In 2016, OECS Heads of Government established the OECS Health Unit in recognition of a single OECS health space to drive the regional functional cooperation approach to implementing the OECS Growth and development strategy (OGDS) for the OECS Health sector.
In April 2017 the Health Unit became operational, incorporating the work of what was previously the HIV/AIDS Programme Unit (HAPU). The Council of Health Ministers meeting in Martinique in November of 2017 was a landmark meeting in which the Ministers of Health in the OECS approved the OGDS Health Agenda 2017-2030 and declared their commitment to the regional approach through the Fort de France Declaration on Health.
Principles of the Revised Treaty of Basseterre
These goals are being pursued with the recognition of the principles of the Revised Treaty of Basseterre including:
- Economic Harmonisation and Integration
- Free movement of goods, people and capital
- Harmonised policies
- Protection of Human and Legal Rights
- Good Governance
- Joint negotiating stances and arrangements
- facilitation of cross border activities
- a common social policy framework
The OGDS Health Agenda 2017-2030, will be used to guide resource mobilization. Actual activities will be determined on an annual basis and programmed into the OECS Commission Annual Work Plan (AWP). Annual activities will be influenced by Member State priorities as documented in the monthly Health Policy Forum, annual Council of Ministers of Health meetings and biannual Heads of Authority meetings. The plans will reflect current national, regional and global priorities and may be limited by capacity, resources and funds. Monitoring and evaluation will be done using SDG and other existing regional and global targets and indicators.
The OECS Health Unit works closely with PAHO/WHO (Pan American Health Organisation/ World Health Organisation), CARPHA (Caribbean Public Health Agency) and CARICOM (Caribbean Community) as key partners. Barbados is included in the PAHO Eastern Caribbean Office and therefore Barbados has a special relationship with the OECS in the area of health. The OECS Health Unit also works closely with other units in the OECS Commission Human and Social Cluster as well as with other parts of the OECS Commission including Environmental Health and Statistics.
The ten commitments of the Fort de France Declaration
The ten commitments of the Fort de France Declaration toward the realization of Health for all are:
- Share Health Human Resources,
- Facilitate pooled procurement of health equipment and services,
- Collect and share the relevant information to drive the strategic direction of health including quality and outcome indicators,
- Develop and implement common policy and legislative approaches in health,
- Develop and disseminate common messages on healthy living,
- Create healthy environments through appropriate planning, development and community engagement,
- Prioritise prevention and primary care particularly for non-communicable diseases,
- Share access to specialized services,
- Jointly prepare for and respond to health emergencies,
- Share Best Practices and conduct common research.
The OGDS Health Agenda 2017-2030
The OGDS Health Agenda 2017-2030 is aligned with the Sustainable Development Goals(SDGs) and with the regional Caribbean Cooperation in Health IV (CCHIV), and PAHOregional strategies with OECS Countries and UK Overseas Territories (UKOTs). Thesestrategies have had wide consultation and input from OECS Member States. TheStrategies were presented and circulated to the OECS Health Policy Forum. The OGDSHealth Agenda 2017-2030 addresses a common approach to health through the followingfour (4) key strategic pillars or goals
- Healthy Environments and Health Empowerment
- Equity in Access to Sustainable Quality Healthcare Services
- Accessible Information for Strategic Governance of Health Systems
- Long-term Investment in the Health Sector.
Healthy Environments and Health Empowerment
Healthy Environments and Health Empowerment
The strategic actions in so far as encouraging Healthy Environments and Health Empowerment is concerned are:
- Health Emergency Response
- Healthy & Safe Physical Environments
- Healthy Behaviors
- Health in All Policies
- Walk the Talk
Health is closely related to behaviours and can be greatly influenced by the environment. Food availability and affordability is a large contributing factor to dietary habits. Schools and workplaces should encourage good nutrition and physical activity while enabling the management of chronic diseases such as asthma in children, and diabetes and hypertension in adults. Individuals should be educated, encouraged and enabled at all spaces to have healthy habits and appropriately manage disease. Lifestyle diseases account for the biggest burden of mortality and morbidity in the OECS. Commitments of the Port of Spain declaration and the “Best Buys” of the NCD Global Action plan can serve as a menu of actions for the related strategic objectives.
