Belize - Country Profile

Environmental and social determinants of health

In 2000 the total population of Belize was 240 799 inhabitants; by 2024 this figure had risen to 417 072, representing a 73.2% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 5.% of the total population, an increase of 1.1 percentage points compared to the year 2000. In 2024, there were 98.2 women per 100 men and 18.9 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 68.4% of the total population of the country in 2024 ( 285 268 people). When we add these figures to the potentially passive population ( 110 851 under 15 years of age and 20 953 over 65 years of age), the result is a dependency ratio of 46.2 potentially passive people per 100 potentially active people. This ratio was 78.1 in 2000.

Life expectancy at birth in 2024 was 73.7 years, lower than the average for the Region of the Americas and 4.8 years higher that in 2000 (68.9). 

Figure 1. Population pyramids, years 2000 and 2024

Between 2005 and 2020, the average number of years of schooling in Belize increased by 10.2%, reaching an average of 8.8 years in the latest year for which information is available. The unemployment rate in 2023 was 8.2%. Disaggregated by sex, the rate was 12.7% for women and 5.3% for men. The literacy rate was 88.3% in 2000 (88.1% for men and 88.5% for women). In 2019, 13.9% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 1.90 per day; this is above the regional average of 3%.

During the period 2000-2022, the country improved its score on the Human Development Index, with an increase of 6.5% (from a score of 0.657 to a score of 0.70); during the same period, the index rose 14.6% internationally and 11.2% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2022

In 2021, public expenditure on health accounted for 3.43% of gross domestic product (GDP) (Figure 3) and 13.66% of total public expenditure, while out-of-pocket spending on health accounted for 22.76% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2021

Digital coverage

In 2021, 62% of the population had an internet connection, representing a considerable increase from 2000, when 6% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2022, infant mortality in Belize decreased from 21.2 to 15.48 deaths per 1000 live births, a decrease of 27% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 14.1% to 9.5% between 2006 and 2022.

Regarding the immunization strategy, measles vaccination coverage was 81% in 2022, a decrease of 15 percentage points from 2000.

The maternal mortality ratio in 2020 was estimated at 129.8 deaths per 100 000 live births, representing a 51.1% increase compared to the estimated value in 2000 (Figure 5). In relation to fertility, it is estimated that in 2024 women had an average of 2.0 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 44.5% decrease, from 100.2 live births per 1000 women aged 15 to 19 years in 2000 to 55.6 in 2024. In 2022, 95.7% of births were attended by skilled birth personnel; while exclusive breastfeeding in the child population up to 6 months of age was 33.2% in 2016, compared with 9.3% in 2006.

Figure 4. Infant mortality per 1000 live births, 1995–2022

Figure 5. Maternal mortality per 100 000 live births, 2000–2020

Communicable diseases

In 2022, there were 19 new cases of tuberculosis per 100 000 population in Belize. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.9 (0.9 in women and 5 in men). In 2022, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 39 per 100 000 population. The age-adjusted mortality rate for HIV was 33.6 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 34.1%. There were no cases of human rabies in the country in 2021.

Between 2010 and 2021, Belize achieved a 100% reduction in local malaria cases (from 150 cases to zero cases), with its last case reported in December 2018. Belize has maintained zero local cases for a third consecutive year, fulfilling a key eligibility for malaria-free certification by the World Health Organization.

Noncommunicable diseases and risk factors

In Belize in 2023, the prevalence of tobacco use among people aged 15 and older was 7.7%. In the same age group, the prevalence of overweight and obesity was 72.8% in 2022.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 22.7%, a decrease of 2.8 percentage points compared to 2000 (25.5%). The prevalence of diabetes mellitus, which stood at 9.5% in 2000, increased to 12.7% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in Belize was 327.8 deaths per 100 000 population, a decrease of 24.3% from a rate of 432.8 in 2000. This meant that, in 2019, the rate in the country was 44.6% higher than the average rate reported for the Region of the Americas as a whole. Among potentially avoidable premature mortality, the rate for preventable causes was 204.4 per 100 000 population in 2019, which is 49.1% higher than the regional average rate; and the rate for treatable causes was 123.4 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 6.4 per 1000 population in 2019, a decrease of 24.7% compared to 2000 (8.5 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 90.4 per 100 000 population (104.7 per 100 000 in men and 76.3 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 452 per 100 000 population (506.7 per 100 000 in men and 76.3 per 100 000 in women). The rate of age-adjusted mortality from external causes was 98.3 per 100 000 population (166.1 per 100 000 in men and 32.3 per 100 000 in women), including road traffic accidents (23.6 per 100 000 population), homicides (40.2 per 100 000 population) and suicides (7.6 per 100 000 population). In 2000, the percentage distribution of causes was 72.3% for noncommunicable diseases, 14.4% for communicable diseases, and 13.4% for external causes; in 2019, the percentages were 70.5%, 14.1%, and 15.3%, respectively (Figure 6).

Figure 6. Proportional mortality in Belize, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 37.3 per 100 000 men; lung cancer, 17.5 per 100 000; and colorectal cancer, 7.2 per 100 000. In women, these values were 15.2 deaths per 100 000 for breast cancer, 5.7 per 100 000 for lung cancer, and 7.7 per 100 000 for colorectal cancer.

