Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III

Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
Caribbean Cooperation in Health Phase III (CCH III)   a
 Caribbean Cooperation
in Health Phase III (CCH III)
Regional Health Framework 2010 - 2015

 “Investing in Health for
Sustainable Development”

                                                          Phase III
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
b   Caribbean Cooperation in Health Phase III (CCH III)
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
Caribbean Cooperation in Health Phase III (CCH III)   i

Caribbean Cooperation in Health Phase III
              (CCH III)
    Regional Health Framework 2010 - 2015

        “Investing in Health for
       Sustainable Development”
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
ii    Caribbean Cooperation in Health Phase III (CCH III)


Guiding Principles and Strategic Approaches...........................................3

Executive Summary...............................................................................4

I - Introductioin.....................................................................................8

II- Overview of the Health Situation........................................................11

III - Challenges We Face....................................................................... 14

IV - Priority Areas And Strategic Objectives............................................17

V - Management And Coordinating Mechanisms..................................... 23

Annex 1...............................................................................................26
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
Caribbean Cooperation in Health Phase III (CCH III)   1

Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
2    Caribbean Cooperation in Health Phase III (CCH III)


The CARICOM member states are called upon to            Solidarity
endorse and apply principles and strategic approaches
                                                        The people and institutions in the Caribbean working
as the commitment to achieving health goals. In
                                                        together to define and achieve the common good.
this regard CCHIII aims to facilitate the necessary
regional response to support country efforts towards    People Centred
regional public goods and services and national         Common health needs will be addressed as public
strategic directions.                                   goods that all member states identify with and support
The Primary Health Care Approach will be the broad      by virtue of their relevance to the national situation
over-arching health development framework which         and the desire to promote health of the community as
will guide the health development in this region. The   a whole. The ultimate aim is to get people healthy and
guiding principles reflect the foundation upon which    to keep them healthy. This means that our regional
all interventions will be planned, implemented and      initiatives must have as their main aim meeting the
evaluated.                                              needs of the people, families and communities of the
The right to the highest attainable level of
health                                       Leadership
Health is a fundamental human right. Every citizen      Public health leadership is a major priority. The at-
of the Caribbean has a right to the highest attain-     tainment of Health for All will be dependent on
able level of health and therefore services must be     leadership that shares regional vision and creates
responsive to people’s health needs. In addition,       an enabling environment for mobilising resources,
there should be accountability in the health system,                               improving performance,
increased efficiency and ef-                                                        ensuring greater trans-
fectiveness whilst effecting                                                        parency and account-
no harm.                                                                             ability of regional health
Working towards eliminating
unfair differences in health
status, access to health care
and health enhancing environ-
ments, and treatment within
the health and social services
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
Caribbean Cooperation in Health Phase III (CCH III)   3

            VISION AND GOAL
  Caribbean Cooperation in Health (CCH III):
“Investing in Health for Sustainable Development”
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
4   Caribbean Cooperation in Health Phase III (CCH III)

Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
Caribbean Cooperation in Health Phase III (CCH III)     5

Executive Summary

The countries of the Caribbean are proud of the        Nassau Declaration and the 2007
gains in health which they have made. The suc-         Declaration of Port of Spain re-
cess of these achievements, namely combating           inforce the Millennium Declara-
serious public health problems such as poliomy-        tion aimed at reducing poverty by
elitis, measles, and cholera, provide significant      2015. The CCH also recognizes
evidence of what can be achieved through a col-        and aims to address the priority is-
lective regional response which supports develop-      sues identified in the Report of the
ment at the national level. The Caribbean Coop-        Caribbean Commission on Health
eration in Health (CCH) represents a mechanism         and Development. The CCH III is
to unite Caribbean Territories in a common goal        charged with the responsibility to
to improve health and wellbeing, develop the pro-      invest in the people of the region
ductive potential of the people, and, by definition,   to ensure the highest attainable
the competitive advantage of the region. Greater       standard of health, reduce ineq-
efforts will be made to support Haiti, the newest      uity, and mobilise traditional and
member of CARICOM to achieve these goals.              non-traditional actors in tackling
Major regional and international policy and stra-      health challenges and building
tegic guidelines serve as the backdrop against         sustainable health systems.
                                                       The mandate of CCH III 2009-
                                                       2015 will address a new orientation
                                                       • People-centred development,
                                                       • Genuine stakeholder and
                                                           community participation and
                                                       • Effective regional coordina-
                                                           tion and public health leader-
                                                       • Outcome-oriented planning
                                                           and implementation and per-
                                                           formance-based monitoring,
                                                       • Resource mobilisation for
                                                           health, health coverage, and
                                                           social protection for the peo-
which the new Regional Strategic Framework                 ple of the region.
has been developed. This framework is a di-            This framework represents a com-
rect response to the commitments made by the           prehensive health and develop-
Caribbean Community (CARICOM) Heads of                 ment strategy for the Caribbean
Government in both regional and international          region. The framework seeks to
declarations and policy guidelines. The 2001           break free from the overemphasis
Caribbean Cooperation in Health Phase III (CCH III) - "Investing in Health for Sustainable Development" Phase III
6     Caribbean Cooperation in Health Phase III (CCH III)

