Dominica

The Health in the Americas+¹ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of Dominica was 68 346 inhabitants; by 2023 this figure had risen to 73 040, representing a 6.9% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 9.8% of the total population, a decrease of 0.0 percentage points compared to the year 2000. In 2023, there were 101.3 women per 100 men and 50.6 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 70.8% of the total population of the country in 2023 (51 706 people). When we add these figures to the potentially passive population (14 162 under 15 years of age and 7 173 over 65 years of age), the result is a dependency ratio of 41.3 potentially passive people per 100 potentially active people, this ratio was 66.3 in 2000. In Dominica in 2000 the dependency ratio was 18, and is estimated to more than double, to 38, by 2040.

Life expectancy at birth in 2023 was 74.2 years, lower than the average for the Region of the Americas and 1.5 years higher that in 2000.

Figure 1. Population pyramids, years 2000 and 2021

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Between 2000 and 2019, the average number of years of schooling in Dominica increased by 3.8%, reaching an average of 8.1 years in the latest year for which information is available. The unemployment rate in 2001 was 11% for the total population. 

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 3.6% (from a score of 0.695 to a score of 0.72); during the same period, the index rose 13.5% internationally and 9.4% in Latin America (Figure 2).

Figure 2. Human Development Index in the Region of the Americas, 2021

In 2020, public expenditure on health accounted for 3.52% of gross domestic product (GDP) (Figure 3) and 5.41% of total public expenditure, while out-of-pocket spending on health accounted for 29.3% of total health expenditure.

Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2019

Digital coverage

In 2021, 80.9% of the population had an internet connection, representing a considerable increase from 2000, when 8.8% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2021, infant mortality in Dominica decreased from 17.5 to 13.8 deaths per 1000 live births, a decrease of 21.1% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 10.5% to 8.6% between 2003 and 2021.

Regarding the immunization strategy, measles vaccination coverage was 83.0% in 2022, a decrease of 16.0 percentage points from 2000.

In relation to fertility, it is estimated that in 2023 women had an average of 1.6 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 36.8% decrease, from 59.5 live births per 1000 women aged 15 to 19 years in 2000 to 37.6 in 2023. In 2021, 100.0% of births were attended by skilled birth personnel. Between 2015 and 2020 the percentage of pregnant people who received antenatal care increased from 89.6% to 95%.

Figure 4. Infant mortality per 1000 live births, 1995–2020

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Communicable diseases

In 2019, there were 14 new cases of tuberculosis per 100 000 population in Dominica (actual new cases were 8). In 2021, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 9.7 per 100 000 population.

Noncommunicable diseases and risk factors

In Dominica, the prevalence of overweight and obesity was 60.3% in 2016. Also in 2016, 21.6% of the population reported insufficient physical activity. 

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 22.5%, a decrease of 4.5 percentage points compared to 2000 (27%). The prevalence of diabetes mellitus, which stood at 8.4% in 2000, increased to 11.1% in 2014.

The health situation and the COVID-19 pandemic

In 2020, Dominica ranked 47th in the Region of the Americas in terms of the number of deaths from COVID-19, and 38th in 2021.

According to estimates by the World Health Organization, there were no excess deaths in the country during 2020;³ a total of 69 excess deaths were estimated in 2021, for an excess mortality rate of 96 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 45.2% of the country's population. As of 31 August 2022 (latest available data), 44% of the population had completed the vaccination schedule. The vaccination campaign began on 20 February 2021, and four types of COVID-19 vaccine have been used to date.

Prospects

Measures to achieve universal health coverage

The Strategic Plan for Health (2008–2018) highlighted chronic disease as the key health challenge along with new and ongoing communicable diseases (such as dengue, Zika, and chikungunya viruses). Population decline and the associated aging population pose recognized challenges for health system realignment, and a continued loss of skilled health professionals overseas affects health service delivery.⁴ The strategic plan outlined strategies in three areas. The first concerns policies to improve population health, with many objectives recognizing the major burden of noncommunicable diseases, and also the ongoing problems of mental health and injuries. The second involves a recognition of the role of social inequalities on the national health burden with objectives to enable healthy lifestyle behaviors such as quitting smoking, reducing alcohol consumption, and increasing physical activity, and to tackle gender and employment-based health inequalities. The third area concerns health system strengthening and improved financing, including ensuring adequate number of health professionals, appropriately trained for the shifting disease burden. More recently, the Government of Dominica has produced a National Resilience Development Plan to guide sustainable and resilient national development for the coming decade.⁵ The plan outlines a broad objective for a robust modern health system that is accessible and affordable – with these elements representing a continued adoption of the global move toward universal health coverage; universal access and equity in health was a broad goal originally outlined in the Strategic Plan for Health. Human resources for health are again a recognized priority, and there are associated objectives for gender equality and for recognizing and tackling the vulnerabilities of the Kalinago communities.

Challenges related to population health

Dominica's population is aging, and the increasing proportion of older adults is predicted to continue. In 2020, the proportion of Dominica's population aged 65 and older was 12.2%. This proportion is predicted to rise further to 17.8% by 2040, and to almost one-quarter by 2060).⁶ The disease burden is dominated by noncommunicable diseases. Cardiovascular diseases, diabetes, and cancers in 2019 were the top three causes of death and disability, collectively accounting for almost half all healthy life lost.⁷ Including all other noncommunicable diseases raises this burden to around three-quarters of all healthy life lost. Neonatal disorders are a continued concern, contributing 5% of all healthy life lost in 2019, and with little change since 2000. Solutions to the prevention and control of noncommunicable diseases and maternal and child health require multisectoral cooperation.

COVID-19 pandemic response

Dominica escaped community transmission of COVID-19 until September 2021 and has since seen three outbreak peaks, and with all of the 67 confirmed deaths by May 2022 concentrated in these outbreak periods. The vaccination program in cooperation with international partners represents a major ongoing COVID-19 policy. COVID-19 is one example of an external pressure, and these pressures are recognized as a major risk to ongoing healthcare improvements. Extreme weather events are another external pressure that have long been a threat to Dominica. On 18 September 2017 the category 5 Hurricane Maria made landfall on the southwest coast of Dominica, resulting in damage estimated at over twice the size of the national GDP. Ninety percent of roofs were damaged or destroyed, and crops were devastated. The hurricane was one more reminder of the fragility of the Small Island Developing States of the Caribbean, and the Government of Dominica has since pushed for national resilience in all development. The National Resilience Development Plan has become the resilience handbook for the nation, with development now focused on resilience to future extreme weather events. In 2021 and 2022 the World Bank approved funds to support Dominica's COVID-19 response to save lives, livelihoods, and jobs, while laying the foundation for longer-term economic recovery. Further funding will enable the establishment of guidelines for a vulnerability, risk, and resilience fund to be able to respond to future shocks quickly. These programs were specifically aligned with the country's National Resilience Development Strategy and COVID-19 response strategy.

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.

Additional data provided directly by Dominica