Public Health: A Return on Investment

CARPHA is an avenue by which the population’s health may be advanced. In accordance with the principle that the health of the region is the wealth of the region, it is an agency that stands at the cusp of this region’s development possibilities by providing epidemic protection, laboratory networking and leadership in effective public health interventions. Investment in CARPHA is thus economically sound.

A document produced in December 2013, ‘Estimating the Economic Value of the Public Health Coverage Provided by CARPHA’ established that the losses averted by CARPHAs work are approximately US$253M annually. As yearly cost has been estimated at US$11M, the economic return rate of investment in CARPHA is by a factor of overPubli 22. This is further demonstrated by a 2016 study based in Trinidad and Tobago, which calculated the economic impact of diabetes, hypertension and cancer to be US$1.2Bil (4.3% GDP), of which 40% is in direct health costs, and 60% is indirectly by productivity decrease. Programs conducted by CARPHA can greatly mitigate this drain on the economy.

However, as the existing core funding affords a very basic level of public health services, investment is urgently needed. It is worth noting that in 2015 the average health expenditure in the Caribbean was 5.9% of GDP, as compared to the world average of 6.3% (WHO data). This need has been partially offset by resource mobilization success and partnerships, but project resourced funding is not sustainable.

Caribbean Cooperation in Health (CCH)

The Caribbean Cooperation in Health (CCH) aims to achieve more efficient cooperation in common health services by developing and maintaining cost-effective and efficient systems. Each iteration of CCH has evolved with the changing times to meet the needs of CARICOM states, and has delivered significant health gains, such as a scaling up of the response to HIV. CCHIV, which spans 2016—2025, intends to address the goals set by WHO, and the non-communicable diseases that are the leading causes of mortality and an economic burden. The strategic priorities set by CCHIV have guided the strategic plan for CARPHA for 2018—2025.

In CCH IV, RPGs include, but are not limited to, shared legislative and policy frameworks, standards, regulations and guidelines; shared capacity through regional technical agencies and common training programs; shared quality assurance mechanisms; common approaches to addressing shared regional and international challenges to public health; shared research to identify effective and replicable practices; shared financing approaches, including pooled procurement.

At the 25th Meeting of Chief Medical Officers in April 2017, CMOs identified the following priority RPGs to guide the implementation of CCHIV:

  • Strengthened legislative framework for health, including legal briefs and model legislation
  • Regional legislation for nutritional labelling
  • Regional approach to trade legislation and regulation in support of reducing childhood obesity
  • Caribbean Regulatory System for essential medicines
  • Regional partnership of health and tourism
  • Caribbean guaranteed minimum package of health services
  • Common health promotion campaigns
  • Common training programs for health and other personnel, including in partnerships and negotiation
  • Common clinical guidelines and auditing tools for national NCD programs
  • Regional data sharing and ethics policy
  • Regional health information systems policy
  • Regional strategy to stimulate private sector partnerships
  • Resource mobilization strategies for reaching non-traditional funders.

These five strategic priorities have been identified in the document "CCHlV: Summary of the Regional Health Framework 2016-2025."

  • 1.  Health Systems for universal access to health and universal health coverage,
  • 2.  Safe, resilient, healthy environments,
  • 3.  Health and well-being of Caribbean people throughout the life course,
  • 4. Data and evidence for decision making and accountability, and
  • 5.  Partnership and resource mobilization for health.

State of Public Health

In conformance with the functions of CARPHA under the Inter-Governmental Agreement (IGA), an annual State of Public Health Report (SPHR) is to be produced. This document is intended to give guidance to CARPHA Member States (CMS) on health priorities and assist in planning and policy formulation to improve the status of health in CMS. It also serves as a guide for International Agencies and Partners for prioritisation of technical assistance, support and funding in the Region. Finally, it can serve as an advocacy tool for regional bodies.

Unlike other SPHR around the world which focus on one country, the CARPHA report has the peculiarity of covering multiple countries with varying levels of development, population sizes as well as cultural and political characteristics. A strategic decision was made to produce topic specific reports for a given period in order to maximise and highlight the public health priorities or issues with which member states are confronted. The report is a balancing act between the broader regional perspective and national information.

CARPHA has now produced four SPHR, the Inaugural issue in 2013, the second issue covering 2014-2016 (Surveillance, Vector Borne Diseases, Childhood Obesity), third issue 2017-2018 (Climate Change and Health) and fourth issue 2019 (Healthy Ageing in the Caribbean). The current iteration under development will focus on the COVID-19 Pandemic in the region.