The Tenth Meeting of the Council for Human and Social Development (COHSOD) of the Caribbean Community (CARICOM) was convened at the Hilton Tobago Hotel, Scarborough, Trinidad and Tobago on 28-30 April 2004 under the Chairmanship of the Hon. John Rahael, Minister of Health, Trinidad and Tobago and under the theme, Investing in Human Resources with Special Reference to Health, Sustainable Development and the Environment.
In attendance were: the Hon. John Maginley, Minister of Health, Sports and Youth Affairs, Antigua and Barbuda; the Hon. Jerome Walcott, Minister of Health, Barbados; the Hon Sylvia Flores, Minister of Human Development, Belize; the Hon. Anne David-Antoine, Minister of Health, Social Security and the Environment, Grenada; the Hon. Dr. Leslie Ramsammy, Minister of Health, Guyana; the Hon John A. Junor, Minister of Health, Jamaica; the Hon. Idabelle Meade, Minister of Education, Health and Community Services, Montserrat; the Hon. Damian E. Greaves, Minister of Health, Human Services, Family Affairs and Gender Affairs, Saint Lucia; and the Hon Douglas Slater, Minister of Health, St. Vincent and the Grenadines.
Representing the British Virgin Islands was the Hon. Irad Potter, Minister of Health. The Bahamas was also represented.
OPENING CEREMONY
The Opening Ceremony was chaired by Dr. Edward Greene, Assistant Secretary-General, Human and Social Development, CARICOM Secretariat who, in welcoming Delegates, thanked them for making at such short notice, the necessary travel adjustments as a result of the change in venue.
Dr. Greene referred to the inter-sectoral agendas of COHSODs VII, VIII and IX that were held since the meeting of the Council, in April 2002, which had focussed on health and development. In so doing, he pointed to the cross-sectoral nature of COHSOD and to its mandate of bringing coherence to the functioning of the social sectors and to complementarity between the economic and human dimensions of the Region's development. He stated that despite the challenge that might be posed by COHSOD's cross-sectoral nature, particularly at the national level, it would be a retrograde step to revert to a process of standing committees for each of the eight segments of the human and social development programme.
In pointing out the synergies between the sectors of the COHSOD, Dr. Greene highlighted a number of activities in which the Directorate has been involved including: resource mobilisation and expanded activities for the Pan Caribbean Partnership against HIV/AIDS (PANCAP); a new strategic emphasis on youth and development; crime and security; consolidating work on gender mainstreaming; putting in place the structures of accreditation and standardisation; and, in the area of culture, spearheading discussions designed to ensure that cultural products yield dividends for the Caribbean's artists.
The Hon. Orville London, Chief Secretary, the Tobago House of Assembly in brief remarks, stated that he was heartened by the fact that this COHSOD placed emphasis on organising and implementation. He urged that even more close attention be paid to the fight against HIV/AIDS and challenged the Meeting to consider the mechanisms and strategies implemented in those countries that have been able to make an impact in this fight.
H.E. Mr. Edwin Carrington, Secretary-General, CARICOM in his address, referred to the many challenges and opportunities for the Community as it endeavours to implement the CARICOM Single Market and Economy (CSME) in the context of new global developments. He noted that the integrating theme of COHSOD, Investing in Human Resources with Equity, provided a very valuable frame of reference for addressing some of the main challenges to the socio-economic well-being of Caribbean peoples. He viewed the main objectives of the programmes promoted under the theme as the “design of policies that make our labour force more educated and trained, and our populations, healthier and wealthier and more capable of competing in the global areas.” He expressed pleasure that despite the difficulties, the Council continued to promote an inter-sectoral agenda that, for example, linked health (and indeed, education) to development.
Dr. Carrington noted that the Council had moved forward on several issues, including the review of regional institutions and the Caribbean Commission on Health and Development (CCHD) chaired by Sir George Alleyne, and looked forward to the continued and even speedier advancement of these issues.
In his remarks, the Hon. John Rahael, Minister of Health, Trinidad and Tobago welcomed Delegates to Trinidad and Tobago and reiterated his Government's recognition of the vital role of the COHSOD in addressing the human condition by placing people at the centre of its development strategies.
Touching on some of the major issues on the Agenda, Mr. Rahael indicated that all were of critical importance to Trinidad and Tobago and to the Region, as in almost all these areas, a regional response was required. He stated that if the Region were serious about establishing a single market and economy, there must be commitment to the concept of free movement of capital and labour and to the issue of accreditation and certification. He added that Caribbean Governments must now deal aggressively with the HIV/AIDS epidemic and a more collaborative approach must be taken. In this respect, he noted that the Government of Trinidad and Tobago had accelerated its approach to the HIV/AIDS epidemic.
