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. 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. 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