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1998 Annual Report
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 | General |
| Surveillance |
| Vital and Health Statistics |
| Laboratory Policies and Operations |
| HIV/AIDS/TB |
| Tourism, Health and Development |
| COUNCIL RESOLUTIONS |
Recognising the progress made by CAREC in reviewing its mission, developing its Vision Statement, and identifying shared values and core competencies needed to guide its strategic planning and action as part of its organisational transform- ation, the Scientific Advisory Committee (SAC) commends CAREC staff and Director for the amount and quality of work undertaken over the past two years.
In light of the many new members of SAC and the biennial frequency of meetings, with the need to better inform SAC members and better assure that they are adequately prepared for the meetings and that their expertise is used most effectively, SAC recommends that:
1.1 CAREC complete the draft brochure describing the role and functions of the Centre;
RESPONSE
Brochure describing role and functions of Centre completed.
1.2 CAREC provide for the new members additional background material about the role and functions of the Centre and roles and responsibilities of SAC members;
RESPONSE
The Multilateral Agreement for the operation of the Centre, which sets out
CAREC'S role and functions, was sent to SAC members as part of their 1999 meeting package.
This agreement describes SAC's role as being "to advise the Director, PAHO through
the Council on the scientific programmeof CAREC." It is suggested that the revision
of the multilateral agreement specify in some more detail the role of SAC to be approved
by Council.
1.3 CAREC prepare advance documentation for issues to be discussed by working groups during the meetings; and
RESPONSE
A draft meeting agenda and list of issues for discussion was circulated with the
1999 meeting package.
1.4 That CAREC use electronic mail and other means of communication to utilise the expertise of SAC members throughout their tenure.
RESPONSE
Expertise of SAC members has been utilised from time to time during the year via
email and other methods of communication.
SAC recommends that:
2.1 CAREC prepare a manual of surveillance procedures, including case definitions and response algorithms, and offer guidance in linking epidemiologic and laboratory databases to strengthen public health surveillance;
RESPONSE
A Communicable Diseases Surveillance Manual for the Caribbean has been produced
and circulated for comment to key persons and will be discussed at the 1999 meeting of
National laboratory Directors and Epidemiologists.
2.2.1 CAREC provide surveillance information to its member countries on a frequent and regular basis. CAREC should continue to inform member countries in emergency situations using Fax Alerts. Recognising the high cost of such publications, CAREC should consider charging a fee to all other than core constituents.
RESPONSE
CAREC produced a quarterly communicable disease feedback report, which is
disseminated to all National Epidemiologists, Laboratory directors and Chief Medical
Officers of Member Countries. Fax Alerts continue to be transmitted to national public
health agencies on urgent matters such as, re-emergence of dengue type 3. The CAREC
Surveillance Report will be re-introduced in 1999.
2.5.1 CAREC continue to work with the EPI Programme in the strengthening of surveillance of the EPI diseases, and in particular, Congenital Rubella Syndrome, and should advocate that Congenital Rubella Syndrome be made officially reportable in member countries;
RESPONSE
CAREC has included Congenital Rubella Syndrome (CRS) as one of the reportable
conditions on the weekly Communicable Disease Surveillance Form. A surveillance system for
Congenital Rubella Syndrome was established for the first time in the region and became
fully operational during 1997. In addition, CAREC/PAHO sought as secured a Ministerial
resolution to eliminate rubella and CRS through mass campaigns.
2.6 CAREC encourage Ministries of Health to improve vector surveillance through the use of tools such as enhanced ovitrapping in their sampling of Aedes aegypti and Aedes albopictus;
RESPONSE
CAREC disseminated information in the literature and in training programmes for
CMC Vector Control (VC) units on the superior value of enhanced ovitrapping in detecting
Aedes aegypti in comparison to routine visual inspection - especially in cases of low
indices - as currently practised by these units. With the intrusion of Aedes albopictus
into at least one CMC (Cayman Islands) in 1997, these improved surveillance tools must be
put in place now for early detection and control in all CMCs.
