1. Group no. 9 ANTIGUA & BARBUDA, BAHAMAS, BARBADOS, BELIZE, GUYANA, HAITI, JAMAICA, ST. LUCIA, TRINIDAD AND TOBAGO, ST. KITTS AND NEVIS, WASHINGTON Facilitator: SURINAME

2. Challenges in Social Protection in Health SPH on political agenda Integrated and “client oriented” Health services Accessible and equitable Quality care health services at all levels, EOC, EmOC Adequate No. of Human Resources Primary health care with sufficient budget

3. Challenges Early attendance to antenatal care Reduced abortion practices Delay initiation of sexual activity Adequate support services available Increased male involvement and access to SRH services Youth friendly services available Reduced no. of pregnancy in teens Strong partnerships “public & private”

4. Barriers to face the challenge Unhealthy behaviors – late antenatal care, home deliveries, low breastfeeding rate, low contraceptive prevalence use, unsafe sex, early sexual initiation- Gender inequities Gender Based Violence Direct payment for services and/or incomplete services Poor partner and family support during pregnancy, childbirth and puerperium Age specific Sexual and reproductive health not included in Education curricula

5. Barriers Negative attitude of staff Poor information on the services available Cultural and religious beliefs Geographical inaccessibility Unemployment Technical and first line staff politically appointed

6. Opportunities to face the challenges Political will towards MDGs - Existence of MDGs task force- Poverty alleviation programs – housing, school feeding program, “PATH”, others- Health sector reform process taking into consideration the integration of the health services Technical assistance from UNCT

7. Opportunities to face the challenges Community empowerment Maternal and mortality review Committee –includes verbal autopsy and clinical audits- Existence of Regional Initiative to eradicate child malnutrition Networking with NGOs and Community Based Organizations Access to and management of Funds e.g. Global Fund, Clinton Foundation- Access to PAHO Revolving Fund – Vaccine procurement-

8. Recommendations SPH to improve health outcomes SPH on Regional & National Agenda – Summit of the Americas, CARICOM, RESSCAD; time frame for universal SPH- SRH a primary health care strategy Increase the regulatory capacity of the Ministries of Health –planning, monitoring, evaluation, policies for accountability, fiscalization – Enable supportive environment for women and children –family and community- Increase capacity of health system to provide Essential Obstetric Care –Basic and Emergency- and Home Based Life Saving Skills.

9. Recommendations SPH to improve health outcomes Update health policies related to MNI and work towards integrated health services Update health information systems Research and evidence based on SPH Reorient services to focus on Primary Health Care and implement COMBI strategies Design and implement retention strategies for health professionals Strengthen Public Health in Medical and allied schools Work force projection for the CARICOM countries

10. Next steps Review and update SPH in countries Focus and align organizations working in the field of MNI health Sensitize health authorities to place SPH on national and regional agenda Reorient services to focus on Primary Health Care and adopt COMBI strategies Empower Communities to demand their right to health Implement Sexual and Reproductive health policies Enable supportive environment for MNI –family and community level- Technical assistance e.g. work force projection, SPH, M&E,

11. Next steps Thank you