Health for All
[15 July 1980]

Your Excellencies Sir Paul and Lady Scoon

Distinguished Secretary-General of CARICOM

Distinguished Ministers of Health of CARICOM

Distinguished Delegates

Observers, Guests

Sisters and Brothers

In the name of the people of Grenada, it gives me very real pleasure to welcome you all to our country.

It is particularly pleasurable to do so because this meeting being hosted in Grenada is a meeting of CARICOM Ministers of Health, and in line with our very deep commitment to the CARICOM Movement, and to Caribbean and regional integration generally, it is always a pleasure for us to have here in our country our friend, our sisters and brothers from the Caribbean countries.

It is also particularly a pleasure because this, in our mind, is a very important meeting on a very important subject with important agenda items.

This meeting can certainly help to influence the future course of our region as proper health to us is a key to the all-round development of any country.

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 if they are hungry, if they have poor eye sight, or if they are otherwise similarly disadvantages.

Thus any serious meeting on this question of improving the quantity and quality of health care must be an important meeting.

We have observed that there are 45 agenda items and all of them appear to us to be relevant to the full development of the regional health 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 matter we are sure that undoubtedly concerns all governments in the Caribbean community—a matter on which all of us have yet to make significant progress or at least have much more to achieve.

As a result of our common history of colonialist exploitation and continuing imperialist domination we all share a number of disadvantages.

An economic system that taught us to look outside of our own 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 rapacious external forces; an economic system that has prepared a tiny elite to be masters while condemning the broad majority to perpetual self-contempt, derogation and poverty; an educational system, moreover, that has trained this tiny elite to measure progress in terms of dollars, and hence to be unpatriotic and uncaring for the suffering of others; to get rich quickly and thus to seek fortunes abroad if and when the local environment does not allow for sufficiently rapid advance; an educational system that did not stress service but stressed rather personal individualist advancement.

Hence a system that made it very difficult for the certificated elite to be willing to put their talents at the disposal of the masses, to work 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 and psychological climate that has deformed our perspectives and priorities.

That has left us thinking that development and progress should not be measured in terms of meeting the basic needs of our people, with regard to jobs, with regard to more housing, with regard to better food, with regard to pipeborne water, with regard to decent health care, with regard to clothing, 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 deep scars and greatly affected our capacity for achieving genuine development and social progress.

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 doctors in most of our countries unwilling to work for any length of time for wages that societies can afford to pay, the result is a continuation of the brain 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 public employment with private practice.

Furthermore, in the case of many of our doctors, we see a great unwillingness to move out of the confines of the hospital system and into the communities, into the medical clinics, the health centres, the day care centres—in other words, into those areas where precisely the vast majority of our people are needing medical attention.

It has left us, too, with a legacy of a serious shortage of nurses; many ill-trained, and also many with an incorrect approach to the whole question of developing a community approach to solving our medical problems.

It has left us with a serious shortage of trained public health workers. It has left us, in many cases, with not even a single paramedic, so important if we are serious about developing the concepts of primary health care.

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 health planners, and there are very limited attempts at scientifically devising a national health plan.

And again, precisely because training historically has been seen as unimportant, the whole question of community participation in improving the 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, cut overhangings, thus helping to deal with the serious problems of disease communicated by the mosquito—these possibilities have by and large been relatively untapped.

This legacy has also left us inadequate and in some cases non-existent facilities. We are faced with a shortage of basic medicines, a shortage of important items of equipment.

The situation with regard to pipeborne water, for example, remains a serious problem and this is certainly a very large contributing factor to the continuing problems of gastro-enteritis and diarrhoeal diseases.

These two problems certainly continue to be a substantial cause of death for children under two years.

In many of our hospitals X-ray machines do not function, 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 of trained health inspectors and even junior inspectors, the necessary equipment for dumping sites, bulldozers, spreaders, the refuse trucks, the garbage bins, all of the basic and very important facilities are missing in several of our territories.

It seems to us, sisters and brothers, that for societies like ours, it is important to identify all the possibilities for improving the quality of life, especially when this quality of life can be improved without a substantial capital expenditure.

We believe that two areas where it is possible to bring benefits without perhaps spending a great deal of money, are precisely in the areas of health and education. We feel this is so for the following reasons at least.

Firstly, the possibility to attract assistance from outside, from friendly countries, from regional and international institutions, these possibilities in our view are more readily available for these two areas of education and health than for several other areas.

