanent Secretary nominate a Chief Medical Officer
(CMO) who is appointed by the Governor General, to
oversee all health responsibilities. In the Public Health
Bureau, a principal PHI and two senior PHIs supervise 14
PHIs with responsibilities including premises inspections
(PAHO/AID 1982).
District Medical Officers (DMOs) are under the
jurisdiction of the CMO. Since Belize does not have any
college training beyond the third year (US) level, Belizeans
study abroad and many do not return. Many DMO's are
young foreign medical doctors (only 12 of 35 government
doctors are Belizeans; CDSS 1983, p. 42). Two DMOs are
assigned to each district and they are responsible for health
services throughout the district. One of the DMOs administers
public health programs (MHHC/PAHO 1983).
Unfortunately, most doctors do not have the rare talents to
administer health programs and provide all the necessary
medical services in a district. There are 29 health
centers throughout Belize. Some problems exist due to
I:tnguage differences as well as preferred cultural practices
interfering with medical treatment.
Belize has seven hospitals, one in each district and
one in Belmopan, and Beliza City has a private hospital as
well. Funds are being secured to build a new hospital in
Belize City (MHHC 1984a; GOB I 984b). Maternal and
child welfare services are available in each district (GOB
I 983g). Outside urban areas, medical services are provided
by rural health centers and mobile clinics. The Belize
School of Nursing provides local training for nurses and
midwives (GOB 1983g).
The EHD now has responsibility for Aedes control,
rural water supply, water quality control, food and environmental
sanitation, occupational health and zoonoses
(communicable diseases).
Though there is no organized continuing education
program for PHIs, they must complete a three-year training
program. PHI duties include control and abatement of
nuisances as defined by the Public Health Ordinance,
1958, Chapter 87, Section 136: collection of water and
fooo samples; inspection of septic tanks, offensive trades,
factories, meats and food samples, and condemnation of
unsound food; drainage; rabies control; port health duties;
health education; specialized campaigns; pollution control
and prevention; keeping of records; reporting promptly and
investigation of complaints and any other investigations
required by the CMO (PAHO/AID 1982). However, the
broad range of responsibilities far exceeds the capacity of
anyone PHI in a district, and this factor leads to frustration
and crisis management.
Qualifications for senior and principal PHI's should
be clearly defined and minimum standards should be
reqUired. Details of their assignments can be found in the
Health Assessment (PAHO/AID 1982). Each district needs
at least one more full-time person, and one of the two
PHIs in a district should be fully trained (i.e., at least a
three-year program).
Problems of Health Personnel
The universal problems facing DMOs, PHIs, health
workers, volunteer health and nutrition trainers and
counselors are communication, definition of and support
for staff responsibilities, and mobility. Many workers
cannot fulfill their duties because of vehicle breakdown,
supplied vehicle not being matched with needs of the health
worker, telephone or two-way radio communication
unavailable to attend promptly and adequately to a
problem, or lack of financial assistance that should have
guaranteed that the worker could fulfill work requirements.
Better management of recurrent expenses and capital
outlays would alleviate problems. In the absence of a
guaranteed budget to cover program expenses, some innovative
solutions might be possible. For example, the telephone
systems should be upgraded to cover more villages
that are not now being serviced. Remote areas should have
two-way radios with open lines to the DMO clinics. Young
people in remote villages should be trained in use and
simple maintenance of radio equipment. Radio communication
could also be expanded to meet goals of other ministries.
Small motorcycles would help health and nutrition
workers carry out their duties. The MHHC budget for
health programs should be guaranteed and then health
personnel can be held accountable for providing their services.
Responsibilities and salaries must also be based on
training and job requirements.
Health legislation is weak, and enforcement is absent.
However, PAHO has been helping the CMO to revise the
Draft Health Plan that will be submitted to Cabinet this
year (C. Harry, pers. comm.).
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