on the disease model. While it acknowledges the im-     The details of the program areas and indicators of
portance of sustaining health gains, and completing     achievement are outlined in the matrices of the CCH
the unfinished health agenda, it proposes an empha-     III. These matrices are available on
sis on strengthening the building blocks of joint ac-   and
tion in health. The CCH III therefore maintains the     The Regional Health Institutions (RHIs) have played
eight priority areas as defined in CCH II.              a significant role in supporting the implementation
The eight priorities are:                               of the Caribbean Cooperation in Health at both re-
1. Communicable Disease                                                                 gional and national
2. Non-Communicable                                                                       levels. The establish-
    Disease                                                                               ment of the Carib-
                                                                                          bean Public Health
3. Health Systems
                                                                                          Agency (CARPHA)
                                                                                          as mandated by the
4. Environmental Health                                                                   Heads of Government
5. Food and Nutrition                                                                     in March 2010 will in-
6. Mental Health                                                                          tegrate the functions
7. Family and Child Health                                                                and administration
8. Human Resource                                                                         of the existing five
    Development                                                                           Caribbean Regional
                                                                                          Health Institutions
In looking at the determinants of                                                         (RHIs); the Carib-
these priority areas, it was recog-                                                       bean Epidemiology
nized that the strategies/actions                                                         Centre (CAREC), the
which need to be adopted in or-                                                           Caribbean Food and
der to have any significant impact                                                        Nutrition Institute
on these priority areas needed to                                                         (CFNI), the Carib-
be:                                                                                       bean Environmen-
• Cross cutting                                                                         tal Health Institute
• Inter-programmatic                                    (CEHI), the Caribbean Regional Drug Testing Labo-
• Trans-sectoral                                        ratory (CRDTL) and the Caribbean Health Research
• Focused on the determinants of health                 Council (CHRC)). The proposed agency will ratio-
The CCH III therefore identifies five project goals     nalize the functions of the current RHIs and have a
which have expected results that are inter-sectoral     more comprehensive mandate in addressing the pub-
and inter-programmatic, addressing the eight pri-       lic health needs of the wider Caribbean Region and
ority areas while aiming to achieve the stated goal     will be a critical success factor in the implementation
“Investing in Health for Sustainable Development”.      of the CCH III.
Caribbean Cooperation in Health Phase III (CCH III)        7

Major Regional and International Guidelines:
•   The Nassau Declaration
•   The 2001 Declaration of Commitment to the Pan Caribbean Partnership
    Against HIV/AIDS – “Provide supportive environment for the collaborative
    response to fighting HIV/AIDS
•   Report of the Caribbean Commission on Health and Development
•   Needham’s Point Declaration
•   Declaration of Port of Spain – “Comprehensive and Integrated Approach to
    the Control of CNCD”
•   The Millennium Declaration and Development Goals – “ Reducing poverty
    related inequalities by 2015”
•   Declaration of Montevideo on the New Orientations for Primary Health Care
    – “Designing people-centered care through a Primary Health – care based
•   International Health Regulations (2005) - ISBN
8   Caribbean Cooperation in Health Phase III (CCH III)

                   A Regional Landmark
Caribbean Cooperation in Health Phase III (CCH III)                                   9

I - Introduction
A Regional Landmark                                         The main thrust of the CCH initiative is to identify
The Caribbean Cooperation                                                         priority health areas and use
in Health (CCH) represents                                                        them as vehicles to1
a mechanism to unite Carib-                                                                          • Foster technical coop-
bean territories in a com-                                                                             eration among the coun-
mon goal to improve health                                                                             tries;
and wellbeing, develop the                                                                           • Optimise the use of re-
productive potential of the                                                                            sources;
people, and, by definition, the
                                                                                                     • Develop projects in the
competitive advantage of the
                                                                                                       priority areas as a way to
region at the global level.
                                                                                                       foster cooperation and
The concept of the Caribbean                                                                           collectively focus on ar-
Cooperation in Health was                                                                              eas of highest priority;
introduced in 1984 at a meet-                                                                          and
ing of the CARICOM Con-                                     •         Mobilize all national and external resourc-
ference of Ministers responsible for Health (CMH).          es to address the most important health problems in
The initiative called for collaborative action in health    the Region.
among the Countries and Institutions of the Caribbe-
                                                            “Investing in Health for Sustainable
an Region. CCH II (1993) was a landmark in Carib-
bean cooperation and CCH has focused on collective          Development “
action with optimisation in the use of resources over a     This new strategic framework is a direct response to
given period, addressing commonly agreed upon ob-           the commitments made by the Caribbean Community
jectives in priority health areas of common concern.        (CARICOM) Heads of Government in both regional

                                                       The Bahamas

                                                                                                          Atlantic O cean

                                         Jamaica                                             Antigua and Barbuda
                                                                   St. Kitts and Nevis
                                          Ca r i b b e a n S e a              Saint Lucia
                                                            St. Vincent & the Grenadines             Barbados
                                                                                               Trinidad & Tobago

10     Caribbean Cooperation in Health Phase III (CCH III)

and international declarations and policy guidelines.     The Reports of the Caribbean Commission on Health
The 2001 Nassau Declaration and the 2007 Decla-           and Development and the Commission on the Social
ration of Port of Spain reinforced the Millennium         Determinants of Health revealed the persistent and
Declaration aimed at reducing poverty by 2015. The        growing inequalities in health and weak health sys-
CCH Phase III is charged with the responsibility to       tems. Evidence of these shortcomings includes:
invest in the health of the people of the region to en-   • The continued lack of resources for health,
sure the highest attainable socioeconomic achieve-        • Limited attempts at universal population cover-
ment, reduce inequities in health, and mobilise tra-          age to address new and emerging health prob-
ditional and non-traditional actors in tackling health        lems e.g. non-communicable diseases, mental
challenges and building sustainable health systems.           health,
• The mandate of CCHIII 2010-2015 will address            • Inadequate access to quality health care services,
     a new orientation towards:                           • Weak leadership and governance of the health
• People- centred development,
                                                              sector, and
• Genuine stakeholder and community participa-
                                                          • Inadequate evaluation and monitoring mecha-
     tion and involvement,
                                                              nisms to chart progress and inform health action.
• Effective regional coordination and public health
     leadership,                                          Implementation of the new orientation is supported
• Outcome-oriented planning, implementation               by the Needham’s Point Declaration (2007) which
     and performance monitoring,                          proposes to use functional cooperation as the means
• Increased efforts at resource mobilisation for          of delivering agreed Common Public Goods.
     health, health coverage, and social protection for
                                                          The chapters which follow outline the new regional
     the people of the region, and
                                                          strategic framework.
• “A Community for All”.
Caribbean Cooperation in Health Phase III (CCH III)                   11

