The whole: greater than the sum of its parts

The whole: greater than the sum of its parts

The Caribbean is integration writ large, and by actively engaging in collaborative ways of working together, the region is well poised to handle the public health issues it faces

The Caribbean is home to many small island developing states, and home to the Caribbean Community – CARICOM – which is integration writ large through its common history, cultural heritage, and shared economic and social issues. CARICOM is celebrating its 50-year existence in 2023, and a legacy that is a testimony to the resilience of integration. Given that for most of us, our ancestors were forcibly transported from their homes all over the world to this region, it is wonderful that we have learned to live and work and play together.

This 50-year journey has birthed many declarations in many sectors. The historic Port of Spain Declaration “Uniting to Stop the Epidemic of Chronic Non-Communicable Diseases” is the most significant demonstration of the power of the collaborative efforts of CARICOM heads of government to address a major public health issue. It triggered a cascade of global action to combat NCDs.

The Caribbean Public Health Agency is itself an example of integration. Prior to 2013, there were five regional health institutions: the Caribbean Environmental Health Institute, the Caribbean Epidemiology Centre, the Caribbean Food and Nutrition Institute, the Caribbean Health Research Council and the Caribbean Regional Drug Testing Laboratory. The heads of government, in seeking to maximise economies of scale and optimise effectiveness, merged them all to form the sole CARICOM regional public health agency.

Integration of services

CARPHA is known for many public health services that are all integrated to deliver quality public goods to its member states. Services include disease surveillance, research, regulation of medicines, monitoring and evaluation of health surveillance, vector-borne disease detection and control, field epidemiology training, NCD surveillance and control, a tourism and health programme, food-borne disease surveillance and control, health information management, communicable disease management and control, disaster preparedness and response, environmental health and sustainable development, medicines quality testing, health promotion, and procurement of medicines and supplies. Since 2019, CARPHA has sought also to integrate these data sets to ensure an integrated surveillance system to offer an integrated evidence-based perspective on the public health product we deliver.

Economic integration

The Caribbean economies are small and, as most heavily depend on tourism, the economies are sometimes referred to as fragile. There have been several attempts to create a CARICOM single market and economy to integrate all members into a single economic unit. At their meeting in July in Trinidad, CARICOM heads of government agreed to reimplement the CARICOM single market to allow unrestricted travel among member states.

Public health threats can weaken fragile economies. The Covid-19 pandemic exemplified this. CARPHA’s Tourism and Health Programme brought together stakeholders before the pandemic. The partnership went into overdrive during the pandemic to ensure the health threat was understood and that the right approach was taken to protect locals and visitors when tourism resumed in full force in 2021. A fragmented response would have been disastrous. Instead, there was a concerted effort to ensure everyone was on the same page in knowledge, understanding and practice to ensure a safer healthier tourism product, even in the worst crisis to date.

Political integration

While each member state has its own sovereignty, the mechanism and structure of the Caribbean Community is a living example of political integration. CARICOM heads of government meet at least twice yearly and on special occasions when necessary to discuss issues affecting the region as a whole and how these can be resolved.

One recent example in public health was the integrated approach to the Covid-19 pandemic response. The decisions by the heads were strategic in saving lives and livelihoods. CARPHA was privileged to have been afforded an opportunity to provide technical guidance.

Collaboration with partners

Partnerships have become one of the strongest pillars of support for the successful implementation of many projects. A large share of the available financial resources comes from friendly governments outside the region and from international development partners.

In ensuring that there is regional health security, CARPHA actively engages partners in all technical and diplomatic aspects of this exercise.

One important lesson learnt from the experience of managing and responding to the Covid-19 pandemic is meaningful partnerships. We saw the collaboration of the CARICOM institutions from the security cluster, using their respective areas of technical expertise and collective advice, to provide optimal security for the region.

CARPHA has found that a successful strategy for integration to equitably provide our services to 26 members is to use networks and mechanisms such as the Inter Agency Technical Committee for implementing the Six-Point Policy Package, the Regional Health Communication Network and the Regional Coordination Mechanism for Health Security. All have been well established at CARPHA to support the integration and coordination of different entities in the interest of the public health of the region.

The most recent example of integration is the recent award of the Pandemic Fund in the first round. CARPHA submitted a proposal with the Inter American Development Bank as the implementing entity. The plan is to use the funds to help the CARICOM’s pandemic preparedness and response in tangible ways.

Integration efforts that span decades are not without their challenges. Getting political, technical and corporate partners from varied disciplines to work together towards a common goal requires extra efforts to build trust, dedication and a willingness to advance the cause.

We are grateful as a region to have witnessed integration in these various dimensions, particularly demonstrated when it was most needed, in a public health crisis.

CARPHA will continue to be mindful that the whole is greater than the sum of its parts. It will continue to actively engage in collaborative and integrated ways of working to achieve its mandate and to contribute to regional public goods through the Caribbean Cooperation in Health framework.