Developing primary care in the Seychelles

Problem

Like the NHS, the Seychelles Health Care System was based upon principles espoused in the Beveridge report, and further developed based on the Alma Ata principles on primary care. The constitution of the country grants all citizens free access to primary health care.Although the country has achieved many gains in universal health coverage, the country still faces significant problems in the dimensions of quality of services. Seychelles has pursued an incremental reform package underpinned by the highest nominal per capita GDP of any African nation and the second-highest Human Development Index of any African country, after Mauritius. The Primary Health Care Package and National Health Strategic Plan 2022-2026 depends upon a highly motivated, well-resourced primary care workforce, supported by strong leadership and resources.

Approach

Document review and semi-structured interview.A comparison of data from national, WHO and World Bank data on health System activity and outcomes as well as undergraduate teaching and postgraduate training between 1992 and 2022 was undertaken and 12 key informants were interviewed in February 2024 using a semi-structured interview.

Findings

During the past thirty years, life expectancy has increased to 74.2y (69.8y M, 77.8y F).The country’s health system has undergone several structural changes in accountability and organization, but the main elements of how the sector is financed how providers are paid, and how services are delivered have remained relatively stable. Seychelles has consistently invested to improve access to and availability of services in 17 community clinics which provide a range of preventative, diagnostic and treatment services to their local communities. Current investment is 4.4% of GDP. Informal care from traditional healers- ‘bonhommes du bois’ remains a first option for many Seychellois, and private health care has expanded to 27 practices. A key change in recent years is the composition of medical/dental professionals– increasing fraction of Seychellois, and increasing fraction of women constituting the workforce. Many are interested in primary care practice. Training and support in the first five years after Seychellois return to the country from undergraduate teaching and postgraduate training intending to be family physicians is obtained from a range of sources including the RCGP and St George’s University of London Medical School.

Consequences

Seychelles, being a small island developing state with limited local expertise, and facing a complex global health developmental environment, requires support from external partners to build health system resilience. Collaboration on postgraduate training and research with members of SAPC may be mutually beneficial. There is significant potential for capacity-building of these staff to strengthen primary care systems in the country.