Perspectives

Belize has made notable progress in the field of public health, particularly in the elimination of mother-to-child transmission (MTCT) of HIV and syphilis. This achievement, certified in late 2023, highlights the country's dedication to advancing healthcare and addressing key health challenges. The initiative is driven by a comprehensive strategy that integrates multiple sectors and stakeholders and is underpinned by strong national leadership and collaboration with international partners.

Achievements in Disease Elimination

Belize was awarded the certification of eliminating the mother to child transmission of HIV and Syphilis in late 2023, that marks a significant milestone in the country's public health efforts. The Elimination of Mother-to-Child Transmission (EMTCT) initiative is spearheaded by the Ministry of Health and Wellness (MOHW) in collaboration with the private sector, demonstrating a robust public-private partnership. The EMTCT program is jointly managed by the national HIV and AIDS program and the Maternal and Child Health (MCH) program, ensuring a cohesive approach to preventing vertical transmission. The program is fully funded by the Government of Belize, with technical support from international organizations such as the Pan American Health Organization (PAHO) and UNICEF.

The certification in 2023 underscores the effectiveness of Belize’s healthcare system in providing timely and accurate services to pregnant women and exposed infants. This success is supported by enhanced monitoring at both national and local levels, ensuring that the services provided are consistent and accessible. The MOHW has improved communication between the national and local levels, facilitating timely access to necessary healthcare services and reinforcing the health system’s capacity to maintain this elimination status.

Current Efforts and Roadmap to 2030

Belize has developed a comprehensive national strategic plan (NSP) for the elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B for the period 2024-2030, based on the EMTCT Plus guidelines issued by the World Health Organization (WHO). This strategic plan outlines the roadmap for achieving zero new infections among infants and young children, reducing the MTCT rate of HIV to less than 2% in non-breastfeeding populations and less than 5% in breastfeeding populations, and achieving a 95% reduction in the incidence of chronic hepatitis B infections.

The NSP’s primary goals are twofold: firstly, to provide timely and accurate services to pregnant women to eliminate the vertical transmission of HIV, syphilis, and hepatitis B; and secondly, to ensure timely and accurate services to exposed infants to prevent vertical transmission. The plan is tailored to the local context, reflecting the unique healthcare needs and challenges of Belize, and sets ambitious targets aligned with global health goals.

Challenges and Gaps

Despite the significant progress, Belize faces several challenges in relation to the four strategic lines of action outlined by the Elimination Initiative:

I. Strengthening and Integration of Health Systems and Services:
One of the main challenges is the shortage of human resources across all clinical categories involved in the elimination initiative. This gap affects the ability to provide consistent and high-quality services, particularly in rural and underserved areas.

II. Strengthening Health Surveillance and Information Systems:
The surveillance system for EMTCT of HIV, syphilis, and hepatitis B requires additional human resources at the local level, such as patient navigators who can facilitate access to services and adherence to treatment. Strengthening laboratory and social support services is also crucial to enhance the overall effectiveness of the surveillance system.

III. Addressing Environmental and Social Determinants of Health:
Social determinants of health, including poverty, unemployment, and unsafe environments such as those affected by gender-based violence, pose significant barriers for women living with HIV or infected with syphilis or hepatitis B. Poor health literacy further complicates efforts to reach these vulnerable populations and ensure they receive appropriate care.

IV. Strengthening Governance, Stewardship, and Finance:
The EMTCT program is fully funded by the Government of Belize, with technical assistance from international partners. However, the reliance on government funding, along with limited financial resources, can constrain the program’s ability to scale up and sustain its initiatives. Strengthening collaboration with the private sector and securing additional funding sources are essential to overcoming these financial challenges.

Health Equity

Belize has made significant strides in ensuring that EMTCT services are accessible to all, regardless of socioeconomic status. The services are provided at health facilities and during outreach sessions through mobile clinics. Local health teams go beyond traditional healthcare settings, conducting home visits and providing transportation to health facilities or government laboratories to ensure that patients can access the care they need. Importantly, these services are provided without any out-of-pocket payments, ensuring that cost is not a barrier to accessing care. The program’s inclusive approach aims to eliminate any discrimination in the provision of care and services, promoting health equity across all communities.

Community and Civil Society Participation

Community and civil society engagement are integral to the success of Belize’s EMTCT initiative. The Ministry of Health and Wellness conducts mobile clinics supported by community leaders and members, which play a vital role in reaching the target population. The Belize Family Life Association (BFLA), a non-governmental organization, provides essential services to those at risk of MTCT. Civil society organizations actively participate through representation on the National AIDS Commission (NAC), ensuring that community voices are heard and integrated into national health strategies. This collaboration strengthens the program’s outreach and effectiveness by fostering trust and community buy-in.

Country Coordination Mechanisms

Effective coordination mechanisms are crucial for maintaining the gains achieved in disease elimination. The National Validation Committee (NVC), a multisectoral and multidisciplinary body, oversees the efforts to sustain the certification of EMTCT for HIV and syphilis. The NVC plays a key role in monitoring and validating the ongoing effectiveness of the program, ensuring that the elimination status is maintained and that any emerging challenges are promptly addressed.

