Parliament of Sint Maarten
Budget 2027

Health & Social

Ministry · Budget 2027

DraftBefore Parliament

Public Health, Social Development & Labour

VSOAVolksgezondheid, Sociale Ontwikkeling en Arbeid (VSA)

In 2027 the Ministry of Public Health, Social Development and Labour (VSA; Dutch VSOA) plans to spend Cg 103.7 million, about 5% less than in 2026. Most of it goes to the public insurer SZV and to cash help for residents with little or no income. The rest pays for public-health services, the ambulance service, the public health inspectorate, labour affairs and job placement, and the remaining Country Package (TWO) reform projects agreed with the Netherlands.

Dr. Luc F. E. Mercelina

Dr. Luc F. E. Mercelina

Acting Minister of Public Health, Social Development & Labor

2027 spendingCg 103.7MDay-to-day running costs in the draft
Share of all spending15.7%of the Cg 662.2M the draft spends in total
Own revenueCg 8.0MIncome the budget books to this ministry
Posts filled74%146 of 198 posts

Explore this ministry

Spending

Day-to-day spending

What it spends it on

The 2027 draft gives this ministry Cg 103.7M for its day-to-day running, salaries, rent, supplies, subsidies and the like. That is down Cg 5.0M on the approved 2026 budget. Investments in buildings and equipment are counted separately, further down.
  • Personnel costsCg 55.7M54%
  • Social provisionsCg 35.9M35%
  • Other operating costsCg 10.2M10%
  • Subsidies & transfersCg 1.3M1%
  • Accommodation & transportCg 0.7M1%

By type of cost, million Cg

Public Health, Social Development & Labour: spending by type of cost, approved 2026 budget and 2027 draft, in million Cg
Type of cost20262027
Personnel costsCg 55.6MCg 55.7M
Social provisionsCg 36.6MCg 35.9M
Other operating costsCg 14.7MCg 10.2M
Subsidies & transfersCg 1.3MCg 1.3M
Accommodation & transportCg 0.5MCg 0.7M
TotalCg 108.7MCg 103.7M

Rows may not add up to the total exactly because each is rounded.

Policy plans

Plans

Plans for 2027

The mission, as the budget describes it

To deliver good-quality products and services that meet the population's needs, and to take social responsibility for protecting the basic necessities of life, so that people have a safe and healthy place to live and work.

  1. Plan 1: Mental well-being and social resilience

    Strengthen mental well-being and psychosocial resilience for individuals, families, workplaces and communities, as a core part of preventive public health and social development. The work runs through a broad package of social provisions, health programmes and community-based services: financial assistance, mental health care, support for the elderly, youth health and disaster preparedness. The aim is that vulnerable groups are protected and every resident can rely on accessible, good-quality care. The programme table's printed total is Cg 39.215 million, but its rows add up to Cg 39.205 million. The text gives Cg 215,000 for NCD awareness, while the table shows 130 + 75 = 205.

  2. Plan 2: A fair and healthy labour market

    Build a fair, inclusive and well-regulated labour market, in both the private and public sectors, that protects workers, helps employers follow the rules and promotes safe, healthy working conditions. That means modernising outdated laws (including the foreign-labour rules, UAV), streamlining permit processes and strengthening enforcement. It also means informing workers, employers and trade unions of their rights and duties, and helping jobseekers find work. The seven programmes total Cg 383,000. Source notes: the programme table's amount column is headed 'Budget 2026', although the amounts are the 2027 figures described in the text. The text also says Cg 27,000 covers both independent committees together, while the table gives 27 to the work-permit objections committee and a separate 15 to the dismissal committee.

  3. Plan 3: Evidence-based governance

    Base decisions, policy design and implementation in all of the ministry's areas on data, evidence and continuous learning. The tools are digital registration systems, monitoring instruments, standardised reporting, updated legislation and active quality control of services, from ambulance care to social provisions. The eleven programmes total Cg 578,000. Source note: the text puts Cg 25,000 next to the ambulance clinical protocols, triage framework and quality-management framework together, while the table gives 50 for protocols and triage plus 25 for quality management.

