GROUP 8

1. GROUP 8

2. Countries within the group • BAHAMAS • BARBADOS • GUYANA • HAITI • ST. KITTS • TRINIDAD & TOBAGO • JAMAICA • SURINAM • ST. VINCENT

3. CHALLENGES IN PROVIDING SOCIAL PROTECTION • THESE WERE NUMEROUS WITH MANY BEING COMMON TO THE VARIOUS COUNTRIES. • AS SUCH, MOST WILL BE DEALT WITH COLLECTIVELY • THOSE PECULIAR TO SPECIFIC COUNTRIES WILL BE HIGHLIGHTED SEPARATELY

4. CHALLENGES

5. Quality of care • STANDARDISATION OF CARE – • ESPECIALLY BETWEEN PUBLIC AND PRIVATE SECTOR • DIFFICULTY PROVIDING HIGH QUALITY OF CARE AT ALL LEVELS DUE TO SHORTAGE OF EQUIPMENT, STAFF OR SPECIALISED SERVICES;

6. Accessibility : • CARE/FACILITIES: • LOGISTICAL /DEMOGRAPHIC DIFFICULTIES • TRANSPORTATION ISSUES • FRAGMENTATION OF SERVICES • ONE OR FEW REFERRAL HOSPITALS • POOR SCHEDULING OF CLINICS; LEADS TO PATIENTS BEING TURNED AWAY BECAUSE “THE DAY AND THEIR COMPLAINT DID NOT COORDINATE”.

7. LEVELS OF CARE • POOR REFERRAL SYSTEMS LEADING TO LENGTHENED ‘WAIT TIME’ FOR CLINICS OR SPECIALIST CARE • MANY LEVELS OF CARE THAT MAY CONFUSE OR FRUSTRATE A PATIENT WHO NEEDS OR DESIRES EMERGENCY OR SPECIALIST CARE • LEVELS NOT ADEQUATELY FUNCTIONING CAUSING OVERCROWDING AT ANY SPECIFIC LEVEL

8. DATA COLLECTION /COMMUNICATION • FRAGMENTATION OF DATA COLLECTION AND POOR COLLABORATION AMONG VARIOUS RELEVANT AGENCIES COLLECTING INFORMATION • POOR RECORD KEEPING • LACK OF CAPACITY FOR CREATING AUTOMATED SYSTEMS

9. IMPLEMENTATION • IMPLEMENTATION OF THE STRATEGIES OUTLINED IN THE STRATEGIC / NATIONAL PLANS FOR VARIOUS REASONS ; LACK OF FINANCE , TECHNICAL SKILLS AND ORGANISATIONAL ABILITY

10. SUSTAINABILITY OF PROGRAMMES • INADEQUATE FUNDING • INABILITY TO MAINTAIN PROJECTS/PROGRAMMES AFTER IMPLEMENTING AGENCY HAS LEFT DUE TO POOR LOCAL ORGANISATION • IMBALANCE OF ALLOCATION OF FUNDS DUE TO INTER AND INTRA-SECTORAL COMPETITION – BUDGET * HAITI

11. COMPLIANCE POOR PATIENT COMPLIANCE WITH TREATMENT, FOLLOW- UP VISITS ETC DUE TO ECONOMIC FACTORS, POOR EDUCATION OR LACK OF AWARENESS.

12. COST OF HEALTH CARE • MOST OF THE COUNTRIES HAD UNIVERSAL COVERAGE / FREE HEALTH CARE. (SUSTAINABILITY DUE TO POSS.ECON.DIFF) • HOWEVER, SOME (HAITI, ST. KITTS) HAD FEES OR COSTS THAT PRECLUDED PATIENTS IN THE LOW SOCIO-ECONOMIC BRACKET FROM ACCESSING SERVICES.

