The Sixth Meeting of the Council for Social and Human Development (COHSOD) was held on 17-19 April 2002 in Georgetown, Guyana under the Chairmanship of the Hon. Dr. Douglas Slater, Minister of Health and the Environment, St Vincent and the Grenadines. The Meeting was attended by Dr the Hon. Jerome Walcott, Minister of Health, Barbados; Dr the Hon. Leslie Ramsammy, Minister of Health, Guyana; the Hon. John Junor, Minister of Health, Jamaica; the Hon. Earl Martin, Minister of Health and the Environment, St Kitts and Nevis; the Hon. Eisenghower Greaves, Minister of Health, Human Services and Family Affairs, Saint Lucia; the Hon. Nelson Bascome Jr., Minister of Health and Family Services, Bermuda; and their delegations.
The Bahamas, Belize, Suriname, and the Turks and Caicos Islands were represented by Senior Health Officials. The Meeting was also attended by representatives of a number of regional and international institutions, including the Caribbean Association of Nutritions and Dieticians (CANDI), Caribbean Association of Pharmacists (CAP), the Caribbean Congress of Labour (CCL), the Caribbean Development Bank (CDB), the Caribbean Environmental Health Institute (CEHI), the Caribbean Epidemiology Centre (CAREC), the Caribbean Regional Network (CRN+), the European Union (EU), the Inter-American Development Bank (IDB), the Organisation of Eastern Caribbean States (OECS), the Pan American Health Organisation (PAHO), the United Nations Drug Control Programme (UNDCP), the United Nations Programme on HIV/AIDS (UNAIDS), the United States Department of Health and Human Services, and the University of the West Indies.
The Opening Ceremony was chaired by Dr. Edward Greene, Assistant Secretary-General, Human and Social Development, Caribbean Community (CARICOM) Secretariat. Remarks were delivered by Mr. Edwin Carrington, Secretary-General, CARICOM and the Hon. Dr Douglas Slater.
Dr Greene welcomed delegates to the Meeting and commented that the Directorate of Human and Social Development was privileged to be working on such an important venture. He extended special thanks to Dr. Carla Barnett, Deputy Secretary-General of CARICOM for her continuous support to the Directorate in its work in the social sector.
The Secretary-General in his opening remarks commended the theme of the Meeting, noting that it was an integral part of the theme “Investing in Human Resources with Equity”. He recalled that health has always been a key priority in the Region, with Governments valiantly preserving social services even in the face of serious challenges such as structural adjustment. He further stressed the need for the Region to take an inter-sectoral approach to health investment in order to increase productivity and well-being in the Region.
The Hon. Dr Douglas Slater in his speech expressed pleasure in chairing the Meeting. He expressed gratitude to the organisers of the Meeting and urged delegates to judiciously use the time alloted to establish concrete mechanisms for implementing the main activities of the Nassau Declaration and to pay tribute to Sir George Alleyne and his illustrious contribution to the Region. He also extended greetings from the Hon. Girlyn Miguel, Minister of Social Development, Cooperatives, Family Gender and Ecclesiastical Affairs and on behalf of the Government of St. Vincent and the Grenadines.
The COHSOD noted that the Nassau Declaration recognised the need for the re-orientation and re-structuring of the health services and emphasised leadership, strategic planning and management in the context of health sector reform. The Declaration provides a challenge to the health sector to ensure that the appropriate mix and levels of health professionals are appropriately deployed, managed and retained. Simultaneously, an opportunity is also provided to prepare the health services and professionals to become competitive players in the trade in professional health services.
The Council expressed its concern about the impact of migration to and recruitment by developed countries of experienced health professionals and agreed to work towards the further development of a comprehensive strategy for managed migration.
Given the complexity of issues to be addressed the COHSOD agreed that these issues be referred to the Futures Policy Group.
Implementing the Nassau Declaration
Members of Government attending COHSOD VI were moved by the current devastation of the region by HIV/AIDS and its partnering forces of the Chronic Non-Communicable Diseases and Mental Health, which have begun to reverse our gains in the fields of Public Health and Economic and Social Development.
They took cognizance of the role that poverty, discrimination, stigmatization, gender bias, and lack of information play in the spread and severity of the impact of diseases.
They also recognized the inextricable link between Health and Development and the regional pursuit of the Caribbean Cooperation in Health II (CCH II) and the CARICOM Single Market and Economy (CSME), which are their respective “umbrella” jurisdictions.
They accepted the further elaboration within the NASSAU Declaration of strategies, goals and targets by the Heads of Government and resolve to work towards their attainment, especially in the area of HIV/AIDS.
In that context Ministers thanked the CARICOM Secretariat for devoting this COHSOD to Health and Human Development.
The Pan Caribbean Partnership
The Caribbean Co-operation in Health Initiative
Recognizing the individual limitations of countries, the presence of best practices within the Region and the potential of regional health institutions Ministers remained convinced of the indispensable nature of a regional approach to health issues.