Chapter two summarises the health challenges facing       areas and Strategic objectives for CCH111. This chap-
this region and reinforces the need for collaborative     ter details the areas for joint collaborative action in
responses to these common issues.                         the Region to achieve the five strategic project goals.
Chapter three presents the lessons learnt and justifies   Chapter five discusses the Management and Coordi-
the approach for the                                      nating mechanisms. The critical success factors are
new CCHIII man-                                                                          discussed     including
date “Investing in                                                                       the regional coordinat-
Health for Sustain-                                                                      ing mechanism for suc-
able Development”.                                                                       cessful implementation
                                                                                         at the national and re-
Chapter four de-                                                                         gional level.
scribes the Priority
12   Caribbean Cooperation in Health Phase III (CCH III)

           An Overview
Caribbean Cooperation in Health Phase III (CCH III)                   13

II - An Overview of the Health Development Challenges

Overview of the Health Situation of the                 The overall population has doubled in the last 50
Region                                                  years, but the proportion of the population aged less
                                                        than 15 years has been declining, while the population
The regional and international policy discourse has
                                                        aged over 60 years has been increasing. Population
elevated the importance of the social determinants of
                                                        dynamics for 2010 reveal that the child population
health in health development planning. Recognition
                                                        is stable or decreasing, population aged 25-64 years
of the importance of changing social norms (related to
                                                        will increase by 13% and the labour force population
violence, injuries, sexual behaviour,
and environmental management)
will become more important as              Population Pyramid for the Caribbean - 2010
Caribbean societies advance in the
                                                 Age - Group
new millennium. While disease
prevention and treatment have
played a significant role in securing 75-79
our health status gains and will
remain critical, equally important 65-69
will be the increased recognition of 55-59
health as a tool for development and
well being.
Sustainable health systems will          35-39

be needed to support the goal of         25-29
“Health for All”. Use of integrated
comprehensive            multi-sector    15-19

measures including information             5-9
and communication networks, legal
and fiscal reform and healthy public             400   300      200      100      0    100     200    300   400
policies, will necessitate new ways                          Thousands     Male       Female   Thousands
of working with traditional and non-
traditional partners, in the public
and private sectors of national,
regional and international entities.
                                                        will comprise 65% of the total population. The
Demographic and Social Indicators                       greatest population increase will be in the 45-64 year
The countries of the Caribbean are undergoing a         old group, with a rate of increase of >10,000 per year.
demographic transition. Demographic indicators of       Persons 65+ will constitute 10% of total population.
most Caribbean countries are consistent with health     Birth and fertility rates are significantly higher in
conditions expected for middle income countries         Haiti compared with the rest of the Caribbean.
with the exception of Haiti. Today, both men and
                                                        The current demographic transition has implications
women live longer, with women living on average four
                                                        for increasing rates of chronic non-communicable
to six years longer than men.
                                                        diseases, and an increasing need for care of the
14     Caribbean Cooperation in Health Phase III (CCH III)

elderly. Increased urbanisation is also making its          Emerging and Re-emerging Infectious
contribution to increased rates of life style diseases.     Diseases
The Caribbean has benefited from universal access to        Among the diseases subject to the International
good primary and secondary education. Its high rates        Health Regulations (2005) and global surveillance,
of literacy have been fundamental determinants of           only yellow fever and cholera are of real concern to
good health and essential in sustaining health gains        the Caribbean Region. The possibility of importation
and achieving social and economic development.              into the islands exists. Maintenance of phytosanitary
Mortality                                                   standards are also important to our trade in food
The disease epidemiology of the region is                   products.
characterised by the coexistence of consequences            Whilst malaria is more dangerous where it exists,
of communicable diseases with those of chronic,             dengue fever has become the more significant vector-
degenerative illnesses4, including heart disease,           borne illness for the CARICOM States. The threat of
strokes, diabetes, and cancer, as well as with other        re-introduction of malaria is real, as evidenced in the
health priorities such as injuries, violence, trauma,       recent outbreaks in Jamaica and Bahamas. This now
occupational disease and mental illness. Chronic            demands risk reduction strategies and maintenance
diseases have replaced communicable diseases as             of outbreak detection and response capacity where
leading causes of death and ill-health.                     risks are high.
Mortality from communicable diseases has been               The Caribbean boasts of high rates of childhood
rising since the late 1980s, after years of decline. This   vaccination. Smallpox and polio have been eliminated.
is linked in particular to the epidemic of HIV/AIDS,        The elimination of measles is now only to be certified.
but more recently to vector-borne illnesses such as         On the heels of the measles elimination will follow
dengue and malaria. In childhood, while infections          mumps, rubella and Congenial Rubella Syndrome.
have decreased as a cause of illness and death,
nutrition-related illness or risk factors for illness       Economic Challenges
such as obesity have increased. In early adulthood,         Most countries of the region are deemed to be
diabetes, suicide and homicide have increased as            of middle income status. However, considerable
causes of death over the past 10-15 years.                  challenges persist in maintaining economic stability
While national and regional statistics show that            and viability. The current global economic challenges
chronic non-communicable diseases are the leading           have created increased pressures on Caribbean
causes of death for the population, HIV/AIDS,               economies and will eventually challenge their
injuries, and violence are the leading causes of death      competitive advantage in key sectors such as tourism,
among the youth and population of productive and            as recovery begins.
reproductive age.                                           Climate change
Risk Factors                                                Climate change can affect, and has affected, the
Current studies in Behavior Risk Factor Surveillance        agricultural economies of the Caribbean. The effects
will greatly assist in identifying the risk factors most    of climate change threatens beaches and low-lying
dominant in influencing the increasing incidence of         coastal zones and will have an enormous potential
non-communicable diseases (NCDs) in all the states.         to impact livelihoods. Catastrophic hurricanes and
The known risk factors of tobacco use, physical             frequent floods have inflicted damage to health and
inactivity, unhealthy nutrition, and alcohol misuse,        other infrastructure, and impacted food security.
will no doubt feature prominently. Similar studies          In addition, the health impacts of the increased
will have to be undertaken in relation to accidental        vector borne diseases like dengue is already being
and intentional violence.                                   witnessed.
Caribbean Cooperation in Health Phase III (CCH III)   15