2.7 Recognising that the cost of application development and system support has led to PAHO's decision not to develop software, it is recommended where possible, that appropriate packages be provided or adapted to the needs of member countries, depending on their readiness as well as their ability to absorb the cost, e.g., the COMDIS module of the Community Health Information System; and
2.8 That CAREC, in collaboration with clinicians, and in the context of dis ease surveillance and control, design, update, and promote guidelines on profiles of major diseases in the Caribbean so as to promote effective diagnosis and management.
RESPONSE
CAREC has concentrated on using or adapting existing packages, such as the Public
Health Laboratory Information System (PHLIS), or Epi-Info. The Internet is also making
possible the development of browser based systems, which can be centrally supported.
Guidelines on major diseases have been done for DHF as well as HIV/AIDS and STDs.
Noting with approval, CAREC's progress in the improvement in the capture, quality and utilisation of mortality data from its member countries;
Recognising the continuing need for health information for identification, prioritisation of health problems and at risk populations as well as for monitoring and evaluation of interventions;
Acknowledging the human and financial resource constraints of CAREC and its member countries;
SAC recommends that:
3.1 CAREC continue to support the strengthening of mortality data collection and the development and utilisation of MORTBASE, including its updating to allow the use of ICD10 codes;
RESPONSE
CAREC has demonstrated the utility of the contents of the database by providing
information to health and social service agencies for the formulation of health policy,
based on current and projected trends. CAREC, as per its collaboration with HDP/HDA, the
technical unit with responsibility for health information, awaited the signing off of the
ICD-9 version and agreement to work on the ICD-10 version of MORTBASE.
3.2 CAREC and the PAHO Health Situation Analysis Program formally urge the medical Schools of the sub-region to put greater emphasis on Medical Certification of Cause of Death in the curriculum;
RESPONSE
CAREC has made approaches to the newly recruited Regional Advisor on Human
Resources to review the content of this course in medical schools. The EWMSC continues to
use the CAREC material in the conduct of the course by in-house staff. Meanwhile, CAREC
continues to conduct in-country workshops for medical practitioners and to train nationals
for the sustained conduct of these workshops.
3.3 CAREC collaborate with the PAHO Information Systems Program to assist countries in accessing, processing and using hospital discharge data with identification of appropriate core variables;
3.4 CAREC summarise existing evaluations of the benefits, costs and sustainability of disease registries and document pertinent issues to guide future action; and
That CAREC explore and strengthen collaboration with sub-regional health economists with a view to assessing the burden of diseases of public health importance and the cost-effectiveness of interventions.
RESPONSE
Limited progress was made in the use of hospital discharge databases for
surveillance in several countries. No progress was made on assessing disease registries.
Collaboration with the UWI Health Economics Unit was very active, e.g., HIV/AIDS modeling
and joint advocacy efforts, and a Memorandum of Agreement is being finalised.
SAC recognises the following primary roles of CAREC's Laboratory as a regional public health reference and referral laboratory:
| Quality assurance programmes to assure quality of testing in laboratories in member countries. |
Quality Assurance (QA) training in country and via distance education continued for regional laboratories (148 technologists and consultants from 5 CMCs ). CAREC continued to assist regional laboratories to monitor and evaluate implementation progress and to provide proficiency testing panels for external quality assessment. Advocacy for support for QA implementation as well as sourcing of funds to expand these activities were major areas of emphasis in 1997. Development and evaluation of new technologies, technology transfer and training.
The laboratory continued to advocate the implementation of more cost-effective HIV alternative confirmatory test algorithms. Evaluations of four new HIV kits are ongoing. Dengue IgM testing technology was transferred to 2 CMCs (Barbados and Suriname).
Implementation of molecular techniques for detection and identification of Dengue serotypes and HIV was initiated.
In addition to QA training, in-country Bacteriology workshops were conducted in Bahamas and British Virgin Islands and a sub-regional workshop on enteric pathogens was conducted at CAREC (PAHO/LCDC Project).
