Hon. John Rahael Minister of Health of Trinidad and Tobago
Other Honourable Ministers
Honourable Chief Secretary and Other Representatives of the Tobago House of Assembly
Ms Carole Ainstey Manager/Director World Bank
Other Distinguished Guests
Members of the Media
Ladies and Gentlemen:
I am pleased that I can participate in this Opening Ceremony of the Tenth Council for Human and Social Development, especially since it is being held here in Tobago for which I have such fond and rooted attachments. It is also a pleasure for me to attend another COHSOD, which focuses on Health and the Environment, issues that are so vital to the sustainable development of our Region. The issue of the environment is particularly pertinent at this time as we and other members of the international community prepare for the International Meeting on the Barbados Programme of Action plus 10 (BPOA+10) on Sustainable Development of Small Island and Low Lying Coastal Developing States, to be held in Mauritius in August/September 2004.
Context
The context in which this meeting is taking place is one, which finds the Region at a critical juncture in the life of the Caribbean Community. We face enormous challenges both regionally and internationally. But we are also not without significant opportunities.
One of the main challenges is the attempt to make the Region fully ready by the end of next year, 2005, for the implementation of the Single Market and Economy. Indeed some of our Member States including Barbados, Jamaica and Trinidad and Tobago, have pledged to complete all necessary arrangements by the end of this year 2004.
One step to which we look forward later this year is the Inauguration of the Caribbean Court of Justice (CCJ) – a central pillar of the CSME – to be headquartered in Port of Spain. The enormity of the task involved in achieving the CSME was most comprehensively set out last Friday, 23 April in the Distinguished Lecture – the CSME, the Way Forward – by the Prime Minister of Barbados, the lead Head of Government with responsibility for the CSME. The Lecture is to be placed on the CARICOM Website – www.caricom.org – and it behoves us all to read it carefully.
The Region cannot afford however, to continue to talk about Community without rationalising its air transport system, not if we are to avoid disenchantment and fragmentation and thereby risk imperiling the achievement of the very flagship activity, the CARICOM Single Market and Economy.
Another major challenge is that which the Region’s slim international negotiating resources continue to encounter by having to be in three trade negotiating theatres, simultaneously. We are currently pre-occupied with negotiations in the World Trade Organization, the Free Trade Area of the Americas and with the European Union for an Economic Partnership Agreement. The latter entered an even more active phase with the launching in Kingston, Jamaica on 16 April 2004, of the Negotiations for the Caribbean’s own Regional Economic Partnership Agreement. The new global order demands of us such simultaneous engagement. There is little or no escape, except perhaps into oblivion.
A community, which aims to fulfill the highest aspirations of its people, must provide adequately for their co-mingling. This involves not only intra-community transport, but also intra-community communications as well. Current efforts for scaling up our information and communication technology are way behindhand if we are to strengthen our Community in the many various ways required at this time.
The building of linkages between our tertiary educational institutions and the more effective management of our regional institutions are particular areas in need of urgent upgrading. Much as a recent project on interconnectivity using information and communication technology received a very favourable response from the Fifteenth Inter-Sessional meeting of Heads of Government held in St. Kitts and Nevis at the end of March, the process is well behindhand and we cannot afford any delay in its implementation.
The Project, which is being undertaken in collaboration with several agencies including UNDP and the World Bank, is intended to provide new and more appropriate opportunities for sharing information via audio-visual and satellite communication. The implications for the work of the Community – be it the holding of meetings and conferences or of course offerings across the Region to various groups simultaneously – are enormous and are already dangerously late. They are expected to yield great cost effectiveness in the delivery of our regional programmes.
COHSOD Specific Challenges
Some of the challenges are more directly related to the special work of your Council. First, the level of crime right across the Region has in recent years reached startling proportions. This crime wave is compounded and reinforced by the trade in illicit drugs and arms and the heightening threat of international terrorism. Thanks to the work of the CARICOM Task Force on Crime and Security, the Region is developing a Regional Crime and Security Strategy. Not a moment too soon this task received a significant boost from a major presentation at the recently concluded Fifteenth Inter-Sessional Meeting of CARICOM Heads of Government in St. Kitts/Nevis, by the Prime Minister of Trinidad and Tobago, in his capacity as CARICOM Lead Head of Government with responsibility for Crime and Security.
The place of Border security, maritime arrangements and strengthening of the Region’s intelligence-sharing capacity and the training of our law enforcement authorities to cope with the new and intransigent crime wave, must be major priorities in any such strategy. And it is important to note that crime and violence, whether resulting in morbidity and/or morality, eventually translate into a health and development issue.
One of the well-known major challenges for the Community is the HIV pandemic. A special dimension of this battle is the urgent necessity to resolve the current impasse within the Community with Haiti, in the post-Aristide era, this I know is very important to this Council as Haiti’s HIV/AIDS programmes are high on the agenda of the Pan Caribbean Partnership and the European Union sponsored project to CARICOM on institutional strengthening for HIV/AIDS and other STDs.
At the recently concluded meeting of the Council for Foreign and Community Relations in Barbados last week Foreign Ministers reiterated the affirmation of the Conference of Heads of Government that Haiti remains a Member of the Caribbean Community and that CARICOM reaffirms its commitment to contributing within the limits of its capacity to the advancement of the socio-economic well-being of the people of Haiti. Already CARICOM is establishing a Task Force intent on pursuing this objective. Hence the urgency to resolve the political situation so as to remove all obstacles to the effective discharge of this commitment.