In the case of education for example, the possibility of getting scholarships from friendly countries and friendly institutions is undoubtedly a reality.

In the case of health, the possibility exists for attracting financial assistance to improve on the water supply in our country, to obtain much desired and vital equipment, the possibilities for getting technical assistance, the possibilities indeed for devising suitable project proposals that form part of an overall national plan.

Secondly, this is possible in our view because of the possibility 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 limited possibilities there for brining about improvement without a great deal of additional expenditure.

We can consider seriously and begin to implement the possibilities of cutting back on wasteful expenditure, looking, for example, 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 proportionate use of the budgetary allocation in health.

We have found in Grenada, for example, that in 1978 something like 70-75 percent of the health budget was being spent on the three general hospitals, while the remaining 25-30 percent of that budget was being spent on the service of the 35 health centres and medical clinics around our country.

The obvious disadvantage of this approach is that the three areas of greatest spending were precisely the areas that were attending to a very small percentage of those in our country who need medical attention.

A third possibility, it seems to us, is to begin to exploit more the opportunities for involving our communities, for involving the masses of our people in participating in this programme of improving on the health needs of our country.

In the area of education, we found in Grenada that in January, for a period of two weeks, by calling on the communities, we were able to get something like 65 primary schools around Grenada repaired, refurbished or renovated. And this, of course, amounted to a massive saving for tax payers.

In the area of health similar possibilities exist. There seems to be no good reason why community centres could not, in some cases, also be used for brining health care to our people.

Our clinics and health centres can certainly be repaired; in part, by community involvement and assistance. The unblocking of drains, establishment of village health committees that would not only look to the question of repairing and maintaining public health buildings, of unblocking drains, but also of monitoring the quantity of health service that the people received, all of these it seems to us must represent important possibilities in this area of health care.

We feel confident, sisters and brothers, that our efforts and goals are in keeping with the oft repeated policy statements issued by the CARICOM Ministers of Health.

These statements have stressed, among other things, that health is a right for all people and as such maximum health opportunities should be provided with fees taking secondary place rather than priority.

These statements have also stressed the need to deliver health opportunities to our rural population, and the need to reduce inequalities in the provision of more housing and other such amenities that have a direct or indirect relationship to the question of proper health care.

These policy positions, in turn, are in keeping with the specific objectives of CARICOM in the field of health.

As long ago as 1977, at the Third Ministers of Health Conference in St. Kitts, these objectives were listed as follows:

Many of these objectives are being tackled and I understand that today the Secretariat can report that there is a clear declaration on the regional health policy, that there is an ongoing management development project, which is helping to train over 700 personnel in our region; that there is a serious threat in the field of health manpower development.

The community is also developing the ability to monitor and to survey the outbreak of epidemics. There is a clear environmental health strategy. There is great progress towards the creation of a food and nutrition strategy.

This could become a reality, I am told, by the end of this year. There is also a dental health strategy which is in need, however, of urgent implementation.

I am advised further that the regional pharmaceutical policy is in the process of preparation, and that progress is being made in the field of disaster prevention, preparedness and relief.

No one can seriously say that these are not important advances, but nonetheless we must also recognise that we still have, individually and collectively, a long, long way to go.

Accordingly, we in Grenada have begun to develop a national health plan, aimed at dramatically improving the quality and quantity of health care in our country.

The People’s Revolutionary Government of Grenada views health as 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 that health for all can only be attained through national political will, and through the coordinated efforts of the health sector and the relevant activities of other social and economic development sectors, since health development, both contributes to, and results from, social and economic development.

Health policies must form part of an overall development policy, thus reflecting the social and economic goals of government and people.

In this way, strategies for the health, social and economic sectors will be mutually supportive and together can contribute to the ultimate goals of our society.

Everywhere people are more and more coming to realise that the motivation in striving to increase their earnings is not simply greater wealth for its own sake, but the social improvements that increased purchasing power can bring to them and their children; such as better food and housing, better 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 and economic development, and the means for attaining them are intimately linked.

For this reason, efforts to improve the health and socio-economic situation of our nation must be regarded as mutually supportive rather then competitive.

Discussions on whether the promotion of health consumes resources or whether it is an economically productive factor contributing to development belong to the academic past.

We fully accept our responsibility to provide our people with adequate health care as a matter of right.

It is imperative, therefore, at the time when resources are scarce, to ensure that comprehensive social and economic planning be implemented.