  4. Plan 4: Country Package economic reforms (TWO)

    This group is listed separately from the three strategic objectives, under 'TWO Projects and Other Financing'. Under the Country Package Sint Maarten (whose implementation arrangement Sint Maarten and the Netherlands signed on 22 December 2020), these reforms aim for a healthy, dynamic and resilient economy and a robust, affordable social security system with the right incentives. There are seven programmes, totalling Cg 1.692 million. All are booked as Staff Bureau advisory costs and financed through TWO (the Temporary Work Organisation).

  5. Plan 5: Country Package healthcare reforms (TWO)

    Also listed under 'TWO Projects and Other Financing'. Six Country Package healthcare measures total Cg 3.703 million: stronger health-sector supervision, mental health care, a register of healthcare professionals, General Health Insurance legislation, prevention of non-communicable diseases and containing the cost of medicines. Together with the economic reforms, they make up the Cg 5.395 million 'Finance TWO/TF' line. The section's introduction repeats the economic-reform objective rather than stating a health-specific one, and the table's description column is left blank.

  6. Plan 6: Healthy nutrition and poverty reduction

    Fight poverty and offer healthy, sustainable food programmes to the most vulnerable groups by funding NGOs that run food programmes. The programme is tagged to the Governing Programme aim 'Promote a Healthy Lifestyle and Well-being for all Residents' and to NDV goal 3.21. It is booked as 'Other Finance' at Cg 550,000, half the Cg 1.1 million of 2026, under Staff Bureau projects and activities. The Country Package 'Contributions and Project Funds' table counts VSA at Cg 5.945 million, which equals the TWO programmes (5.395) plus this 550. The numbers book shows matching project-fund income (Opbrengsten Projectgelden) of Cg 5,945,000 for the VSOA Staff Bureau.

Programmes & delivery

Programmes

Programmes and spending

The budget lists 45 programmes for this ministry, each tied to one of the plans above. Amounts are for 2027, where the ministry printed one. Programmes marked Dutch-funded are paid from Dutch money, the Country Package, the Temporary Work Organisation (TWO) or the Trust Fund, not from local taxes.

Showing 12 of 45 programmes.

  • Medical cost contribution to SZV for PP card holders (Medical Assistance; Dutch: Medische Bijstand)

    Cg 22M
    Plan 1
    Intended result

    Funds are transferred to SZV to cover medical care for people who are uninsured or not entitled to regular health insurance, and are reserved for the following year.

  • Financial Assistance (Public Assistance; Dutch: Onderstand)

    Cg 8.2M
    Plan 1
    Intended result

    People with no or very low income receive financial support on time.

  • Government contribution to SZV for medical insurance

    Cg 5.5M
    Plan 1
    Intended result

    The yearly government contribution to SZV for the health insurance of civil servants and the recently unemployed (up to 1 year) is paid.

  • Other Social Provisions (funeral costs for the indigent and emergency provisions)

    Cg 120k
    Plan 1
    Intended result

    Applications are processed and paid.

  • Transformation of community-based mental health care: legal and expert advice (Public Health department)

    Cg 900k
    Plan 1
    Intended result

    Implementation of the 'Insanity Act' (Krankzinnigenwet) and related policy; a contribution towards an adequate mental health care facility; implementation of the National Strategic Plan for Mental Health Care.

  • Transformation of community-based mental health care: contribution to the Mental Health Foundation (booked under Staff Bureau, health insurance costs)

    Cg 1M
    Plan 1
    Intended result

    Implementation of the 'Insanity Act' (Krankzinnigenwet) and related policy; a contribution towards an adequate mental health care facility; implementation of the National Strategic Plan for Mental Health Care.

  • Subsidies for health education by NGOs (HIV/AIDS and diabetes foundations)

    Cg 214k
    Plan 1
    Intended result

    The foundations successfully carry out the approved proposals.

