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INTRODUCTION
The ultimate goal of regional cooperation in the Caribbean is the improvement
of the living standards of the people.
The health of the people is an integral and important component of their
standard of life. It is at once a prerequisite and a goal of development.
Economic growth, defined in terms of increase in per capita income, does
not necessarily reach the most vulnerable groups in the population. Indeed,
the single-minded quest for economic growth has resulted, in some countries,
in the poor becoming relatively poorer. Therefore our development effort
must give separate and special priority to health strategy, particularly
designed to reach those who have been by-passed by economic growth and
are worst affected by economic recession.
Nevertheless, the Caribbean health situation is greatly influenced by
broad social and economic factors. Among these factors are the equitable
distribution of wealth and food, general education, community development
and the rate of growth of the population. Thus we no longer perceive the
attainment of health as the result solely of medical measures; we see
it as a significant part of the socio-economic system, combining political,
social, economic and other elements.
Health is indivisible. It is indivisible in the sense that our Caribbean
activities are not to be seen in geographical isolation. They are a part
of the hemispheric effort as well as of the world strategy. The international
mandate at these levels is held by PAHO/WHO, and it behooves us work closely
with this Organization and to harmonize our efforts.
Health is indivisible in its relationship to global social and economic
strategy. Our activities contribute to the broad goals that the Governments
have enunciated in their proposals for economic reform of the Third World,
for meeting the basic needs of their peoples for achieving social justice
and self reliance and for promoting the integration of women in development.
Health in indivisible within the Caribbean Community itself. The achievements
of any Member Country in the prevention and treatment of disease are of
value to all, and among the countries unequal development of health services
is a common danger, particularly where communicable diseases are concerned.
Health is indivisible within each Member State. Health cannot be achieved
by the health sector alone. Insofar as central planning, agriculture,
education, water supply and other sectors contribute to health, their
activities need to be coordinated, and the health sector should take the
initiative.
With its emphasis on intersectoral relationships the modern health care
system provides the opportunity for ample, broad-based cooperation among
government departments as well as a point of entry for the individual
citizen into socio-economic development.
Unprecedented scientific advance in recent times has placed in our hands
many new tools that should be brought to bear upon the health problems
of the people of the Community. However, the need is for a technology
which is strictly appropriate to the needs and potential of our people.
We are resolved that Caribbean programmes shall originate - and be seen
to originate - from the Caribbean internal situation and not seen to emerge
from situations and solutions that are plainly external to the area.
If we insist on the principle of coordination in our relationships with
other sectors, it is no less valid in the internal operations of the health
sector. Modern health care requires a totally integrated health service
in which the various levels of care articulate with one another in a planned
way and are interdependent. Thus, while this Policy emphasises community
care, we cannot continue to tolerate the existing low standards in our
hospitals, to which those receiving community care have to be referred
from time to time.
It has become increasingly evident that the efforts of the individual
countries are insufficient to deal adequately with such diverse issues
as the development and pooling of human resources, food and nutrition
planning, epidemiological surveillance, pharmaceutical policy, and the
development of research.
This is not to say that the national effort is of secondary importance.
Quite the contrary. The broad social and economic dimensions of health
development in no way diminish the need for a vigorous and imaginative
technical contribution from the health sector in each country. Experience
has shown that dynamic and creative leadership - technical as well as
administrative - in each ministry of health is the principal determining
factor in the development of the health services.
A. THE PRINCIPAL HEALTH ISSUES
One of the fundamental prerequisites for formulating a health policy is
the careful and correct diagnosis of the health situation, including the
analysis of the existing health problems as well as the observable trends,
the whole activity being based on adequate information system.
The principal health issues in the Caribbean Community fall under two
headings:
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(a) those related to the health status;
(b) those related to the health infrastructure. |
(a) Issues Related to Health Status
1. The Caribbean population is young, 60% being under 25 years of
age. Thus a large number of people are entering the reproductive age.
Girls under 20 years of age produce up to 80% of first births. Half of
all the last pregnancies are unwanted. Illegal abortion is common. Fertility
rates have fallen, but even if they are reduced to the "replacement"
level, births will greatly exceed deaths well into the future, so that
a typical Less Developed Country will double its population within a few
years of the turn of the century. The number of elderly people (over 65
years) is increasing and is expected to reach 500,000 by the year 2000.
There has been a marked decline in emigration. These demographic trends
have far-reaching social and economic implications.
2. Poor environmental conditions and the resulting communicable diseases,
namely, gastro-enteritis, dysentery and typhoid, are a common cause of
sickness and death, particularly in the very young. The high rate of intestinal
parasitic infestation among children is significant. Cholera remains a
serious threat.