They therefore urged the strengthening and operationalisation of the CCH II Secretariat and the financing and implementation of its programmes. They also pledged to renew efforts to mobilize resources for CCH II programmes in general.
However, given the cost in Human life and loss of Productivity, not to mention the grief, pain, inconvenience and family dislocation, expense and income loss consequent on the persistence of HIV/AIDS, Chronic Non-Communicable Diseases and Mental Health (including Drug Abuse) they urged the CARICOM Secretariat and PAHO to establish the CCH Secretariat without delay and to coordinate implementation of the Nassau Declaration mandates with respect to the following:
The Regional Strategic Plan on Non-communicable Diseases
To collaborate with other agencies to secure the necessary resources and complete the work in progress for the regional strategic plan for Chronic Non-Communicable Diseases, ensuring that adequate emphasis is placed on Health Promotion, Nutrition and access to Treatment and Care. They promised to collaborate with sister Ministries of Agriculture, Trade and Education within the Framework of National and Regional COHSODs.
The Regional Strategic Plan on Mental Health
Accepting that mental ill-health is on the increase and that mentally afflicted persons can and are commonly disenfranchised, that is removed from the economic, political and social life of the community, Ministers pledged to work to up-grade the legislation and put in place the appropriate enforcement mechanisms, taking account of similar work being done in the area of HIV/AIDS.
The Regional Strategic Plan on HIV/AIDS
Ministers supported efforts to expand and build the capacity of the Pan Caribbean Partnership to discharge its mandate but wish to charge the CARICOM Secretariat with the responsibility of ensuring that the resources mobilized for HIV/AIDS are applied to, inter alia, capacity building of regional and national institutions. In consonance with these activities, Ministers also pledged to incorporate and give emphasis to capacity building within national work programmes to facilitate the achievement of the regional objectives.
The Review of Regional Health Institutions
Ministers recognized the work of regional health institutions and the lead role they play in the fight against diseases. They affirmed commitment to assess the management and operations of these institutions and to strengthen and build their capacity for effective discharge of their mandates.
Ministers understood that their actions will be guided by the results of the review of the regional health institutions. They took the opportunity to thank the Caribbean Development Bank for its generosity in financing the review and to urge the CARICOM Secretariat and Caribbean Development Bank to expedite the study.
The Human Resource Development Strategy
Ministers recommitted themselves to the integration of Health as a serious partner in the Development process and to promote the implementation of a Human Resource Development Strategy.
To this end, they embraced the work of the Regional Task Force on Human Resource Development and pledge to support its operations. They recommended that the terms of reference of the Task Force include an assessment of the WHO/Commission on Macro-economics and health, with a view to its relevance to the Caribbean. They further recommended that the focus on financing health in the Caribbean be specially addressed.
Food Security
The link between food security and the implementation of the Nassau Declaration was seen to revolve around the links between Nutrition and HIV/AIDS, Non-Communicable Diseases and Health and Human Development. The need for the development of an integrated food security policy through multi-sectoral efforts involving sectors such as trade, health and agriculture, was recognised as well as the need to address food safety issues such as the measurement of pesticides, heavy metals and anti-biotics in food. In examining the issue of food security “from the farm to the table” the issues of trade policies and international food safety standards as articulated by the WTO were discussed. The Meeting proposed that the impact of WTO rules on food security be analysed since they affected domestic agricultural production, especially that of small farmers. The impact of the protection granted to US farmers as well as food aid programmes such as PL 480 on regional food security was also mooted for further study.
Ministerial Panel on Health and Development
A Ministerial panel led by Hon Dr. Leslie Ramsammy, Minister of Health, Guyana, Hon. John Junor, Minister of Health, Jamaica and Assistant Secretary General, Dr. Edward Greene, identified the importance of developing policies and programmes in support of the central role of health in development. Among the priorities are reduction of inequity in health linked to poverty, and income inequality. It stressed to need for revisiting the methods of financing health and indicated that the traditional safety net approach to alleviating poverty and health inequalities have been tried and have been proven to be short-term remedies and therefore, unsustainable.
Reference was made to the important WHO Commission Report on Macro-economics and Health (2001). However, it was noted that some of the issues more relevant to the Caribbean were not dealt with adequately in the Report. It gives priorities to the initiatives like the Global Fund that pays attention to a cluster of diseases such as HIV/AIDS, malaria and tubercolosis. This is a necessary but not sufficiently viable response, given the character of the problems in the Caribbean which differ from that of Africa. It was suggested that approaches, which gave prominence to health coverage for the poor, might be more sustainable. Similarly, more emphasis need to be placed on mitigating the debt burden in many of the small economies in the Caribbean which makes it difficult and sometimes impossible to embark on essential programmes for scaling up in a timely fashion, responses to epidemics such as HIV/AIDS.
