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Ministerials Paragraphs Related to the Theme Paragraphs VII Summit
Date:  4/11/2012 
A National Health Sector Plan 2012 – 2016 (NHSP) has been formulated for Suriname. Implementation of a program for Universal Health Insurance is being considered, which includes the Basic Package of Health Care services plan and the proposed Universal Health Insurance Law.
Progress has been made to integrate vertical programs in the PHC, i.e. HIV services and capacity building to establish the chronic care model within the PHC delivery network. The physical infrastructure has also been upgraded through construction of new hospitals and primary care outpatient clinics.

Achievements in human resources are furthermore:
• New training programs (diabetes and HIV) at the Central School of Nursing have been implemented since 2007 to enhance chronic care competencies in PHC settings.
• The numerous fixus has been expanded to 30 students per year at the University’s Faculty of Medical Sciences.
• Public health professionals have been trained through cooperation between the Anton de Kom Universiteit and the Tulane School of Public Health and Tropical Medicine.

1. Overcoming fragmentation in the health system through coordination of the various public and private providers, institutions and health programs, as well as aligning different levels of care and financing mechanisms.
2. Provide leadership and advocate intersectional collaboration to address environmental risks, gender inequality and other social factors, as well as creating an environment for healthy lifestyles.
3. Re-evaluation of the health system to ensure maximum responsiveness and efficiency to prepare for and mitigate future threats.
4. With respect to the persistent unequal access to comprehensive health care and health services, Suriname needs to conduct a Periodic National Health Accounts Study to enhance the information on the government’s expenditures.
5. To ensure a balanced geographical distribution of the health workforce, effective deployment and retention measures, specific incentives and creative management strategies need to be developed and implemented.
6. Address the increase in mobility of populations, especially those of the interior, and establish more interaction with migrated populations across borders.
7. Apply advances in medical technology, creating opportunities to improve diagnostic and other services outside hospital settings.

Maternal and infant health
• Antenatal and post partum/postnatal care coverage are available to all pregnant women.
• In the period 2000 – 2009, the Maternal Mortality Ratio (MMR) has decreased from 153/100,000 live births to 122.5 /100,000 live births.
• The national capacity in emergency obstetric care and the registration thereof, including maternal mortality case investigations, needs strengthening.
• There are still discrepancies between the current Infant Mortality Rate and the MDG target for 2015, which is set at 7, as the baseline for 1990 was 21.1.
• The Perinatal mortality (PMR) rate decreased from 35.8 in 2000 (351 deaths) to 32.1 in 2009 (321 deaths). Correspondingly, the number of stillbirths decreased from 240 (stillbirth rate: 23.9) in 2000 to 195 (stillbirth rate: 19.5) in 2009.
• There was a decrease in the post-neonatal mortality rate (the number of deaths after 28 days but before one year per 1,000 live births); the rate decreased from 6.8 (67 deaths) in 2000 to 4.3 (42 deaths) in 2009.

Similar to global and regional trends, Suriname is experiencing an increasing mortality attributable to NCDs, while mortality linked to infectious diseases show significant decreases. In 2009, 60.5% of all deaths among the ten leading causes of mortality were attributed to Non-Communicable Diseases, including chronic respiratory diseases.

Drug abuse
Suriname, informed by the National Anti- Drug Council and relevant stakeholders, implemented the National Drug Master Plan (NDMP) 2006 – 2010. The NDMP 2011 - 2015 was approved in 2011. The National Drug Prevention Plan 2011 - 2014 was also approved in 2011. The new board of the National Anti- Drugs Council 2012 - 2015 will be established soon.

Achievements in reducing drug abuse and illicit drug abuse:
• Studies in the field of drug prevention and drug use were completed and published.
• Guidelines for residential addiction treatment were approved.
• The Inter-American Convention on Mutual Assistance in Criminal Matters and the UN Convention against the Illicit Traffic in Narcotics and Psychotropic Substances were ratified.
• Active participation in the OAS/CICAD Multilateral Evaluation Mechanism and compliance with its recommendations, to the extent possible.

Suriname’s mixed cultural heritage extends into the food culture and is apparent in the extensive variety and blending of available foods from many cuisines. This leads to difficulty in determining the typical diet, nutritional intake and deficiencies. Data on nutrition and the health status of the Surinamese population is limited and out-dated.