3. The chief danger in the environment arise from insufficient and unsafe
water supplies. Insanitary excreta disposal and inadequate food safety
and control measures come next in importance.
4. Other environmental issues are solid waste management; vector and rodent
control; agricultural and industrial pollution; housing and human settlements;
the health of workers; port health; pesticide management; traffic and
other accidents; disaster mitigation, preparedness and relief, and the
education and training of personnel.
5. Mothers and children make up two-thirds of the whole population and
have high rates of sickness and death. Service, including family planning
and immunisation, are inadequate in coverage and in quality.
6. Combined malnutrition and diarrhoeal disease are an importation cause
of death in children under two years of age, but they no longer occupy
their former high place in lists of causes of deaths in Member States.
They are being replaced by cardiovascular and other chronic diseases of
the later years (see 13 and 14 below) and even to accidents.
7. Approximately half of the children of the Caribbean Community under
five years of age show signs of undernutrition, and more than half the
households are not receiving their food energy requirements. We may conclude
that large numbers of our citizens of all ages are unable to achieve their
full potential because of undernutrition.
8. Though 1981 was International Year for Disabled Persons, services for
the prevention and treatment of disability remain inadequate and notably
uncoordinated in all Member Countries.
9. Deaths from communicable diseases have fallen from 25 percent of all
deaths five years ago to less than 10 percent, but one-fifth of these
deaths are due to diseases that could easily be prevented by immunization.
10. Sexually transmitted diseases are on the increase. Tuberculosis remains
a major problem, and so does leprosy.
11. Respiratory diseases contribute significantly to sickness and death,
especially among children.
12. All the countries are infested with Aedes aegypti, the mosquito that
transmits yellow fever and dengue. The yellow fever virus occurs in the
forests of Guyana and Trinidad and in nearly all the South American countries
and can at any time be disseminated by a number of methods and spread
rapidly throughout the Caribbean Community.
13. Diabetes and high blood pressure are common and often undetected and
uncontrolled until they give rise to grave complications that strike down
adults at the height of their productive capacity. These conditions are
frequently associated with obesity, which is comparatively common among
middle-aged Caribbean women.
14. Approximately 5,000 new cases of cancer occur in the Caribbean Community
each year. Cancer of the cervix is the most common form, and nearly half
the patients seek attention at a stage too advanced for effective treatment.
In women, breast cancer and cervical cancer accounts for half the cases.
15. Mental illness constitutes about one-half of the total volume of illness,
and the mental health services are sadly deficient. Drug abuse falls under
this heading, but in the Caribbean Community the most important drug problem
are alcohol and tobacco smoking.
16. Diseases of the teeth and gums are universal, and the dental health
services are ill-developed in terms of preventive work among children
and in numerous other respects.
(b) Issues Related to the Health Infrastructure
1. The fundamental changes in structure and orientation of the health
services that the Primary Health Care Approach requires have, in the majority
of Member States, not yet begun. These changes include:
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(a) integration of health with development planning;
(b) setting up mechanisms for effective cooperation with the other sectors
that contribute to health, namely, central planning, education, agriculture,
water supply, labour, community development, housing, public works,
and communication;
(c) health education, with emphasis on the responsibility of the individual
and the involvement of the mass of the people in all health activities,
including problem identification, planning, implementation and evaluation;
(d) a progressive shift of resources in the direction of Primary Health
Care. |
2. Management lacks effectiveness at all levels and there
is consequent poor utilization of resources.
3. Only a minority of the countries have a clearly defined health policy,
and very few have a national health plan. Planning as a continuous process
is ill-developed. In the Caribbean Community there is not yet general
observance of the principle that plans and programmes should be formulated
not for problems seen in isolation but only after careful selection of
priorities, careful definition of objectives, selection of efficient techniques,
as simple and as inexpensive as possible, and the creation of good systems
of information and evaluation.
4. Programming in key sub-sectors, such as population, disease control,
the environment, and health education is virtually non-existent.
5. Human resource development remains a crucial area. The major issues
are relevance, attitudes, orientation towards Primary Health Care and
the community, the training of trainers, the team approach, and the stemming
of the brain drain. Educational institutions lack written policies.
Fundamental changes are needed in the attitudes of doctors and other health
workers - attitudes towards service in the Caribbean and especially in
the rural areas as well as towards preventative and social action and
the solution of the health problems. These changes in attitude require,
for their part, fundamental changes in systems of education with respect
to relevance to the needs of the health services and of the people of
the Community. We are convinced that all community workers must be primarily
educators and that all technical activities must have an educational component.