| Applied research, in collaboration with appropriate partners, into diseases of public
health importance in the Caribbean. Applied research was conducted and is ongoing, on antimicrobial resistance patterns of enteric pathogens, N. gonhorrhoea and S. pneumoniae in several CMCs, in collaboration with WHO and LCDC, Canada and Smith-Kline & Beecham respectively. A study of Chagas' disease in low- and high-risk populations continued in 1997. A longitudinal study of parasitism levels in school children is ongoing in St. Kitts. |
| CAREC's role in outbreak investigation is to analyse sufficient specimens to confirm
etiology and to monitor trends of public health importance, and not to diagnose every
individual case |
| CAREC's laboratory should primarily act as a confirmatory tool within the context of
active epidemiological surveillance, and not only as the provider of the earliest data for
passive surveillance systems. A policy for sampling in dengue outbreak situations was developed and letters outlining this policy were circulated to the institutions in several CMCs. A videotape describing policies and procedures for dengue laboratory surveillance during and between outbreaks was circulated to CMCs. In 1998, outbreak sampling policies will be developed in collaboration with the Epidemiology Division and disseminated to users. |
| In some areas, CAREC Laboratory will retain some diagnostic role, however, there needs to be careful consideration of which tests should be included, based on uniqueness of availability and need. |
SAC recommends that:
4.1 CAREC confirm this role with Chief Medical Officers, National Epidemiologists and Laboratory Directors, and encourage dissemination of this information to National clinicians in member countries;
RESPONSE
The role of CAREC's Laboratory as a regional reference and referral laboratory
was discussed at the biennial meeting of Laboratory Directors and Epidemiologists in 1997.
A user manual outlining this role and providing specific information on sample submission
is being prepared for dissemination to users in 1998.
4.2 CAREC continue its development of the LABIS module of the CARISURV system, that CAREC gather data on the impact of the implementation of CARISURV in the CAREC Laboratory, and subsequently pursue selected offering to CAREC member countries, based on their state of readiness and their ability to absorb the cost, beginning with a pilot in one member country, possibly the Trinidad and Tobago Public Health Laboratory;
RESPONSE
With many aspects of the information related to the laboratory testing process at
CAREC now handled by the Laboratory Information System (LABIS) component of CARISURV,
development shifted focus towards analysis of data generated by the system, to facilitate
process and resource management / decision making, and laboratory-based surveillance.
Limited CAREC human and financial resources in the area of Information technology have
prevented the piloting of LABIS in any CMC to date.
4.3 CAREC laboratory institute a system for costing of services and that this be represented and disseminated in the annual report;
RESPONSE
A protocol and spreadsheet for costing of laboratory testing has been developed,
and has been applied to a limited selection of tests. The Laboratory Information System
(LABIS) now allows us to track laboratory services delivered to each country, and on
completion of the costing exercise for all laboratory services, will allow us to determine
total costs.
4.4 CAREC re-commission a minimal facility for arbovirology in compliance with international safety standards; and
RESPONSE
Plans have been drafted for a new arbovirology facility, and a proposal developed
for funding of the capital equipment and plant renovations required to meet the
international safety standards. This proposal is being incorporated into a broader
proposal to be forwarded for funding consideration. A portion of CAREC's building fund has
also been allocated to this end.
4.5 That CAREC laboratory establish a cost-recovery policy, including a formula for computing the total costs and charges for such services.
RESPONSE
Establishment of a policy for cost recovery requires a cost accounting
capability. CAREC is currently exploring potential accounting systems, and implementation
of such a policy by the Laboratory Division will require close collaboration with CAREC's
Administration Division.
SAC endorses CAREC's proposal to the EEC for "Strengthening of Medical Laboratory Services in the Caribbean" and urges CAREC to seek the necessary political support within the region.
CAREC continued to actively lobby for political support for the EEC project proposal "Strengthening of Medical Laboratory Services in the Caribbean." Significant success was evident in the support indicated by Ministers of Trade, Finance and Tourism of the region at the CARIFORUM meeting held in October, 1997. In March 1998, CARIFORUM Ministers approved $10m US (ECU 8m) for funding the project under the second financial protocol of Lome IV. It is hoped that negotiations will be completed in 1999.
SAC RECOMMENDS THAT
5.1 CAREC continue to strengthen the surveillance capability of its member countries to address weaknesses identified relative to the quality, accuracy, completeness, confidentiality and utility of HIV/AIDS surveillance data generated in countries;
RESPONSE
HIV/AIDS/STD surveillance team members comprising CAREC/PAHO and FTC staff
conducted evaluations of the surveillance systems in Belize and St Kitts in 1998. This
brought to nine, the number of country evaluations done for the period 1996 to1998. For
each of the following countries, the Evaluation Teams formulated recommendations and plans
of action to address the weaknesses identified in Antigua and Barbuda, Barbados, Belize,
Dominica, Grenada, Guyana, St Kitts and Nevis, St Vincent and the Grenadines, and Trinidad
and Tobago.
