Release Type: News Article

Image: JAMAICA | (l-r) Tameka Clough (Jamaica Country Programme Coordinator, HP+), Dr Jennifer Knight-Johnson (Acting Director for Environment and Health, USAID), Rebecca Robinson (Acting Mission Director, USAID), Sandra McLeish (Jamaica Country Programme Director, HP+) and Dr The Honorable Christopher Tufton, Minister of Health, Jamaica.

The Health Policy Plus (HP+) project presented Hon. Dr Christopher Tufton, Minister of Health, Jamaica with 100 copies of a Complaint Management System (CMS) Manual and Toolkit.  The CMS outlined clear processes for accessing, documenting, investigating and resolving customer complaints. It also included a monitoring and evaluation framework that ensured complaint data is captured for quality improvement activities and programme and policy development.

The manual was designed to be used by Ministry of Health (MOH) staff involved in the complaint management process at all levels, within health facilities, regional health authorities, health departments and the Investigation and Enforcement Branch (Standards and Regulation Division). The aim of the initiative was to empower MOH staff to provide clients with the necessary guidance on how to raise their concerns and complaints.

The production of the manual formed part of the Ministry’s ongoing efforts to strengthen its customer service initiatives with its increased emphasis on patient-centered care. The production of the manual aimed to improve quality of service delivery in the public health sector by driving the demand for users to raise their concerns and lodge complaints and collect feedback from internal and external clients on the delivery of services.

The initiative also aimed to provide guidance on the means for failures and or complaints to be investigated as well as provide information on corrective and preventative actions, track data and trends on complaints to inform programme and policy changes for development and provide redress to clients.

In 2015, the Standards and Regulation Division, which has oversight for the CMS, approached the Health Policy Project (HPP), the predecessor project to HP+, to strengthen the Client Complaint Mechanism (CCM), launched in 2000.  Through the technical assistance provided by HP+, the CCM has evolved from procedural steps to a Complaint Management System with the inclusion of Quality Assurance components.  It is aligned with the International Organization for Standardization (ISO) 9001, Quality Management Systems – Requirements (2008).

Ms Sandra McLeish, Jamaica Country Programme Director for HP+, is proud of the collaboration with the Investigation and Enforcement Branch of the Standards and Regulation Division and has indicated the potential for future collaborations to strengthen customer service. “Having a robust reporting and redress system will go a far way in increasing the confidence of clients of the health sector since it is evident that the Ministry of Health is taking issues of discrimination seriously. The Standards and Regulations Division of the Ministry of Health has partnered with us for more than three years in developing this manual and toolkit that will strengthen not only the reporting but the avenues for redress for users of the system,” stated Ms McLeish.

The Minister anticipates that “the manual will be a useful tool in standardizing and streamlining the Complaint Management System across public health facilities and will strengthen the Ministry’s efforts in the delivery of quality care. The distribution and implementation of the CMS Manual and Toolkit to public health facilities will also strengthen the Compassionate Care Programme which was launched earlier this year at the Victoria Jubilee Hospital.”

The United States Agency for International Development (USAID) was represented by Ms Rebecca Robinson (Acting Mission Director), Dr Jennifer Knight-Johnson (Acting Director for Environment and Health) and Ms Diana Acosta, the new Health Officer.

During the presentation of the Manual, Dr Knight-Johnson stated, “the initiative is a best practice, highlighting how PEPFAR resources are used effectively to address issues associated with stigma, discrimination and redress in country.  We recognize the work and effort beyond the call of duty that was put into ensuring that there is a trainers guide that accompanies the manual and that augurs well for sustainability. We also recognize the associated inputs and the level of effort involved with developing the case routing algorithm, the mystery client intervention and the Privacy and Confidentiality policy related to S&D”.

Image: JAMAICA | Representatives from the Bureau of Gender Affairs, HP+, Eve for Life, National Family Planning Board presenting the Comprehensive Package for Healthcare Workers and Providers to Mr Dunstan Bryan, Permanent Secretary, Ministry of Health, Jamaica.

In January 2019, the Health Policy Plus (HP+) project presented Permanent Secretary (PS), Ministry of Health (MOH), Mr Dunstan Bryan with a Comprehensive Package for Healthcare Workers and Providers to Address Gender-based Violence for clients of healthcare facilities in Jamaica.