Every health facility should serve as a classroom.
6. Team work is essential. Health care for the community includes a wide
range of services. To mention only a few: special care for mothers and
children, including immunisation and family planning, safe drinking water
supplies, health education and rehabilitation. Health care of such a varied
character requires, besides the doctor, the nurse and the pharmacist,
a wide range of worker the administrator, the school teacher, the environmental
engineer, the health educator, the dental and other auxiliaries, the community
health aide, and even - until she can be phased out in all the countries
- the traditional birth attendant. Team work is therefore fundamental,
and the new systems of education must prepare doctors and other health
workers to be effective members of the team.
7. Physical facilities are a major problem area. There is little planning.
The factor of accessibility - geographic, economic and cultural - is pivotal.
8. Medical equipment of the value of hundreds of thousands of dollars
is in disrepair, and the majority of the countries have no programme for
the maintenance of health-care facilities.
9. Supply management is a major issue. The drugs now available for medical
care are numerous, complex, powerful and potentially harmful. They take
up a large and increasing share of health costs. It is therefore essential
to continue to develop and put into effect national and regional pharmaceutical
policies.
10. Health information systems, which are essential for planning and evaluation
- indeed, for management in its entirety - are woefully inadequate. Our
plea for prompt annual reporting by Chief Medical Officers has been disregarded
in several of the countries.
11. An important issue is the development of a technology which is suited
in all respects to the Caribbean society; that is to say, which is inexpensive,
safe and effective; acceptable to the policy-makers, the health providers
and the community; simple enough to be operated and maintained with local
facilities, and free from the risk of damaging side-effects on the society,
the economy, the culture and the environment.
12. Finance is a serious constraint.
13. The health laws are out of date. This is serious when it impedes the
humane treatment of mental patients and the effectiveness of new categories
of health workers.
14. Research is not yet accepted as having an importance comparable with
that of the patient-oriented services, and the Commonwealth Caribbean
Medical Research Council is not being given the resources that it needs
to carry out its responsibility in this significant area. Research needs
to be relevant to the priority needs of the Caribbean people as defined
in this Declaration.
15. Systematic evaluation of the health services is virtually non-existent,
particularly because of the weakness of health information systems and
the fact that some Ministries of Health lack the capacity to analyse,
interpret and utilise even the limited data available.
16. Intercountry cooperation and the coordination of the work of the various
international agencies have become issues of considerable interest and
concern. We accept the principle that in regional health programmes priority
should be given to the so-called Less Developed Countries. The More Developed
Countries accept the reality that in many cases they are the source of
aid most readily accessible to the LDCs.
B. THE PRIORITIES
In determining health priorities for the Caribbean Community, we have
adopted as our criteria:
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a) the magnitude of a given problem;
b) its social and economic importance
c) its susceptibility to preventive and remedial measures. |
We shall give priority to the Primary Health Care Approach,
which will permeate the whole of the health service.
Specifically, we have arrived at the following determination of the priorities:
1. the more dynamic and creative management of the
health services;
2. the education, training and retention of health personnel and especially
those involved in the delivery of primary health care;
3. the health education of the public, with particular emphasis on the
responsibility of the individual and active community involvement;
4. the prevention and control of diseases - communicable and non-communicable
- that have social and economic importance;
5. environmental health, with special reference to the quantity and quality
of drinking water supplies, food safety and control and the sanitary disposal
of human waste;
6. food and nutrition, and especially a strategy that makes immediate
provision for the needs of the vulnerable groups and, in the longer term,
ensures that no citizen of the Community is prevented by malnutrition
from achieving his full potential;
7. the health of mothers and children, our principal concerns being total
coverage of maternal and child health care during pregnancy, childbirth
and childhood and services that include the promotion of breastfeeding,
the feeding of the weaning age group, immunisation, and family planning.
C. THE GOAL AND THE STRATEGY:
THE PRIMARY HEALTH CARE APPROACH
Our Goal is Health for All in the Caribbean Community by the
Year 2000.
Our strategy for achieving this Goal is Primary Health Care
Three basic concepts underlie the Primary Health Care Approach:
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(a) Health is a fundamental right of every human being.
(b) The government has a duty, on economic as well as humanitarian grounds,
to provide essential health care for everyone irrespective of his or
her ability to pay at the time of receiving attention.
(c) Every individual citizen - and the community as a whole - have a
responsibility for their own health, not only in terms of habits and
behaviour, but in all aspects of health within their competence. |
Primary Health Care is not a separate "programme" - distinct
from say the "hospital programme". It is an Approach - an Approach
which must be closely interwoven through the health service and indeed
pervades the whole of this Declaration on Health Policy.