And in this regard, it is mandatory for Grenada and the region’s developmental efforts to give separate and special priority to a health strategy particularly designed to reach the poorest of the poor in our respective countries.

In order to effect such changes in the health care system, the following minimum positions have been recognised and agreed upon.

Firstly, our government has recognised health Planning as a function of the highest level of decision-making.

This is essential to ensure the appropriate delegation of responsibility and authority, the preferential allocation of resources to health care, and the proper location of the supporting services so that they are accessibly to the communities they are to serve.

And since the planning of health care involved political, social and economic factors, multi-disciplinary planning teams are needed especially at the central level.

Central planning will aim at enabling communities to plan their own health care activities, it will therefore, provide them with a clear idea of the part they have to plan in the national health care strategy and in the overall development process at community level.

In Grenada, health care services are not now sufficiently accessible, or sufficiently readily available to a majority of the population.

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 investigation of existing health care services—manpower, supplies, equipment and facilities; secondly, an investigation into the basic needs of the population, and thirdly, the question of linkages and referrals.

It is necessary to thoroughly research the present health delivery system to ascertain exactly what components are presently being offered, to whom are these services available, by whom are they provided, at what time are they available and at what price, both to the consumer and the government.

The object of this research will be to serve as the platform from which a comprehensive health delivery system can be planned.

It will address such problems as poor or uneven quality, and in-adequate and inaccessible health care, intersectoral coordination between health and some or all other sectors as finance, education, agriculture and water resources, will also be sought and established.

It is our firm belief that all genuine democratic processes rest on, promote, and are strengthened by a mass movement.

The active participation of the popular masses in all such processes is essential for the realisation of these goals.

At the Alma Atta Conference, members clearly recognised that primary health care was the means of attaining health for all. And in order to make primary health care universally accessible in the community as quickly as possible, maximum community and individual self-reliance for health development is essential.

To attain such self-reliance requires full community participation in the planning, organisation and management of their health care.

Such participation is best mobilised, in our view, through appropriate education which will enable communities to deal with their health 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 in our country, be they of workers, farmers, youth, women, business—all of them should be involved in planning and monitoring of this system.

The fundamental tasks which are hoped to be developed on an intersectoral level are the raising of the heath education level for the entire population; obtaining the effective support of the population on health programmes; strengthening community service and doctor/patient relations; and increasing and strengthening the communities’ confidence in their health services.

Curative medicine, although it is continuously perfecting its techniques, cannot alone assure the maintenance of the population’s high health level.

The promotion and protection of health are activities which are priorities when it some to offering the community a high level of health.

The national health system being developed in our country will encourage medical practice to take a preventive/curative approach, and allow for the development of programmes for the lessening and eradication of diseases.

This activity will be based on the integration of the preventive and curative activities of the Ministry of Health.

We are also actively looking at the question of administrative reform and we are publicly committing ourselves as government to bring about the necessary health reforms that are essential to convert a goal into a reality.

It is clear that the full development of the primary health care programme and the achievement of its fundamental purposes is a long-term process.

The strategy will need to be constantly adjusted in the light of new information, day-to-day experiences, and social changes taking place.

However, while the primary health care approach itself is universal there is no universal recipe for primary health care programmes, each one being a national endeavour specific to the country’s concrete situation.

What succeeds in one country cannot necessarily be transplanted and have the same results everywhere.

However, we firmly believe in the words of the 1977 draft resolution, which was proposed at the 1977 St. Kitts Ministers of Health Conference, that in the Caribbean community the question of health is geographically indivisible.

That to the extent that any of us are able to make progress in this important area of improving on the quality of health for our people, it must be of benefit tot he rest of us in the region, to the extend we are so closely connected and linked together by different forms of transportation, by regularity of travel and in other such ways.

Primary health care would be more acceptable and easier to implement for all countries, if we all realise that others are successfully using this approach.

For this reason, regional and international, political, moral, technical and financial support are important.

Our government has recognised the fact that with the availability of basic health techniques and opportunities, the provision of food, education, decent housing, more pipeborne water, and assistance in improving productivity, the health of communities can improve dramatically and in a way that ensures 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, affordable and of a high quality.

And although we are fully aware of, and limited by financial and human constraints, we are determined to achieve the goal of health for all by 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 time off to enjoy our hospitality, our friendship and the beauty of our country and people.

Thank you very much.