The package constitutes several elements and is a culmination of years of work done under the project with Gender-based Violence (GBV).  It included a guideline document for healthcare workers and providers when dealing with known, suspected or potential clients who may be suffering from GBV.

The package also included a GBV Referral Directory with contact information for entities that provide GBV services including those for adolescence, information, education and communication (IEC) material in the form of a brochure with a self-assessment tool and a safety card, which is a small discreet card that can be kept by the client in case they need contact information for entities that provide GBV services.

The Ministry was also provided with “Recommendations for Mainstreaming GBV into the National HIV Response” and a Dissemination Plan for the material.

At the handover exercise, PS Bryan indicated that “he appreciates the work and help of the HP+ and agrees that the guidelines and materials are necessary to help not only staff but the public to combat GBV and HIV”.

Eve for Life (EFL) co-founder and Director of Impact, Joy Crawford, was the consultant for the project.  Eve for Life is a Non-Governmental Organization (NGO) founded in 2008, to support women and children living with or affected by HIV and AIDS.  EFL is seen as a champion for shaping a world where the sexual health and rights of young women and girls are protected and upheld.  The organization is involved in extensive work in GBV.

In 2004, the National AIDS Commission (NAC) Belize became a statutory body with a legal mandate for coordination, monitoring, advocacy action and policy development in relation to HIV and AIDS in Belize. Its Policy and Legislation Project then provided input into the National Policy on HIV and AIDS adopted in 2005.

The NAC’s constitution calls for the state to address the social and economic disparity between citizens and even acknowledges the need for non-discriminatory treatment in law by authorities. Differential treatment of women, children and other social groups in the workplace, school settings and communities calls for scaling up of Civil Rights legislation and regulations that examine standards for service delivery that affect the users of our health system who are impacted by socio-economic and civil rights issues that affect access to justice.

Without comprehensive HIV and AIDS laws, general anti-discrimination laws, or a human rights act to legally enforce non-discrimination against People Living with HIV (PLHIV), there will be challenges in ensuring equal access to prevention, care, treatment, and support by key populations, as well as the full enjoyment of PLHIV in all aspects of social, cultural, civil, and political life.

Hence, the NAC Belize has championed the cause of drafting an anti-discrimination bill based on the CARICOM Model Anti-Discrimination Bill. The bill aims to establish a comprehensive anti-discrimination law addressing multiple areas of discrimination in Belize.

The anti-discrimination bill is being supported jointly by Hon. Laura Tucker-Longsworth OBE, National AIDS Commission Chair and Ms Kim Simplis Barrow, First Lady of Belize, Special Envoy for Women and Children and Chair of the Spouses of CARICOM Leaders Action Network (SCLAN).

It is the goal of the NAC and its partners that by the end of 2019, Belize will have a robust and all-inclusive anti-discrimination law that effectively addresses stigma and discrimination.

The Total Facility Approach to S&D-reduction Project is a three-phase project commencing with the collection of baseline stigma and discrimination (S&D) data from both health care providers (HCP) and People Living with HIV (PLHIV) clients at three sites including the Kingston Public Hospital (KPH), Windward Road Health Centre (WRHC) and Savanna la Mar Public General Hospital (SPGH). It was implemented over the summer of 2017.

The findings were later disseminated to each site, and at a national dissemination meeting in September 2017.  The final report was finalized in March 2018.  The data and feedback from these meetings were then used to tailor facility-based S&D-reduction activities for each facility for the second phase which encompassed capacity building including the development of a facilitators guide for Jamaica titled “Towards Stigma Free Health Facilities in Jamaica: Western and Southern”.

The draft guide was then used to train staff of the KPH and SPGH, members from HIV-related Civil Society Organizations and staff of the National Family Planning Board Jamaica (NFPB) and HP+, using a Training of Facilitators (ToF) approach.

Training (which is the beginning of phase two) was conducted in S&D-reduction strategies using participatory methodologies over five days by Ayana Hypolite, Master Trainer/Counselor from RTI/Barbados and Joy Crawford, local Master Trainer and Co-founder and Director of Impact for Eve for Life.