The action plans are in various stages of implementation in many of the countries, for example, Epidemiology training in Antigua and Barbuda, Guyana and Barbados has resulted in improved HIV/AIDS/STD data management and reporting.
5.2 CAREC continue to foster collaboration between clinicians, laboratory personnel, and epidemiologists, recognising the importance of these linkages to the generation of quality HIV/AIDS data critical to clinical management and public health action.
RESPONSE
During 1998, emphasis was placed on the importance of collaboration among all
health professionals as a major objective of the laboratory Quality Assurance initiative.
5.3 CAREC foster collaboration between its epidemiologists and its behavioural team to undertake the design, testing and implementation of an HIV/AIDS behavioral surveillance tool for the collection of reliable risk category information.
RESPONSE
A behavior surveillance instrument developed and tested among pregnant women in Antigua
and Barbuda will be adapted and used simultaneously with sero-prevalence studies to be
undertaken among the general population.
5.4 CAREC continue to promote and facilitate implementation of cost-effective, unlinked, anonymous HIV surveillance studies in CMCs among specific target groups, conducted in parellel with relevant behavioural surveillance
RESPONSE
Such studies were completed among pregnant women in Trinidad and Tobago, and BVI
in 1997, and in Antigua and Barbuda in 1998, and the results are available. This will be
replicated in other CMCs during 1999, however, the drive to prevent vertical transmission
through the use of anti-retroviral therapy will also have to be factored in.
5.5 CAREC encourage member countries to focus on the generation of incidence data for specific STD syndromes, including genital ulcers, male urethral discharge and prevalence data for syphilis among pregnant women.
RESPONSE
A new reporting form was developed and introduced in Barbados and Guyana to
capture the STD Syndromes and the distribution of their causes. This will be extensively
replicated in other CMCs during 1999.
5.6 CAREC support member countries' efforts to eliminate congenital syphilis
RESPONSE
Trinidad and Tobago has taken preliminary steps towards elimination of congenital
syphilis. Assessments of syphilis trends were completed in Antigua and Barbuda, Cayman
Islands and Grenada and feedback sent to countries for improved control of the disease.
5.7 CAREC should work with individual countries to strengthen the HIV/AIDS case reporting systems.
RESPONSE
A new HIV/AIDS reporting form has been developed, capturing date of HIV onset,
date of AIDS onset and AIDS death. Dissemination to countries has begun , along with a
programme to brief clinicians on use of the form. Clinicians in Guyana and Barbados have
benefitted so far.
5.8 CAREC continue to promote adequate care and support as an integral part of prevention and care programmes for HIV/AIDS.
RESPONSE
CAREC's role has been to facilitate strengthening of the regional organisation of
HIV positive people, CRN+, and people living with HIV/AIDS through institutional
strengthening at the regional and national level. CAREC supported a regional workshop of
people living with HIV/AIDS under the direction of the CRN+ held in St. Vincent and the
Grenadines at which a board was selected and plans of action were developed. CAREC and
others hosted regional workshop on prevention of mother to child transmission of HIV and
an interim policy and guidelines have been developed and disseminated.
5.9 Behavior modification continue to be a major CAREC strategy for HIV/AIDS prevention and control
RESPONSE
Behaviour modification, targeting groups at high risk, has continued to be a
major strategy for HIV/AIDS prevention and control.
5.10 CAREC promote targeted behavior interventions among specific groups in member countries.
RESPONSE
Individual countries have been receiving technical and financial support to
develop, implement and evaluate interventions for their priority populations. For example,
resources have been made available to Ministries of Health and NGOs for Voluntary
Counselling and Testing, and targetting People Living with HIV/AIDS, Commercial Sex
Workers (CSWs), Beach Boys, Youths, and Men who have Sex with Men (MSM).
5.11 CAREC continue to strengthen the capacity of member countries to identify target groups and to develop, implement and evaluate behavioral interventions.