13. ECONOMIC STATUS OF POPULATION • DETERMINES WHETHER PEOPLE VISIT THEIR HEALTH CARE FACILITIES. • HAITI- CHOICES BETWEEN FOOD VS. HEALTH CARE CAN ARISE • ST KITTS – OVERALL WELL BEING; NUTRITIONAL STATUS CAN BE DETERMINED BY FINANCIAL STABILITY

14. CLIMATE WITHIN THE COUNTRY • THIS IMPACTS ON HEALTH CARE PROVISION, POLICIES AND IMPLEMENTATION OF PROGRAMMES, AS WELL AS PATIENT’S ABILITY TO AFFORD HEALTH CARE. SOCIAL , POLITICAL, ECONOMIC • JAMAICA: CRIME RATE, UNEMPLOYMENT, • SURINAM: POLITICAL INSTABILTY, GOVERNMENTAL CHANGES AND PREFERENCES

15. EDUCATION & AWARENESS • PATIENT/POPULATION UNAWARE OF SERVICES OFFERED, DISEASE AND PROGRESSION/COMPLICATIONS- • LATE VISITS TO HEALTH FACILITES: • TERMINAL OR LATE STAGE DISEASE • POOR ANTE, PRE ,POST NATAL CARE • PATIENTS UNAWARE OF THEIR RIGHTS

16. BARRIERS • CULTURAL – HAITI* WOMEN WILL NOT LEAVE THEIR HOMES FOR AT LEAST 40 DAYS AFTER DELIVERY • LANGUAGE – GUYANA; RECRUITING FOREIGN SPECIALISTS, MIGRATION OF NEIGHBORING PEOPLES • MYTHS*

17. PATIENT PREFERENCE • ST KITTS – ALTHOUGH TRAINED / EXPERIENCED NURSES ARE AVAILABLE, PATIENTS MAY PREFER TO GO TO A DOCTOR/ PRIVATE CARE FACILITY AND MAY DELAY OR NOT GO BECAUSE THEY CANNOT AFFORD SAME

18. ACCOUNTABILITY • INAPPROPIATE MECHANISMS TO ADDRESS MATERNAL MORTALITY AT THE INSTITUTIONAL AND NATIONAL LEVEL • INADEQUATE LEGAL FRAMEWORK TO ENSURE COMPLIANCE WITH STANDARDS

19. CHALLENGES: • HUMAN RESOURCES • Shortage of: • Specialists (medical) • Nurses/ midwives/ skilled or experienced nurses • pharmacists • Trained technicians/ technologists

20. MIGRATION • THIS FACTOR AFFECTED COUNTRIES IN 2 WAYS: • LOSS OF SKILLED/TRAINED PERSONNEL • INFLUX OF PERSONS FROM OTHER COUNTRIES WHO REQUIRED SPECIAL CARE OR NECESSITATED ADDITIONAL EXPENDITURE FROM BUDGET(DO YOU DENY THEM CARE?

21. RECRUITMENT OF SKILLED PERSONNEL • DIFFICULTIES DUE TO • MIGRATION • POOR INCENTIVES ESPECIALLY IN PUBLIC SECTOR

22. FACILITIES:POPULATION RATIO • LIMITED FACILITIES; GENERAL OR SPECIALISED ( ICU, NICU, ULTRASOUND ETC) TO LARGE POPULATIONS OR SECTIONS OF POPULATIONS • DECENTRALISATION RESULTING IN CHALLENGES WITH ACCESS – TRINIDAD – 3 NICUs TO 5 REGIONS

23. INADEQUATE FACILITIES • THIS CAN LEAD TO OVERCROWDING IN INSTITUTIONS; PEAK DELIVERY PERIODS (CROP SEASON)

24. GENERATION GAP • POOR COMMUNICATION AND ACCEPTANCE BETWEEN “NEW AND OLD” MEDICAL DOCTORS • NEW CULTURAL INFLUENCES WITH STRONG SEXUAL MESSAGES THAT DIRECTLY THWART HEALTH MESSAGES. FOR EXAMPLE, MUSIC/DANCE THAT GLORIFY THE MACHO MALE OR SEXUAL PROCLIVITIES AS AGAINST A MESSAGE OF ABSTINANCE OR RESPONSIBLE SEXUAL BEHAVIOUR

