Caribbean: Further Integration is Needed in Terms of Health Coverage

This week I have seen a news that raised my attention, about the caribbean health market.I decided to investigate because in general I do not have too much insight in such a fantastic place, mainly because due to the differences of language (predominate the english) in Latin America the caribbean are regarded as a “different” continent…

Triggered by the new policy  endorsed by Barbados regarding non-national citizens on healthcare and drugs, countries from the Caribbean Community (CARICOM)  are to discuss about difficulties combining regional integration and access to healthcare, in order to define a future policy as a group.

According to The Guyana Chronicle, the government of Barbados has begun the implementation of a new Health Care Act that restricts access to cost-free drugs/medical care to non-nationals who have neither Barbadian citizenship nor permanent residency status. In such  a context, unless proof of citizenship or permanent residency status could be established when seeking medical care, then non-nationals who lived in Barbados could be denied health benefits previously freely accessed. Driven by this decision, different member states that are part of CARICOM, such as Guyana, Jamaica, St. Kitts and Nevis and St. Vincent and the Grenadines, have expressed concerns about the application of the new Barbados Health Care law that would require clarifications.

CARICOM: The Caribbean Community and regional integration

In 1972, Commonwealth Caribbean leaders at the Seventh Heads of Government Conference decided to transform the Caribbean Free Trade Association (CARIFTA) into a Common Market and establish the Caribbean Community, signing the treaty establishing CARICOM July 4^th 1973, was a defining moment in the history of the Commonwealth Caribbean. The objectives of the Community were to improve standards of living and work, through economic and social policies within the region and among the different members. In 2001 it was created a new version of the Treaty, called formally, The Revised Treaty of Chaguaramas Establishing the Caribbean Community, including the CARICOM Single Market and Economy, which added new protocols, including the rights contingent on the free movement of persons and labour.

However, the treaty did not establish what it would happen with internal polices such as access to health and drugs. Now CARICOM governments need to collectively  move towards a common strategy for shared medical benefits by all nationals of member states that have signed on to the Community’s Single Market and Economy (CSME) project. It has been noted that implementation of the Barbados health care legislation, has come at a time when CARICOM is in the process of seeking to establish appropriate mechanisms consistent with arrangements for the CSME. These arrangements, which would facilitate more than the estimated nine categories of skilled nationals to have freedom to live and work in any of the participating CSME member states, relate to outstanding issues like contingent rights and creation of a regional health insurance scheme that’s applicable across the region.

Countries such as Trinidad and Tobago has a significant presence of nationals from other Community states, which makes rather important to officially set up a policy in relation to non-nationals accessing cost-free medical care and drugs. According to sources from Barbados, even citizen that hold valid work permits, Barbados ID card and are tax payers, are being classified as immigrant and are being left without access to care. This inconsistency in the legislation and the social problems that it brings is fuelling pressure in the Community, in order to prioritise arrangements for common approach in the provision of health care and reimbursement of drugs for all nationals of the Community, towards the evolution of a common health-care programme for Community nationals, including non-citizens who live and work there.

The Caribbean is formed by several small states, such as Antigua y Barbuda, Bahamas, Barbados, Belize, Guyana, Haiti, Jamaica, Surinam and Trinidad & Tobago. Together this  market  is characterised by a  health sector which is predominantly public, with important needs in terms of maternal and child care. From the point of view of the Healthcare & Pharmaceutical industry, opportunities for a more integral approach as a region can come with the definition of common approaches on healthcare programmes within the region, which is about to be discussed in the Inter-Sessional Meeting of CARICOM leaders.

CARICOM	Bahamas	Barbados	Guyana	Jamaica	Trinidad and Tobago
Total life expectancy at birth 2008 (years)	73.49	77.01	67.11	71.84	69.34
Infant mortality rate (IMR 2009)	8.50	9.80	28.90	25.90	31.10
Public health expenditure 2007 % GDP	3.71	4.45	7.18	2.36	2.69
Private health expenditure 2007 % GDP	3.56	2.51	1.01	2.33	2.11
Total health expenditure 2007 % GDP	7.27	6.96	8.18	4.68	4.80
Total population (Millions) 2009	0.34	0.26	0.76	2.70	1.34