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There are 15 primary public and 4 secondary public schools. There are 10 private primary and 3 private secondary schools, with one public technical and vocational school.

Higher education is free to residents at the local community college up to Associate degree level. In , the literacy rate for 15 years and older was According to census data, unemployment was 2.

The first case of Zika was reported in July , with 22 confirmed cases as of September Chikungunya was introduced in and 47 cases have been confirmed in the territory.

The number of dengue cases spiked in , but showed a significant decline in and ; there were reported cases of dengue fever between and Malaria is not endemic and there were no imported cases in the reporting period.

Chronic, noncommunicable diseases mainly cancer , diabetes , and hypertension contribute significantly to morbidity and mortality in adults. The prevalence of obesity, due mainly to a sedentary lifestyle and a diet high in processed or refined foods, is one of the leading health risks for chronic conditions in the territory, where it primarily affects women and children.

A hemodialysis program was started in , and as of May , served 47 local patients. There is a vibrant referral program and renal clinic for Stage III patients.

In addition, there is a living donor transplant program through referrals to the United Kingdom that has had some success, with seven persons having received transplants since Patients have been on dialysis a average of 7 years, but there are currently 18 persons who have been on dialysis longer than that one of them for 14 years.

The Ministry of Health and Social Development is implementing a year strategy for the Prevention of Chronic Non-Communicable Diseases that relies on a multi-sector approach.

To that end, this strategy strives to mobilize support and actions at a high level in education, planning, tourism, health, and the community or NGO sectors.

The BVI Health Services Authority has developed a three-year action plan for the public hospital to implement the Chronic Care Model aimed at standardizing and improving care delivered to persons with diabetes and hypertension.

There are no training facilities in the territory, so nationals train in the health professions elsewhere in the Caribbean, in the United Kingdom, and in the United States.

In order to fill the necessary public- and private-sector health-personnel positions, staff is recruited from the Caribbean, the United States, Canada, the Philippines, and some African countries.

The majority of health care workers are employed in the public health sector 3. In , physicians were registered to practice in the territory; of these, 88 were actively practicing, 45 of whom worked in the public sector.

That same year, of the 13 dentists working in the territory, only 2 worked in the public sector 3. Of the nurses registered to practice, worked in the public sector.

Opportunities for continuing education of doctors and nurses are available locally. Most private-sector providers, as well as the public health system, utilize electronic health records and other forms of electronic data management.

There also is an electronic reporting system for communicable diseases, which utilizes an online survey tool to report data on vector-borne diseases in real time to the Ministry of Health and the Environmental Health Division.

All other data are reported to the Ministry of Health on paper forms. Every home in the territory has a reliable supply of safe water through rainwater catchments, which are mandated by law unless the home has access to the municipal water supply.

Municipal water distribution, derived from seawater desalination, is limited. Ministry of Health personnel monitor the quality of the water supply.

Municipal sewage mains serve 2. With no heavy industry in the territory, outdoor air pollution is not a significant concern.

Following concerns raised by surrounding communities regarding air pollution generated by the previous Pockwood Pond incinerator, the Ministry of Health has commissioned the installation of scrubbers on the new incinerator to further reduce emissions.

The management of solid waste is a critical issue in the British Virgin Islands. The territory has experienced a threefold increase in waste volume in the last decade; waste is either dumped or incinerated, and there are no recycling facilities currently in place.

In , a new incinerator was operationalized, with the scrubbers to be installed at a later date. The territory, like most small-island developing states, is expected to experience climate-change consequences such as rising sea levels, changes in rainfall pattern, and an increase in the intensity and frequency of hurricanes.

Immigration is a complex issue that directly touches on nationality and citizenship issues, which are governed by the British Nationality Act. Persons born in the territory to foreign nationals are not automatically granted citizenship.

Many births occur in the United States and, to a lesser extent, in other territories. The proportion of transient migrants in the territory is considerably smaller, predominantly working-age; conditions in this group are not well documented.

This has implications for access to care, particularly for non-English speakers and undocumented persons who will not have National Health Insurance coverage and therefore will have to pay out-of-pocket for health care.

Since , public health care services have fallen under the responsibility of the BVI Health Services Authority, a statutory corporate body.

Public primary health care services are provided through 10 health centers and 4 health posts; public secondary care is provided at the Peebles Hospital, a bed institution that offers services in the major medical disciplines.

There is a well-developed private health care system that includes a private hospital. Visiting specialists from the English-speaking Caribbean, Puerto Rico, and the United States provide care at public and private institutions, mostly on a monthly basis, depending on demand.

Visiting specialist services cover areas such as neurology, rheumatology, urology, ophthalmologic subspecialties, and plastic surgery. Health services are financed through National Health Insurance, which was put in place in January The NHI receives contributions from employers and employees in addition to government direct investment and reimbursement for care provided in both the public and private sector.