We have adopted certain definitions suited to our Caribbean needs and
potentials and recommended to us by the Caribbean Workshop on Primary
Health Care convened in Saint Lucia in June, 1981.
In the first place we have defined our Goal as follows:
Health for All by the Year 2000
"Health for all by the Year 2000 in the Caribbean context is taken
to mean much more than the absence of disease. It means that working people
are fit and productive and are able to acquire and use new skills, that
school children are fit and able to benefit from their education and that
their physical and mental development has not been permanently impaired
by malnutrition in infancy and early childhood. It means that every Caribbean
family has the means either to produce or to buy the food that it needs.
It means that every Caribbean family has enough piped water, safe or drinking,
and an approved system of disposal of excreta and other wastes. It means
that there is ample coverage of maternal and child health care, including
family planning and immunisation. It means that the teeth and gums are
well looked after. It means that people are emotionally well-adjusted
individually, in families and as communities, and free from dependence
on alcohol, tobacco or other substances. It means that health care is
delivered by teams of well-trained and deeply committed health workers.
It means that there is dynamic and creative management of the health services.
It means, above all, that people have determined for themselves the most
important community health problems and are actively involved in the programmes
for solving them."
Primary Health Care (PHC)
"Primary Health Care is essential health care based on practical,
scientifically sound and socially acceptable methods and technology, made
universally accessible to individuals and families in the community through
their full participation and at a cost that the community and country
can afford to maintain at every stage of their development in the spirit
of self-reliance and self-determination. It forms an integral part both
of the country's health system, of which it is the central function and
main focus, and of the overall social and economic development of the
community. It is the first level of contact of individuals, the family
and community with the national health system, bringing health care as
close as possible to where people live and work, and constitutes the first
element of a continuing health care process."
Since we have used the term "Essential Health Care" at the very
beginning of the definition of Primary Health Care, we have arrived at
a separate definition of Essential Health Care.
Essential Health Care
"Essential Health Care includes at least: education concerning
prevailing health problems and the method of preventing and controlling
them; promotion of food supply and proper nutrition; an adequate supply
of safe water and basic sanitation; maternal and child health care, including
family planning; immunisation against the major infectious diseases; prevention
and control of locally endemic diseases; appropriate treatment of common
diseases and injuries; promotion of mental health; and provision of essential
drugs."
D. OBJECTIVES
1. General Objectives
Each Member Government will carry out a careful study of the existing
health situation and select its own priorities.
Each Member Government will design a comprehensive health service, adapted
to its particular needs and potential, applying as may be appropriate,
the 25-Point Plan of Action prepared by the Caribbean Workshop on Primary
Health Care, Saint Lucia, June 1981.
Each Member Government will initiate early and simultaneous action, if
only on a modest scale at first, in the three major Primary Health Care
areas, so that the various elements can begin to interact with one another.
These major areas are intersectoral cooperation, community involvement,
and the shift of resources.
Even greater attention will be given to promotion, prevention and early
detection than to treatment.
We shall ensure that high-risk and vulnerable groups and those who are
now underserved , receive adequate care. These groups are those living
in rural areas, young children, expectant and nursing mothers, the poor,
the elderly and the disabled.
We shall identify the constraints that are impeding the efficient operation
of the health services and the achievement of health in the broad sense
in which it is conceived in this Declaration.
Each Member Government, and the Secretariat at the regional level, will
prepare a plan of work for achieving our objectives in the shortest possible
time.
Each Member Government, and the Secretariat at the regional level, will
make a continuous evaluation of health status and of its health programme
and report promptly each year to its own people and to the Community,
respectively.
2. Specific Objectives
Our Specific Objectives are:
2.1 General Development of the Health System
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2.1.1.1 Prepare in each country a health policy that includes
the description and analysis of problems, the diagnosis of the health
situation, the determination of priorities and the definition of objectives,
and adopts the Primary Health Care Approach.
2.1.1.2 Promote initiatives by each health administration in establishing
an effective mechanism for inter-sectoral coordination such as - |
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(a) a national health council at the central level, and
(b) community committees at the local level.
2.1.1.3 Include in this mechanism the sectors mentioned in A(b)i
on Page 4 of this Declaration.
2.1.1.4 Ensure, by the mechanism outlined above, the inclusion of
the health component in socio-economic development. |
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2.1.2 Management
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2.1.2.1 Develop a management system which includes planning, programming,
implementation, monitoring, evaluation and updating of the PHC Approach
to ensure continuous responsiveness to changing needs.