  • National Immunisation Programme (vaccinations and preventive health checks for children aged 0–17)

    Cg 208k
    Plan 1
    Intended result

    Fewer cases of vaccine-preventable diseases, by reaching and keeping a 98% vaccination rate.

  • Education and promotional activities for the NCD (non-communicable disease) Strategic Action Plan: Collective Prevention Service

    Cg 130k
    Plan 1
    Intended result

    Stronger disease surveillance, more awareness of 'Health in All Policies', more promotion and better prevention; training carried out.

  • Education and promotional activities for the NCD (non-communicable disease) Strategic Action Plan: Public Health department

    Cg 75k
    Plan 1
    Intended result

    Stronger disease surveillance, more awareness of 'Health in All Policies', more promotion and better prevention; training carried out.

  • Subsidy: supervision of domestic violence shelter

    Cg 218k
    Plan 1
    Intended result

    Shelter services provided for abused women and children.

  • Subsidy: supervision of community centre services (after-school and community programmes)

    Cg 180k
    Plan 1
    Intended result

    Services provided through the community centre.

Changes

Since 2026

What changed and why

The lines that moved most since the approved 2026 budget, largest change first, with the ministry's explanation where it gives one; where it gives none, we say so.

  • Staff Bureau (cost centre 7110): advisory costs and SLAs, mostly Country Package (TWO) reform projects

    2026: Cg 10.8M2027: Cg 5.9M

    Decrease due to the termination of the TWO-related projects in 2027. Source note: elsewhere the memorandum says the arrangement for carrying out the TWO projects is expected to expire at the end of the first quarter of 2027, and Cg 5.395 million of TWO programmes are still budgeted for 2027.

  • Public Health department (cost centre 7210): advisory costs

    2026: Cg 275k2027: Cg 900k

    Increase because TWO-related projects continue but are no longer financed by TWO. The same Cg 900,000 appears in the programme table as legal and expert advice for the mental health care transformation. Source note: the numbers book shows this account at Cg 29,000 in 2026, not 275.

  • Community Development, Family and Humanitarian Affairs (CDFHA, cost centre 7360): projects and activities

    2026: Cg 955k2027: Cg 488k

    Decrease because funds were moved to other purposes (the memorandum does not say which).

  • Collective Prevention Service (cost centre 7350): other goods and services (vaccines)

    2026: Cg 38k2027: Cg 208k

    Increase to buy vaccines, for the National Immunisation Programme's 98% vaccination target for children aged 0–17.

  • Public Health department (cost centre 7210): projects and activities

    2026: Cg 280k2027: Cg 135k

    Decrease because funds were moved to other purposes. Source note: the numbers book shows this account rising from Cg 75,000 to Cg 135,000 (+80%), not falling by 52%.

Capital projects

Capital budget

Building and equipment

The capital budget is money for buildings, roads, vehicles and equipment, mostly paid for with borrowed money. It is separate from the day-to-day spending above. These are the projects the ministry lists for 2027, largest first.

  • Ambulance Service: vehicles

    Cg 862k

    Numbers book: Cg 861,964 (cost centre 7340 vehicles). The investment annex describes the line as '2 voertuigen: middelgrote SUV, 1 compacte SUV en 2 ambulances' ('2 vehicles: mid-size SUV, 1 compact SUV and 2 ambulances', as printed) and adds Cg 131,004 for 2028, while the memorandum shows nothing after 2027. The project sheet on EN 174 uses the same Cg 862 thousand for the whole VSA fleet renewal: 12 vehicles older than 7 years replaced plus 1 new transport bus, across the Inspectorate, Ambulance (listed there as 2 mid-size pickup trucks), CDFHA and CPS. That conflicts with EN 118, where 862 is the ambulance line alone and all VSA vehicles together come to Cg 1,877 thousand.

  • Public Health Inspectorate: vehicles

    Cg 382k

    Numbers book: Cg 382,391 (cost centre 7320). The annex splits it into 1 mid-size SUV (Cg 54,882, also budgeted in 2026) and 5 medium-size pickups (Cg 327,509, new in 2027).