The aim of the training was to strengthen the capacity of the co-facilitators with capacity building on the procedures, tools and expectations for S&D-reduction programming.  It was intended that the knowledge gained would be disseminated to staff of the three facilities.   The guide was then finalized with input from the newly trained co-facilitators.

The capacity-building phase also included a two-day roll out of training with at least 60% of the staff of each facility via Health Care Workers (HCW) and PLHIV lead trainings, with support from NFPB and HP+.  Three hundred and Fifty-eight (358) healthcare staff from the KPH, WRHC and SPGH, were trained in S&D-reduction strategies.

The last element of this phase of the project was the development of tailored policy interventions for each facility coming out of recommendations from the staff trainings and other observations.

After several consultations with staff, it was recommended that information, education and communication (IEC) material be developed for the policy intervention.  An e-poster, video and printable posters were developed and presented to the three sites.

Verification was subsequently done to ensure that either the poster or video was displayed in the three facilities to facilitate entry into the final and 3rd phase of the project, which was the end line survey.

This was to determine if the capacity building initiatives (both trainings and IEC material) instituted in the facilities resulted in a change in behaviour and hopefully a reduction in stigma and discrimination of clients.

The initiative was supported by United States Agency for International Development (USAID) and The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).

Image: Xavier Biggs, Monitoring and Evaluation Programme Officer, Jamaica AIDS Support for Life (JASL)

The Jamaica AIDS Support for Life (JASL) E-Learning initiative is the organization’s response to the need for capacity development among its staff cohort.

Xavier Biggs, Monitoring and Evaluation Programme Officer at JASL recently spoke with the Editor of the PANCAP Newsletter about the new initiative.

“We wanted to create a learning space that allowed us to do training and sensitization sessions that people could access both live and delayed,” explained Xavier, “We are not always able to pull all the sites together for a face-to-face meeting for a number of reasons and so this is one part of how we would mitigate for that”.

The E-learning programme utilizes webinars, video conferencing, pre-recorded sessions and podcasts as a means of sharing new information or even refreshers. “We will then make that available (post-event) through a centralized online space for people to access in their own time,” explained Xavier, “as a post evaluation, we will tie it to a mandatory number of education hours per staff level that requires members of the team to go in and engage with the material posted there. That component is not quite ready just yet”.

JASL E-Learning is an initiative of the in-house Monitoring and Evaluation Department and was officially launched on Wednesday 6 February 2019. A logo was also created to support and brand the platform.

Xavier further highlighted that the first learning engagement involved JASL’s Medical Director, Dr Jennifer Tomlinson who led a session on “Index Testing”. “We invited our CSO partners, The Ashe Company and Children First Agency to join. This has now added a new layer for how we could also improve capacity across agencies,” explained Xavier, “We are super excited about this one!”

Leaving no one behind continues to be the goal of the Partnership and its stakeholders as the Region continues to focus on initiatives that ensure equal access to prevention, care, treatment, and support for vulnerable populations.

On Zero Discrimination Day, 1 March 2019, UNAIDS is highlighting the urgent need to take action against discriminatory laws.  UNAIDS Executive Director Michel Sidibé called on countries to review their laws and policies to protect those vulnerable to discrimination.  “Laws should protect, not harm,” stated Sidibé, “All countries must carefully review their laws and policies to ensure equality and protection for all people, no exceptions”.

The campaign will be highlighted with social media messages from partners and stakeholders from across the region under the theme “act to change laws that discriminate”.

To maintain the momentum of ending stigma and discrimination, the Caribbean Regional Network of People Living with HIV and AIDS (CRN+) will launch #UnitedPositively at the opening ceremony of the upcoming Seventh Meeting of the National AIDS Programme Managers and Key Partners, 11 March 2019.

The initiative aims to target policymakers and high-level decision makers with social media messages from People living with and affected by HIV.  Messages will illustrate how discrimination and the fear of stigma prevent vulnerable populations from accessing prevention, care, treatment, and support.

According to Jason Shepherd, Senior Programme Officer, CRN+ “Despite the gains made in relation to vulnerable populations’ access to services to achieve prevention, it is not uncommon to hear testimonials from persons within our networks who continue to not access prevention and treatment services for fear of discrimination. Hence, #UnitedPositively aims to motivate people living with or affected by HIV to advocate with policymakers to review discriminatory laws and policies that impact vulnerable populations’ access. We need to stand up as one Caribbean against stigma and discrimination”.

