Evaluating and strengthening the health system of Curacao to improve its performance for future outbreaks of vector-borne diseases

Vaitiare Mulderij-Jansen*, Izzy Gerstenbluth, Ashley Duits, Adriana Tami, Ajay Bailey

*Corresponding author voor dit werk

OnderzoeksoutputAcademicpeer review

3 Citaten (Scopus)
150 Downloads (Pure)


Background: Vector-borne diseases (VBDs) such as dengue, chikungunya, and Zika pose a significant challenge to health systems in countries they affect, especially countries with less developed healthcare systems. Therefore, countries are encouraged to work towards more resilient health systems. This qualitative study aims to examine the performance of the health system of the Dutch Caribbean island of Curacao regarding the prevention and control of VBDs in the last decade by using the WHO health system building blocks.

Methods: From November 2018 to December 2020, a multi-method qualitative study was performed in Curacao, applying content analysis of documents (n = 50), five focus group discussions (n = 30), interviews with experts (n = 11) and 15 observation sessions. The study was designed based on the WHO framework: health system building blocks. Two cycles of inductive and deductive coding were employed, and Nvivo software was used to analyse the data.

Results: This study's data highlighted the challenges (e.g. insufficient oversight, coordination, leadership skills, structure and communication) that the departments of the health system of Curacao faced during the last three epidemics of VBDs (2010-2020). Furthermore, low levels of collaboration between governmental and non-governmental organisations (e.g. semi-governmental and private laboratories) and insufficient capacity building to improve skills (e.g. entomological, surveillance skills) were also observed. Lastly, we observed how bottlenecks in one building block negatively influenced other building blocks (e.g. inadequate leadership/governance obstructed the workforce's performance).

Conclusions: This study uncovers potential organisational bottlenecks that have affected the performance of the health system of Curacao negatively. We recommend starting with the reinforcement of oversight of the integrated vector management programme to ensure the development, implementation and evaluation of related legislation, policies and interventions. Also, we recommend evaluating and reforming the existing administrative and organisational structure of the health system by considering the cultural style, challenges and barriers of the current health system. More efforts are needed to improve the documentation of agreements, recruitment and evaluation of the workforce's performance. Based on our findings, we conceptualised actions to strengthen the health system's building blocks to improve its performance for future outbreaks of infectious diseases.

Originele taal-2English
Aantal pagina's17
TijdschriftParasites & Vectors
Nummer van het tijdschrift1
StatusPublished - 26-sep.-2021


Duik in de onderzoeksthema's van 'Evaluating and strengthening the health system of Curacao to improve its performance for future outbreaks of vector-borne diseases'. Samen vormen ze een unieke vingerafdruk.

Citeer dit