2.1.2.2 Develop in each country a system of health information which
facilitates the evaluation of the Primary Health Care Action Plan
and of this Policy Declaration and which includes demographic data,
vital statistics, medical records, morbidity data and statistics
on health resources, activities and finances.
2.1.2.3 Procure prompt and systematic annual reporting by each Chief
Medical Officer, utilising the agreed proforma.
2.1.2.4 Institutionalize for the Community as a whole a system of
training in the management of health services.
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2.1.3 Planning
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2.1.3.1 Introduce the planning process at all levels of
the health service.
2.1.3.2 Prepare in each country a comprehensive health plan, integrated
within the national development plan, with clearly defined objectives,
priorities and resources and a built-in system of evaluation and feedback
strategies.
2.1.3.3 Introduce or strengthen, as the case may be, programming in
the following areas: services, infrastructure, resources (including
external aid), implementation and evaluation. |
2.1.4 Human Resources
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2.1.4.1 Promote human resource planning, within the health
planning process, as a guide for human resource development.
2.1.4.2 Promote education and training of the various types of health
and health-related staff making up health teams, imbuing them with
the knowledge, skills and attitudes for carrying out health programmes.
2.1.4.3 Develop programmes for the training of community leaders in
Primary Health Care.
2.1.4.4 Field community health development teams that include all
relevant personnel in all areas/districts.
2.1.4.5 Re-examine the education of medical, nursing and other health
personnel in respect of relevance to the needs of the people of the
Caribbean and to inter-relationships within the health team and within
the system of general education.
2.1.4.6 Promote curriculum development as well as evaluation with
respect to basic and continuing education for all categories of health
staff.
2.1.4.7 Ensure optimum utilisation of staff, e.g. by providing them
with adequate supplies and equipment, and training and utilising auxiliaries
for appropriate tasks.
2.1.4.8 Arrange training in educational techniques for those responsible
for training health staff.
2.1.4.9 Stimulate research to develop better understanding of the
motivation of health workers in respect of service in the Caribbean
Community and particularly in rural areas so as the better to appreciate
their aspirations and provide them with suitable conditions of work
and prospects for career development.
2.1.4.10 Review and revise the measures that are needed to combat
the "brain drain" in the health professions.
2.1.4.11 Complete the development of the system of regional nursing
examinations.
2.1.4.12 Maintain a permanent mechanism of consultation between those
who train health staff, on the one hand, and the ministries who employ
them, on the other.
2.1.4.13 Develop other mechanisms for evaluating the relevance of
the educational processes to the needs of the health services and
of the Caribbean people.
2.1.4.14 Involve the two Universities of the Region in the study of
the health situation and the strengthening of the health services.
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2.1.5. Physical Facilities
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2.1.5.1 Develop a programme within which each Member
Country would:
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- make an inventory and analysis of existing facilities;
- review the geographic distribution and dynamics of the population;
- analyse the productivity of the existing system, e.g. coverage
of mothers and children;
- study the location, type and function of each unit and its equipment;
- programme the restoration and/or upgrading of existing facilities;
- prepare projects for new facilities, including supplies and equipment;
- estimate capital, recurrent and maintenance costs;
- examine alternative methods of financing;
- train the necessary staff;
- motivate the community to utilise the facilities. |
2.1.5.2 Procure in each country the management of hospitals by qualified
hospital administrators
. 2.1.5.3 Explore the feasibility of a system of voluntary accreditation
of hospitals as a means of raising the standards of care of patients.
2.1.5.4 Install in each country a supplies management system, including
pharmaceuticals.
2.1.5.5 Develop a regional programme for the maintenance of health
care facilities and the setting up of a centre for training and advisory
services in this field.
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2.1.6 Appropriate Technology
Prepare a plan of action for the development of a technology which
is suited in all respects to the Caribbean society and meets the criteria
set out at A(b)11 on Page 7 of this Declaration.
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2.1.7.1 Find and utilise all potential sources of funds
for health programmes and health-related activities, both national
and regional.
2.1.7.2 Develop relationships with other agencies and obtain external
assistance for health programmes, for the health component of development
programmes, and for development programmes with identifiable effects
on health, including community water supplies and systems of waste
disposal.
2.1.7.3 Promote a progressive shift of resources in the direction
of Primary Health Care.
2.1.7.4 Carry out a comprehensive review of alternative methods of
financing the health sector, including the social security approach.
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2.1.8 Legislation
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2.1.8.1 Reactivate the regional project for bringing up
to date and harmonizing the health laws of Member Countries.
