The Healthcare System in French Guiana: Organisation, Hospitals, Emergencies, Medical Evacuations and Health Risks

Title V of Book VII of the Social Security Code applies in French Guiana, and the general social security legislation there is therefore that of France (article L751-1). CLEISS (the French centre for European and international social security liaison) specifies that, in the overseas departments, benefits are paid by the general social security funds and not by the primary funds. The CGSS of French Guiana presents on its website health insurance (Vitale card, complémentaire santé solidaire, State medical aid, sick leave, medical evacuation), retirement, occupational risks and collection from employers.

The Regional Health Agency of French Guiana steers public health policy and regulates the healthcare offering; its 2018-2028 regional health plan consists of a strategic orientation framework, a regional health scheme and a programme for access to prevention and care for the most deprived (IEDOM). The Territorial Collectivity of French Guiana is responsible for promoting the territory's health development (IEDOM). For details of the scheme, affiliation and status, see the page social protection and healthcare in French Guiana.

The population's health indicators are less favourable than in metropolitan France: 11% of inhabitants judge their health bad or very bad against 7%, and the mortality rate from infectious or parasitic diseases reaches about 37 per 100,000 inhabitants against about 15 (European health survey and INSERM, via the IEDOM). Insee estimates that about a third of Guianese people delayed or gave up medical care, for lack of supplementary insurance, means, waiting times, transport or specialists. These benchmarks explain the place of solidarity schemes: many beneficiaries of the complémentaire santé solidaire and of State medical aid (CGSS, via the IEDOM).

According to the Assurance Maladie, anyone who works or lives in France on a stable and lawful basis is entitled to have their healthcare costs covered. An employee no longer has to prove a minimum activity, a self-employed person is covered from the start of their activity, and a person with no activity is covered on the basis of stable and lawful residence, with proof of 6 months of residence in France over the last 12 months during checks. The application to open rights is made with form Cerfa S1106, sent to the fund of the place of residence.

The Vitale card is free and available once a definitive social security number has been obtained; it covers the spouse and children under 25 living under the same roof (CGSS of French Guiana). The referring doctor is compulsory from age 16, and a consultation within the care pathway gives access to better reimbursement, generally 70% for a doctor's consultation (CLEISS). The CGSS offers to create your ameli account, update your Vitale card and declare your referring doctor. Details of reimbursement by situation are in the guide healthcare reimbursement in French Guiana.

The French Guiana CHU website presents sites in Cayenne (3 avenue Alexis Blaise), Saint-Laurent-du-Maroni (1465 boulevard de la Liberté) and Kourou (avenue Léopold Héder), three local hospitals and 14 decentralised prevention and care centres (CDPS), including some in Maripasoula, Saül and Camopi, as well as decentralised consultations. The IEDOM's annual report describes the three historic public establishments (the Andrée Rosemon hospital centre in Cayenne, the western French Guiana hospital centre in Saint-Laurent-du-Maroni and the Kourou hospital centre) and the announced creation of a regional university hospital centre bringing them together; it specifies that the CDPS are based in isolated communes and cover about 20% of the population.

• Capacity: just over 1,000 beds and nearly 200 places. In beds per 100,000 inhabitants, French Guiana is less well equipped than the French Antilles, particularly for long-term care, follow-up and rehabilitation care and psychiatry; the level of equipment in medicine, surgery, obstetrics and dentistry is, however, closer to that of the Antilles and mainland France (DREES, via the IEDOM).
• Staff: about 700 doctors, i.e. a density of about 24 per 10,000 inhabitants against about 34 in France; the headcount is stable, and the density of other health professionals is also below the national average (IEDOM).
• Access times: according to an Insee and ARS study reported by the IEDOM, 75% of inhabitants of coastal communes were less than 4 minutes by car from a doctor, 10% of the population not living in a town centre took more than 24 minutes and 5% were more than an hour away; communes in the interior depend on river and air transport.

For settling, these benchmarks suggest choosing your place of residence with the proximity of a referring doctor and a hospital site in mind, and planning follow-up arrangements before departure for a family with young children or a person followed for a chronic illness.

First-contact care rests on the referring doctor and GPs (about 11 per 10,000 inhabitants, against about 14 in France, according to the IEDOM), and the CDPS provide care in isolated communes. Insee counts about fifty pharmacies in the territory. The Assurance Maladie directory allows you to search for a health professional.