He pointed to the significance of this Tenth Meeting of the COHSOD placing emphasis not only on matters related to health, but also on the environment and sustainable development. “One of the major challenges the Region faces is the management of its natural resources and ecologically vulnerable ecosystems, such as fresh water, land and forests. The challenge for the Region is to provide infrastructure and basic social services including access to safe drinking water and adequate sanitation,” he stated.
Dr. Mirta Roses Periago, Director, Pan American Health Organisation (PAHO) in her remarks, noted the need for multi-sectoral involvement in achieving sustained health. She referred to the cooperation and collaboration between PAHO and CARICOM in defining the way forward for such collaboration in the quest for equity in health. She also pledged the support of PAHO to the reordering of the Caribbean Cooperation in Health Initiative (CCH), one of the two fundamental principles of the Nassau Declaration which addresses some of the major health conditions such as Non-communicable Diseases, Mental Health, Family Life Education (FLE) and the training of health professionals. She noted that it is vital for the Region to succeed in the implementation the CCH.
WORLD BANK/IDA GRANT TO PANCAP FOR HIV/AIDS
One of the important features of the Opening Ceremony was the signing of the CARICOM- World Bank/International Development Association (IDA) Grant Agreement for the PANCAP. H.E. Mr. Edwin Carrington, Secretary-General, CARICOM signed on behalf of the Community and Ms. Caroline Anstey, Director, Caribbean Department, Latin America and the Caribbean, World Bank, signed on behalf of the World Bank. In her remarks she stated that PANCAP was already “an international best practice influencing other regions…” and commended the Caribbean countries for the accelerated approach in combatting this pandemic. In this regard, she singled out a number of Caribbean Heads of Government, including the Hon. Dr. Denzil Douglas, Prime Minister of St. Kitts and Nevis for showing extraordinary leadership in the response to this challenge and reiterated the World Bank's support for the Caribbean's effort to address in an effective manner, the HIV/AIDS challenge.
The Grant Agreement, in the sum of US$9M, will be used to support the work of the CARICOM-led PANCAP.
IMPLEMENTATION OF THE NASSAU DECLARATION
In the assessment of the status of implementation and determination of the process of the Nassau Declaration, resource mobilisation and establishing a nexus between the Nassau Declaration and the United Nations Millennium Development Goals (MDGs) were among the challenges identified. The COHSOD requested that the CARICOM Secretariat continue its efforts to mobilise resources for the implementation of the CCH; strategic plans for Non-Communicable Diseases and Mental Health. The COHSOD agreed that social statistics capacity should be strengthened at the national and regional levels.
The COHSOD also agreed that attention be given to: the development of MDG indicators which reflected the realities of CARICOM and are more responsive to the needs of Member States; and to disaggregated data which allow monitoring and evaluation of the status of vulnerable and at risk groups, as well as the targetting and assessment of the impact of programmes for these groups.
The COHSOD requested the Secretariat to examine the proposal for the sharing of services and the establishment of Centres of Excellence with a view to utilising the capacity available in Barbados.
CURRENT STATUS OF IMPLEMENTATION AND
DEVELOPMENTS IN THE REGIONAL STRATEGIC RESPONSE TO HIV/AIDS
PANCAP
The current status of the PANCAP and developments in response to HIV/AIDS, as well as new projects and their implications for Member States were examined and a number of challenges identified. These included: cost-effectiveness and efficiency of implementation of the Caribbean Regional Strategic Framework (CRSF), through Strengthening the Institutional Response to HIV/AIDS/STI in the Caribbean (SIRHASC) and the PANCAP; the need to increase treatment to Persons Living with HIV/AIDS (PLWHA); and the acceleration of the development of legislation related to Ethics, Human Rights and reduction of stigma.
The COHSOD agreed to a merger of the PANCAP and SIRHASC units by January 2005 to reduce administrative and financial costs. It also agreed that more efforts would be made to accelerate access to treatment and care and that Member States should promote (accelerate) Law, Ethics and Human Rights programmes at the national level to reduce stigma and discrimination as well as contribute to the drafting of regional legislation. The COHSOD further agreed that Member States should identify their needs and request assistance from CARICOM/PANCAP and the regional institutions.
SIRHASC
In respect of SIRHASC, the COHSOD noted the programmes in training, research and outreach and agreed that the work programme should be prepared to reflect the “outcomes” as indicators of success. The COHSOD also agreed that there should be continued engagement of the Universities of Guyana and the West Indies in project activities. It also agreed that a joint approach should be taken by CARICOM/PANCAP, the Caribbean Regional Network (CRN+) and national authorities to expand national networks of PLWHA.
Care and Treatment Programmes
In respect of Care and Treatment Programmes and the implications for scaling up the response, the COHSOD agreed that the highest priority should be given to negotiation for lower prices for laboratory services.