2.1.8.2 Promote the appointment - nationally and regionally - of standing
committees of medical and legal representatives to address such issues
as the marketing of breastmilk substitutes and abortion. |
2.1.9 Research
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2.1.9.1 Adopt a research policy in health and include this
policy in the national health policy of each country.
2.1.9.2 Support, through the Commonwealth Caribbean Medical Research
Council, research relevant to the priority needs of the people with
attention to biological, socio-epidemiological and operational research,
including studies of ways of increasing the efficiency and effectiveness
of health care.
2.1.9.3 Establish mechanisms to ensure inter-sectoral cooperation
in the promotion of research and the training of the kinds of researchers
who are needed in the Community.
2.1.9.4 Make specific provision for research in the national health
budget.
2.1.9.5 Develop in and for the Caribbean Community a system for coordinating
the distribution of scientific and technological information in health. |
2.1.10 Evaluation
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Take part, in close co-operation with the Pan American
Health Organization/World Health Organization (PAHO/WHO), in a work programme
to evaluate the implementation of the Plan of Action for Primary Health
Care and of this Policy, including the selection of indicators to measure
impact and services.
2.2 Personal Health Services
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2.2.1 Disease Prevention and Control
Develop a regional plan of action and national programmes for the
control of diseases of major public health importance. |
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2.2.1.2 Reduce sickness and death from measles, whooping
cough, tetanus, diptheria and tuberculosis by provision of immunisation
services to all children, particularly those under one year of age.
2.2.1.3 Administer tetanus toxoid to all women of child-bearing age
and to agricultural and industrial workers.
2.2.1.4 Reduce by 50 per cent the death rates from enteric infections.
2.2.1.5 Prepare and carry out in each country a programme for controlling
the sexually transmitted diseases.
2.2.1.6 Eradicate yaws by surveillance and by implementation of the
WHO guidelines for control.
2.2.1.7 Control leprosy and tuberculosis by implementing WHO guidelines
for prevention, surveillance, diagnosis and treatment through the
Primary Health Care Approach.
2.2.1.8 Control malaria in the countries that are still infected and
maintain the transmission-free status in the other countries of the
Community.
2.2.1.9 Eradicate Aedes aegypti in the countries that are still infested
and prevent the reinfestation of areas from which it has been eliminated.
2.2.1.10 Develop veterinary public health services, with particular
attention to the control of such important diseases as salmonellosis,
rabies, bovine tuberculosis, leptospirosis, brucellosis and equine
encephalitis.
2.2.1.11 Develop programmes for the control of non-communicable diseases
of major public health importance, such as high blood pressure and
other forms of cardiovascular disease, and cancer.
2.2.1.12 Prepare a plan of action to reduce the ill effects of smoking.
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2.2.2 Health of Mothers and Children
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2.2.2.1 Reduce deaths and sickness among mothers and children,
aiming at the total coverage of maternal and child health care during
pregnancy, childbirth and childhood.
2.2.2.2 Put into effect in the Community as a whole and in each country
the Strategy and Plan of Action for Strengthening the Maternal and
Child Health Services.
2.2.2.3 Procure the designation by each Member Government of a person
or group of persons to be responsible for the implementation of the
Strategy.
2.2.2.4 Pay special attention to those measures which imply the economic
use of resources, for example, the identification of high-risk groups,
the utilization of auxiliaries, breastfeeding, immunization, and health
education, including family life education.
2.2.2.5 Implement the Strategy for Promotion of Breastfeeding and
the Guidelines for Feeding the Weaning Age Group.
2.2.2.6 Procure the inclusion of family planning among the services
provided.
2.2.2.7 Adopt the quantified targets set out in the Strategy, appropriately
modified.
2.2.2.8 Carry out the regional activities set out in the Strategy.
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2.2.3 Food and Nutrition
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2.2.3.1 Improve rapidly the quantity and quality of food
taken by the vulnerable sections of the population, namely, small
children, expectant and nursing mothers, and the poor.
2.2.3.2 Eliminate under-nutrition as a public health problem, reduce
anaemia to functionally acceptable levels, and control obesity and
other nutritional-related diseases.
2.2.3.3 Attain in the longer term a level of food intake that prevents
any degree of malnutrition that impairs human well-being and productivity.