Challenges We Face
16     Caribbean Cooperation in Health Phase III (CCH III)

III - Challenges We Face
The lessons learnt from the design and implementation        and partners, including the private sector, in the
of the CCH I and CCH II have been carefully                  new global health environment
considered in this new planning and implementation       Resource Mobilisation and Efficiency
                                                         Resource constraints were identified as one of the
Governance                                               main barriers to the successful implementation
The importance of governance and stewardship in          of health initiatives. There is need for greater
the region cannot be understated. There is need          emphasis on a more strategic approach to resource
to prioritise efforts at ensuring sound leadership       mobilisation for health and an understanding of
to bring about change in our complex regional            the real cost of achieving health outcomes. It is
                                                         generally agreed that recent economic growth
environments. Equally important is the need to clarify
                                                         brought additional resources to health, though the
the monitoring roles and functions of all stakeholders
                                                         more recent global and economic and financial crisis
and responsible agencies.
                                                         now puts their sustainability at risk. However, this is
Weak structural and institutional operations were        accompanied by the growing demand for health and
identified as major weaknesses in the execution of       better performance. The Caribbean Region will have
CCH I and CCH II.                                        to show better results in programme planning and
• Limited effectiveness and efficiency in the deliv-     implementation and the link to health development
    ery and financing of functional cooperation ini-     if it is to secure much-needed funding for health.
    tiatives                                             Pooled financing of country needs and priorities
• Lack of adequate resources for the implementa-         can help increase the relevance of interventions and
    tion of developmental health initiatives             address the lack of capacity in country. The lack of a
• Absence of sustainable approaches to health de-        clear financial strategy to support the implementation
    velopment                                            of the regional strategic direction must be addressed
                                                         in this new orientation. The new framework must
• Inadequate emphasis on performance manage-
                                                         demonstrate greater integration among the strategic
                                                         objectives to reduce duplication and better utilise
• Inadequate focus on knowledge creation and
                                                         scarce resources. This will require the following:
    management                                           • Refinement of overlaps, consolidation and priori-
• Insufficient staff and technical resources to coor-         tisation of some interventions,
    dinate and inform implementation processes           • Feasibility studies, and
• Weak strategy for monitoring performance and           • Greater focus on cross sectional opportunities.
    competence of the regional human resources
• Inadequate harmonisation and alignment of re-          Capacity
    gional programmes and policy declarations in         The issue of limited human resource capacity in
    health                                               the region calls for a new strategy to reversing
• General lack of strong leadership and governance       the negative impacts of professional migration.
    in the field of health at all levels of the system   Equally important is the need to enhance skills and
• Lack of a truly regional approach to address the       competencies of our human resources and also the
    unimplemented health agenda                          institutions responsible for nurturing and training
• Inadequate emphasis on and support for explor-         minds. Standards of quality in all educational
    ing the potential of non-traditional stakeholders    institutions need to be enhanced.
Caribbean Cooperation in Health Phase III (CCH III)                  17

Participatory Strategies and Stakeholders in              Areas where common public goods have been derived
Health                                                    include cross-regional frameworks for the control of
                                                          NCDs and HIV/AIDS, development of HIS, reporting
Given the intersectoral nature of health and the          on health status, and strengthening the regional
importance of all sectors in the achievement of health    mental health response. While resource constraints
outcomes, the multi-sector approach in health is          may prohibit a closer examination of health tourism,
gaining prominence. Private sector and other non-         the role played by this sector cannot be ignored.
traditional sectors can play a meaningful role in the
implementation of CCH III.                                Monitoring and Evaluation
How we engage our stakeholders will determine the         Performance–based funding is presently being
degree and quality of different forms of participation.   used by many funding agencies to chart progress
The regional focus will make this issue all the more      and performance in use of funds for stated health
challenging. Enhancing stakeholder buy-in, and            interventions. The establishment of monitoring
engendering a truly multi-sector and intersectoral        and evaluation mechanisms and effective health
approach will require continued use of top down and       information systems to chart progress is critical
                                                          to securing funding for health and ensuring the
bottom-up approaches involving policy guidance and
genuine input from countries and institutions.
                                                          • Effective and efficient programme implementa-
Priority Health Areas                                          tion,
The priority areas reflect the main issues affecting      • Improving health and sustainable funding,
the health and well-being of the region to date. The      • Obtaining accurate information for evidence-
challenge to arrive at common public goods is further          based decisions, and
exacerbated by inadequate health information and          • Supporting accountability mechanisms.
health research, weak health information systems          Regional Challenges and Priorities
(HIS) and lack of focal points to continually monitor
                                                          The establishment of the Caribbean Public Health
                                                          Agency (CARPHA) will provide an opportunity in
It was generally accepted that significant                realizing the goals of the CCH111. This institution
improvements were realised during the execution           will provide leadership in public health and support
of CCH I and II in the original priorities of CCH.        evidence based decision making in the Caribbean
However, the real challenge remains two-fold:             Region, guide the development of policy and monitor
1. The limited capacity of the region to finance and      and evaluate interventions in priority areas. This
    sustain sub-regional initiatives, and                 will involve rationalization of services provided by
2. The limited capacity of countries to translate         the existing five Regional Health Institutions and
    regional objectives into concrete policy formula-     significant attention will need to be paid to ensuring
    tion and sustainable programmes and infrastruc-       a smooth transition in the establishment of this new
    ture at the national level.                           Agency.
18   Caribbean Cooperation in Health Phase III (CCH III)

         Priority Areas
                 & strategic objectives
Caribbean Cooperation in Health Phase III (CCH III)              19

