Suriname, a middle-income country with a total
population of 540,000, is facing a major burden
of disease even compared to other similar
countries. Policy makers in the South American
country recognise the potential for collaboration
and synergies to address this challenge.
Health promotion is mentioned in Article 36 of
the Constitution1
and given its ethnic diversity
health equity is of importance to the Surinamese
people. However, policy makers have long
felt restricted in solving policy problems in an
intersectoral manner and have been looking for
ways to institutionalise a mechanism that allows
for negotiation on the inclusion of health goals in
the policies of other ministries, and vice versa.
Every year Suriname loses about 170,000
DALYs due to ill health. This seriously affects
the social and economic development of the
country. The top 15 contributors to the burden
of disease (BoD) are: HIV/AIDS, stroke, preterm
birth complications, ischemic heart disease,
self-harm, major depressive disorder, road
injury, diabetes, iron-deficiency anaemia, low
back pain, neonatal encephalopathy, congenital
anomalies, lower respiratory infections, chronic
kidney disease and adverse medical treatment.
The main risk factors are an unhealthy diet,
tobacco smoking, alcohol consumption, lack of
exercise, domestic violence, sexual abuse and
neglect, high or low maternal age, incomplete
vaccination coverage, low use of antenatal
care services, multiple pregnancies, high blood
pressure, co-existence of noncommunicable
diseases, obesity, coexistence of communicable,
maternal, neonatal and nutritional disorders,
genetics and high blood cholesterol.2
In the Global Burden of Disease study’s
benchmarking with 14 other countries with
similar GDP per capita, Suriname comes off
worse than most for the top 15 diseases.3
Suriname’s economy is based primarily on low
exports other than those related to the extraction
and export of natural resources (gold, wood and
bauxite) and high imports. The country has, even
before the start of the HiAP process in mid-2015,
been seriously hit by the fall in global commodity
prices. Suriname is a very diverse country –
ethnically and geographically. The country has
8 languages and 7 major ethnic groupings
(Amerindians, Chinese, Creole, Hindustani,
Javanese, Marron, Europeans).4
Suriname has a
vast, jungle covered and lowly populated interior
and a narrow and densely populated coastal
strip, where the capital city of Paramaribo with
over 80% of the total population of the country is
situated