  • Collective Prevention Service (CPS): vehicles

    Cg 330k

    Numbers book: Cg 330,429 (cost centre 7350). The annex splits it into 1 mid-size pickup (Cg 64,782, also budgeted in 2026) and 1 transport van / 3 mid-size pickups (Cg 265,647, new in 2027).

  • Ambulance Service: 'Shelter System' (other equipment)

    Cg 313k

    The numbers-book line is 'Other Equipment', Cg 312,618 (cost centre 7340). The investment annex shows that only Cg 55,000 of it is the shelter system. The rest is training mannequins and equipment (Cg 186,538) and medical diagnostic equipment (Cg 71,080), both also budgeted in 2026. The project sheet on EN 174 likewise prices the shelter system at Cg 55 thousand. It is a mobile facility for triage, treatment and reception of patients in mass-casualty incidents.

  • Community Development, Family and Humanitarian Affairs (CDFHA): vehicles

    Cg 90k

    Numbers book: Cg 89,964 (cost centre 7360), described in the investment annex as 2 compact SUVs, the same amount as in the 2026 budget; the annex also lists Cg 131,004 for 2028. The EN 174 fleet sheet instead lists 2 mid-size pickup trucks for CDFHA. The memorandum says all 2026 capital items were included again in 2027 because it is not known whether the 2026 loan will be obtained. The numbers book prints a 100% difference for this line even though 2026 and 2027 are equal.

  • Labour Affairs Service: vehicles

    Cg 90k

    Numbers book: Cg 89,964 (cost centre 7370, Dienst Arbeidszaken), the same as in the 2026 budget; the investment annex describes it as 2 compact SUVs and labels it '7270, Afd. Arbeidszaken'. It is a different cost centre from the Labour Affairs Department line (7230), not a duplicate.

  • Social Services: vehicles

    Cg 68k

    Numbers book: Cg 68,382 for 1 delivery van (cost centre 7310), the same as in the 2026 budget. 2026 capital items were repeated in 2027 because it is not known whether the 2026 loan will be obtained.

  • Labour Affairs Department (Department of Labour): vehicles

    Cg 55k

    Numbers book: Cg 54,882 for 1 mid-size SUV (cost centre 7230), the same as in the 2026 budget. The memorandum total for all eight lines, Cg 2,190 thousand, matches the numbers book's Cg 2,190,594 for chapter 7.

This ministry's capital chapter, 2027

Cg 2,190,594

0.9% of the country's Cg 248,519,771 capital budget, to the guilder, as printed in the numbers book. Across all chapters the capital budget also covers loan repayments and study loans.

Targets & staff

Targets

Targets to track

The indicators and targets the ministry sets itself in the draft budget.

  • Vaccination rate of children aged 0–17 (National Immunisation Programme)

    TargetReach and maintain 98%

  • Clinical protocols and triage guidelines for ambulance services researched, drafted and standardised

    Target35 protocols/guidelines

  • Nurses trained for a cardiovascular risk-management pilot (NCD prevention, Country Package)

    Target10–12 nurses

  • Schools and/or after-school care institutions supported by the healthy-eating programme

    TargetThree

  • Yearly sports activity for children under the healthy-eating programme

    TargetAt least one activity for approximately 100 children

  • Senior households reached by the food discount programme

    Target100 senior households

Every ministry's targets side by side →

Staffing

People and posts

How many of the ministry's posts are filled. Empty posts can mean planned work is delayed.
Posts filled74%

146 filledof 198 posts (establishment)

Posts filled
146
Empty posts with money in the budget
5
All posts (establishment)
198