CARIBBEAN COOPERATION IN HEALTH INITIATIVE (CCH II)
The COHSOD reviewed the Caribbean Cooperation in Health Initiative II (CCH II) – the policy framework for health in the Region. It noted that there has been limited advancement with respect to non-communicable diseases and mental health, mainly due to lack of funds. The COHSOD noted that a proposal for a phased approach to these issues has been prepared by the Secretariat and Phase I activities, with budgets, have been identified. A working group established by the COHSOD to consider this issue recommended that a Task Force be established to review the issues that should form the basis of CCH III (the successor to CCH II) and strategies for its implementation.
MANAGED MIGRATION
In discussing the management of the migration of nurses, the COHSOD recognised the economic cost to the Region of the loss of its investment and training, and the need to develop strategies and mechanisms to recruit and retain nurses and other health professionals. It was pointed out that between 2002 and 2003, the Caribbean had lost some 900 nurses to the United Kingdom and North America.
The COHSOD supported a review of the existing policies to ensure that they are consistent with enhanced recruitment and retention of nurses in the Region and agreed that there should be regional representation at the proposed Commonwealth Secretariat Meeting on Trade in Services, with specific reference to Mode IV, white is scheduled for October 2004. It also endorsed the Declaration on Nursing issued by the International Nurses Conference on Managed Migration held in Barbados in 2004.
THE CARIBBEAN COMMISSION ON HEALTH AND DEVELOPMENT (CCHD)
The COHSOD endorsed the process outlined by Sir George Alleyne, Chairman of the CCHD, which includes 12 eminent professionals and focusses on the links between health and macro-economic policies. The activities of the CCHD include 11 policy research papers, policy round tables and meetings with a cross section of stakeholders, the results of which will be included in the CCHD's report to the Conference of Heads of Government in July 2005.
TRADE RELATED INTELLECTUAL PROPERTY RIGHTS (TRIPS) AND PUBLIC HEALTH
On the issue of maximising flexibilities under the TRIPS Agreement to access pharmaceuticals for the Region for HIV/AIDS and Non-Communicable Diseases, Ministers of Health and other health officials were deeply concerned that the cost of Anti-Retroviral drugs (ARVs) could increase significantly by as early as January 2005, when the TRIPS Agreement is expected to be implemented. They noted that under the TRIPS Agreement, countries such as India, from which the Region has been accessing ARVs, would have to decide on the position they will adopt regarding the patenting of ARVS. In this regard, the COHSOD mandated the establishment of a technical working group to review studies to address the technical and political concerns of the Region as they relate to TRIPS. The COHSOD also agreed that a pilot study should be conducted to determine the challenges and barriers relating to implementing the TRIPS Agreement
The COHSOD further agreed that the Technical Working Group would act as an advisory body to the Caribbean Regional Negotiating Machinery (CRNM) in the development of regional negotiating positions in respect of pharmaceuticals and TRIPS.
HEALTH AND THE ENVIRONMENT
The HEMA Process
The COHSOD noted developments in the context of the Health and Environment Ministers of the Americas (HEMA) process. The Ministers noted the importance of raising awareness and soliciting support for implementation of the HEMA Agenda and to the challenges which included agreement on priorities for the Caribbean and the mobilisation of resources for the implementation of Caribbean projects.
The COHSOD endorsed the work of the HEMA Task Force and agreed to support the continuation of the initiative.
CAPACITY-BUILDING FOR THE INTEGRATION OF ENVIRONMENTAL HEALTH KNOWLEDGE INTO DECISION-MAKING
In discussing the issue of capacity-building and its challenges of inadequate financial resources, capacity and capability and poor access to data, the COHSOD supported the approach by the Caribbean Environmental Health Institute (CEHI) to build a partnership with a number of regional institutions and extra-regional organisations.
INTEGRATING WATERSHED AND COASTAL AREA MANAGEMENT (IWCAM) IN CARIBBEAN SMALL ISLAND DEVELOPING STATES (SIDS)
On the issue of planning for the management of watershed and coastal areas, the COHSOD noted the progress made in the development of the Project and the efforts at resource mobilisation through the Global Environmental Facility (GEF). It also noted the key role that has been identified for CEHI in the IWCAM and agreed to provide support, as necessary, for the successful implementation of the project.
Climate Variability and Change
The COHSOD considered the impact of climate variability (CV) and climate change (CC) on human health and the challenges to determining these as a result of a lack of adequate systems for linking CV/CC to health, as well as inadequate resources to execute surveillance.
The COHSOD acknowledged the need for greater attention to be directed to the potential impact of climate variability and change on sustainable development, and the implications for the Caribbean.
Barriers to Trade: Health and Environmental Issues
The COHSOD examined the relationship between health, the environment and trade and the challenges of control of infectious diseases, food safety, among others. The capacity of Health Ministers to advise on trade issues as they related to health and the environment and the question of tasking the CARICOM Secretariat and the Caribbean Regional Negotiating Machinery (CRMN) to advise on such matters were also considered.