On reflection, the integrating theme of COHSOD – Investing in Human Resources with Equity – provides a very valuable frame of reference for addressing some of the main challenges to which I have referred. As the main objectives of the programmes that are being promoted under this theme are to design policies that make our labour force more educated and trained, and our populations, healthier and wealthier and more capable of competing in the global arena. I am therefore glad that despite the difficulties with the approach, this Council continues to promote an intersectoral agenda that, for example, links health (and indeed education) to development.
In this regard, having attended the meeting of this Council two years ago when you focused on health and development, I am pleased to note that you have moved forward on several issues including the review of regional institutions and the Commission for Health and Development, chaired by Sir George Alleyne. I look forward to the continued and even speedier advancement.
It is my expectation that the institutional review would move beyond the proposals for the re-definition of priorities toward some concrete notions of the re-configuration of governance and the financing options for the sustainability of these institutions. A major outcome must be to ensure that reforms help institutions to perform their roles more effectively and efficiently in response to the growing challenges to which the Nassau Declaration – The Health of the Region is the Wealth of the Region -refers.
We must for example be in a better position in this immediate period to adequately finance the programmes that are associated with the Caribbean Cooperation in Health (CCH), for which CARICOM shares responsibility with PAHO. The focus in CCH II includes Mental Health, Health and Family Life, the Non Communicable Chronic Diseases – diabetes, hypertension and heart disease – that are increasingly afflicting our societies. We need resources to strengthen the capabilities of our national health laboratories and in so doing, we must re-think the relationship between core functions of national regional facilities, and where necessary, decentralize or rationalize those functions.
In this regard, we need to seek to improve the Caribbean Regional Epidemiology Centre’s (CAREC’s) surveillance capability; enhance the Caribbean Health Research Centre (CHRC) research potential; and the training programmes at the University of the West Indies (UWI) and other Universities in the Region. We must also guarantee the efficiency of the Caribbean Regional Drug Testing Laboratory (CDRTL) and the OECS Pooled Procurement Service.
Focusing on institutional strengthening must be part of the overall strategy of development, of which streamlining our accreditation procedures and health information systems are important dimensions. This type of institutional strengthening is a prerequisite for the Region to be competitive in the international arena of trade in health services, which fall under the TRIPs agreement that you are also addressing at this meeting.
Making Partnerships work
This brings me to the wider and more critical collaboration with and involvement of economists and legal specialists in the analysis of health and development issues. We anxiously await the results of the research and policy round tables that form an essential part of the activities of the Caribbean Commission on Health and Development which, besides Sir George, includes some of the leading minds in the Region. I look forward to the findings of their endeavours but know up front, that it is necessary for the Commission to assist the Region in determining two interrelated aspects of health financing:
1. Where is the money to come from for the provision of health?
2. What is the most efficient allocation among health priorities, in the context of resource constraints?
It seems to me that although there is need to generate policy that impacts on national health systems, the logic of strong regional facilities to drive the process through sharing and pooling of resources is unassailable. The prerequisites to which I have already referred are the use of modernized information and communication, and more efficient regional transportation.
PANCAP: Great Expectations
One example of the results of regional collaboration is the benefits and the potential of the Pan Caribbean Partnership against HIV/AIDS. PANCAP is an experiment in bringing together a cross section of partners in a network to tackle a pandemic. The regional systems have been defined and the process for implementing activities developed around the Caribbean Regional Strategic Framework.
However, PANCAP now has to deliver at the levels of the people living with HIV/AIDS (PLWA). It must focus on methods for preventing the spread of the disease especially among the youth, who are disproportionately infected. It also has to focus on the reduction of stigma and discrimination. However, the most important immediate challenge to PANCAP in my view is to collectively move toward the reduction of prices for the anti-retroviral drugs and, thereby increase accessibility by people living with HIV/AIDS.
We know that the Clinton Foundation is a Partner of PANCAP. We hear that the Foundation has managed to broker deals for various regions and countries including the Bahamas. We also know that Brazil is one of the leading producers of ARVs in our region and we hear that Guyana can now produce ARVs. Why, therefore, are we not seeing more results on this front in the Caribbean? I urge COHSOD to help us to forge ahead without more delay.
CARICOM is pleased to be accorded the responsibility for coordinating this PANCAP endeavour. The process has been a fairly intense one and those of us that are involved in coordinating regional projects have a good idea of what this means. But PANCAP has been fortunate to have willing partners that have contributed resources to assist in implementing the Caribbean Regional Framework. Among them are the European Union; CIDA; UASID; the IDB; UNAIDS; UNDP; DFID; GTZ; KFW; the global fund and the World Bank.
Acknowledgements
I wish to take this opportunity to express our deep gratitude for the leadership given to this process by Dr. The Honorable Denzil Douglas, Prime Minister of St. Kitts and Nevis, CARICOM’s Head of Government with Lead responsibility for Human Resources, Health and HIV/AIDS. I also wish to thank you Ministers and other officials, for your unstinting support. My only request is that if we truly believe in the value of PANCAP, we give due recognition and more publicly endorse its role and functions in the scheme of things.
I am pleased that at this opening ceremony of this COHSOD and in the presence of the Ministers of Health and other officials, we would witness the signing of an agreement for an International Development Association Grant to CARICOM for PANCAP with the Representative of the World Bank. On behalf of CARICOM I would like to particularly thank Mr. Patricio Marquez, Team leader on the World Bank side, for the tremendous role he played in bringing this project together. I could see from your agenda that there is much work to be done. I wish you a very successful meeting.
I thank you.