2.2.3.4 With these aims in view complete the development and implementation
of the Regional Food and Nutrition Strategy and in particular:
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a) establish linkages between national and regional programmes
and projects and facilitate coordination between them;
b) promote and foster community development and participation in
the Regional Food and Nutrition Strategy;
c) promote the development of National Food and Nutrition Councils;
and
d) develop and implement appropriate management training programmes
for senior and operational level personnel to facilitate the efficient
and effective implementation of the Strategy. |
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2.2.4 Mental Health
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2.2.4.1 Put into effect in each country a programme that
is integrated within the general health service and includes the treatment
of mental illness by psychiatrists at health centres; the provision
of services in general hospitals for the short-term treatment of mental
illness; educational and other measures for prevention of mental illness;
the control of alcoholism, tobacco smoking and other forms of drug
dependence, and a serious attempt to change - in the direction of
greater acceptance - the attitudes of people towards mental illness
and the psycho-social aspects of general ailments.
2.2.4.2 Provide orientation for all levels of health and social and
other workers with respect to mental health problems, including the
early identification of mental illness and the management of chronic
cases. |
2.2.5 Dental Health
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2.2.5.1 Implement the Strategy and Plan of Action for the
Reform of the Dental Health Services prepared at the Saint Lucia Workshop
in May 1977 for the purpose of increased population coverage by the
services, prevention, special attention to children, use of fluorides,
training of dentists and auxiliaries, legislation and the dental health
education of the community. |
2.2.6 Health Education and Community Involvement
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2.2.6.1 Develop a programme to help the people of the Community
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(a) to identify the priority health problems for themselves;
(b) to feel responsible for solving these problems;
(c) to make the changes in their habits and behaviour that are needed;
and
(d) to become involved in the promotion, planning, execution, utilisation
and evaluation of the health services, |
so that in the end health is achieved by the actions and efforts of
the people themselves.
2.2.6.2 For this purpose, convene, in cooperation with interested
agencies, a Caribbean multi-sectoral workshop to prepare a comprehensive
plan of action.
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2.3 Environmental Health
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2.3.1.1 Implement the Environmental Health Strategy.
2.3.1.2 Develop the Caribbean Environmental Health Institute in Saint
Lucia.
2.3.1.3 Stimulate and assist each Member Country to develop an environmental
policy.
2.3.1.4 Participate in the International Drinking Water and Sanitation
Decade. |
2.3.2 Water Supply
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2.3.2.1 Provide piped water, safe for drinking, inside
the house, for twenty-four hours a day, to every citizen in the Caribbean
Community. |
2.3.3 Liquid Waste and Excreta Disposal
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2.3.3.1 Provide approved facilities for liquid waste and
excreta disposal to every household in the Community. |
2.3.4 Food Safety and Control
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2.3.4.1 Prepare a comprehensive Caribbean plan of action
and for this purpose convene, in cooperation with interested agencies,
a multi-sectoral workshop. |
2.3.5 Solid Waste Management
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2.3.5.1 Procure the adoption by each country of a system
of management of solid waste adapted to its needs, including efficient
collection, treatment and disposal, improved by institutional development,
the training of staff, educational work to obtain community participation,
and the necessary legislation. |
2.3.6 Vector and Rodent Control
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2.3.6.1 Develop programmes integrated within the environmental
health strategy. |
2.3.7 Industrial and Agricultural Pollution
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2.3.7.1 Develop programmes for the early detection, prevention
and control of pollution of air, water and soil (chemical, e.g. industrial
waste and pesticides; physical, e.g. radiation; biological, e.g excreta). |
2.3.8 Housing and Human Settlements
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2.3.8.1 Improve housing and health conditions in human
settlements and promote the health and psycho-social aspects of town
and country planning, attempting to prevent and solve the health problems
of industrial development and urbanisation.
2.3.8.2 Improve community sanitation (streets, parks and other public
places) and institutional sanitation (especially schools). |
2.3.9 The Health of Workers
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2.3.9.1 Develop a programme, integrated within the general
health services, to promote the health of the working population,
control occupational health risks and procure humanization of work.
2.3.9.2 With this in view, implement the Plan of Action prepared at
the Caribbean Workshop conducted in Guyana in March 1981. |
2.3.10 Port Health
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2.3.10.1 Rationalise port health practices in Member States
with the aim of facilitating travel in the Community without endangering
public health. |
2.3.11 Pesticide Management
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2.3.11.1 Prepare a programme in each country and in the
Community as a whole for pesticide management, adopting the agro-medical
approach, enacting the necessary legislation and expanding capacity
in the Community to monitor pesticide residues in human beings and
in the environment. |
2.3.12 Traffic and other Accidents
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2.3.12.1 In order to reduce the number of deaths and the
amount of disability caused by traffic and other accidents, carry
out a coordinated programme that takes account of the numerous causes
of accidents and the need for collaboration among various sectors,
such as the ministries responsible for police, health, labour, transport
and education, as well as the interested non-governmental organisations.
