Public Health Relevance

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.

The Economic Value of CARPHA

The Caribbean Public Health Agency (CARPHA) can be seen as one institutional manifestation of the commitment of the region to ensure that it remains on the right side of the link between health and development. In shaping up the Region on a sustainable development path, governments of the region have displayed reliance on CARPHA in piloting the way to the right development choice. This means that as far as the Caribbean is concerned, CARPHA is a public health agency with a difference, since it presents developmental prospects to the region.  Still, ever since the Heads of Government proposed the adoption of the principle that the health of the region is the wealth of the region, there has been a greater consciousness of the economic contribution of health investments in the Caribbean. Still, ever since the Heads of Government proposed the adoption of the principle that the health of the region is the wealth of the region, there has been a greater consciousness of the economic contribution of health investments in the Caribbean.

A simple model was constructed to highlight the responsibility CARPHA shares with other public health agencies in the region and to find a way of identifying the share of the regional benefit than can be attributed to CARPHA. The main finding here was that the losses averted by CARPHA’s work have been estimated at US$253 million annually. It is important to point out that all the relevant assumptions made leaned in the direction of an underestimate of averted losses. Determining the soundness of investing in CARPHA—a study compared the projected cost of CARPHA over a three-year period with the estimate of averted losses. Since the three-year cost has been previously estimated at US$33 million, it is clear that the averted losses for the period, namely US$756 million, outweigh these costs by a factor of more than 22.

Research shows that the potential economic contribution of CARPHA will only be realized if the Agency is able to carry out its functions to the best of its ability. What this means is that, unlike its predecessor agencies, CARPHA will need to be adequately financed. In a situation where the financing of CARPHA amounts to less than 0.05% of the region’s income and with CARPHA contributing more than 22 times what it costs to run the agency, the case for making the investment in CARPHA is a very strong one. CARPHA’s role takes it into areas where its costs are double what have been estimated so far, these extended costs will pale in comparison to the value that CARPHA brings to the region.

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.

The following are 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."

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