RESPONSE
Capacity in this respect was greatly enhanced when representatives of the
Government and non-Government sector from 12 CMCs benefitted from a regional skill
development workshop on Promoting Safer Sexual Behaviours. The workshop was aimed at
providing skills to identify target groups and design, implement and evaluate
interventions to reach these groups.Participants drafted proposals for interventions to
reach priority groups in their respective countries and benefitted from the sharing of
country experiences. At the workshop, participants examined a framework for targetting
populations, which was developed during 1997.
5.12 CAREC continue strengthening linkages between Tuberculosis and HIV/AIDS/ STD control and prevention programmes.
RESPONSE
Selected countries have been identified for cohort studies on the impact of the
HIV/AIDS epidemic on the re-emerging Tuberculosis problem in CMCs. The studies are
ongoing.
5.13 That CAREC promote "Directly Observed Therapy" using the short term chemotherapy approach.
RESPONSE
CAREC has been actively promoting DOTS as an essential component of any effective
TB management programme. DOTS has already been adopted in Jamaica.
Within the Caribbean, the travel and tourism industry is extremely important to regional development. In 1996, it accounted for some US$ 25 billion of gross output, 25% of the GDP, one in four jobs, and more than 50% of the hard currency earnings for most countries, making the Caribbean the most tourism dependent region in the world. In 1996, there were over 12 million stay-over tourist arrivals (10% from within the Caribbean) and 6 million cruise ship arrivals, some of whom needed health care services.
Tourism is predicted to become more important in the next fifteen years, with a doubling of the number of hotels and visitors. Tourism will become even more important to our economies, given the directions of global trade liberalisation, and the likely loss of some or all of our preferential trade status with respect to products such as bananas, rice, and sugar, unless there is swift and real progress towards regional integration, so that we can speak with one voice.
Yet the future of tourism is not guaranteed. High energy costs, relatively low labour productivity, the importation of most supplies and equipment, and natural disasters are challenges. Safety, health and environmental concerns, among increasingly discerning customers, also challenge the region to continuously improve the quality of its tourism product.
With respect to safety and health, the presence of the Internet in member countries in 1995-6 now makes good and bad news easier to spread. The 1994 EC Directive on package tours, which holds the tour operator liable for problems on a vacation, makes it clear that the health and safety experience of a visitor is an important part of the quality of their stay.
In many countries, the expansion in the tourism and hospitality industry has not been matched by Ministries of Health capacity to service hotels, e.g., in relation to food safety. Tourism agencies tend to focus on issues such as the appointment of rooms and not on issues such as food safety, or vector control in hotels. There are no agreed health and hygiene standards for hotels in the Caribbean. Communicable diseases, such as HIV/AIDS, dengue, Legionnaires' Disease (LD) and Foodborne Disease (FBD) are of concern, as are issues of safety and injuries. The increasing amounts of travel are also a threat to our measles and polio elimination status.
In recent years, there have been outbreaks of FBD in hotels in several countries, and an outbreak of LD in a hotel in one country, which CAREC has been involved in investigating. The swift investigation of the latter saved the island's tourism industry an estimated US$2-4 million.
In May 1996, CAREC and the Caribbean Hotel Association (CHA) hosted the "First Caribbean Conference on the Prevention of FBD in the Hotel Industry". The theme of the conference was "Healthy Guests are Great for Business". The conference identified need for:
| High level commitment, public and private |
| Training, at all levels |
| Surveillance and Research |
| Standardised inspections, self audit |
Following the conference, CAREC developed a vision for the Caribbean to be the safest, happiest, and healthiest of comparable destinations in the world, which is in keeping with the quality perspectives of the Caribbean Tourism Organisation ("Caribbean development through quality tourism"), and the CHA ("The Caribbean cares"). A proposal for a Caribbean Hotel Sanitation Program was then developed, in which CAREC, in partnership with the CHA, would provide services of independent audit, surveillance, training and consultations to the hotel industry, on a cost recovery basis. The aim is to improve the quality and competitiveness of participating hotels through providing a safer and healthier environment. It would improve hygiene to agreed standards in hotels, and contribute to sustainable tourism.