Solid Waste and Waste Water Management
On the issue of improving the management of solid and liquid waste in the Caribbean, the COHSOD noted the establishment of a Forum for the exchange of expertise among regional waste management professionals; the development of a directory of appropriate technology for waste management; and on-going training in areas including sewage treatment plants operation and maintenance. The COHSOD noted with pleasure the completion of the waste management programme in the OECS.
The COHSOD recognised that many challenges still existed, including disposal of radioactive waste. The Ministers also discussed models for biomedical waste management with a focus on HIV/AIDS used in Guyana and Barbados. It noted the challenges and supported the exploration of further opportunities for improving waste management.
AIDS and Occupational Safety and Health
The COHSOD acknowledged the invitation extended by Guyana to examine that Member State's World Bank project for medical waste disposal. It also endorsed and supported the development of a Regional Strategy and Programme for Biomedical Waste Management, with specific reference to HIV/AIDS.
REVIEW OF REGIONAL HEALTH INSTITUTIONS
Caribbean Food and Nutrition Institute (CFNI)
In highlighting the progress made in implementing the CFNI's designated four areas of functional engagement with member countries, viz., planning and coordination; human resource development; surveillance and research; and promotion and dissemination, the COHSOD noted developments with respect to upgraded food and nutritional policies; school feeding programmes; and nutrition modules for Master's in Public Health (MPH) and Bachelor of Science (B.Sc.) degree programmes. The COHSOD also noted the generic programmes to monitor obesity, food consumption and information and communication material.
Caribbean Epidemiology Centre (CAREC)
The COHSOD recognised the need for a coordinated regional approach to resource mobilisation and for the identification of better country objectives and principles in respect of the CAREC programme.
Caribbean Health Research Council (CHRC)
The COHSOD noted the progress made in implementing the four performance areas in fulfilment of the mission and vision of the CHRC, viz., advocacy, research, capacity-building and financial sustainability.
REGIONAL FOOD SECURITY
Caribbean Agricultural Health and Food Safety Agency (CAHFSA)
The COHSOD received a status report on the work being undertaken in relation to the CAHFSA, which included building inter-sectoral linkages/collaboration, an inter-agency and a multidisciplinary approach to strengthening the national agricultural health and food safety system.
CARIBBEAN WORLD CUP CRICKET (CWC) 2007
The COHSOD noted the establishment of a Technical Advisory Group (TAG) to advise the Prime Ministerial Sub-Committee on Cricket, on the conditions that countries are required to satisfy with respect to sunset legislation, transportation and accommodation, security, and health and emergency services.
The COHSOD agreed to establish a Sub-Committee on Health and Emergency Services to collaborate with CWC 2007 on meeting the International Cricket Council (ICC)/CWC 2007 requirements by June 2005. In this regard, several major areas were identified and it was agreed that an action plan would be formulated to guarantee the Region's preparedness for the delivery of health and emergency services during the CWC 2007. These include medical facilities, food security, smoking and liquor policy at stadiums and disaster preparedness.
CARIBBEAN ASSOCIATION OF MEDICAL COUNCILS (CAMC)
The Hon. John Junor, Minister of Health, Jamaica and Chairman of the Ministerial Task Force on CAMC reported on the functions, constitution, legal status and examination process of the Caribbean Association of Medical Councils (CAMC).
The COHSOD endorsed recommendations that the CAMC be the recognised authority for medical practice, networking with National Medical Councils and development of guidelines for registration. The COHSOD recommended that the CAMC be authorised to advise National Medical Councils (NMCs) on disciplinary matters and collaborate with the Accreditation Authority in accreditation of skills.
CARIBBEAN ACCREDITATION AUTHORITY FOR MEDICAL AND OTHER HEALTH PROFESSIONALS
The COHSOD noted with pleasure the progress being made toward the establishment of the Authority and the plans for its formal launch at the end of May 2007.
The COHSOD urged Member States to make their contributions to this Authority in a timely manner and in keeping with the agreement of the Conference of Heads of Government at its Special Meet9ing in Saint Lucia in October 2003.
ACKNOWLEDGEMENTS
The COHSOD, noting that Mr. Hamid O'Brien, Permanent Secretary, Ministry of Health would soon be retiring from service, extended best wishes and commended him for the invaluable role he has played in the various forums of the Community.
The COHSOD also expressed gratitude to the Government and people of Trinidad and Tobago for their warm and generous hospitality and for the arrangements put in place for this meeting. The COHSOD specifically expressed its appreciation to the Chief Secretary and Staff of the Tobago House of Assembly whose efforts also contributed to the success of the Meeting.
30 April 2004
Hilton Tobago
Trinidad and Tobago