Origin of the National AIDS Programme Managers and Key Partners Meeting 

The Partnership is preparing for the Seventh Meeting of National AIDS Programme Managers and Key Partners scheduled for 11 to 13 March 2019. This meeting is the brainchild of Professor Peter Figueroa who served as Chair of the Priority Area Coordinating Committee and Vice Chair of the PANCAP Executive Board from 2009 to the end of 2013. Prof. Figueroa, like other partners, recognized that PANCAP was challenged to transfer regional public goods to the countries. He reflected on the experience and success of the Annual meeting of the Expanded Programme on Immunization Programme Managers and recommended that the HIV response could benefit tremendously from a similar annual meeting. With funding from the Global Fund, this meeting became a reality.

Evolution 

After six years, the meeting has evolved as a forum for reflecting on the Region’s progress and challenges, discussing and agreeing on strategies that countries can implement to better respond to the epidemic and sharing of global developments and innovations and country experiences in implementing innovative strategies to achieve the end of AIDS. It fosters dialogue and respect among NAP managers and civil society partners and has allowed NAP managers to better appreciate the contributions of civil society partners. It provides regional and development partners with the opportunity to learn from the countries and to better tailor their assistance to support country needs.

Knowledge Management Share Fair 

We have also added an extra day for knowledge sharing and capacity building among NAP managers and civil society partners with funding from the PEPFAR-USAID Johns Hopkins University funded PANCAP Knowledge for Health Project. A fifth day is now dedicated to NAP managers only to enable them to meet and identify their priorities and needs including technical support from partners.

Platform for reflection 

This year the Planning Committee has agreed to create space for individual countries to reflect on each session and to indicate which strategy or innovation they can commit to implement and to report on the following year. This would facilitate increased transfer of regional public goods by allowing countries the flexibility to implement innovative strategies and activities that take into consideration the available human and financial resources.

Increased interest 

We have also seen increased interest in this meeting, which has expanded its target audience to include chief medical officers and permanent secretaries. All development partners in the Region now actively participate in this meeting.

We look forward to welcoming all partners and sharing and learning from each other and to the outcomes and follow up actions.

Funding is guaranteed for this meeting under the new three-year PANCAP-CVC-COIN Global Fund grant, which will commence on 1 October 2019.

I wish to extend a special thank you to the Planning Committee for framing an agenda that responds to the needs of our National AIDS Programmes.

Washington, DC, 15 February  2019 (PAHO) – The Americas region is home to more than one billion people. Every year, 15 million babies are born, and nearly 7 million people die. Life expectancy is 80.2 years for women and 74.6 for men. More than 8 in 10 people live in urban areas. These are some of the key statistics presented in the new “2018 Basic Indicators,” just published by the Pan American Health Organization (PAHO).

The compendium, produced annually, presents PAHO’s most recent data from 49 countries and territories on the demographic and socioeconomic situation of the Americas, the population’s health status, risk factors, and coverage of health care services and health systems.

“Indicators are an essential element in the production of evidence in health to inform decision making,” says PAHO Director Carissa F. Etienne, in the preface to the publication. Such evidence means that “decision-making will be better informed and lead to increased opportunities for more effective interventions that have a greater impact on health outcomes.”

Health status

The document shows—among other findings—that approximately 6,000 women die from pregnancy-related causes each year in the Region, and more than 163,700 infants die.

The publication also shows that women in the Americas have on average two children, while teenage mothers (ages 15 to 19) have 48 newborns per 1,000 women, with subregional differences ranging from a low of 18 teen births per 1,000 women in North America to 61 per 1,000 in Latin America and the Caribbean.

Noncommunicable diseases—such as heart disease, cancer, and stroke—are the main causes of death in the Americas. Regionwide, the death rate from noncommunicable diseases is 427.6 people per 100,000 population, which is seven times higher than the death rate from communicable (infectious) diseases, at 59.9 people per 100,000 population.

With regard to infectious diseases, in 2017 Latin America and the Caribbean reported approximately 580,000 cases of dengue (44% of this total were reported from Brazil), more than 31,000 cases of leprosy (nearly 90% from Brazil), and more than 13,800 cholera cases (99% from Haiti). The HIV diagnostic rate was 14.6 people per 100,000 population regionwide, and for every new HIV diagnosis among women, there were 3.6 HIV diagnoses among men.

