Dominican Republic

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 Dominican Republic was 8 540 791 inhabitants; by 2023 this figure had risen to 11 332 972, representing a 32.7% increase. Regarding the country’s demographic profile, in 2023 people over 65 years of age accounted for 7.7% of the total population, an increase of 2.9 percentage points compared to the year 2000. In 2023, there were 99.4 women per 100 men and 28.6 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 65.5% of the total population of the country in 2023 (7 422 790 people). When we add these figures to the potentially passive population (3 040 456 under 15 years of age and 869 727 over 65 years of age), the result is a dependency ratio of 52.7 potentially passive people per 100 potentially active people. This ratio was 66.1 in 2000.

Life expectancy at birth in 2023 was 74.4 years, lower than the average for the Region of the Americas and 4.9 years higher that in 2000.

Figure 1. Population pyramids of Dominican Republic, years 2000 and 2023

Between 2007 and 2016, the average number of years of schooling in Dominican Republic increased by 26.1%, reaching an average of 9.0 years in the latest year for which information is available. The unemployment rate in 2022 was 7.1%. Disaggregated by sex, the rate was 11.7% for women and 4.0% for men. The literacy rate was 98.9% in 2021. In men, this figure was 98.8%; in women, 99.1%. In addition, 21.0% of the population were below the national poverty line in 2019, a decrease from 25.6% in 2017. In 2020, 0.8% 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 below the regional average of 3%.

During the period 2000-2021, the country improved its score on the Human Development Index, with an increase of 18.7% (from a score of 0.646 to a score of 0.767); 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 3.24% of gross domestic product (GDP) (Figure 3) and 14.68% of total public expenditure, while out-of-pocket spending on health accounted for 24.65% of total health expenditure.

Figure 3. Domestic general government health expenditure as percentage of gross domestic product, 2020

Digital coverage

In 2021, 85.2% of the population had an internet connection, representing a considerable increase from 2000, when 3.7% of the population had an internet connection.

Health situation

Maternal and child health

Between 2000 and 2018, infant mortality in Dominican Republic decreased from 39.1 to 22.7 deaths per 1000 live births, a decrease of 41.9% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 10.9% to 7.3% between 2007 and 2019, while exclusive breastfeeding in the child population up to 6 months of age was 11.0% in 2000, the same value as in 2000, and 4.6% in 2014 (the latest year for which information is available). 

Regarding the immunization strategy, measles vaccination coverage was 91.0% in 2022, an increase of three percentage points from 2000.

The maternal mortality ratio for 2020 was estimated at 107.3 deaths per 100 000 live births, a reduction of 35.8% from the estimated value for 2000 (Figure 5). In relation to fertility, it is estimated that in 2023 women had an average of 2.2 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 46.2% decrease, from 112.2 live births per 1000 women aged 15 to 19 years in 2000 to 60.4 in 2023. In 2021, 99.9% of births were attended by skilled birth personnel. Between 2002 and 2014 the percentage of pregnant people who had four or more consultations for antenatal care decreased from 93.5% to 92.9%.

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

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

Communicable diseases

In 2021, there were 30 new cases of tuberculosis per 100 000 population in Dominican Republic. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.3 (1.1 in women and 3.6 in men).

In 2020, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 45.6 per 100 000 population. The age-adjusted mortality rate for HIV was 18.9 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 75.6%.

There was one reported case of human rabies in the country in 2020.

Noncommunicable diseases and risk factors

In Dominican Republic in 2023, the prevalence of tobacco use among people aged 15 and older was 8.4%. In the same age group, the prevalence of overweight and obesity was 61.2% in 2016.

Also in 2016, 39% 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 21.5%, a decrease of 4.1 percentage points compared to 2000 (25.6%). The prevalence of diabetes mellitus, which stood at 7.4% in 2000, increased to 10.1% in 2014.

Mortality

In 2019, the adjusted rate of potentially avoidable premature mortality in the Dominican Republic was 380 deaths per 100 000 population, an increase of 2.3% from a rate of 371.3 in 2000. This meant that, in 2019, the rate in the country was 67.6% higher than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 219.8 per 100 000 population in 2019, which is 60.3% higher than the regional average rate; and the rate for treatable causes was 160.2 per 100 000 population, below the regional average of 89.6.

The overall age-adjusted mortality rate was 7 per 1000 population in 2019, an increase of 9.1% compared to 2000 (6.4 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 85.4 per 100 000 population (92.1 per 100 000 in men and 78.6 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 512.7 per 100 000 population (583.4 per 100 000 in men and 448.3 per 100 000 in women). The rate of age-adjusted mortality from external causes was 108.4 per 100 000 population (183.1 per 100 000 in men and 36.6 per 100 000 in women), including road traffic accidents (67.2 per 100 000 population), homicides (18.1 per 100 000 population), and suicides (5.1 per 100 000 population). In 2000, the percentage distribution of causes was 51.5% for noncommunicable diseases, 34.9% for communicable diseases, and 13.6% for external causes; in 2019, the percentages were 79.6%, 12.6%, and 15.5%, respectively (Figure 6).

