Today we gather in this auditorium of one of the most enduring and respected organizations in the Hemisphere of the Americas, to discuss and take forward the agenda for establishing the Caribbean Public Health Agency. I am sure, that in time, the delegates to this Partners Meeting will look back with pride to our individual and collective roles in the establishment of a landmark institution.
We who have been involved in this process know the challenges that have been encountered. There was the issue of overcoming the skeptics across the spectrum of the region and the international community, of the vision and viability the Caribbean Public Health Agency (CARPHA). There was the need to convince others of the feasibility of consolidating five (5) institutions into one Agency. This is despite the evidence from a range of objective studies by the most credible sources and the careful scrutiny of the recommendations from these studies by our technical officers and decision makers. Evidence shows that the configuration of the public health response by the existing health institutions was not the most efficient.
There were also the lessons from around the world. There were the debates within the World Health Organization on the ideals of health for all and within PAHO on equity in health. The Report of the Caribbean Commission on Health and Development (2006) underscored the need for revamping the Region’s approach to public health and helped to shape the underlying philosophy of CARPHA. In addition, the experiences of Canada, the UK, USA and European Union have provided useful guidelines for public health approaches. In the European Union for example, notwithstanding the long established health systems within most of the member states, mechanisms for cooperation in health are being promoted including the European Observatory in Health Systems and Policies, the Association of Schools of Public Health in Europe (ASHER), the European Health Management Association and the European Public Health Alliance. These models notwithstanding, our biggest challenge was coming up with a formula that best fits the needs and peculiar circumstances of the Caribbean Region.
In so doing, it is important for us to place CARPHA in context. The Caribbean Community is no longer an experiment. It is a reality. It was constructed on the basis of a treaty – The Treaty of Chaguaramus in 1973 – which has evolved through amendments over the past 38 years. While the establishment of the Caribbean Single Market and Economy is the acknowledge flagship of the integration movement, it is not the only yard stick by which to measure the progress made in regional integration. The Treaty of Chaguaramus has identified three pillars of integration including Trade and Economic integration, Foreign Policy and Community Relations and functional Cooperation replaced by Human and Social Development, while acknowledging Functional Cooperation as a cross cutting element. More recently, a fourth pillar, Crime and Security has been added.
Indeed, it must be recognized that long before the trade and economic integration took root, it was in the areas of health, education and culture that the Caribbean Community made its greatest impact. The activities in these areas, singly and collectively, continue to connect the Caribbean people, including the Caribbean Diaspora and to project distinctiveness about the Caribbean in the global arena. In particular, the area of health cooperation has been an outstanding illustration of what can be gained by acting collectively to achieve outcomes that benefit all the citizens across the region, minimizing the inequities and maximizing the efficiencies. There is no better modality, in principle, than the Caribbean Cooperation in Health (CCH) initiative. The weaknesses of the CCH identified in the various studies have to do with a failure to consistently implement its priorities due to a lack of a consolidated system and in many cases because of a lack of resources.
The Caribbean Public Health Agency is conceived as a response and a remedy to this situation. It is seen as an example of functional cooperation: as a mechanism by which the health of the people of the Caribbean will be promoted and protected from disease, injury and disability, thereby fostering the wellness revolution enunciated in the Port of Spain Declaration, unifying to fight the non-communicable diseases (2007). It is also intended to advance the realization, embodied in the Nassau Declaration (2001), the Health of the Region is the Wealth of the Region. In this regard, it is expected to highlight the opportunity costs of pursuing the public health functions in a consolidated way, rather than as disparate entities that duplicate efforts and dilute the public health objectives for which they were designed.
This is by no means to suggest that our existing public health institutions have not served the region well. In many cases they have functioned under circumstances that challenged the creative imagination and management capability of their respective directors, which we celebrate and which I ask you to duly recognize.
As we move forward with the implementation of the Caribbean Public Health Agency (CARPHA), we note that the surveillance and laboratory functions of the Caribbean Epidemiological Centre (CAREC), would constitute the core of the Agency. In this regard, we are deeply grateful that the Government of Trinidad and Tobago is committed to supporting the relocation of the CAREC facility and thereby providing a home for the agency’s core activities.