Protective and risk factors for health

Data are also presented on risk factors (variables that increase the chances for ill health) and protective factors (which reduce that risk). For example, breast milk is a protective factor, as it meets all a young child’s nutritional and immunological needs. In the short term, it reduces the risk of disease and death from diarrhea, respiratory and ear infections, and sudden infant death syndrome. In the long term, it reduces the risk of dental malocclusion, overweight/obesity, and diabetes mellitus. In women, it reduces the risk of invasive breast cancer, ovarian cancer, overweight/obesity, and diabetes.

Despite ample evidence that breastfeeding benefits children’s health, cognitive development and likely even their long-term economic prospects, the prevalence of exclusive breastfeeding at 6 months varies considerably among countries, ranging from 2.8% to 68%.

Regarding risk factors, about 8% of newborns in the Region have low birthweight (less than 2,500 grams/5.5 pounds). Chronic malnutrition affects 10% of children under 5, and 6% of children in the same age group are overweight (data from 2012). Rates of overweight and obesity are high among adults in the Americas: in 2016, 64% of men and 61% of women were overweight or obese. Additionally, 39% of adults do not perform enough physical activity.

In the Americas, 13% of adolescents consume tobacco, a percentage that varies across countries from a low of 3.8% in Canada to 25% in Chile and Dominica.

High blood pressure affects 21% of men and 15% of women in the Region (latest available data from 2015), while diabetes mellitus affects 9% of men and 8% of women.

Vaccination

Vaccination coverage in 2017 varies for different vaccines: 94% percent of the target population of children in the Americas received the tuberculosis (BCG) vaccine; 90% received the vaccine for the first dose of measles, mumps, and rubella (MMR1); 88% received three doses of diphtheria, tetanus and pertussis (DTP3) vaccine; 85% received three doses of polio vaccine; and 73% received the last dose of rotavirus vaccine.

Health systems

 In the Americas, there are 18 doctors, 59.7 nurses and 6.7 dentists per 10,000 population. Public expenditure on health as a percentage of gross domestic product (GDP) is 5% on average regionwide (below the 6% recommended by PAHO’s Strategy for Universal Access to Health and Universal Health Coverage). The percentage in North America (8%) is twice that of Latin America and the Caribbean (4%). Out-of-pocket expenditure as a percentage of total health expenditure was 22% as of 2015. PAHO’s strategy on universal health recommends eventually eliminating out-of-pocket payments altogether because they constitute a significant barrier to access health services.

Blood donation from voluntary donors, the safest way to collect blood, varied from 100% in North America to an average of 40% in the rest of the Region (data from 2015).

Special topics: air pollution and homicides

This year’s publication also includes three special features: the burden of disease attributable to air pollution, recommendations on the limitations of epidemiological analysis when handling small numbers, and a map showing the distribution of homicides in the countries of the Region.

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 The Pan American Health Organization (PAHO) works with the countries of the Americas to improve the health and quality of life of its population. Founded in 1902, it is the world’s oldest international public health agency. It serves as the Regional Office of WHO for the Americas and is the specialized health agency of the Inter-American system.

LINKS

For more information, see the Basic Indicators 2018:

http://iris.paho.org/xmlui/bitstream/handle/123456789/49511/CoreIndicators2018_eng.pdf?sequence=1&isAllowed=y

MEDIA CONTACTS

Leticia Linn: Tel.: +1 202 974 3440. Cell: +1 (202) 701 4005. Email: linnl@paho.org

Sebastián Oliel: Tel.: +1 202 974 3459. Cell: +1 (202) 316 5679. Email: oliels@paho.org

Ashley Baldwin: Tel.: +1 202 974 3872. Cell: +1 (202) 340 4025. Email: baldwinash@paho.org

The evaluation of the Caribbean Regional Strategic Framework (CRSF) 2014-2018 was completed and was accepted by the Priority Areas Coordinating Committee (PACC) and the Executive Board earlier this month. Among other findings, the evaluation revealed that while the Caribbean has made progress in responding to the HIV epidemic, the impact of the prevention response has been inadequate, particularly among key populations.