Malaria Elimination

Another significant achievement for Belize is its certification as malaria-free by the World Health Organization on June 19, 2023. This certification marks the culmination of decades of work, starting in the late 1950s, and aligns with the Sustainable Development Goal (SDG) target of ending malaria by 2030. Belize sustained five and a half consecutive years without local transmission, with the last local case detected in December 2018. The strategic plan for malaria elimination from 2018 to 2022 was instrumental in mapping out strategies and priorities, allowing district teams to develop micro plans tailored to priority areas through a risk stratification process.

The success of this plan led to the development of a new strategic plan for the Prevention of Malaria Re-establishment (2023–2027), which aims to build on previous achievements while addressing current challenges. The focus is on ensuring a timely and accurate surveillance information system capable of identifying imported cases and responding promptly to prevent potential outbreaks. Through the ongoing Regional Malaria Elimination Initiative (RMEI) and the supporting COVID-19 Response Mechanism (C19RM), significant efforts have been made to build the capacity of healthcare workers in malaria surveillance and response.

Cervical Cancer Elimination

Belize has also made progress in the elimination of cervical cancer. The introduction of the HPV vaccine in 2016 marked a significant step forward, although vaccination coverage fluctuated during the COVID-19 pandemic, where the vaccine coverage for HPV declined from 50% as low as 16%. Despite this, efforts have continued with a one-dose HPV vaccine administered to school-aged boys and girls, and coverage has increased to 40% in 2023. HPV testing, introduced in 2022, has been well-received, with self-collected samples being preferred by women. The districts have the capacity for the processing of samples locally (XPRT HPV), reducing the turnaround time for results. Also, the implementation of visual inspection of the cervix with acetic acid (VIA) and the introduction of visual assessment and triage (VAT) have strengthened the screening process. However, challenges remain, including limited human resources and the lack of in-country radiotherapy services. Belize continues to address these gaps through collaborations with visiting specialists and enhancing the capacity of local healthcare providers.

Challenges in the HIV/TB/STI Response

The response to the HIV epidemic and achieving the 95-95-95 targets pose significant challenges. While there has been an increase in testing, a gender disparity persists, with more females being tested than males. Achieving the targets of 95% of people diagnosed, 95% on treatment, and 95% virally suppressed remains a challenge, with only 60% on treatment and 30% achieving viral suppression. The introduction and rollout of Dolutegravir as part of the antiretroviral treatment regimen have shown promise, but further efforts are needed to strengthen testing, linkage to care, and treatment adherence. Partnerships with civil society, the National AIDS Commission, and international partners are critical to addressing these gaps and improving outcomes for people living with HIV.

Our efforts to enhance HIV testing have significantly improved with more rapid tests, allowing expanded testing across civil society, healthcare facilities, and specialized groups. We’ve introduced 4th Generation Antigen Rapid tests to reduce discrepancies in HIV results. Point-of-care (POC) testing is now widely available, with comprehensive training for medical, nursing, laboratory, pharmacy, and social work staff. This includes dual testing kits for HIV and syphilis, particularly in STI detection and management, rolled out to NHI facilities in the Belize District. Collaboration with adherence counselors and social workers aims to improve patient linkage to care, addressing medical and social factors hindering access.

Additionally, we’ve strengthened our partnership with Hands in Hands Ministry to support pediatric cases, ensuring smoother transitions from adolescence to adulthood. Continuous training for providers on HIV, TB, and STI management, as well as for social workers and adherence counselors, is ongoing to enhance service delivery. We’re revisiting referral processes among laboratories and providers to ensure timely results. District-level facilities now have an HIV Patient District monitoring tool for better case management and patient progress monitoring. We’re committed to research on testing modalities and challenges and improving ARV and TB medication procurement through the PAHO strategic fund, based on patient consumption data.

The Health Situation and the Elimination Initiative Diseases – Challenges

The ongoing challenges we face include the need to strengthen surveillance systems and ensure continuous capacity building across all levels of healthcare. A critical issue is the limitation of Human Resources for Health (HRH), which affects our ability to provide consistent and effective services. Additionally, there's a pressing need for further laboratory strengthening to support accurate and timely diagnoses. Financial resources remain constrained, impacting our ability to fully implement programs and scale up interventions. Moreover, improving communication strategies is essential to effectively disseminate information, engage stakeholders, and ensure coordinated efforts across the health system.

To address health equity, we have removed all fees at public health facilities, ensuring that cost is no longer a barrier to accessing care. We are also increasing community engagement to better understand and meet the needs of diverse populations. By improving mobile health services, we aim to reach underserved areas more effectively. Strengthening the training and recruitment of Community Health Workers (CHWs) is another key focus, empowering them to provide essential services at the grassroots level. Additionally, we are intensifying efforts in disease prevention to reduce the burden of illness and promote healthier communities.

The sources of the interagency indicators used in this profile can be found in this table.

For the latest data on health indicators for the Region of the Americas, be sure to visit the PAHO Core Indicators portal.