IV - Priority Areas And Strategic Objectives

Investing in Health for Sustainable                    matrices outlining the expected outcomes, lines of
Development in the Caribbean                           action and indicators of achievement can be found
The Caribbean Ministers of Health have recognized      on various websites in the Region including www.
that the eight priority areas to be addressed in CCH;
III are:
1. Communicable Disease                                Creation of a Healthy Caribbean
2. Non-Communicable Disease                            environment conducive to promoting the
3. Health Systems Strengthening                        health of its people and visitors
4. Environmental Health                                Expected Outcomes at National Level:
5. Food and Nutrition                                                       • Strengthened legal and
6. Mental Health                                                            regulatory framework for
7. Family and Child Health                                                  environmental health (EH)
8. Human Resource Develop-                                                  management
     ment                                                                   • Improved management
                                                                                of water resources, in-
In order to achieve an impact                                                   cluding recreational wa-
on these priority areas, it                                                     ters, through a holistic
is necessary to address the                                                     and integrated approach
determinants of the diseases/                                                   to ensure quality
conditions. The strategies/                                                 • Implementation of the
actions which need to be                                                        integrated vector-borne
adopted must be:                                                                management strategy
• Cross cutting                                                             • Implementation of inte-
• Inter-programmatic                                                            grated waste manage-
• Trans-sectoral                                                                ment options
• People-focused                                                            • Full implementation of
• Holistic in their approach                                                    the International Health
• Increasingly focused on ad-                                                   Regulations (2005)
     dressing the determinants of health                                    • Availability of healthy
• Able to create an enabling environment for                                    foods for consumption
     change through trans-sectoral policy develop-
     ment to make the healthy choices the easier       Areas for Joint Collaborative Action:
     choices                                           • Development of Regional Environmental Health
                                                         framework that incorporates climate change ef-
In looking at the need to adopt a people-focused         fects and projections using the risk management
approach in CCH III, a focus on the priorities as        approach
defined, and sustainable strategies to be harmonized   • Development and implementation of Regional
with the Nassau Declaration, “the Health of the          Environmental Health Strategic Plan as ap-
Region is the Wealth of the Region”, the goals for       propriate (EH professional network, climate
CCH III were defined along the theme: “Investing in      change, tourism, guidelines for drinking and
Health for Sustainable Development”. The detailed        recreational waters)
20      Caribbean Cooperation in Health Phase III (CCH III)

• Development of model harmonized legislation            • Improved capacity to monitor and manage condi-
  for environmental health priorities, including           tions which influence perinatal, fetal and neona-
  port health                                              tal mortality and diseases in the under-5 popula-
• Development of regional guidelines, strate-              tion
  gies and tools to promote environmental health         • Improved capacity of the health and other sectors
  awareness                                                to respond to the specific health and develop-
• Development of guidelines and indicators in var-         ment needs of adolescents and youth
  ious settings which impact on the population’s         • Strengthened and integrated programmes to
  health, namely schools, workplaces, home and             promote and protect the health and well-being of
  recreation facilities                                    the elderly
• Development of Core Indicators and Framework           • Strengthened multi-sectoral approach and ca-
  for Health Promoting Schools and support for             pacity of countries to reduce the incidence of vio-
  the development of Health Promoting Schools              lence and unintentional injuries
  in the Region through the strengthening of the
  Caribbean Health Promoting School Network              Areas for Joint Collaborative Action:
• Ensuring/establishing regional nutritional and         • Development of models and pilot programs
  quality criteria for imported and locally pro-           which address Integration of Early Childhood
  duced foods as part of trade policy which would          Development programs into primary care
  include standards for food labeling                    • Support for the implementation of the new WHO
• Development of intersectoral policies with agri-         Child Growth Policy and Standards
  culture, trade and marketing to develop a mecha-       • Maintenance of high levels of immunization
  nism to assure that healthy foods are available at       rates for the vaccine preventable diseases and
  affordable prices                                        assessment of feasibility of introducing new vac-
• Support for capacity at the regional and nation-         cines in the Region, with particular emphasis on
  al level to implement the International Health           HPV vaccine for the prevention of cervical can-
  Regulations (2005) and to mount an effective             cer
  response to outbreak or disaster crisis at national    • Development of Regional nutrition standards
  and regional level.                                      and guidelines for school meals and food sold in
• Support for enhanced capacity at national and            school cafeterias; dietetic guidelines for institu-
  regional level to establish an effective early warn-     tions on NCDs
  ing system for disasters and mount an effective        • Development of a regional plan to adopt an inte-
  and coordinated response.                                grated approach to the challenges of Adolescent
                                                           Health, which will include, amongst other issues,
Improved health and quality of life for                    mental health, unintentional injuries and vio-
Caribbean people throughout the life cycle                 lence, and sexual and reproductive health
                                                         • Development of a Regional plan on Injury and
Adding years to life and Life to Years
                                                           Violence Reduction
Expected Outcomes at National Level
                                                         • Development of models of care and sharing of
• Promotion of mental wellness of the population
                                                           best practices of integrative care for the elderly
  and mechanisms to support appropriate care for
                                                           and the physically and mentally challenged
  the mentally ill at the primary care level, with
                                                         • Implementation of the Caribbean Regional Stra-
  early detection and appropriate care
                                                           tegic Framework for HIV/AIDS
• Programs for early childhood development inte-
  grated into Primary Health Care
Caribbean Cooperation in Health Phase III (CCH III)                    21