Counts are FTEs (full-time equivalents). The memorandum prints 76% occupancy, which is budgeted FTEs (146 filled + 5 funded vacancies = 151) divided by the 198-post establishment; posts actually filled are 146 of 198 (73.7%). The ministry says it is understaffed by about 24%, which matches the 47 vacancies with no budget (47 of 198); counting all 52 open posts, 26% are empty. It also says necessary positions are missing from the establishment plan, which needs revising. Lowest share of posts filled: the Public Health department (6 of 12) and Social Development (5 of 10), both 50%. Most open posts: the Collective Prevention Service (11 of 33, all unbudgeted), the Labour Affairs Service (9 of 29) and the Public Health Inspectorate (8 of 27). Staat B in the numbers book gives the same counts (146 filled, 52 vacancies, 198 formation, 5 budgeted vacancies, 151 budgeted) with a budgeted personnel cost of Cg 15,797,842.04. That is far below the Cg 55.7 million personnel-cost total in the memorandum, which also includes the Cg 38.5 million BZV health-insurance contribution paid to SZV.

Staffing across government →
Risks

Risks

Risks to delivery

The risks the ministry names itself in the draft budget.

  • Understaffing, brain drain and skills gaps

    On top of chronic understaffing, staff leave through retirement or for other jobs and take their knowledge with them, which delays or halts projects. Government salaries cannot compete with the private sector or abroad, so the ministry sometimes hires less-experienced staff who need coaching. It also lacks the resources to give staff enough training and often cannot release them for it, which causes dissatisfaction and is partly why some staff leave. Budget effect: funded vacancies may not be filled in time and staff may leave, so the personnel budget is underspent. The ministry estimates no budget risk from keeping skills up to date.

  • Too few resources overall

    Sint Maarten does not have enough money to give every ministry the budget it needs, so the ministry has to prioritise: not recruiting staff, not buying resources or scaling down projects. The ministry says it performs its tasks to a good level, but the lack of resources risks the population not being adequately served. Budget effect: 'limited'; budget items may need to be reallocated.

  • Public assistance budget may run short

    The ministry sees a 'considerable risk' that the Cg 8.2 million reserved for financial assistance will not be enough, since Cg 9.2 million was spent the previous year. More claims are expected, and newly approved legislation (not named) adds costs, so further cost increases in 2027 are likely. Wars in the Middle East and Eastern Europe, combined with US protectionist trade measures, could push up prices of food, medical supplies and energy. That could cause stagflation (rising prices in a stalling economy) and more demand for social services.

  • Disasters

    Major disasters, as the hurricanes and Covid showed, disrupt the organisation. They force new priorities, cancel or delay projects and raise the cost of living, so planned help or legal changes no longer fit people's needs. Smaller events such as hurricane threats, flooding or extreme heat also make target groups hard to reach. Budget effect: the risk of a major disaster cannot be estimated, but its budget consequences would be considerable. Minor disasters happen every year and cause small extra costs, such as rescheduling activities.

  • Slow procedures and cross-ministry cooperation

    Internal procedures, decision-making and cooperation with other ministries or third parties can slow results. The ministry has only limited influence over cross-ministerial work and cannot enforce how quickly matters are handled. Budget effect: funds may not be requested and spent in time, and because some projects' financing has an end date, (external) money may be lost.

  • Budget framework too tight for the mandate

    The ministry states that the 2027 budget framework is so restricted that it does not reflect the activities the ministry would like to carry out. In its words, the workforce cannot be properly supplemented and resources are insufficient to carry out its mandate, with consequences for the population of Sint Maarten.

Detailed budget lines

The numbers book

The biggest budget lines

The numbers book (Getallenboek, in the Dutch submission) lists every line of spending to the guilder. These are this ministry's 10 largest lines for 2027, with the Dutch wording as printed.
Search all 127 lines for this ministry

