Your Excellencies Sir Paul and Lady Scoon
Distinguished Secretary-General of CARICOM
Distinguished Ministers of Health of CARICOM
Sisters and Brothers
In the name of the people of Grenada, it gives me very
pleasure to welcome you all to our country.
It is particularly pleasurable to do so because this
being hosted in Grenada is a meeting of CARICOM Ministers of Health,
line with our very deep commitment to the CARICOM Movement, and to
and regional integration generally, it is always a pleasure for us to
in our country our friend, our sisters and brothers from the Caribbean
It is also particularly a pleasure because this, in our
a very important meeting on a very important subject with important
This meeting can certainly help to influence the future
our region as proper health to us is a key to the all-round development
Clearly, our working people will be unable to be fully
productive, a goal that all of us desire, if they are unhealthy.
Clearly, likewise, the children of our region will not
be able to
receive or to benefit from the educational opportunities open to them
are hungry, if they have poor eye sight, or if they are otherwise
Thus any serious meeting on this question of improving
quantity and quality of health care must be an important meeting.
We have observed that there are 45 agenda items and all
appear to us to be relevant to the full development of the regional
strategy and to the smooth continuation of the process of improving the
quantity and quality of health care for the people of this region—a
are sure that undoubtedly concerns all governments in the Caribbean
matter on which all of us have yet to make significant progress or at
have much more to achieve.
As a result of our common history of colonialist
continuing imperialist domination we all share a number of
An economic system that taught us to look outside of
countries for solutions to our problems, an economic system that has perpetuated the rule of a privileged
local elite working in the interest of, and as the hand maidens of
external forces; an economic system that has prepared a tiny elite to
while condemning the broad majority to perpetual self-contempt,
poverty; an educational system, moreover, that has trained this tiny
measure progress in terms of dollars, and hence to be unpatriotic and
for the suffering of others; to get rich quickly and thus to seek
abroad if and when the local environment does not allow for
advance; an educational system that did not stress service but stressed
personal individualist advancement.
Hence a system that made it very difficult for the
elite to be willing to put their talents at the disposal of the masses,
as part of a team with people deemed to be their “inferiors”, and to be
unwilling to make any personal sacrifices or concessions in the
interest of the
deprived and oppressed masses.
This legacy has also left us a political, social, moral
psychological climate that has deformed our perspectives and priorities.
That has left us thinking that development and progress
not be measured in terms of meeting the basic needs of our people, with
to jobs, with regard to more housing, with regard to better food, with
to pipeborne water, with regard to decent health care, with regard to
with regard to education.
It has instead left us measuring progress in terms of
how many of
us can become new millionaires or new members of the middle classes.
This experience past and present has therefore left
and greatly affected our capacity for achieving genuine development and
In the area of health, there are many ways in which
this can be
seen. Firstly, in the area of the serious manpower shortage, with the
in most of our countries unwilling to work for any length of time for
that societies can afford to pay, the result is a continuation of the
drain, a resumption or a turning in the first place to private
practice, or an
insistence on the right to use tax payers’ time and money to supplement
employment with private practice.
Furthermore, in the case of many of our doctors, we see
unwillingness to move out of the confines of the hospital system and
communities, into the medical clinics, the health centres, the day care
centres—in other words, into those areas where precisely the vast
our people are needing medical attention.
It has left us, too, with a legacy of a serious
nurses; many ill-trained, and also many with an incorrect approach to
question of developing a community approach to solving our medical
It has left us with a serious shortage of trained
workers. It has left us, in many cases, with not even a single
important if we are serious about developing the concepts of primary
A second broad area of concern arising out of this
legacy is in
the area of the serious management and planning problems that we face.
In many cases in our countries, there are not even
planners, and there are very limited attempts at scientifically
national health plan.
And again, precisely because training historically has
as unimportant, the whole question of community participation in
quality and quantity of health care have also been sadly neglected.
Food and nutrition councils are still the rare
exception in the
region. The possibility for mobilising communities to unblock drains,
overhangings, thus helping to deal with the serious problems of disease
communicated by the mosquito—these possibilities have by and large been
This legacy has also left us inadequate and in some
non-existent facilities. We are faced with a shortage of basic
shortage of important items of equipment.
The situation with regard to pipeborne water, for
remains a serious problem and this is certainly a very large
factor to the continuing problems of gastro-enteritis and diarrhoeal
These two problems certainly continue to be a
of death for children under two years.
In many of our hospitals X-ray machines do not
specialised services—for example provision of eye clinics, provision of
dentists—these continue to be missing.
In the area of environmental health, the serious lack
health inspectors and even junior inspectors, the necessary equipment
dumping sites, bulldozers, spreaders, the refuse trucks, the garbage
of the basic and very important facilities are missing in several of
It seems to us, sisters and brothers, that for
ours, it is important to identify all the possibilities for improving
quality of life, especially when this quality of life can be improved
substantial capital expenditure.