Healthy Environments include environmental issues such as water and sanitation as well as safe environments free from accidents and violence. Climate change and poor environmental conditions have contributed to the re-emergence of communicable disease outbreaks due to the Aedes mosquitoes such as Dengue, Zika, Chikungunya and Yellow Fever (WHO, 2017).
An important aspect of this strategic goal is the response to natural, manmade and health specific emergencies and disasters. The Caribbean Region is known to especially vulnerable to natural disasters such as earthquakes and hurricanes, and the health sector has an immediate response following these disasters. In addition the recent outbreak of Ebola and previous global outbreaks of SARS and Avian Flu underscore the need for robust health emergency response systems and fulfillment of requirements of the International Health Regulations (IHR).
Equity in Access to Sustainable Quality Healthcare Services
Equity in Access to Sustainable Quality Healthcare Services
The OECS strategic actions which support opportunities that take advantage of the regional context to improve access are to:
- Maintain and Develop Primary Care
- Improve access to secondary andTertiary Care
- Prevent Death and Disability
- Provide Palliative Care
The World Health Organisation defines Universal health coverage (UHC) as “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services”. While the countries of the OECS region have made and maintained great strides in access to primary care services, access to secondary services sometimes mean out of pocket expenses that can lead to financial hardship, and some services necessitate travel to other countries- an enterprise that is financially challenging for many. The populations of most OECS countries are financially unable to support the tertiary care services needed to address certain specialised health conditions.
Accessible Information for Strategic Governance of Health Systems
Accessible Information for Strategic Governance of Health Systems
The priority information areas in terms of accessible information for strategic governance of health systems are:
- Performance Indicators for Quality Assurance
- Information for Strategic Planning and Policy
- Information for efficient Management of Medicines, Medical Products and Medical Technologies
- Health Surveillance for appropriate and timely response
- Relevant Health Systems Research
The WHO describes the following six building blocks of Health Systems: (i) service delivery, (ii) health workforce, (iii) health information systems, (iv) access to essential medicines, (v) financing, and (vi) leadership/governance. Leadership and Governance speaks to vision, management and accountability. Recent research done on Health Leadership in the Caribbean suggests that decisions are made intuitively and without use of evidence (Greaves D.E., 2017). Crucial to the success of accountability is the foundation of underlying information. Information is essential to all six building blocks of the Health Systems.
Within the Caribbean we have been able to collect good information on longstanding health issues related to vaccines, maternal and child health and basic health statistics. However, with the epidemiological transition of the OECS member states, and rise in burden of chronic disease the emphasis must shift to collect the relevant information for NCDs.
Long-term Investment for Resilience in the Health Sector
Long-term Investment for Resilience in the Health Sector
The priority information areas for long term investment in resilience of health systems are:
- Health Human Resources Development
- Safe Sustainable Health Infrastructure
- Investment in the OECS PPS
- Technology to improve efficiency,effectiveness and accessibility
- Exploring Economic Opportunities in Health
Within the health sector in the OECS short term fixes may cost more in the long term. Commitment to long-term investment in health will not only provide returns within the sector but also to the wider economy as the availability high quality health systems are known to improve long term investor and visitor perception of a destination.
Health is seen as a human right. However, in Small Island Developing States, it is also important to identify and maximise the economic opportunities in health, that can work synergistically with the region’s need to improve access to and sustainability of health services. The 2016 High level Commission on Health Employment and Economic Growth Report notes that “The health sector is a key economic sector, a job generator and a driver of inclusive economic growth. Growing evidence suggests that adequate investment in the health system and its workforce can offer high economic returns.”