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2.3.13 Disaster Prevention, Preparedness and Relief
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2.3.13.1 Promote national and regional programmes for disaster
prevention, preparedness and relief.
2.3.13.2 Take part in the activities which have been decided upon
by the CARICOM Council of Ministers and which have as their objective
the establishment of
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a) a permanent Caribbean Disaster Preparedness Organisation andb)
a Caribbean Disaster Rehabilitation and Reconstruction Trust Fund.
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2.3.14 Education and Training
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2.3.14.1 Develop a comprehensive programme of education
and training of all levels of environmental health worker, ensuring
an engineering component and including provision of a degree course
in environmental health and/or public health engineering. |
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2.4 Supporting Services
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2.4.1.1 Procure the setting up in each Member State of
a system of nursing in which the role of nursing, the categories and
members of nursing personnel, and the programmes of nursing education
required to achieve our objectives are clearly defined.
2.4.1.2 Develop and implement standards of nursing care at the primary,
secondary and tertiary levels as well as a system of quality control.
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2.4.2 Epidemiological Surveillance
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2.4.2.1 Cooperating closely with the Caribbean Epidemiology
Centre (CAREC), promote in the Community and in each country a system
of surveillance that ensures -
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a) that there is adequate, readily available information on the
occurrence of diseases and the factors that facilitate their transmission;
and
b) that this information is utilised for programme formulation
and evaluation.
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2.4.3 Pharmaceutical Policy
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2.4.3.1 Develop the Caribbean Pharmaceutical Centre, which will formulate
a comprehensive pharmaceutical policy that will ensure that safe and
efficacious drugs are available at reasonable cost in the Caribbean
Community.
2.4.3.2 Specifically, the Centre will, among other things:
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a) operate an expanded pooled procurement system;
b) in collaboration with the Regional Drug Testing Laboratory, promote
the prescribing of drugs by generic as distinct from brand name;
c) develop a Caribbean formulary and promote its utilisation;
d) disseminate information about pharmaceuticals;
e) develop a comprehensive programme of training in pharmacy, which
will include orientation towards Primary Health Care;
f) stimulate and assist health administrations in the formulation
and implementation of pharmaceutical policy and in intercountry
cooperation.
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2.4.4 Laboratory Services
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2.4.4.1 Strengthen the diagnostic facilities both for clinical medicine
and community health, including water quality control, food safety
and veterinary public health. With this in view and adopting as the
starting-point the new Laboratory Project for the LDCs, develop a
regional laboratory service for the Caribbean Community.
2.4.4.2 Develop a regional service in forensic medicine.
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2.5 Inter-country Cooperation
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2.5.1. Develop a programme within which each country and each agency
would organise its cooperation so as to achieve maximum impact, at
the same time avoiding costly duplication.
2.5.2 Under this programme the Caribbean Community Secretariat would:
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a) promote and assist the continuous identification and study of
problem areas which lend themselves to intercountry cooperation
and external aid;
b) promote and coordinate the sharing of information, experiences
and resources among Member States;
c) strengthen its relationships with the various interested agencies
- both Universities, other Associate Institutions of the Caribbean
Community, the United Nations family, bilateral agencies and non-governmental
organisations - and work closely with them in activities aimed at
attaining the Goal;
d) collect and collate information on the policies and projects
of each agency;
e) stimulate and assist Member States to strengthen their capacity
for attracting and utilising external aid, e.g. by enhancing their
skills in project identification, design and management;
f) strengthen its own capacity to perform these various functions.
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CONCLUSION
Under the Treaty establishing the Caribbean Community, the
Secretariat is the principal administrative organ of the Community and the
Secretary-General its principal administrative officer.
It is to the Secretary-General, therefore, and to the Secretariat that we
assign the responsibility of taking, at the regional level, the action that
must follow this Declaration.
This is not to say that we expect the Secretariat to play a passive role
and await our guidance. It clearly has a leadership role to play in promoting
the health of the people of the Community. It best performs this role by
constant stimulation of thought and action in the field of health and by
proposing new solutions for difficult health problems.
We urge all those, within the Caribbean Community and outside it, who are
interested in promoting the health of the people and assisting us to attain
the objectives that we have outlined, to collaborate with the Secretary-General
and the Secretariat. Since health is inextricably linked with social and
economic development, this call is made, not only to PAHO/WHO and the other
organisations of the United Nations system, but also to all other agencies
concerned with social and economic development.
We call upon individual Member Governments to do their part, which is the
most important of all. |
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