Subregional Workshop for Cooperation Effectiveness- Caribbean Chapter

21 September 2010

Presented by Ian Ho-a-Shu, Health Specialist, IDB

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• Background – NCDs in the Caribbean• The Regional Surveillance System project• The Cooperation Framework • Implementation – mutual learning and local

solutions• Challenges• Conclusion

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• Chronic Non-Communicable Diseases (NCDs) are the leading cause of mortality, morbidity, and disability worldwide – approx 59%.

• In LAC, NCDs account for as many as two out of three deaths.

• The Caribbean is the region in the Americas that is worst affected by the chronic disease epidemic.

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• In 2007, CARICOM Heads met at a Summit on NCDs in Trinidad

• They recognized the need for comprehensive and integrated responses which address prevention, control and treatment

• They agreed to “establish, as a matter of urgency, the programmes necessary for research and surveillance of the risk factors for NCDs….”

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• Six countries – The Bahamas, Barbados, Belize, Guyana, Jamaica and T&T – joined together with support from the IDB to develop a Regional NCDs Surveillance System

• They recognized the value of a regional approach.• They saw it as a unique opportunity to leverage on

existing experiences and initiatives and bring countries together to work collectively, a regional solution is being sought for a regional problem.

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Goal : To improve the overall capacity of the countries to deliver cost-effective health services associated with NCDs.

Outcome: The development of a Caribbean Regional NCDs Surveillance System

Outputs:• Diagnosis and Gap Analysis of national NCD registers and

information systems• Design of the Surveillance System and its components

(including IT platform)• Develop protocols and mechanisms for regional

harmonisation of public policy to respond to NCDs.

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• The CMOs and Ministries of Health of the six countries

• The University of the West Indies

• The IDB – Regional Public Good Programme

• CAREC/PAHO7

• Consensus on and roll out of the Caribbean Minimum Dataset for NCDs

• Capacity building undertaken in country on the use of the Dataset

• Gap Analysis of NCD registers and information systems• Development for the Surveillance system on an web-based

IT platform• Inaugural annual meeting of CARICOM NCD focal points• First draft of Chronic Care Model for care for the region. • Draft of updated Primary Health Care Policy

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South-South Cooperation – Caribbean countries have ownership and lead the technical cooperation component

Triangular Cooperation – led and implemented by Southern countries with financial and technical support from a multilateral organisation

IDB’s Regional Public Good methodology – the Bank’s key instrument of S-S Cooperation

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Guiding principles:

• Pragmatic innovation • Institutional Coordination• Strategic Partnership • Capacity Development

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• Collective action – UWI, CMOs and Ministries, IDB, CAREC/PAHO working together to develop and implement innovative strategies, emphasizing the use of local systems and expertise

• Country ownership• Demand driven • Aligned with country objectives and systems• Bottom-up approach

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• Governance = horizontal partnership and country leadership based on consensus– Steering Committee (CMOs)– Project Coordinating Unit (UWI)– Focal Points (MOHs)

• Harmonisation – operating plan, financial management, procurement processes, reporting, M&E

• Managing for results –based on agreed AOP which measures achievements not process

• Mutually accountable – all partners signed letters of agreement

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• UWI – Convenor, PCU, Business Development Office, Medical Faculty, IT expertise, Admin support

• CAREC/PAHO – Technical expertise

• CARICOM – use of regional meetings to facilitate gatherings of project participants

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• Traditional – trainings on the Dataset, workshops on surveillance, etc.

• Non-traditional – Horizontal mechanism for mutual learning. – Countries share experiences and information on

the development of disease registries, modalities of data collection, accessing funding, clinical practices, promotion and awareness, etc. They learn from each other.

– E.g. The Bahamas medical record system14

Innovations in Implementation in the Caribbean Context • The use of an independent regional institution as

executing agency, facilitator of collective action and technical advisor.

• Letters of agreement signed by all parties establishing formal commitment to the project and contributing to long term sustainability.

• The designation of country Focal Points as points of contact at a functional level.

• A strong and committed project champion -the Chancellor of the University and former head of PAHO - propels the project using high-level networking, institutional memory and expertise to provide guidance, solve problems and open doors.

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Sustainability• Changing of project personnel in MOHs.• Limiting Human and Financial resources in

MOHs• Continued funding for further phases

including continued hosting of the platform on which the IT system is built.

• Scaling up

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• The project is an example of collective development and integration which takes advantage of SSC and Triangular Cooperation– take advantage of the strengths of South-South Cooperation,

such as well-adapted expertise and innovative solutions– use the comparative advantages of each Southern partner – leverage the resources and knowledge of the multilateral donor

• It uses innovative, dynamic strategies to mitigate the challenges of ownership, alignment, coordination and sustainability.

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THANK YOU

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