• Support for implementation of the Port of Spain       • Development of Regional Quality Management
  Declaration on Stemming the Tide of Non-Com-            and Accreditation Framework, including Patient
  municable Diseases                                      Charters
• Support for implementation of the Regional            • Support for the implementation of the safe hospi-
  Mental Health Policy                                    tal assessments in all hospitals in the Region
                                                        • Support for the development of national centres
Health Services that respond effectively to               of excellence in laboratory and public health
                                                        • Support for the implementation of the Caribbean
the needs of the Caribbean people
                                                          HIV/AIDS Plan for the Health Services
Expected Outcomes at the National Level:
• Universal access to health care services at pri-
  mary care level                                       Developing Human Resource capacity to
• Re-orientation of health care to Primary Health       support health development in the Region
  Care-based systems                                    Our smaller member states are faced with problems of
• Access to safe, affordable and effective medicines    retention of trained personnel, the quality, skills and
  and their rational use improved                       competencies of the existing health workforce, as well
• Health sector organized and prepared to respond       as limitations in capacity to train a health workforce
  to disasters through safe hospitals and health        to meet their needs. This includes the full extent of
  care facilities                                       the health workforce such as nurses, physician, public
• Health sector organized and prepared to respond       health practitioners, researchers and health care
  to mass casualty national/regional events/disas-      managers. This is also mirrored at CARICOM level.
• Strengthened capacity of Member States to per-        Our vision aims to provide access to quality health
  form essential public health functions                services for all people of the CARICOM Region
                                                        through the strengthening of health human
Areas for Joint Collaborative Action                    resources. The strategic direction laid out in the
• Assessment of the feasibility of developing a         CCH III aims to mobilise institutional actors at the
  mechanism for Shared Services in tertiary care        national, regional and global levels of the health and
  in the Caribbean Region                               related sectors and other relevant civil society actors,
• Development/Review of protocols and standards         to collectively strengthen the human resources in
  of care for mental health, non-communicable dis-      health through policies, interventions, and networks.
  eases and other priority diseases identified in the
  CCH III                                               We have incorporated strategies to mitigate against
• Study to assess the feasibility of establishing a     the effects of regional and international labour
  Regional Health Insurance Scheme                      force challenges but to also embrace the potential
• Development of a comprehensive and integrated         opportunities presented by the regional and global
  chronic disease management models                     trends. Our response supports the Toronto Call to
• Support the design and implementation of a            Action (2006) and is designed to specifically address
  Caribbean Pharmaceutical Policy and mecha-            the Millennium Development Goals in accordance
  nisms to enhance access, quality and rational use     with national health priorities.
  of medicines in the Region;
• Support the strengthening and the harmoniza-          Areas for Joint Collaborative Action:
  tion of pharmaceutical regulation, including          • Support for the development of a Regional Stra-
  Pharmacovigilance;                                      tegic plan for health human resources
22     Caribbean Cooperation in Health Phase III (CCH III)

• Support for the development of infrastructure to         including substance abuse prevention and care,
  enable the free movement of skilled health per-          into primary health care systems
  sonnel in the CARICOM Region
• Development of a Regional Health Professional        Evidence-based decision making as the
  Registration Database                                mainstay of Policy Development in the
• Models and frameworks of trans-sectoral poli-        Region
  cies and protocols for health workforce planning     Expected Outcomes at the National Level:
• Development of a mechanism for the coordina-         • Improved surveillance systems in the priority ar-
  tion of schools of public health in the Caribbean,     eas of CCH III
  to strengthen research and training in public        • Evidence-informed policy formulation
• Enhanced coordination of schools of medicine,        Areas for Joint Collaborative Action
  nursing, and allied health professions in the Ca-    • Support for the development of a minimum data
  ribbean to strengthen the training of health pro-      set for health information systems, to include in-
  fessionals to meet the health and development          dicators in the priority areas for CCH III namely,
  needs of the CARICOM Region                            mental health, environmental health, communi-
• Development of mechanisms for coordination of          cable and non-communicable diseases, food and
  the health services and the Caribbean academic         nutrition, human resource development, health
  institutions to work cooperatively in human re-        systems assessments and program evaluation
  source planning and the development of human         • Establishment/Review of guidelines for the sur-
  resources management programs as part of the           veillance of selected communicable diseases,
  curricula                                              vector-borne diseases, nutrition, and environ-
                                                         mental hazards including vector surveillance
• Identification of regionally accepted compe-
                                                       • Enhanced laboratory capacity at the Regional
  tencies in the health workforce for primary and
                                                         level to support countries in surveillance of com-
  secondary prevention, quality health and health
                                                         municable diseases, environmental health, wa-
  care, with particular emphasis on the CCH III
                                                         ter- and food-borne diseases, and quality assess-
  priority areas                                         ments
• Development of initiatives and strategies to sup-    • Establishment of baseline data for the CCH III
  port the expansion of residency training pro-          priorities and support for countries’ capacity to
  grams that focus on primary care and chronic           collate, analyze data and present in a meaningful
  disease prevention and management                      way to various stakeholders
• Curriculum development at pre-service level,         • Development and implementation of a Carib-
  Continuing Professional Development (CPD)              bean Health Information System supported by a
  and integration of mental health management,           regional health information network
Caribbean Cooperation in Health Phase III (CCH III)   23

  & coordinating mechanisms
24     Caribbean Cooperation in Health Phase III (CCH III)