  • Health insurance

    Ziekteverzekering Kosten

    Staff bureau

    2026Cg 38,800,000
    2027Cg 38,500,000
    Down Cg 300,000 vs 2026

  • Medical assistance

    Medische Bijstand

    Social insurance & healthcare costs

    2026Cg 22,000,000
    2027Cg 22,000,000
    No change vs 2026

  • Public financial assistance

    Onderstand

    Social insurance & healthcare costs

    2026Cg 8,950,000
    2027Cg 8,200,000
    Down Cg 750,000 vs 2026

  • Accountancy, advisory & SLAs

    Accountants- en Advieskosten en SLA's

    Staff bureau

    2026Cg 10,846,379
    2027Cg 5,912,000
    Down Cg 4,934,379 vs 2026

  • Government contribution to SZV

    Overheidsbijdrage SZV

    Social insurance & healthcare costs

    2026Cg 5,500,000
    2027Cg 5,500,000
    No change vs 2026

  • Gross salaries

    Brutolonen en Salarissen

    Ambulance Service

    2026Cg 3,088,528
    2027Cg 2,914,294
    Down Cg 174,234 vs 2026

  • Gross salaries

    Brutolonen en Salarissen

    Collective Prevention Services

    2026Cg 2,026,641
    2027Cg 1,853,696
    Down Cg 172,945 vs 2026

  • Gross salaries

    Brutolonen en Salarissen

    Health Inspectorate

    2026Cg 1,603,773
    2027Cg 1,704,660
    Up Cg 100,887 vs 2026

  • Gross salaries

    Brutolonen en Salarissen

    Labour Affairs

    2026Cg 1,603,779
    2027Cg 1,621,853
    Up Cg 18,074 vs 2026

  • Subsidy

    Subsidie

    Semi-private & NGO organisations

    2026Cg 1,186,800
    2027Cg 1,186,800
    No change vs 2026
For you

In plain English

What this means for you

Our summary of the ministry's chapter. The figures in it come from the pages cited on this page.

  • Nearly two-thirds of the ministry's Cg 103.7 million is paid to SZV, the public social and health insurer. That covers Cg 38.5 million for the BZV health-insurance contribution (booked under personnel costs, although the memorandum says it is a collective health-insurance obligation rather than staff capacity), Cg 22 million for medical care of people without regular insurance (PP card holders) and Cg 5.5 million towards health insurance for civil servants, teachers, government-related employees and recently unemployed former government employees (for up to one year): about Cg 66 million in total (EN 108, EN 109, EN 112).

  • Cash help for residents with no or very low income (public assistance) is budgeted at Cg 8.2 million, down from Cg 8.95 million in 2026. Cg 9.2 million was spent on it in 2025, and the ministry itself calls the risk that the money runs short 'considerable' (EN 109, EN 123).

  • The ministry's total drops about 5%, from Cg 108.7 million to Cg 103.7 million, because the Country Package (TWO) reform money, agreed with the Netherlands, halves from Cg 10.7 million to Cg 5.4 million and the 'Other Finance' nutrition programme halves from Cg 1.1 million to Cg 0.55 million. The remaining reforms include work on general health insurance legislation (Cg 800,000), a register letting medical professionals from outside the Kingdom register and practise here (Cg 790,000), an unemployment-benefit scheme (Cg 510,000), a poverty and social-minimum study (Cg 259,000) and research on linking the AOV pension age to life expectancy (Cg 176,000) (EN 107, EN 119, EN 120, EN 167).

  • The Collective Prevention Service line used to buy vaccines rises from Cg 38,000 to Cg 208,000, for the National Immunisation Programme's aim of a 98% vaccination rate among 0–17-year-olds. Mental health care is meant to move from institutions into the community: a Trust Fund-financed project, plus Cg 900,000 for legal and expert advice and Cg 1 million for the Mental Health Foundation from the ministry's own budget (EN 110, EN 112, EN 113).

  • The ministry has 146 of its 198 posts (FTEs) filled, and 47 of the 52 open posts have no money in the budget. It says the 2027 budget framework is so restricted that it does not reflect the activities it would like to carry out, and that it cannot properly fill its workforce (EN 122, EN 124).

2027–2030

The four-year path

The budget's own forecast for this ministry's day-to-day spending, in whole millions. The years after 2027 are estimates and usually change in later budgets.
20272030Cg 111M
2027 draft
Cg 104M
2028 estimate
Cg 103M
2029 estimate
Cg 107M
2030 estimate
Cg 111M
The line zooms in on the range of these years; the small bars start at zero.
Sources and publication notes