The idea of the Commission for Health and Development arose out of the concern that the Report of the WHO Commission on Macro-economic and Health, though it provided a dynamic frame of reference did not adequately portray the Caribbean situation.
Hence the Ministers of Health at COHSOD VII in April 2002 recommended that a task Force be established and the Heads of Government in July 2002 mandated the establishment of the Caribbean Commission on health and Development. In January 2003 the Commission was established with the Support of the WHO- Macro economic Committee.
Tribute is to be given to the 12 Commissioners under the leadership of Sir George Alleyne for honouring their obligations and providing such a highly commendable document that is a landmark for all in the field of development.
The Commission's work was carried out in a period of great ferment over the development and application of a variety of international agreements. Among them the MDGs (2000), the UNGASS Declaration (2001), the Global Fund for HIV/AIDS/TB and Malaria (GFATM) (2002) and the establishment of the 3-Ones Principle enunciated by UNAIDS (2003) of comparable importance to us is the Nassau Declaration (2001), was a watershed in the history of the Community. Heads of Government for the first time acknowledged the critical role of health in development.
The Heads of Government declared further that they were “cognizant of the critical role of Health in the economic development of our people and [were] overawed by the prospect that out current health problems, especially HIV/AIDS may impede such development through the devastation of our human capital”.
The declaration specifically mandated that attention be given to:
– re-orienting and restructuring health services;
– increasing access to health services; and
– placing emphasis on equity and health.
It went beyond these precepts to recommend an operational framework for implementing priorities resting on two pillars:
– the Caribbean Cooperation in Health (CCH) which was inaugurated in the early 1980s; and
– the Pan-Caribbean Partnership against HIV/AIDFS(PANCAP) that was established in 2001 to deal specifically with the consolidated regional/accelerated approach to HIV/AIDS
The Nassau Declaration captured within its ambit a range of health imperatives for managing and pre-empting the ill effects of:
– chronic and non-chronic diseases;
– Human resource requirements;
– Epidemiological tools; – Institutional strengthening; and
– Governance arrangements.
It would be useful to examine the Nassau Declaration in some detail in an effort to assert the premises, the historical connections, the contextual basis of its assumptions and the intent of its trajectory “that propels health to the centre of development”.
It is however quite evident from a reading of the Nassau Declaration that the Heads of Government challenged us to formulate regional mechanisms (CCH and PANCAP) to further the cause of health and enhance the viability of the Region's health.
The intent of these regional mechanisms no doubt was to provide systematic guidelines for national programmes.
While the CARICOM Community was given the impetus by the revision of the Treaty some of its main elements are very pertinent:
– unrestricted movement of persons and capital;
– harmonizing macro-economic policies and trade policies;
– operationalising policies for sectoral development; and
– providing for the establishment of enterprises.
Within the Revised Treaty, Chapter 4 deals with sectoral development to health as one of the sectors but does not spell out the methods for functioning as a sector in the same way as it does for agriculture and transportation.
However, the Revised Treaty does establish the conditions for the Nassau Declaration to be implemented in such a way that health is fully established and defined as a sector of development within the CSME.
The Nassau Declaration and this Report provide us with a coordinated approach/the basis of a coherent strategy for health and development. Working with the messages of this Report gives a golden opportunity to operate with the solidarity of a “rock” in a violent sea of globalization rather than as mere pebbles adrift and at the mercy of others”
The findings in the Report intersects with elements of the CCH. The 13 studies that comprise the Report deal with many of the concerns within CCH II. This Report sets the stage for a transition from CCH II and III.
Without pre-empting the discussion of Ministers on the Report, I wish to end with a couple of suggestions on “Where we go from here” –
– A core number of 4-5 Commissioners should be retained as an Advisory Group to collaborate with CARICOM/PAHO in promoting and defining the major scope of the transition from CCH II – CCH III. In this regard, the sourcing of support for CCH II – CCH III will be based on empirically-based policy options resulting from the Report.
– Just as the CCHD was established to make Caribbean specific analyses so too consideration should be given to the execution of National Health and Development Studies.
In the final analysis the objectives of the follow-up will be to give even fuller effect to the Nassau Declaration that is to ensure that health is propelled to the centre of national and regional development. In this way, we will ensure that indeed and in fact the Health of the Region is the Wealth of the Region.