V - Management And Coordinating Mechanisms
This new phase of the CCH III will require              • Provide adequate data on monitoring indicators;
stronger leadership, more effective management          • Ensure adequate participation of traditional
and coordination, and enhanced technical and              and non-traditional sectors in the attainment of
administrative capacity at both regional and country      health and development objectives; and
level, as well as effective resource mobilization.      • Build capacity at national level to contribute to
Emphasis will be placed on achieving genuine              national and regional progress.
involvement and participation by all actors in health
and related sectors as well as instituting greater      Management Mechanism
accountability for the delivery of agreed upon          The Council of Health and Social Development
common public goods and related interventions.
                                                        (COHSOD) responsible for Health
Coordination and monitoring of the implementation
                                                        The COHSOD is ultimately responsible for
of the CCH Phase III is structured along two levels:
                                                        guiding the implementation of the CCH III. The
     - The Regional Level Functions
                                                        Annual Caucus of Ministers of Health will have the
     - The National level Functions
                                                        responsibility to direct the CCH in between meetings
                                                        of the COHSOD. The CARICOM CAUCUS of
Regional Level Functions will
                                                        Health Ministers is a sub-committee of the Council
• Support individual countries in developing ca-
                                                        for Human and Social Development (COHSOD).
  pacity to implement and monitor regional public
                                                        The Caribbean Cooperation in Health Secretariat
  goods and fulfil global health and development
                                                        The Secretariat comprises the CARICOM Secretariat
                                                        and the PAHO/WHO Office of the Caribbean
• Provide effective and efficient technical coopera-
                                                        Programme Coordination (OCPC). The Secretariat
  tion through a greater streamlining of regional
                                                        will be strengthened to manage the administrative
  agency responsibility;
                                                        and technical implementation of CCH.
• Establish multi-sector and multi-disciplinary
  Priority Area and Program Goal monitoring
  committees;                                           The CCH Secretariat will hold formal meetings
• Provide timely reports on regional and national       and will be responsible for the following:
  progress towards accepted goals and indicators;       • Definition of the technical and administrative
• Improve regional support machineries through            support required for implementation and coordi-
  effective technical support to countries;               nation of project implementation;
• Reduce duplication and gaps in technical sup-         • Development of an annual implementation plan;
  port to countries; and                                • Formulation of annual reports;
• Facilitate a regional data base and knowledge ac-     • Commissioning of the Monitoring and Evalua-
  cess tools to ensure involvement by all participat-     tion Framework;
  ing agencies and countries.                           • Coordination of resource mobilisation; and
                                                        • Adopting and supporting a communications
National Level Functions:                                 strategy.
The individual countries will, through national
mechanisms:                                             The Steering Committee
• Ensure effective functioning of national mecha-       The Steering Committee (SC) comprises the
  nisms;                                                Executive Committee of the Chief Medical Officers
Caribbean Cooperation in Health Phase III (CCH III)                    25

(CMOs); Regional Focal Points for the Priority Areas        in the Caribbean Region, guide the development of
drawn from the Regional Technical Programmes;               policy and monitor and evaluate interventions in
Regional Tertiary Institutions; and the Caribbean           priority areas.
Cooperation in Health Secretariat (which will be the
SC secretariat as well).                                    Sustained commitment from all responsible
                                                            parties to ensure the following:
The Committee will meet twice per year and its              • Ownership from the regional and national levels
functions are:                                                 and among non-traditional actors in health .
• Supporting and facilitating the implementation            • Strong leadership at country level and at the level
  at national level based on sound evidence;                   of the CARICOM Secretariat.
• Promoting and facilitating technical cooperation          • More effective monitoring of regional and associ-
  within and among countries, agencies, and insti-             ated national programs.
  tutions in both traditional and non-traditional           • Adequate technical cooperation for implementa-
  sectors;                                                     tion of health care programmes.
• Resource mobilisation; and                                • Capacity building at country level and among
• Monitoring and evaluation of progress of the                 technical staff for using the regional priorities
  CCH III implementation.                                      and objectives to guide national planning and to
                                                               produce reliable health data.
The Regional Focal Points                                   • Support for the regional and national coordinat-
This technical structure will operate at two levels.           ing mechanisms
Firstly, at the level of the individual agencies with       1. A proficient joint CCH Secretariat (PAHO/
specific responsibility, and secondly as an integrated         WHO OCPC and CARICOM Secretariat) to
multi-disciplinary team. Overall responsibilities will         coordinate, and work in close collaboration with
include:                                                       the Chief Medical Officers CMOs ( the CCH co-
• Monitoring the progress of priority health pro-              ordinators).
     grammes and reporting to the Steering Commit-          2. Greater attention to communication and access
     tee,                                                      to knowledge sharing networks between and
• Promoting, facilitating and guiding countries                within countries through the implementation of
     in developing plans, policies, programmes, and            a comprehensive communications strategy, up-
     projects to achieve the regional goals set in the         grading existing systems where necessary, to fa-
     priority areas at the national level, and                 cilitate communication between the Secretariat
• Assisting in building capacity for the implemen-             and countries.
     tation of CCH III at the national level.                  • Establishment of regional data base for mon-
                                                                    itoring of all indicators and ensuring that
Critical Success Factors                                            reliable data are available for evidence-based
The Caribbean Public Health Agency (CARPHA)                         planning and decision making in health
                                                                    planning and programme strengthening,
will rationalize the functions of the current
                                                                    nationally and regionally.
Regional Health Institutions (RHIs) and have a more
comprehensive mandate in addressing the public              Country level responsibilities:
health needs of the wider Caribbean Region and will         • Formulation, needs identification, resource mo-
be a critical success factor in the implementation of the     bilisation and information sharing
CCH III. CARPHA will provide leadership in public           • Provision of guidance, direction and relevant in-
health and support evidence based decision making             formation to the CCH Secretariat
26    Caribbean Cooperation in Health Phase III (CCH III)

• Communication with key stakeholders, particu-   accountability will be carefully defined. The
  larly the public, about CCH benefits            regional planning, monitoring and implementation
• Support for the CCH Coordinators( CMOs) in      mechanism outlined above will serve as the main
  implementing the Initiative                     programme accountability system.
• Full participation in all activities of CCH
                                                  • The CARICOM Secretariat
Programme and Financial Accountability            • CCH Secretariat
Lines of reporting for technical and financial    • Caribbean Public Health Agency (CARPHA)
Caribbean Cooperation in Health Phase III (CCH III)                       27