The activities in Tourism and Health have been led by the newly formed Public Health Intelligence Unit and are in keeping with the mission of the Unit - To provide visionary leadership to CAREC and member countries into a healthier 21st century, and the objective of identifying the strategic disease prevention and control issues facing the Caribbean.
These and other Health and Tourism activities are summarised below.
| Attendance at CHA Board of Directors Meeting and Environment Committee quarterly | ||||||
| Holding of "First Caribbean Conference on Prevention of Foodborne Disease in Hotel Industry", May '96 - in collaboration with CHA. Theme: "Healthy Guests are Great for Business" | ||||||
| Securing of CHA commitment to be proactive on FBD prevention, September 1996 · Hotel Based Surveillance System developed with EPIET and CDC/EIS input, November 1996 Joint Food Safety "Training of Trainers" proposal developed with CHA and Caribbean Culinary Federation, December 1996 | ||||||
| Hotel Based Surveillance System pilot began in Antigua, January 1997 | ||||||
| Developed concept for "Caribbean Hotel Sanitation Program" (HSP), like CDC
Vessel Sanitation Programme System comprises:
|
With PAHO Barbados and the Caribbean Food and Nutrition Institute, the concept of the HSP has evolved to a concept of a "Caribbean Healthy Hotel Program."
A Travel and Health component has been included in the CAREC Biennial Programme Budget for 1998-99, which will be largely dependent on sourcing extra-budgetary funds.
| Increased awareness of issue of health as part of quality of tourism |
| Appreciation of CAREC as valuable partner - but still some wariness |
| Invitation to deliver HSP/HHP as part of new CHA initiative (CAST). |
| US CDC, Diarrhoeal Diseases Branch, for enhanced surveillance and notification of FBD outbreaks in returning travelers |
| UK CDSC - for participation in the European LD surveillance network; and the SALMNET (Salmonella Network) |
| Caribbean Council for Europe; European Commission on Development Policy Management; UK Federation of Tour Operators. |
Recognising the importance of health and tourism in development and CAREC's expertise in disease prevention and control in the Region;
SAC endorses the initiative and foresight of CAREC's work in the area of tourism, health and development, and the work with the Caribbean Hotel Association.
SAC recommends that:
6.2 CAREC advocate with the industry and governments on the need to be proactive in relation to public health issues as it relates to travel and tourism in order to support sustainable tourism and economic development; and
RESPONSE
The Centre actively advocated on health in sustainable tourism with the Caribbean
Hotel and Tourism Industry jointly with the PAHO/CPC office. Sensitisation on this issue
was facilitated by much publicized health problems in some major tourism destinations.
6.3 That CAREC forge partnerships with relevant Ministries in member countries, the Caribbean Hotel Association, and the Caribbean Tourism Organisation to improve the standards, surveillance, and human resource development in pursuit of the vision for the Caribbean to be the safest, happiest and healthiest of comparable destinations in the world.
RESPONSE
Partnership with the tourism industry was actively pursued. Agreement was reached
with the Caribbean Action of Sustainable Tourism, Caribbean Hotel Association, for a joint
venture "Caribbean Tourism, Health and Resource Conservation Project." Initial
start-up funding for the project was provided by PAHO. Negotiations with the
Inter-American Development Bank's (IADB), Multi-lateral Investment Fund (MIF), have
resulted in agreement that IADB/MIF will contribute US$1.33million and CAREC/CAST will
contribute US$800,000 (in-kind and cash ). The project includes Bahamas, Barbados, Jamaica
and Trinidad and Tobago. A proposal has also been submitted to the Caribbean Development
Bank for funding.
Council, having reviewed and discussed the Annual Report of CAREC for 1997, and having received the report of the Acting Director of CAREC;
Notes that the report was produced with the Acting Director having been in office for four months of the reporting period;
Notes with appreciation the high standard and informative nature of the 1997 Annual Report and the high quality of the work of the Centre that it presents;
Commends the Centre for its effective support to member countries in the investigation and control of several recent outbreaks;
And Resolves
1.1 To accept the Annual report of CAREC for 1997, and to commend the staff, the former Director, and Acting Director of CAREC for the program and accomplishments during 1997