Figure 6. Proportional mortality in Dominican Republic, 2000 and 2019

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 35.4 per 100 000 men; lung cancer, 15.7 per 100 000; and colorectal cancer, 9 per 100 000. In women, these values were 28.3 deaths per 100 000 for breast cancer; 9.9 per 100 000 for lung cancer; and 8 per 100 000 for colorectal cancer.

The health situation and the COVID-19 pandemic

In the Dominican Republic in 2020, there were a total of 170 785 cases of COVID-19, representing 15 364.7 per million population. In 2021, there were 247 993 identified cases, equivalent to 22 310.7 per million population. In 2020, there were 2414 deaths directly caused by COVID-19 in people diagnosed with the disease, or 217.2 per million population; in 2021, 1833 deaths were reported, or 164.9 per million. In 2020, the Dominican Republic ranked 26th in the Region of the Americas in terms of the number of deaths from COVID-19, and 47th in 2021, with a cumulative 382 deaths per million population over the two years (Figure 7). 

According to estimates by the World Health Organization, there was a total of 1085 excess deaths in 2020, or 10 per 100 000 population; a total of 10 844 deaths were estimated in 2021, for an excess mortality rate of 99 per 100 000.

As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 66.4% of the country's population. As of 2 July 2022 (latest available data), 55% of the population had completed the vaccination schedule. The vaccination campaign began on 20 February 2021, and three types of COVID-19 vaccine have been used to date.

Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to July 29th, 2023

Prospects

Measures to achieve universal health coverage

The current government has prioritized universal access to health services as a fundamental principle in the design and overall planning of the national health strategy. This is aligned with the Sustainable Development Goals (SDGs)  and guides the programs, interventions, and actions of the various public agencies.

In the same vein, through the National Multi-year Public Sector Plan (PNPSP),  public policies have established a series of actions aimed at achieving universal access to health. Among the basic objectives of these initiatives are the following:

• Implementing the Comprehensive Primary Health Care Strategy.
• Ensuring the population's access to integrated networks of individual and collective health services, in order to promote health and prevent disease. 
• Guaranteeing universal, timely, and affordable access to safe and effective essential medicines.
• Guaranteeing care, rehabilitation, prevention, and promotional services in order to reduce the morbidity and lethality of preventable diseases, teenage pregnancies, maternal and infant mortality, and deaths and injuries from traffic accidents.
• Ensuring the dignity of people who have health conditions that are considered ‘catastrophic’, considering the need to reduce the harm caused by the COVID-19 pandemic that began in 2020.
• Ensuring equity in access to services provided through a single basic health plan, which will increase the coverage of collective health and individual services. 
• Reducing the gap in old-age, disability, and survivors' insurance through solidarity pensions.
• Ensuring that coverage of occupational risks is expanded.
• Ensuring comprehensive care and early stimulation in early childhood.
   

Challenges related to population health

The government has adopted the principle of universal access to health as a part of all public sector planning—through the National Multi-year Public Sector Plan (PNSP) — which sets forth the goals and desired outcomes, with the priority of implementing the Comprehensive Primary Health Care Strategy. The PNSP is also aligned with the National Development Strategy and with the SDGs. 
Within this framework, a further challenge for the country is to fully implement the “Health in All Policies” strategy.  This serves as a basis for the various sectors and local governments to coordinate policies, outcomes, interventions, and activities to promote the health of the population through initiatives aimed at problems such as sanitation, security, and access to drinking water. The health and planning departments are expected to provide guidelines for these strategies and initiatives, with a view to establishing more fluid dynamics between sectors.

COVID-19 pandemic response

Ongoing efforts are in place to strengthen COVID-19 diagnostic testing, follow-up procedures for people with COVID-19, and epidemiological surveillance, in addition to more robust information systems. In order to improve monitoring of the current pandemic and prepare for potential similar future events, three major updates have been established: an update on COVID-19 surveillance procedures in February 2022, which includes training on reporting cases and recording antigen test results; updating the information system platforms for the National Epidemiological Surveillance System, such as ViEpi and SAT; and updating the EpiVigila tool for database management and epidemiological analysis.

Measures to reduce inequalities in health

Notable within the set of public policy initiatives to address health inequalities are the National Development Strategy (particularly regarding axis 2) and the Institutional Strategic Plan.  Both are part of the PNPSP; in 2022, for the first time, outcome indicators and units of measurement with an equity approach were established to highlight health inequalities and facilitate the design and implementation of future interventions to remedy this major public health problem.

National strategy to address inequalities in health

The country has begun the process of preparing the National Ten-Year Health Plan, which will include a strategy to address health inequalities.  At present, the National Development Strategy 2030 addresses health inequalities under axis 2. This axis sets out certain objectives (specifically, general objective 2.3: Health and comprehensive social security, and specific objective 2.3: Equal rights and opportunities). The plan establishes lines of action to address equality and equity between men and women, promotion of comprehensive early childhood care, registration of minors belonging to excluded social groups, eradication of child labor, and promotion of infrastructure and mobility planning for people with disabilities. 

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.