We believe that two areas where it is possible to bring
without perhaps spending a great deal of money, are precisely in the
health and education. We feel this is so for the following reasons at
Firstly, the possibility to attract assistance from
friendly countries, from regional and international institutions, these
possibilities in our view are more readily available for these two
education and health than for several other areas.
In the case of education for example, the possibility
scholarships from friendly countries and friendly institutions is
In the case of health, the possibility exists for
financial assistance to improve on the water supply in our country, to
much desired and vital equipment, the possibilities for getting
assistance, the possibilities indeed for devising suitable project
that form part of an overall national plan.
Secondly, this is possible in our view because of the
to rationalise the allocation of our scarce resources.
For example, improvements can certainly be made in
areas such as
our nursing schools, in the area of in-service training—there are
possibilities there for brining about improvement without a great deal
We can consider seriously and begin to implement the
possibilities of cutting back on wasteful expenditure, looking, for
for cheaper sources of drug supplies. This is one of the areas in which
regional cooperation must certainly move decisively.
Finally, in this area we can begin to ensure a more
use of the budgetary allocation in health.
We have found in Grenada, for example, that in 1978
like 70-75 percent of the health budget was being spent on the three
hospitals, while the remaining 25-30 percent of that budget was being
the service of the 35 health centres and medical clinics around our
The obvious disadvantage of this approach is that the
of greatest spending were precisely the areas that were attending to a
small percentage of those in our country who need medical attention.
A third possibility, it seems to us, is to begin to
the opportunities for involving our communities, for involving the
our people in participating in this programme of improving on the
of our country.
In the area of education, we found in Grenada that in
for a period of two weeks, by calling on the communities, we were able
something like 65 primary schools around Grenada repaired, refurbished
renovated. And this, of course, amounted to a massive saving for tax
In the area of health similar possibilities exist.
There seems to
be no good reason why community centres could not, in some cases, also
for brining health care to our people.
Our clinics and health centres can certainly be
part, by community involvement and assistance. The unblocking of
establishment of village health committees that would not only look to
question of repairing and maintaining public health buildings, of
drains, but also of monitoring the quantity of health service that the
received, all of these it seems to us must represent important
this area of health care.
We feel confident, sisters and brothers, that our
goals are in keeping with the oft repeated policy statements issued by
CARICOM Ministers of Health.
These statements have stressed, among other things,
is a right for all people and as such maximum health opportunities
provided with fees taking secondary place rather than priority.
These statements have also stressed the need to deliver
opportunities to our rural population, and the need to reduce
the provision of more housing and other such amenities that have a
indirect relationship to the question of proper health care.
These policy positions, in turn, are in keeping with
objectives of CARICOM in the field of health.
As long ago as 1977, at the Third Ministers of Health
in St. Kitts, these objectives were listed as follows:
development of comprehensive health
health care for mothers and children.
Thirdly, a proper
strategy for food and nutrition.
Fourthly, control of
Fifthly, control of
and finally, the
development of adequate supporting services.
Many of these objectives are being tackled and I
today the Secretariat can report that there is a clear declaration on
regional health policy, that there is an ongoing management development
project, which is helping to train over 700 personnel in our region;
is a serious threat in the field of health manpower development.
The community is also developing the ability to monitor
survey the outbreak of epidemics. There is a clear environmental health
strategy. There is great progress towards the creation of a food and
This could become a reality, I am told, by the end of
There is also a dental health strategy which is in need, however, of
I am advised further that the regional pharmaceutical
in the process of preparation, and that progress is being made in the
disaster prevention, preparedness and relief.
No one can seriously say that these are not important
but nonetheless we must also recognise that we still have, individually
collectively, a long, long way to go.
Accordingly, we in Grenada have begun to develop a
health plan, aimed at dramatically improving the quality and quantity
care in our country.
The People’s Revolutionary Government of Grenada views
a basic human right and as a fundamental prerequisite for the
formulation of a
sound economic policy.
Further, the People’s Revolutionary Government is aware
health for all can only be attained through national political will,
through the coordinated efforts of the health sector and the relevant
activities of other social and economic development sectors, since
development, both contributes to, and results from, social and economic
Health policies must form part of an overall
thus reflecting the social and economic goals of government and people.
In this way, strategies for the health, social and
sectors will be mutually supportive and together can contribute to the
goals of our society.
Everywhere people are more and more coming to realise
motivation in striving to increase their earnings is not simply greater
for its own sake, but the social improvements that increased purchasing
can bring to them and their children; such as better food and housing,
education, better leisure opportunities and, of course, better health.
Only when they have an acceptable level of health, can
individuals, families and communities enjoy the other benefits of life.
