The Healthcare System in Antigua and Barbuda: How a Foreigner Gets Treated

The public healthcare system comes under the Ministry of Health, Wellness and the Environment (address: Lower Long and High Street, St. John’s). Its website lists the Sir Lester Bird Medical Centre, the Hanna Thomas Hospital, the Clarevue Psychiatric Hospital, the Fiennes Institute, polyclinics and community health centres, a dental service, a nutrition unit, an infectious disease control centre, an epidemiology unit and the Emergency Medical Services (EMS). Mobile clinics are announced, for example at Cobbs Cross for people aged 40 and over and in Barbuda.

The private sector complements this offer with doctors’ practices: the Medical Benefits Scheme in fact reimburses tests, X-rays, ultrasound scans and procedures carried out in the doctor’s private office. France Diplomatie observes that some hospitals ask for payment in advance and that the French embassy cannot pay the costs. No official tariff was found on the ministry and hospital websites consulted: the prices of private consultations are unregulated and should be requested before treatment.

A national health insurance project is mentioned by the Medical Benefits Scheme: in 2020 the government, the Ministry of Health and the MBS began a process to establish a “Proposed National Health Insurance”, with the aim of universal health coverage. The page consulted gives neither an implementation timetable nor a launch date; it is a project, not a scheme in force.

The Medical Benefits Scheme (MBS) is funded by monthly contributions: 3.5% of wages for the employee and 3.5% for the employer from age 16 to under 60; 2.5% for the employee aged 60 to under 70, with no employer share; 0% from age 70; 5% of income for the self-employed aged 16 to under 60, 2.5% from 60 to under 70. People aged 16 to 69 who have been without a job for three months or more can contribute voluntarily to keep their rights.

• Access conditions: 26 weeks of contributions before benefits can be claimed; a smart card is then issued. Each person has their own card: an insured person’s contribution covers neither their spouse nor their children, who can be registered individually.
• Benefits: reimbursement of laboratory tests, X-rays, ultrasound scans, electrocardiograms, surgery, hospitalisation and medicines; medical consultations reimbursed only for eleven illnesses: asthma, cancer, cardiovascular disease, certified mental illness, diabetes, epilepsy, glaucoma, hypertension, leprosy, Parkinson’s disease and sickle cell disease.
• Care abroad: reimbursed on the recommendation of a registered local doctor, with the MBS card, original receipts, a letter from the local doctor, the foreign doctor’s report and proof of travel.
• Reimbursement rates: the pages consulted publish no percentages, ceilings or list of covered medicines: they should be requested from customer service (+1 268 481 6413).

The Social Security Board also pays cash benefits: sickness benefit is 60% of the average insurable weekly wage, after 26 weekly contributions, and maternity allowance is 60% for up to 13 weeks. Government employees are not covered by sickness benefit.

For a non-national, the MBS requires a valid passport, a social security card and proof of twelve consecutive months of legal residence before registration; a work permit or proof of legal residence stating the period granted is requested. For a non-national child, the proof includes evidence of one year of residence and, if the child attends school, authorisation to attend school. Registration takes place at the registration office on Nevis Street, in St. John’s, where a photo is taken for the card.

In practical terms, a newcomer is not covered locally during the first year of residence, then for at least 26 weeks of contributions. This period is covered by private or voluntary insurance, by keeping the French scheme for a posted worker, or by the CFE (Caisse des Français de l’Étranger, the voluntary health insurance body for French people abroad). The situations are compared in the page on healthcare reimbursement in Antigua and Barbuda.

First-line care relies on the ministry’s polyclinics and community health centres, as well as private doctors. The Sir Lester Bird Medical Centre (formerly Mount St. John’s Medical Centre) is presented on its website as the large establishment of St. John’s: emergency care open 24 hours a day on the first floor, advanced diagnostic imaging, surgery, maternity, cardiology, dialysis, laboratory, rehabilitation, adult and neonatal intensive care, paediatrics and obstetrics-gynaecology. Its switchboard is +1 268 484 2700. The website mentions neither the number of beds, nor the pricing policy, nor the insurance accepted.

• Ambulance: 911, service provided by the fire brigade (France Diplomatie).
• Police: +1 268 462 0045 (France Diplomatie).
• Emergency care: France Diplomatie gives the emergency department of the Holberton Hospital, in St. John’s, on +1 268 462 0251; the Sir Lester Bird Medical Centre for its part publishes its own emergency department. Confirm by telephone which establishment to go to before travelling.
• Ministry of Health: +1 268 462 5522.

France Diplomatie also recommends seeing a dentist before leaving. Rare specialities may require evacuation to another country, which an assistance contract covers: see the guide to how medical repatriation works.

The MBS runs six pharmacies, four of them in collaboration with the Ministry of Health at district level: Nevis Street, Browne’s Avenue, Clare Hall and All Saints are open Monday to Friday from 8 a.m. to 3 p.m., and Gray’s Farm and Johnson’s Point from 8 a.m. to 12 noon. All are closed on Saturdays, Sundays and public holidays; a prescription renewal is requested 5 to 7 days before the last tablet is taken. Covered medicines are collected at one of these pharmacies or at the reference medical centre, with the MBS card.

France Diplomatie advises taking only the medicines needed, in their original packaging, with a prescription giving names in international non-proprietary form, and checking that they are permitted locally. Chronic treatment should be prepared with the treating doctor before departure.

• Mosquitoes: France Diplomatie reports chikungunya, dengue and Zika. There is no curative treatment; in case of dengue, anti-inflammatory drugs should be avoided. Pregnant women or those planning a pregnancy should consult before travelling. Protection relies on covering clothing, repellents, mosquito nets and getting rid of standing water.
• Water and food: typhoid fever linked to contaminated water or food; frequent hand washing, well-cooked food, peeled fruit and vegetables, drinking only safe water.
• Vaccines: update the French schedule (diphtheria, tetanus, polio, whooping cough, measles); depending on the stay, hepatitis A and B, typhoid fever, chikungunya and dengue. Yellow fever is compulsory when arriving from an endemic zone. Occasional regional alerts from France Diplomatie may report rises in measles cases.
• Climate and sea: protection against heat and sun; cautious swimming, as not all beaches are supervised; a single decompression chamber for divers.
• Hurricanes: from June to the end of November, they can disrupt essential services, including healthcare.

The schedule should be discussed with a doctor or an international vaccination centre well before departure to allow time for boosters. The cover to plan for is described in the guide to the medical questionnaire and medical history and on the page on expat health insurance.