All legal residents are mandated by law to participate in the National Health Insurance, which acts as the legal primary health insurer in the territory, covering a set, comprehensive benefits package that includes medical, dental, and vision benefits.

The Ministry of Health reviews and updates its legislative framework on an ongoing basis to improve its leadership and governance roles.

The improvements in the monitoring and evaluation of efficacy, customer service, quality of patient care, and access of all persons interfacing with the system will also be facilitated through improved access to care provided for by the National Health Insurance System.

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All deliveries almost exclusively take place at Peebles Hospital and are all attended by skilled birth attendants.

The proportion of low birthweight infants fluctuated between and with a high of Among the main findings of this evaluation was the need to strengthen quality control at the Peebles Hospital Laboratory; other elimination components were considered adequate.

From to , there were births recorded, with low birthweight infants accounting for 6. Infant mortality fluctuated between and , ranging between The leading causes of death in children under 5 years old were conditions originating in the perinatal period followed by congenital anomalies.

Acute respiratory infections and gastroenteritis are the leading causes of illnesses in this age group. IPV targeted children aged 2 months.

A well-organized school health system includes screening for vision, hearing, and disabilities; the program also includes dental health.

The program spans child and adolescent periods. The Global School-based Student Health Survey GSHS that covered students 13 15 years old showed that approximately one-third of students surveyed had at least one alcoholic drink in the 30 days prior to the survey.

Of students interviewed, One in every three Condom use at last sexual intercourse was high at Dependency is low, with the proportion of elderly being relatively small due to immigration of working-age groups.

According to the census, there were 1, persons 65 years and older. A study on the situation of the elderly in the British Virgin Islands in highlighted the need for more care for the elderly suffering from chronic diseases and better access to care.

There is no state-run residential housing for the elderly. In , there were deaths. Men continue to experience a higher mortality rate.

Hypertension continues to be the leading cause of death in the population The overall average age of death in was Figure 2A and B shows the percentage distribution of causes of death for males and females.

Figure 2 A and B. Percentage distribution of causes of death, by sex, British Virgin Islands, The projection is that more persons will acquire chronic noncommunicable diseases and become ill in their productive years 4.

Diseases of the lungs ranked as the second leading cause of death in , and fourth in ; these diseases included pulmonary edema, pulmonary infarction, bacterial pneumonia, and obstructive lung disease.

Malignant neoplasms including cancer of the prostate, breast, lung, stomach, uterus, and colon ranked as the third leading cause of death in Malignant neoplasms affect more men than women.

Cardiovascular disease , including congestive health failure, arteriosclerosis, ischemic heart disease, coronary artery disease, hypertensive cardiovascular disease, myocardial infarction, and congestive heart failure, remains the leading cause of death for the population; more men than women died as a result of heart disease in In , most cardiac deaths occurred in persons older than 60 years, In , stroke ranked as the fifth leading cause of death.

Among males who died of stroke in that year, the average age was There were two deaths due to stroke in children 11 years old. Vector-borne diseases remain endemic in the territory, with dengue fever and chikungunya being the most important such diseases in the territory.

In there were cases of dengue and 14 cases of chikungunya. Regarding vaccine-preventable diseases , there were eight reported cases of chicken pox varicella in , all in unvaccinated persons.

No other cases of vaccine-preventable diseases were diagnosed. In , nine new cases of the disease were reported.

The average age of persons being diagnosed with the disease is 35 years of age. Chronic diseases continue to be a major cause of morbidity and mortality.

In , such diseases accounted for four of the five leading causes of death. The territory advanced significantly towards universal health coverage and universal health access by establishing the National Health Insurance System in That said, the development of a universal health coverage road map is considered necessary to ensure that this goal will be attained.

Recommendations in the road map include a focus on the renewal of primary health care and ensuring that additional resources are available and dedicated to address the social determinants of health.

Reversing the findings of the STEPS survey will require the full commitment of the Government and society to this end.

Further, additional resources must be made available to the chronic, noncommunicable disease strategy, and there is a clear need to develop an e-health policy and plan and the enacting of supporting legislation to cover the handling of personal information.

The territory continues to be at risk for vector-borne diseases, particularly those transmitted by Aedes aegypti.

Outbreaks of such diseases lead to illness and loss of productivity, and they erode the economy, which is highly dependent on tourism.

The National Health Insurance is a new system that has provided health care coverage to the entire population and reduced the impact of price as a barrier to care to a significant number of persons for whom previously this would have been an important deterrent.

It is projected that the total health care expenditures in the program will rise in the short term and later stabilize, as unmet demand for health care in the population is met.

This will necessitate constant surveillance of these trends and modifications to the system as necessary. Bureau of the Census United States.

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