Health development is, therefore, essential for social
economic development, and the means for attaining them are intimately
For this reason, efforts to improve the health and
situation of our nation must be regarded as mutually supportive rather
Discussions on whether the promotion of health consumes
or whether it is an economically productive factor contributing to
belong to the academic past.
We fully accept our responsibility to provide our
adequate health care as a matter of right.
It is imperative, therefore, at the time when resources
scarce, to ensure that comprehensive social and economic planning be
And in this regard, it is mandatory for Grenada and the
developmental efforts to give separate and special priority to a health
strategy particularly designed to reach the poorest of the poor in our
In order to effect such changes in the health care
following minimum positions have been recognised and agreed upon.
Firstly, our government has recognised health Planning
function of the highest level of decision-making.
This is essential to ensure the appropriate delegation
and authority, the preferential allocation of resources to health care,
proper location of the supporting services so that they are accessibly
communities they are to serve.
And since the planning of health care involved
and economic factors, multi-disciplinary planning teams are needed
at the central level.
Central planning will aim at enabling communities to
own health care activities, it will therefore, provide them with a
of the part they have to plan in the national health care strategy and
overall development process at community level.
In Grenada, health care services are not now
accessible, or sufficiently readily available to a majority of the
A nationwide plan of action to overcome the problems of
availability and accessibility has therefore been initiated.
The main components of this plan are: firstly, an
of existing health care services—manpower, supplies, equipment and
secondly, an investigation into the basic needs of the population, and
the question of linkages and referrals.
It is necessary to thoroughly research the present
delivery system to ascertain exactly what components are presently
offered, to whom are these services available, by whom are they
what time are they available and at what price, both to the consumer
The object of this research will be to serve as the
which a comprehensive health delivery system can be planned.
It will address such problems as poor or uneven
in-adequate and inaccessible health care, intersectoral coordination
health and some or all other sectors as finance, education, agriculture
resources, will also be sought and established.
It is our firm belief that all genuine democratic
on, promote, and are strengthened by a mass movement.
The active participation of the popular masses in all
processes is essential for the realisation of these goals.
At the Alma Atta Conference, members clearly recognised
primary health care was the means of attaining health for all. And in
make primary health care universally accessible in the community as
possible, maximum community and individual self-reliance for health
To attain such self-reliance requires full community
participation in the planning, organisation and management of their
Such participation is best mobilised, in our view,
appropriate education which will enable communities to deal with their
problems in the most suitable way.
Substantial community support is, therefore, a key
factor in the
success and continuity of a primary health care system.
We certainly believe that all organisations and groups
country, be they of workers, farmers, youth, women, business—all of
be involved in planning and monitoring of this system.
The fundamental tasks which are hoped to be developed
intersectoral level are the raising of the heath education level for
population; obtaining the effective support of the population on health
programmes; strengthening community service and doctor/patient
increasing and strengthening the communities’ confidence in their
Curative medicine, although it is continuously
techniques, cannot alone assure the maintenance of the population’s
The promotion and protection of health are activities
priorities when it some to offering the community a high level of
The national health system being developed in our
encourage medical practice to take a preventive/curative approach, and
for the development of programmes for the lessening and eradication of
This activity will be based on the integration of the
and curative activities of the Ministry of Health.
We are also actively looking at the question of
reform and we are publicly committing ourselves as government to bring
the necessary health reforms that are essential to convert a goal into
It is clear that the full development of the primary
programme and the achievement of its fundamental purposes is a
The strategy will need to be constantly adjusted in the
new information, day-to-day experiences, and social changes taking
However, while the primary health care approach itself
universal there is no universal recipe for primary health care
one being a national endeavour specific to the country’s concrete
What succeeds in one country cannot necessarily be
and have the same results everywhere.
However, we firmly believe in the words of the 1977
resolution, which was proposed at the 1977 St. Kitts Ministers of
Conference, that in the Caribbean community the question of health is
That to the extent that any of us are able to make
this important area of improving on the quality of health for our
must be of benefit tot he rest of us in the region, to the extend we
closely connected and linked together by different forms of
regularity of travel and in other such ways.
Primary health care would be more acceptable and easier
implement for all countries, if we all realise that others are
using this approach.
For this reason, regional and international, political,
technical and financial support are important.
Our government has recognised the fact that with the
of basic health techniques and opportunities, the provision of food,
decent housing, more pipeborne water, and assistance in improving
the health of communities can improve dramatically and in a way that
the potential for continuing and continuous change.
We have acknowledged that it is our duty to provide the
population with a health care system which is available, accessible,
and of a high quality.
And although we are fully aware of, and limited by
human constraints, we are determined to achieve the goal of health for
the year 2000, through primary health care.
And we believe that this should certainly continue to
be the aim
of all of us in the Caribbean community and in the region.
May I therefore, once again, welcome
you to our shores, wish you a very successful
conference and ask that while you are here with us that you take the
to enjoy our hospitality, our friendship and the beauty of our country
Thank you very much.