The evaluation reinforced the critical need for member states to invest in activities to achieve prevention and the UNAIDS 90-90-90 Targets. The Board called upon countries and the Partnership to renew efforts to build capacity and work together to achieve the targets. Members noted the legal judgments in Caribbean courts affirming human rights arising from litigation and called on countries not to wait on litigation but to make amendments to laws to recognize the rights of key populations and the rights of all to access sexual and reproductive health services. The board also noted that while tens of thousands of cases of HIV infections have been prevented there is a critical need to significantly reduce new infections. This requires countries to promote age-appropriate sexual education and skills and extend sexual reproductive health services to all youth and key populations. Members recommended the introduction of innovative prevention approaches and the improvement of prevention services to ensure greater impact in reducing new HIV infections.

The Board also called on the PACC to develop a new CRSF for the period 2019 to 2023 and agreed on the following strategic priority areas:

• An Enabling Environment
• Prevention of HIV Transmission
• Care, Treatment and Support
• Integrate HIV into Health and Socioeconomic Development
• Sustainability
• Strategic Information, Monitoring and Evaluation and Research.

The evaluation also reinforced the critical need for PANCAP to accelerate the implementation of its Resource Mobilization Strategy 2018-2020 to buffer member states as they fully transition to domestic resources for HIV. We need to work with member states to get more people to know their HIV status, retain more people on treatment and get more people virally suppressed. We must intensify our efforts to achieve the 90-90-90 Targets by the end of 2020.

The PANCAP Advisory Group on Resource Mobilization will meet in the middle of February to discuss and agree on strategies for increasing our donor base including the private sector. The Group will also explore how to stimulate creative and innovative fundraising that would be developed and packaged in a very competitive way to attract potential funders/sponsors without compromising the strategic interests of PANCAP. We look forward to using the innovative strategies agreed to accelerate the implementation of the Resource Mobilization Strategy 2018-2020.

Image: (L-R) Parliamentarians Hon. Nigel Dharamlall, M.P., Hon. Gail Teixeira, M.P., of the People’s Progressive Party (PPP), Managing Director of SASOD Guyana, Mr Joel Simpson and Hon. Dr Nicolette Henry, M.P, Minister of Education (Guyana). 

In December 2018, Guyana’s Society against Sexual Orientation Discrimination (SASOD) celebrated its 15th anniversary with a cocktail reception at the Impeccable Banquet Hall in Georgetown, Guyana. For over 15 years, SASOD Guyana has been a dedicated voice for the LGBTQ+ Guyanese and has promoted non-discrimination and equality in the country and the Caribbean region.

The Hon. Dr Nicolette Henry, M.P, Minister of Education, delivered special remarks on behalf of the Government of Guyana. Minister Henry spoke about SASOD’s notable achievements on local, regional, and international stages such as engaging local government, leading public education and sensitization on gender and sexual diversity, and providing essential services to Guyana’s most marginalized citizens.

Minister Henry also commended SASOD for the recent victory at the Caribbean Court of Justice where the organization played a critical role in demolishing a colonial-era law that criminalized cross-dressing and disproportionately penalized transgender and gender non-conforming persons. She said that this landmark decision highlights the fact that outdated laws do not reflect the current realities and values of inclusion and cohesion in Guyana today. The Minister confirmed the Government’s commitment to ending all forms of discrimination and fulfilling the promise of equality and a good life for all Guyanese.

Founder and Managing Director, Joel Simpson, spoke on behalf of SASOD Guyana. Simpson spoke fondly of the humble beginnings of the grassroots movement as a student-led lobby group, and proudly of the acclaimed, influential movement, it has become.

“SASOD Guyana has represented the LGBTQ+ community for the past 15 years and has used every opportunity possible to hold the state accountable for its human rights obligations. SASOD will continue to advocate for equality and inclusion of all persons in Guyana”, stated the Managing Director.

Also in attendance were Opposition Chief Whip, Hon. Gail Teixeira, M.P., and Hon. Nigel Dharamlall, M.P., of the People’s Progressive Party (PPP). The two PPP parliamentarians joined the Education Minister and Simpson in cutting the SASOD 15th Anniversary cake.

The celebratory event was supported by the United Nations Development Programme (UNDP) and COC Netherlands, a Dutch organization that supports LGBT people.