25. ST. KITTS • ANEMIA IN PREGNANCY • SHORTAGE OF NURSES TRAINED IN IUCD TECHNIQUES • POOR COMPLIANCE OF PATIENTS – CONTRACEPTIVES -DUE TO SIDE EFFECTS • DIFFICULTY REACHING NEW PATIENTS WHO SHOULD BE SCREENED FOR CANCER • PATIENTS FEAR OF INSTRUMENTATION AND PAIN – PAP SMEAR

26. JAMAICA • OUTDATED TECHNOLOGY AND FACILITIES • DEFICIENT MIDDLE MANAGEMENT – SENIOR PERSONNEL AND INEXPERIENCED PERSONNEL – NO SUCCESSION PLANNING • POOR HEALTH REFORMS – ‘TOP HEAVY MANAGEMENT; COST RECOVERY PROGRAM EMPHASIS WHICH FORCES INCREASED OUT OF POCKET EXPENSES FOR WOMEN

27. SURINAME • SPECIALISTS NOT UNDERGOING PRACTICAL CMES • GRANTS GIVEN PROVIDE ADVANCED FACILITIES EG EQUIPMENT , WHICH REQUIRE INCREASED COST OF MAINTENANCE • PREGNANT WOMEN PAYING HIGHER PREMIUM IN INSURANCE SCHEME • NO MONITORING AND REGULATION OF POLICY DEVELOPMENT

28. BARRIERS

29. BARRIERS • ACCEPTANCE OF REFORM • POLITICAL CHANGE/INSTABILITY • POVERTY • ECONOMIC INSTABILITY • CULTURAL FACTORS • LANGUAGE • INABILITY TO SOURCE/TRAIN/RECRUIT PERSONNEL • ADMINISTRATION/GOVERNING COMPOSITION –RE:UNDERSTANDING NEEDS AND ISSUES – AFFECTS DECISION MAKING

30. BARRIERS CONT’D • RESISTANCE TO CHANGE • DONOR AGENCIES DETERMINING WHERE FUNDING SHOULD BE DIRECTED – OVER ALLOCATION IN SOME AREAS EG HIV/AIDS

31. OPPORTUNITIES

32. OPPORTUNITIES AVAILABLE • FREE CARE • IMPLEMENTATION OF NATIONAL INSURANCE PROGRAMMES • GOV’T - GOV’T COLLABORATION- CUBA AND MANY CARIBBEAN COUNTRIES • DONOR AGENCIES- FINANCIAL,DATA, TRAINING ETC – PAHO, USAID,

33. TRAINING, RECRUITMENT PROGRAMMES NATIONALLY &INTERNATIONALLY • EXPERTISE PROVIDED BY AGENCIES THAT FACILITATES PILOT PROJECTS – GUYANA* -GOOD RESULTS-DECREASED MATERNAL MORTALITY IN REGION 6 DUE TO ASSISTANCE FROM PAHO –IMPLEMENTATION OF PILOT PROGRAMME INVOLVING TRAINING AND EDUCATION.

34. COLLABORATION WITH STAKEHOLDERS IN DEVELOPING HEALTH CARE PROGRAMMES THAT CAN ASSIST IN VARIOUS ASPECTS ; NGOS, FBOS ETC • HEALTH PROMOTION

35. SUCCESSFUL STRATEGIES

36. JAMAICA • PATH- POVERTY ALLEVIATION THROUGH HEALTH EDUCATION- PROVIDES SERVICES FOR POOR/ MARGINALISED OR AGED MEMBERS OF THE POPULATION • NATIONAL HEALTH FUND- PATIENTS’ CARE SUBSIDISED BY GOV’T – THEY MUST HAVE 14 OR MORE SPECIFIC HEALTH CONDITIONS

37. TRINIDAD • PRESCRIPTION FILLING AT ALL PHARMACIES INSPITE OF ORIGIN OF SAME – DECREASED WAIT TIME AND CONGESTION OF PARTICULAR PHARMACIES • VISION AND HEARING SCREENING FOR ALL CHILDREN • LIASON UNITS THAT BRIDGE GAPS BETWEEN PRIMARY AND SECONDARY CARE, MANAGE DEFAULTERS ON CHILDREN’S ISSUES • EMPOWERMENT PATIENTS’ CHARTER OF RIGHTS AND OBLIGATIONS

