Issues related to sexuality affect individuals throughout the life cycle. The Government of Trinidad andTobago established the Population Programme Unit in 1969 to facilitate the delivery of fertility management services to citizens. This department has been the major provider of Sexual and Reproductive Health (SRH) services in the country. These services include fertility management in all primary care facilities, the Port of Spain General Hospital and the Mt Hope Women’s Hospital, diagnostic screening or cervical cancer, first line counselling in SRH, specialist referrals and education and training programmes.
At present, the department, through the Ministry of Health, has developed a new policy for the reorganization of SRH services. A number of activities have been initiated to ensure a collaborative approach to this paradigm shift for the delivery of SRH services.
Services are provided at all Health Centres on scheduled clinic days and at Port-of-Spain, Mt. Hope and San Fernando Hospitals.
No appointment is necessary. Clients are attended to on a first come first serve basis.
You are not required to provide any documents to access these services. If you are a new client, however, you will be required to provide some basic demographic information (age, area of residence etc.)
- a variety of contraceptive options;
- diagnostic screening services for pap smear
(in selected health facilities);
- referral to Specialist Medical services
- pregnancy testing; and
- family life counselling
ADDITIONAL SERVICES TO BE OFFERED
- Adolescent and youth services
- Male services
- Post fertility services
- Expanded diagnostic screening services
- Secondary referral for counselling
- Referral to social services
The Populaltion Programme Unit has focused on the provision of fertility control services in the past decades. This has resulted in an emphasis on services targeting mainly women, through the provision of maternal and child services and contraceptive options. As a result, there has been a steady decline in fertility rate from 5.3 in the 1950’s (PAHO, 1992) to 1.7 in 1997 (CSO, 1997). While the fertility rate has been declining steadily, other epidemiological trends are creating formidable challenges to the sustainability of quality SRH services. These trends include:
- individuals experiencing greater longevity resulting in a larger population of elderly persons;
- increasing incidence of cancer of reproductive organs namely, cervix and breast in females and prostate in men;
- increasing incidence of Sexually Transmitted Infections (STI) including HIV/AIDS, especially those in the reproductive years;
- increasing incidence of Chronic Non-communicable Diseases (CNCD) including diabetes mellitus and hypertension;
- increasing incidence of domestic violence among both sexes which affects the quality of family life; and
- erectile dysfunction in men.
These challenges will require innovate and proactive approaches to ensure a reversal in trends. As a consequence, the Ministry of Health has adopted a proactive stance to ensure the provision of services that are needs focused and comprehensive.
The International Conference on Population and Development (ICPD, 1994) challenged governments and organizations to expand the quality and variety of SRH services to its citizens/clients. As a result, the call for national action at the Conference encompassed:
- a call for national policies and plans of action to make population and development programmes successful due to its intrinsic interrelation;
- programme management and human resources development to ensure a client centered approach to service delivery;
- resource mobilization and allocation to ensure the provision of basic SRH services (UN,1995).
Notwithstanding the Population Programme Unit’s successes in providing a sustainable, cost free service for over thirty years, opportunities to further augment these services have been embraced. The Ministry of Health, through the Health Sector Reform (HSR) programme is utilizing a decentralized approach for the provision of health services. As a consequence, SRH services will undergo such a transition as well. A number of activities have been and will be initiated to facilitate this transition.
Such re-organization will be reoriented beyond the provision of fertility control services to address issues such as STI’s, including HIV/AIDS; social relationships psycho-physiological dynamics of ageing; male health and adolescent SRH and rights. These reoriented services will encompass -
- the availability and acceptability of contraceptive options consistent with current technological developments;
- the availability, accessibility, affordability and acceptability of diagnostic screening services for cancers of the reproductive organs including cancer of the prostate in males;
- a comprehensive referral system intrasectorally within the primary and secondary health care setting and intersectorally with other Ministries/NGO’s;
- opportunities for first line and professional counselling as a significant service in addressing SRH problems exacerbated by CNCD, including diabetes mellitus, hypertension, cancers and arthritis;
- an emphasis on the establishment of SRH services to previously disenfranchised groups including adolescents and males.
- the provision of post fertility support to women and men, including Hormonal Replacement Therapy (HRT);
- the availability of ongoing education and training programmes for staff and organizations involved in SRH services; and
- a co-ordinated intersectoral collaborative approach to SRH service delivery with all agencies.
To ensure a comprehensive, technologically advanced and research based SRH service to clients of all ages.
To enhance the quality of life of all citizens by providing acceptable and accessible SRH services through qualified health professionals with the capacity to adapt to changing epidemiological trends and client needs.
The following is a summary of activities that have been initiated thus far:
- technical document for the reorganization of SRH services developed by Mr Selwyn Ragoonanan, former Director, and Mr Oscar Noel Ocho, Acting Director, Population Programme Unit, 1999;
- technical meeting to discuss SRH services using a collaborative approach was sponsored by Pan American Health Organization/World Health Organization (PAHO/WHO) and facilitated by Dr Ernest Pate, Advisor, SRH, PAHO/WHO, Washington, 1999;
- revised policy for SRH services facilitated by
Mrs Caroline Alexis-Thomas, Policy Analyst, Ministry of Health;
- strategic Plan for reorganized SRH services developed using an intersectoral, collaborative approach and facilitated by
Dr Ernest Pate, Advisor, SRH, PAHO/WHO, Washington; Dr Gina Watson, Technical Advisor, Health Promotion, PAHO/WHO office, Trinidad and Dr Ingrid Behm, Professor, University of Costa Rica, 2000;
- in-service education training programmes in cervical screening and IUD insertion for community nurses in the Eastern Regional Health Authority. This was done at the Family Planning Clinic, Mt Hope Women’s Hospital. At present, a similar facility is extended to community nurses attached to the North West Regional Health Authority;
- training of community nurses and other service providers, other Ministries, NGO’s/CBO’s and professional organizations in a ‘Train the Trainers’ basic and advanced first line counselling in SRH;
- workshop entitled, ‘Train the Trainers’ in Adolescent Sexual and Reproductive Health issues for individuals involved in adolescent and youth services co-ordinated by Ministries, NGO’s and CBO’s;
- intersectoral collaboration with Valsayn Teacher’s Training College and University of the West Indies for facilitating of Health and Family Life Education module to assist teachers in developing necessary attitudes and skills to deal with issues of sexuality in the classroom;
- intersectoral collaboration with Ministries and Agencies involved in youth services and development;
- mini project from Population Leadership Fellowship for a need assessment for adolescent SRH services in one health district in Trinidad sponsored by the Fellowship programme;
- proposal for implementation of a pilot project for adolescent SRH services in Tobago developed and presented to Mrs Cynthia Alfred, Secretary for Health, Tobago House of Assembly; and
- path for reorganized SRH services developed.
ACTIVITIES TO BE INITIATED
- Development of guidelines for the provision of SRH services.
- Establishment of an in-service education practical laboratory for community nurses in diagnostic screening for cervical and breast cancer and insertion of Intra-uterine Devise (IUD) at the Mt Hope Women’s Hospital.
- Development of a model for adolescent and male SRH services.
- Development of a database management system for SRH services.