GROUP 8

Countries within the group

BAHAMASBARBADOSGUYANAHAITIST. KITTSTRINIDAD & TOBAGOJAMAICASURINAMST. VINCENT

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

CHALLENGES

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;

Accessibility :

CARE/FACILITIES:LOGISTICAL /DEMOGRAPHIC DIFFICULTIESTRANSPORTATION ISSUESFRAGMENTATION OF SERVICESONE OR FEW REFERRAL HOSPITALSPOOR SCHEDULING OF CLINICS; LEADS TO PATIENTS BEING TURNED AWAY BECAUSE “THE DAY AND THEIR COMPLAINT DID NOT COORDINATE”.

LEVELS OF CARE

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

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

IMPLEMENTATION

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

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

COMPLIANCE

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

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.

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

CLIMATE WITHIN THE COUNTRYTHIS 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

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

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*

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

ACCOUNTABILITY

INAPPROPIATE MECHANISMS TO ADDRESS MATERNAL MORTALITY AT THE INSTITUTIONAL AND NATIONAL LEVEL

INADEQUATE LEGAL FRAMEWORK TO ENSURE COMPLIANCE WITH STANDARDS

CHALLENGES:

HUMAN RESOURCES

Shortage of:

Specialists (medical)

Nurses/ midwives/ skilled or experienced nurses

pharmacists

Trained technicians/ technologists

MIGRATION

THIS FACTOR AFFECTED COUNTRIES IN 2 WAYS:

LOSS OF SKILLED/TRAINED PERSONNELINFLUX OF PERSONS FROM OTHER COUNTRIES WHO REQUIRED SPECIAL CARE OR NECESSITATED ADDITIONAL EXPENDITURE FROM BUDGET(DO YOU DENY THEM CARE?

RECRUITMENT OF SKILLED PERSONNEL

DIFFICULTIES DUE TO

MIGRATION

POOR INCENTIVES ESPECIALLY IN PUBLIC SECTOR

FACILITIES:POPULATION RATIO

LIMITED FACILITIES; GENERAL OR SPECIALISED ( ICU, NICU, ULTRASOUND ETC) TO LARGE POPULATIONS OR SECTIONS OF POPULATIONSDECENTRALISATION RESULTING IN CHALLENGES WITH ACCESS – TRINIDAD – 3 NICUs TO 5 REGIONS

INADEQUATE FACILITIES

THIS CAN LEAD TO OVERCROWDING IN INSTITUTIONS; PEAK DELIVERY PERIODS (CROP SEASON)

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

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

JAMAICA

OUTDATED TECHNOLOGY AND FACILITIESDEFICIENT MIDDLE MANAGEMENT – SENIOR PERSONNEL AND INEXPERIENCED PERSONNEL – NO SUCCESSION PLANNINGPOOR HEALTH REFORMS – ‘TOP HEAVY MANAGEMENT; COST RECOVERY PROGRAM EMPHASIS WHICH FORCES INCREASED OUT OF POCKET EXPENSES FOR WOMEN

SURINAME

SPECIALISTS NOT UNDERGOING PRACTICAL CMESGRANTS GIVEN PROVIDE ADVANCED FACILITIES EG EQUIPMENT , WHICH REQUIRE INCREASED COST OF MAINTENANCEPREGNANT WOMEN PAYING HIGHER PREMIUM IN INSURANCE SCHEMENO MONITORING AND REGULATION OF POLICY DEVELOPMENT

BARRIERS

BARRIERS

ACCEPTANCE OF REFORMPOLITICAL CHANGE/INSTABILITYPOVERTYECONOMIC INSTABILITYCULTURAL FACTORSLANGUAGE INABILITY TO SOURCE/TRAIN/RECRUIT PERSONNELADMINISTRATION/GOVERNING COMPOSITION –RE:UNDERSTANDING NEEDS AND ISSUES – AFFECTS DECISION MAKING

BARRIERS CONT’D

RESISTANCE TO CHANGE

DONOR AGENCIES DETERMINING WHERE FUNDING SHOULD BE DIRECTED – OVER ALLOCATION IN SOME AREAS EG HIV/AIDS

OPPORTUNITIES

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,

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.

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

HEALTH PROMOTION

SUCCESSFUL STRATEGIES

JAMAICA

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

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 CHILDRENLIASON UNITS THAT BRIDGE GAPS BETWEEN PRIMARY AND SECONDARY CARE, MANAGE DEFAULTERS ON CHILDREN’S ISSUESEMPOWERMENT PATIENTS’ CHARTER OF RIGHTS AND OBLIGATIONS

SURINAME

SOCIAL SECURITY SCHEME

INSURANCE SCHEME

SYMPATHETIC MINISTER – FOCUSES ON PUBLIC HEALTH CARE

RECOMMENDATIONS

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

RECOMMENDATIONS

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

RECOMMENDATIONS

FINALISE OR DEVELOP NATIONAL STRATEGIC PLANS AND IMPLEMENTATION PLANS TO SECURE NATIONAL AND INTERNATIONAL FUNDINGDEVELOP PROGRAMMES TO REACH CLIENTS IN RURAL AREAS OR STRENGHTEN EXISTING PROGRAMMES

RECOMMENDATIONS

REMIND COUNTRY DECISION MAKERS OF THE COMMITMENTS TO THE MDGs,

RESOLUTIONS 13, 14 WOMEN AND CHILDREN

RESOLUTION 22, SOCIAL PROTECTION IN HEALTH ETC.

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

EFFECTIVE USAGE OF MEDIATRAINING AT ALL DEFICIENT LEVELSFOSTER HEALTH PROMOTIONMANAGED MIGRATION PROGRAMMESENCOURAGE YOUTH AMBASSADORSINCENTIVES FOR PROFESSIONALSTRAINING FOR EXPORT - * GUYANAEFFECTIVE DEPLOYMENT OF SKILLED PERSONNEL – PYRAMID*RAISE THE AGE OF RETIREMENT - *GUYANA

RECOMMENDATIONS

MORE REVIEWS INTO PATIENT DEATHS – ENSURING THAT HEALTH CARE WORKERS/DOCTORS RECOGNISE THAT THEY ARE ACCOUNTABLEREVIEW MORBIDITYMONITORING AND EVALUATION OF CLIICAL INTERVENTION EFFECTIVENESS

NEXT STEPS

STEPS IN RESPONSEADVOCACY AT ALL LEVELS FOR IMPROVEMENTDEVELOPMENT AND IMPLEMENTATION OF STRATEGIES TO REDUCE MORBIDITY AND MORTALITYENFORCING CMEs- IN-SERVICE, PRE-SERVICE TRAINING; INTEGRATION OF TRAININGWORK TO REGAIN CONFIDENCE OF SECONDARY CARE PROFESSIONALS TO CHANGE CURRENT POLARISED ENVIRONMENTFEEDBACK INFORMATION TO CAREGIVERS TO MAXIMISE HEALTH CARE DELIVERYIMPROVE REACH OF INFORMATION/EDUCATION TO VULNERABLE/TARGET POPULATION

THANK YOU