However, existing food supply data for Suriname indicate increased energy availability per capita over the past four decades (from 2000 kcal in 1961-1963 to ~2700 kcal in 2003-2005). This appears to be related to corresponding increases in fat and sugar availability and possibly reflects changing food consumption patterns.

Nutrition Policies: confronting malnutrition and promoting helathy diets
A specific bill provides all needy children with breakfast, allocating SRD 6 million for the period 2010 - 2011 and 10 million for the period 2011 - 2012. The project is being implemented at the national level, incorporating coastal and interior areas.

Youth and sport are areas of priority for Suriname and as such a physical activity and national sports plan is being developed. In 2012, SRD 6 million has been allocated for a pilot project to support vulnerable communities in several districts, by setting up multifunctional sports centers. Furthermore, the Regional Sports Academy for the Caribbean has been launched in March 2012.

Efforts at the NGO level are being undertaken to educate the population on healthy lifestyles and prevention of obesity. A Surinamese nutrition guideline has been developed for people with diabetes, hypertension and obesity.

Overall, the percentage of malnourished children under the age of five is decreasing since 2000. WHO Child Growth Standards are incorporated in a new child health record, which includes growth, development skills and nutrition counselling. The results of this study indicate that more intensive training is needed for clinic staff.

1. Not all clinics appear to be equipped or have sufficient capacity for care of children under age 5.
2. A baseline assessment of the food that is available in 70 primary schools has been conducted in 2009, showing that a majority of schools sell high-fat foods and sugary drinks. For snacks, mainly fried foods are available, while only one school sold milk products.
3. A manual to improve the food availability at kindergarten and primary schools has been developed and piloted in 2 schools. The pilot indicates that the nutrition value of food and drinks offered at schools needs to be improved.

Commitment to international health regulations
Suriname is implementing the IHR 2005 in order to prevent the international spread of diseases such as pandemic influenza, yellow fever, dengue, malaria and others, and is establishing the basic capacities needed for surveillance and response to events that could constitute public health emergencies of international concern.

In 2002, the first national HIV/AIDS treatment protocol was developed, followed by several adjustments. Until 2002, treatment of HIV+ was very limited.
Private efforts have been made to increase access to medicines through donations and establishment of a revolving fund for HAART in 2003, which enabled the start of public ARV treatment on a small scale.

In 2004, Suriname’s Global Fund grant was approved, and resources became available to work towards the goal of universal access to ARV. Since 2005, ARV is provided free of charge to all eligible HIV+ persons, and interventions rapidly increased to appropriately assess, diagnose and guide PLHIV and AIDS patients, thus ensuring access to high quality HIV and AIDS care and treatment for all in Suriname.
With increasing HIV screening of pregnant women, expansion of VCT sites, and introduction of free access to treatment in 2005, the number of persons diagnosed with HIV and eligible for treatment with ARV, more than tripled in 2007.

During 2005 - 2007 the cumulative number of persons under ARV treatment increased from 350 in 2005 to 412 in 2006, to 729 in 2007. Considering the estimated number of people in need for ARV, in 2006 the estimated coverage of ARV treatment was 41%.

The HIV response in Suriname is guided by the National Strategic Plan (NSP) for a multi sectorial approach of HIV/AIDS. The NSP 2009 - 2013 is currently in operation. The 5 priority areas are:
1. National Coordination, Policy and Capacity building
2. Prevention of further spread of HIV
3. Treatment, Care and Support
4. Reduction of stigma and discrimination of PLHIV
5. Strategic Information for policy development and service provision

Achievements in combating HIV/AIDS:
- Strengthened coordination through establishment of a national multi-sectorial HIV Board in 2009, with Technical Working Groups on prevention, treatment and care.
- Increased governmental budget for HIV/AIDS treatment and HIV/AIDS prophylaxis and treatment in the PMTCT program. In 2010, almost 70% were treated.
- Establishment of the Center of Excellence on treatment and care in 2010.
- Outcome achievements include access to early infant diagnosis, all treatment protocols revised, increased access to condoms, and implementation of the National Monitoring and Evaluation plan.
Paragraphs: 26, 27, 28, 30, 31, 33, 34, 35 Paragraphs VII Summit: -

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