Annex 1
The Caribbean Community (CARICOM) was                          for the collective program. In this process the Pan
established in 1973 by the signing of the Treaty of            American Health Organization, the Regional Office of
Chaguaramas in Trinidad and Tobago with the purpose            the World Health Organization in the Americas (PAHO/
of enhancing economic and foreign policy coordination          WHO), has been the major partner. PAHO/WHO has
and promoting functional cooperation. CARICOM                  provided technical and financial resources through its
Member States are Antigua & Barbuda, The Bahamas,              country representations and to at least two of the five
Barbados, Belize, Dominica, Grenada, Guyana, Haiti,            Caribbean Regional Health Institutions (RHI), namely the
Jamaica, Montserrat, Saint Kitts & Nevis, Saint Lucia, Saint   Caribbean Epidemiological Centre (CAREC) and the
Vincent & the Grenadines, Suriname, and Trinidad &             Caribbean Food and Nutrition Institute (CFNI), which
Tobago. Associated Membership is extended to Anguilla,         are PAHO/WHO specialized centres. The other RHI
Bermuda, British Virgin Islands, Cayman Islands, and Turks     are the Caribbean Health Research Centre (CHRC),
and Caicos Islands.                                            the Caribbean Environmental Health Institute (CEHI),
The Caribbean Cooperation in Health Initiative                 and the Caribbean Regional Drug Testing Laboratory
(CCH) was developed in the framework of functional             (CRDTL).
cooperation. It was adopted by CARICOM Health                  CCH II, approved in 1999 for the period 1999-
Ministers in 1984 to optimize the utilization of resources,    2003, sought to emphasize country ownership in the
promote technical cooperation among countries,                 development of the processes and the implementation
develop projects in priority health areas, and secure          of programs. The CCH II established eight program
funding for their implementation.The concept promoted          priorities, namely Chronic Non-Communicable
collective and collaborative action to solve critical health   Diseases; Communicable Diseases including HIV/AIDS;
problems best addressed through a regional approach            Environmental Health; Family Health; Food and Nutrition;
rather than by individual country action.                      Health Systems Development; Human Resource
The initiative was approved by CARICOM Heads of                Development; and Mental Health. The management and
Government in 1986 and CCH Phase I was launched.               monitoring of the program was the responsibility of the
The CCH, although lauded by both Caribbean regional            CCH Secretariat, comprising the Health Desk of the
governments and international agencies as a positive           CARICOM Secretariat and the PAHO/WHO Office of
intervention, only partially realized the goal of securing     Caribbean Program Coordination (OCPC), supported
external funding to implement all the priority projects.       by a Steering Committee with technical representatives
However the concept of collective and collaborative            from the Chief Medical Officers and the RHIs.
action and the prioritization of health concerns               During the period 1999-2005, the actual timeframe of
was adopted by the countries as a framework for                CCH II, only limited success was achieved in obtaining
national interventions and the promotion of technical          external funds for special regional projects. However, the
cooperation.                                                   CARICOM Heads of Government recognised the CCH
Over the years special efforts were made to promote            mechanism as a contributor to enhancing development
partnership with national, bilateral, multilateral, regional   and formulated the Nassau Declaration 2001, which
and international agencies to secure additional resources      proclaimed that the “Health of the Region is the Wealth
28      Caribbean Cooperation in Health Phase III (CCH III)

of the Region”. This Declaration mandated that special        Carr and Ward recommended that the successor to
attention be given to three of the eight priorities namely,   CCH II, namely CCH III, should retain the same eight
Chronic Non-Communicable Diseases, Mental Health,             priorities as in CCH II and add an additional goal to
and HIV/AIDS. Among these, HIV/AIDS obtained                  address the promotion of healthy lifestyles and behaviour
significant funding and an increase in programming            change from at-risk behaviour.
and partnerships. As a result, CARICOM established a          CARICOM Policy decisions and initiatives
separate Secretariat, the Pan Caribbean Partnership for
                                                              At the 2001 CARICOM Heads of Governments’
HIV/AIDS (PANCAP), for coordination and monitoring.
                                                              Conference, the Nassau Declaration recognised that
Resources for monitoring the CCH II process and               the “Health of the Region is the Wealth of the Region”,
progress were also not readily available, as there was also   recommended continued emphasis should be given
a reduction in “project resources” from the OCPC and          to the implementation of the CCH Framework and
CARICOM for the management of the CCH Secretariat.            mandated that increased attention should be given to
However the PAHO/WHO programming budget for                   the development and implementation of three priority
the Caribbean was used to support specific activities         health areas namely HIV/AIDS, Mental Health and
relating to the priority areas as a component of its          Chronic Non-Communicable Diseases. These items
ongoing work-plan. Some of these activities included the      provide the stimulus to keep the strategic health agenda
hosting of several regional meetings to build consensus       for functional cooperation in focus.
and accelerate program development, for example the           Process of developing CCHIII
completion of a draft action plan for the management of
                                                              PAHO/WHO OCPC and the CARICOM Secretariat
Chronic Non-Communicable Diseases (CNCD) and the
                                                              convened a series of meetings with the relevant
preparation of a core curriculum for building capacity for
                                                              stakeholders and facilitators to review the CCH II
environmental health officers.
                                                              Evaluation Report and define the roles and functions of
Evaluation of CCH II and                                      PAHO/WHO and the CARICOM RHI in the formulation
Recommendations                                               and implementation of CCH III.
The CCH II evaluation report highlights that although         Administrative structure for
some regional projects were developed by CARICOM,             implementation of CCH III
PAHO/WHO OCPC, CAREC, CFNI, CEHI, and CHRC,                   The management structure for the CCH III should
insufficient additional resources were secured by the         include a mechanism for working with CARPHA.
region to mobilize, promote, and coordinate technical         However, the role of the CCH Secretariat as proposed
cooperation among countries. As a result, the CCH,            in the Carr and Ward report will fulfil the responsibilities
although used conceptually in planning by most countries,     for strategic direction and monitoring and evaluation of
took a lesser role in the context of national programming.    the initiative.
Some of this posture was also due to limitations in the
national management and program structures.
Caribbean Cooperation in Health Phase III (CCH III)   29
30   Caribbean Cooperation in Health Phase III (CCH III)

Regional Health Framework 2010 - 2015
Caribbean Cooperation in Health Phase III (CCH III)
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