Over the years the Caribbean Food and Nutrition Institution (CFNI) has provided the essential regional guidelines and directions for Member States. Its integration into CARPHA, for example, would foster greater synchronization of the laboratory functions while enhancing its ability to contribute to the programmes and policies, including training of public health specialists in the areas of food and nutrition. In the area of environmental health, many of the Caribbean Environmental Health Institute’s (CEHI) programmes that focus on water and sanitation as well as the links between climate change and health will be maintained, but integrated more specially to respond to the public health requirements.
The functions of the Regional Drug Testing Laboratory will remain intact but again would be more clearly aligned to the overall mandate of the integrated agency. In the case of the Caribbean Health Research Council, , its research and development capabilities are likely to be enhanced and expanded under the consolidated agency. Its scientific committees and its annual conference could help to transform the ethic within CARPHA with an infusion of international cooperation, thereby stimulating dynamism of Caribbean public health through its linkages with the regional and research centres and experts in the international arena.
This is merely a schematic illustration of the CARPHA functions and organization which no doubt would be further elaborated on, in the substantive presentations. But an essential feature of CARPHA is the rationalization of resources which may yet provide a model of how the Caribbean Community shapes the future of over 25 regional institutions. These span the gamut of services ranging from meteorology, disaster management and climate change; through to quality and standards, examinations and accreditation; to fisheries, agriculture and crime and security. A review of these institutions together with that of the Caribbean Community Secretariat is currently being undertaken as part of a comprehensive plan to increase the effectiveness and efficiency of the conduct of Community’s business.
The leaders of our Region are quite aware that the global economic crisis has engendered a new economic order and escalated a changed political landscape, with deep structural barriers and access to overseas development assistance (ODA). Hence there is need to revisit our approach to partnership and resource mobilization.
This is why in convening this Partners Meeting, the Community has called for a resource mobilization and sustainability plan that illustrates the commitment of its Member States to maintain their quota contributions. This together with PAHO’s pledge to maintain the level of its support to the regional institutions will no doubt guarantee the delivery of basic public health functions during CARPHA’s transitional period between now and 2014, and set the stage for a solid foundation in the periods to follow.
CARPHA is being inaugurated at a time when the global debates on the new deal in HIV as well as the new approaches to NCDs are taking place. In both cases the role of public health in reducing the impact of the communicable and non-communicable diseases is being identified as a critical component of sustaining economic development. The costs of adequately responding to each of these sets of diseases are enormous. CARPHA therefore provides the possibility of being that bridge for channeling scarce resources and fostering shared responsibility and institutionalizing effective management.
This is therefore the context in which we invite partners to collaborate in accelerating CARPHA’s implementation plan. The tasks before us are many but not insurmountable. The immediate ones revolve around building up the laboratory facilities, strengthening its surveillance capabilities, increasing the cadre of public health professionals, enhancing public health leadership, supporting research and development and investing in social marketing techniques to broaden the understanding of the public health mission and generally set the stage for enhanced public/private sector partnership.
The CARPHA Steering Committee, chaired by Dr. Leslie Ramsammy, Minister of Health, Guyana and Chair of the Council for Human and Social Development, together with the CARICOM Secretariat and PAHO groups, have worked tirelessly since the last Partners Meeting in June 2010 to move the implementation process forward. I wish to commend them. On behalf of the CARICOM Heads of Government, I also wish to express my gratitude to Dr. Mirta Roses, Director of PAHO and her staff for their invaluable contribution to this process and for their gracious hospitality in hosting this meeting. We are also aware of the vital role being played by the Government of Trinidad and Tobago which has undertaken to continue to host CAREC, the core of CARPHA. In addition, we wish to recognize the support and outstanding contributions to this process made by the Public Health Agency of Canada as well as the ongoing collaboration of the UK Department of Public Health and the National Social Marketing Company of the UK. I also must place on record the deep commitment made by the European Commissioner for Development to support CARPHA and we are glad that he has accepted our invitation to attend the Heads of Government Meeting on 1 July 2011 in St Kitts and Nevis at which the ceremonial signing of the intergovernmental Agreement establishing CARPHA as a legal entity will be done.
Let this Partnership Meeting therefore provide a further impetus for us to truly say that we are gathered here today on 13 June, 2011 during the period designated by President Obama as Caribbean American Heritage Month. Let us use this occasion to rewrite Caribbean public health history. Let us join in amplifying the inspiring sentiments of the American writer women Sonia Jones:
“We must remember that one determined person can make a significant difference, and that a small group of determined people can change the course of history.”
