4.6 Caribbean Health Systems, Regional Agencies & Contemporary Health Issues

Caribbean Health Systems, Regional Agencies and Contemporary Health Issues

NLM competency 10 asks you to know the "contemporary health issues of national, regional and international significance and the roles of various stakeholder groups and agencies". Competency 9 links ward goals to national priorities, and competency 11 asks you to assess a population's health care and emergency-preparedness needs. You cannot do those things without knowing how the health system is organised and which agencies set the agenda.

How Jamaica's Public Health System Is Organised

The four RHAs and their parishes are:

• South East (SERHA): Kingston and St Andrew, St Thomas and St Catherine.
• North East (NERHA): Portland, St Mary and St Ann.
• Western (WRHA): Trelawny, St James, Hanover and Westmoreland.
• Southern (SRHA): St Elizabeth, Manchester and Clarendon.

Hospitals are classed Type A (multi-specialty referral centres, such as Kingston Public Hospital and Cornwall Regional Hospital), Type B (larger urban hospitals with the four basic specialties) and Type C (district hospitals). Health centres were historically classed Type 1–5. Under primary health care reform they are being reorganised into community, district/parish and comprehensive health centres (approved by Cabinet in 2016 and carried into the MOHW's 2021–2030 strategy). User fees in public health facilities were abolished in 2008, except for pharmaceuticals. The National Health Fund (NHF) subsidises medicines for specified chronic illnesses, which helps with drug-cost barriers in teaching and adherence.

Regional and International Agencies

Contemporary Health Issues

Non-Communicable Diseases (NCDs)

NCDs (heart disease, stroke, diabetes, cancer and chronic respiratory disease) cause most deaths in the Caribbean. In September 2007, CARICOM heads of government signed the Declaration of Port of Spain, "Uniting to Stop the Epidemic of Chronic NCDs". It was the first summit of its kind, and it led to Caribbean Wellness Day (the second Saturday in September) and fed into the 2011 UN High-Level Meeting on NCDs. Nursing roles include screening, self-management education, foot and eye checks, and tackling risk factors such as tobacco, salt, sugar, physical inactivity, harmful alcohol use and obesity, including childhood obesity.

Climate, Disasters and Health Security

The Caribbean lies in the Atlantic hurricane belt. Hurricane Melissa made landfall in south-western Jamaica on 28 October 2025 as a Category 5 storm with winds of about 185 mph. Relief agencies reported about 135 health facilities damaged, disrupted power and water, and later a leptospirosis outbreak with continued dengue surveillance (ReliefWeb). Lessons include:

• protect water and power for health facilities;
• plan to evacuate coastal hospitals;
• keep chronic disease medication supplies going; and
• expect waterborne and vector-borne disease after flooding (Sections 3.3, 3.5 and 4.4).

Emerging and Re-emerging Infections

Recent examples are chikungunya (2014), Zika (2016), recurring dengue epidemics and the COVID-19 pandemic. Antimicrobial resistance is driven by inappropriate antibiotic use, so nurses support stewardship and infection prevention.

Other Priorities

• Violence and injuries, including gun violence and road traffic injuries, which load emergency and surgical services.
• HIV, with treatment targets and anti-stigma work.
• Mental health and substance use.
• Ageing populations, with more dementia, falls and long-term care needs.
• Maternal and child health quality.

The Nursing Workforce

International recruitment of Caribbean nurses to higher-income countries causes shortages and loss of experienced staff. The WHO Global Code of Practice on the International Recruitment of Health Personnel (2010) asks recruiting countries to recruit ethically. Regional responses include retention incentives, expanding training places and bonding arrangements. An RENR item may ask how a nurse manager can maintain safe care despite vacancies. Look for answers that prioritise patients, use the skill mix safely, escalate formally and support staff retention.

Global Frameworks

The Sustainable Development Goals (2015–2030), especially SDG 3 (good health and well-being), set targets for maternal and child mortality, NCDs, HIV and universal health coverage. The Declaration of Astana (2018) renewed the 1978 Alma-Ata commitment to primary health care (Section 3.1).

Assessing a Population's Needs

When an item asks how a nurse should assess a community's health or emergency-preparedness needs, use the following:

• existing data: vital statistics, clinic registers, notifiable-disease surveillance, census and poverty data;
• a windshield survey and key informants: housing, water supply, flood-prone areas, access roads, vulnerable residents such as people who are bedridden, on dialysis or using oxygen; and
• community participation: meetings with community leaders and groups.

Then rank the problems by size, seriousness and how feasible it is to act. Map the resources available, such as shelters, the parish disaster committee, health centres and community health aides.