National Audit of SDG 3.d: Strengthening Montserrat’s Public Health Systems

25th September, 2023

The Office of the Auditor General announces that its report entitled Montserrat’s Implementation of the United Nations’ Sustainable Development Goal #3.d: Building a Resilient National Public Health System was presented to the Legislative Assembly in July.  It assessed Montserrat’s progress in implementing S.D.G. 3.d, including planning, preparing, and responding to international health-risks, while maintaining regular services.

Background: The SDGs were established by agreement of 190 member-countries of the United Nations in 2015 as a sequel to the Millennium Development Goals.  The SDGs cover the period 2015 to 2030 with aims such as eliminating hunger, poverty, illiteracy, inequity, homelessness, etc.

Some Key Findings:

  • Continuing shortages of healthcare workers. Every year, the MOHSS faces turnover of employees, multiple vacant posts, & a limited local pool of qualified persons to fill all posts. Overseas recruitment has been necessary, but faces regional & global competition.  
  • Gaps in data and reporting. Gathering of health-related data is regular in some areas, but very inefficient, relying heavily on paper-forms and manual processes. Some helpful publishing of data has been happening, but comprehensive and up-to-date SDG-related statistics and health-related data were not available, in several instances, either from the MOHSS or from the national Statistics Department.
  • Most of the Ministry of Health & Social Services’ (MOHSS) resources go to sickness; very little goes to prevention.   Chronic diseases and acute care consume most of the budgeted resources each year. We also found that budgets for Primary Healthcare were cut repeatedly in recent years. On average, less than $40,000 per year goes to Health Promotion, out of the Ministry’s total budget exceeding $23 million per year.
  • Chronic diseases have worsened, including among children. Of great concern is the rising incidence of chronic diseases such as diabetes, hypertension, heart-disease, cancer, and obesity. A notable trend of the past decade is that the incidence of NCDs has increased at earlier ages, predisposing the future adult population and workforce to greater risks of unfavourable outcomes, and a growing impact on the public healthcare-system.

Some Key Recommendations:

  • Urgently accelerate efforts to close capacity-gaps in public healthcare.    Resolve the barriers to recruitment and retention.
  • Better include and address the needs of vulnerable groups.   Expand the range of stakeholders identified and included in planning, in formulating policies, and in delivering programmes and services. Better align resources and service-delivery to stakeholders’ different needs: e.g., physical challenges, mental challenges, those for whom English is a foreign language, low-income/unemployed households, the elderly, persons with various disabilities, those with limited mobility/access to transportation, et cetera.
  • Strengthen primary healthcare and health-equity.  E.g., expanding health-checks, screening, counselling, and wellness-programmes to all workplaces and to all schools, rather than only selected age-groups.  Expanding the access of all age-groups to a full range of primary health-services. Ensure equal treatment of all applicants by need, regardless of age, of gender, of ethnicity, or of place of birth.  Pursue a whole-of-Government approach that integrates public health, housing, social services, et cetera.
  • Prioritise health-promotion and disease-prevention. This requires a major improvement in the quality and quantum of the allocations of people, funding, and planning to health-promotion, healthy lifestyles, disease-prevention, nutrition, and wellness.  Chronic diseases worsen the impact of crises, including pandemics, & have a far greater cumulative cost socially, economically, and fiscally.

The report in its entirety can be found at the Montserrat Public Library, on the Office of the Auditor General Publications Page or by requesting an electronic copy from the Office of the Auditor General, located upstairs Angelo’s Complex, Brades. E-mail:; Telephone: (664) 491 – 3460 or 491 – 4569.