Importance was placed on policies and programmes in support of the health in development thrust, as a complement to implementing the activities in the Nassau Declaration. It was considered that the dollar value for investment in health would translate into increased income especially for the poor. The social benefits of health coverage for the poor and the provisions for reproductive health, health education and other programmes that are associated with an intersectoral approach to planning and implementing appropriate health reform strategies should be reviewed. It was agreed that a Task Force to be commissioned and assigned responsibility to examine the main issues and strategies for implementing programmes at the regional and national levels, paying particular attention to shared services in specific areas. The core members of this Task Force will comprise PAHO/WHO, CDB, OECS, and the Health Economics Unit, UWI, coordinated by the CARICOM Secretariat.
Free Movement of Skills and Travel
The COHSOD was informed that a meeting of officials was held in March 2002 to discuss the operationalisation of the free movement of University Graduates, Artistes, Musicians, Sports Persons and Media Personnel by the end of June 2002. It was noted that the Meeting of Officials proposed that the free movement should be facilitated, even if the necessary regulations were not yet in place in a number of Member States.
The COHSOD noted that further work needed to be done with respect to the criteria for free movement by Sports Persons. The need to ensure, secure and authenticate skills certificates was highlighted, notwithstanding the fact that Musicians, Artistes and Sports Persons do not have academic qualifications, but skills obtained through practice and experience. The COHSOD also noted the difficulties relating to the introduction of a CARICOM Passport and urged that all efforts be made by Member States to fulfill their remaining commitments to facilitate early implementation of free movement of skills.
Facilitation of Travel and the Movement of Skills and Services Providers
This issue of the establishment of a Regional Accreditation Mechanism incorporating National Accreditation Agencies overarched by a Regional Accreditation Agency was analysed. The purpose of the mechanism was to deal with the accreditation, equivalency and certification of education and training programmes in order to facilitate the free movement of skills in the CARICOM Region.
National Accreditation Bodies have already been established in Jamaica, Saint Lucia, St Kitts and Nevis and Trinidad and Tobago. The Bahamas, Barbados, Belize and Guyana are in the process of establishing their national bodies. An Inter-Governmental Agreement establishing the Regional Accreditation Agency is in the process of being drafted.
Among the matters that call for urgent attention are the acceleration of efforts to put the remaining national bodies in place and a decision on the part of the OECS countries on the recommendation for the establishment of a sub-regional accreditation agency attached to focal points.
The COHSOD thanked the Government and people of Guyana for their usual warm hospitality and for the excellent arrangements put in place for the conduct of the business of the Meeting.
UN Special Session
The COHSOD was informed that on 9-10 May 2002, the United Nations Special Session on Children will be held in New York to facilitate an end of decade review of the 1990 World Summit for Children and World Declaration Plan of Action (POA). It was further noted that the session was expected to produce a global agenda with a set of goals and a POA to ensure the following three outcomes:
(i) the best possible start in life for all children;
(ii) a good quality basic education for all children; and
(iii) opportunities for all children, especially adolescents, for meaningful participation in their communities.
The COHSOD was reminded that CARICOM's position on children's issues was set out in the Kingston Consensus, which was approved at the Fifth Ministerial Meeting on Children and Social Policy in the Americas in October 2002 in Jamaica. The COHSOD noted that H.E. Ambassador Marjorie Taylor as the Secretary of the Secretariat Pro-Tempore of the Americas for Children, will submit a Report from the Fifth Ministerial Meeting to the Secretary-General of the United Nations.
The COHSOD agreed that the position of CARICOM must be fully articulated at the UN Special Session on Children and that the implementation of the Regional Plan of action as a follow-up to the Kingston Consensus was urgent.
Presentation from Costa Rica
The Meeting noted the general information provided on Costa Rica by its two representatives Ambassador Echeverria and Dr Juan Antonio Casas-Samora.
The Meeting was reminded of the Joint Declaration involving Central America, the Dominican Republic and CARICOM Heads of Government signed in Belize in February 2002 and was advised of the desire of Costa Rica to enter into a cooperation agreement with CARICOM countries on specific areas, including HIV/AIDS, non-chronic communicable disease, shared information and training of health professionals.
Caribbean Environmental Health Institute (CEHI) Sub-Committee of the Board
The COHSOD noted the presentation of the representative of CEHI concerning the Global Environmental Facility (GEF) Project on Integrating Watershed and Coastal Area Management in Caribbean SIDS (IWCAM). The Project emphasises three components consistent with the identification of aquatic environmental problems and other issues within the Region. The components of the Project reflected the need for development of cross-sectoral management approaches, institutional and infrastructural re-alignment, sectoral participation, capacity building, linkage to social and economic root- causes of environmental degradation and sustainability. The COHSOD indicated its support for the project, taking into account that most Member States are part of the SIDS Network.