1.2 To convey their thanks and best wishes to the former Director of the Centre, Dr.Stephen Blount.
Council, having received the financial Report for 1997; Notes the improvement in the financial position of the Centre, with respect to both quota collections and extra-budgetary funds;
Note with appreciation the payment of arrears by some countries and expresses concern that a few members continue to have substantial arrears;
Expresses concern that Council's recommendation for a modest 3% increase in the quota budget was not approved by the Caucus of Ministers;
Regrets that the financial reports were not received by the members before the meeting;
Notes the increased responsibilities of the Centre in relation to the administration of two new member countries in 1996, Aruba and the Netherlands Antilles;
And resolves
2.1 To accept the interim financial report for 1997;
2.2 To re-instate the request for the 3% increase in the quota budget;
2.3 To ask the Director of PAHO/WHO and the Acting Director of CAREC to continue their efforts to secure full payments of the quota commitments by member countries and to encourage member countries to establish payment plans to eliminate arrears;
2.4 Approves the request to draw down approximately $160,000 from the building fund as recommended in the financial report;
2.5 Requests the provision of inform- ation on the costs of laboratory tests done at the Centre;
2.6 Requests the Acting Director of CAREC to work with PAHO to improve the timeliness of financial reports and to provide information on the distribution of expenditure between equipment and supplies.
RESPONSE
Following a presentation by the Director, CAREC, the Caucus of Health Ministers
in September 1998, agreed to the 3% increase pending the review of the regional health
institutions. Efforts were made to arrange payment plans with Grenada and Jamaica, and the
Director PAHO and Director CAREC continued efforts to secure full quota payments. Nineteen
of 21 countries paid 93% of the assessed quota. Laboratory test costs will be provided to
the 1999 Council meeting.
Council having review progress with the implementation of the 1997 recommen- dations of the Scientific Advisory Committee (SAC);
Notes the innovative efforts of the Centre in disseminating information via international cricket broadcasts in 1997 and that an evaluation of its effectiveness is in progress;
Noted the progress made in the development of partnerships with the Caribbean hotel and tourism industry.
And resolves
3.1 That CAREC continue to expand its communication efforts with specific regard to use of the CAREC video, Surveillance reports and the annual reports, to inform the various publics, including national authorities, and to include advocacy for rights of HIV affected persons;
3.2 That CAREC continues to give technical guidance and support to governments on new emerging public health conditions including the prevention and control of vector borne disease, e.g., dengue fever; the conduct of HIV and other vaccine trials in member countries; and on the health effects of major environmental and climate changes;
3.3 The Director, CAREC continue to widen links in the tourism sector in collaboration with other units in PAHO and other regional institutions
RESPONSE
a. Communication efforts were expanded in 1998, including more extensive use of
print and electronic media; advocacy for the rights of HIV infected persons was included
in all advocacy efforts with Parliaments
b. CAREC worked to bring about behavioural change among school children with regard to prevention of the production of vectors of disease; involved NGOs such as Rotary in the fight against mosquito production; evaluated the efficacy of adulticidal sprays against Aedes aegypti in intra-domiciliary conditions; collaborated with the Ministries of Health to manage outbreaks of malaria in two islands; worked with the Ministry of Health (Guyana) and the US Navy for the detection of resistance to chloroquine of Plasmodium vivax; and advised Ministries of Health of the findings
c. Links with the tourism industry were widened in collaboration with other units of PAHO and other regional institutions.
Council notes that the multi-lateral agreement with expires on Dec 31, 2000, and that there is CARICOM review of regional health institutions in progress;
And resolves
4.1 That the Director of PAHO be asked to set up a Council subcommittee to review the multi-lateral agreement and the sub committee should work with CARICOM during its review of the regional health institutions. 4.2 To urge CARICOM, in collaboration with PAHO to expedite the review of regional institutions.
RESPONSE
A Council sub-committee, including CARICOM, will consider modifications to the
multilateral agreement during the 1999 meeting. The review of regional health institutions
is scheduled for completion by the end of 1999.
Council was presented by the Acting Director with the elements of an Institutional Strengthening Project currently being negotiated with the UK Department for International Development;
And resolves
To support the plan in principle and encourage CAREC to go forward with the Institutional Strengthening Project.
RESPONSE
The Institutional Strengthening Project will be actively pursued in 1999.
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Caribbean Epidemiology Centre Page last modified 21 May, 1999 |