Medicines are reimbursed according to their medical benefit: 65% when it is major or important, 30% when moderate, 15% when low, with a medical deductible of €1 per box (Assurance Maladie, CLEISS). Two local specificities: preventive malaria treatment (atovaquone-proguanil, mefloquine or doxycycline, according to the ARS) is covered for social security members in French Guiana, and coastal residents travelling to the interior are reimbursed on prescription stating the length and area of the stay; in the case of dengue, the ARS advises against anti-inflammatories and aspirin because of the bleeding risk and recommends consulting your referring doctor.

National numbers (Ministry of the Interior): 15 gives access to the SAMU (emergency medical service), a single number per department; 18 is the fire brigade, to be dialled when a life is in danger; 17 is the police; 112 is the European emergency number; 114 is for deaf, hard-of-hearing or aphasic people; 196 is for sea rescue. On the coast, hospital emergencies are attached to the "Emergencies and Critical Care" department of the French Guiana CHU, which brings together emergencies, intensive care and forensic medicine.

Emergency organisation can be adapted to the local situation: the ARS may thus authorise by order a particular organisation of access to the emergency department of the western French Guiana hospital centre, for example with daily regulation from 6:50 p.m. to 8:00 a.m. In these situations, calling 15 gives you direction. Isolated communes depend on river and air transport (IEDOM), hence the role of the decentralised prevention and care centres.

According to the Assurance Maladie, a health transfer is a journey from home to a distant place of care, and a medical evacuation is a medicalised journey from a place of hospitalisation to a distant establishment. Transport can be covered with prior approval, which serves as a medical prescription, if the state of health justifies it; the travel costs of an accompanying person can be covered under conditions in agreement with the doctor; medical costs are covered in part or in full if the exemption conditions are met. During a hospital stay, the establishment's social service or healthcare access office helps with the procedures; otherwise, it is the administrative or social contact person at the fund of residence.

The CGSS of French Guiana specifies the pathway for scheduled care, tests or check-ups in mainland France or the French Antilles: the patient must be affiliated to the CGSS with rights open, obtain a favourable opinion from the medical service and use the least costly means of transport compatible with their state of health. The doctor completes form S3139g, which serves as the prior transport approval request. The appointment date must be more than 15 days after the medical service receives the documents, and the service processes the request within 15 days; otherwise, the patient may leave but risks not being reimbursed if the opinion is unfavourable. A 45% ticket modérateur applies, unless exempt under conditions, in which case transport is covered at 100%. For more information: 3646.

Care received in neighbouring Suriname or Brazil is care abroad, outside the European Union: the Assurance Maladie only possibly reimburses urgent and unforeseen care, after advancing the costs, on the basis of French flat-rate tariffs. An assistance policy with repatriation usefully complements the evacuation organised by the fund.

• Yellow fever: vaccination is compulsory in French Guiana for any resident or tourist aged 1 or over, since 1967. An up-to-date vaccination certificate or a medical contraindication certificate must be presented on entry; the vaccination must be done more than ten days before arrival. A person vaccinated after the age of 2 is in principle protected for life; children vaccinated before 2, pregnant women and immunocompromised people consult their doctor on the need for a booster. Authorised centres and certain authorised GPs are listed by the ARS.
• Malaria: transmitted by the Anopheles darlingi mosquito, which bites mainly at night. The risk persists mainly along the border rivers and in the communes of the interior. There is no vaccine: the ARS recommends an impregnated mosquito net or an air-conditioned room, covering clothing, repellent and, before a stay in a risk area, a consultation for preventive treatment. Santé publique France reports few cases, contracted mainly in gold-panning areas, in the Upper Maroni and in the Savanes sector. In case of fever, consult quickly; report for 12 months any stay in a transmission area when consulting for fever.
• Dengue: transmitted by Aedes aegypti, which bites mainly by day; all four serotypes are present in French Guiana according to the ARS. Breeding sites (stagnant water, containers, gutters) should be eliminated and bites avoided. Santé publique France follows activity across the territory in its bulletins.
• Chikungunya: laboratory-confirmed cases are monitored, with possible circulation, notably in the Savanes sector (Santé publique France).
• Other surveillance: influenza, bronchiolitis, COVID-19 and diarrhoea are monitored in the decentralised centres and in the emergency departments of the three CHU sites (Santé publique France). The national vaccination schedule remains up to date; the ARS publishes its campaigns (influenza, COVID-19, papillomavirus).

Before departure, a medical consultation allows you to review yellow fever, malaria prevention according to the areas you will visit and the schedule vaccines. The page living in French Guiana complements this advice with the climate and settling-in formalities.