38. SURINAME • SOCIAL SECURITY SCHEME • INSURANCE SCHEME • SYMPATHETIC MINISTER – FOCUSES ON PUBLIC HEALTH CARE

39. RECOMMENDATIONS

40. RECOMMENDATIONS EMBARK ON AGGRESSIVE HEALTH PROMOTION AND EDUCATION PROGRAMMES THAT INCLUDE; EDUCATION OF PATIENT- RIGHTS, TREATMENT OPTIONS, SERVICES AND FACILITIES AVAILABLE, ALL ASPECTS OF DISEASES; SIGNS, SYMPTOMS, IMPORTANCE OF HEALTH VISITS ETC BALANCED ALLOCATION OF FUNDS – NATIONALLY/BUDGET AND FROM DONOR AGENCIES. ALLOCATION SHOULD BE BASED ON NEEDS AND SOUND INVESTIGATION

41. RECOMMENDATIONS • DEVELOP A HUMAN RESOURCE STRATEGY THAT INCLUDES RECRUITMENT AND RETENTION, TRAINING AND RETRAINING OF STAFF, AS WELL AS DEPLOYMENT BASED ON SKILLS REQUIRED. • REGULATION • DEVELOP MINIMUM STANDARDS OF CARE FOR MCHP

42. RECOMMENDATIONS • FINALISE OR DEVELOP NATIONAL STRATEGIC PLANS AND IMPLEMENTATION PLANS TO SECURE NATIONAL AND INTERNATIONAL FUNDING • DEVELOP PROGRAMMES TO REACH CLIENTS IN RURAL AREAS OR STRENGHTEN EXISTING PROGRAMMES

43. RECOMMENDATIONS • REMIND COUNTRY DECISION MAKERS OF THE COMMITMENTS TO THE MDGs, • RESOLUTIONS 13, 14 WOMEN AND CHILDREN • RESOLUTION 22, SOCIAL PROTECTION IN HEALTH ETC.

44. COMMUNITY MEETINGS WITH RELEVANT HEALTH PERSONNEL TO ENHANCE COMMUNICATION, UNDERSTAND NEEDS AND IMPROVE THE EFFICACY AND EFFICIENCY OF DELIVERY OF HEALTH SERVICES • INTEGRATION OF HEALTH AND WELLNESS STRAGIES

45. EFFECTIVE USAGE OF MEDIA • TRAINING AT ALL DEFICIENT LEVELS • FOSTER HEALTH PROMOTION • MANAGED MIGRATION PROGRAMMES • ENCOURAGE YOUTH AMBASSADORS • INCENTIVES FOR PROFESSIONALS • TRAINING FOR EXPORT - * GUYANA • EFFECTIVE DEPLOYMENT OF SKILLED PERSONNEL – PYRAMID* • RAISE THE AGE OF RETIREMENT - *GUYANA

46. RECOMMENDATIONS • MORE REVIEWS INTO PATIENT DEATHS – ENSURING THAT HEALTH CARE WORKERS/DOCTORS RECOGNISE THAT THEY ARE ACCOUNTABLE • REVIEW MORBIDITY • MONITORING AND EVALUATION OF CLIICAL INTERVENTION EFFECTIVENESS

47. NEXT STEPS

48. STEPS IN RESPONSE • ADVOCACY AT ALL LEVELS FOR IMPROVEMENT • DEVELOPMENT AND IMPLEMENTATION OF STRATEGIES TO REDUCE MORBIDITY AND MORTALITY • ENFORCING CMEs- IN-SERVICE, PRE-SERVICE TRAINING; INTEGRATION OF TRAINING • WORK TO REGAIN CONFIDENCE OF SECONDARY CARE PROFESSIONALS TO CHANGE CURRENT POLARISED ENVIRONMENT • FEEDBACK INFORMATION TO CAREGIVERS TO MAXIMISE HEALTH CARE DELIVERY • IMPROVE REACH OF INFORMATION/EDUCATION TO VULNERABLE/TARGET POPULATION

49. THANK YOU