Social issues, mental health among priorities in PAHO new country strategy

A new Country Cooperation Strategy (CCS) for the health sector has been developed by PAHO/WHO for the next five years, during which significant emphasis will be placed on social issues that affect the health sector, mental health and non-communicable diseases.

Dr Leslie Ramsammy

The new CCS for 2010-2015 was yesterday handed over to Minister of Health Dr Leslie Ramsammy by acting PAHO/WHO Country Representative Adrianus Vlugman, who is also the senior advisor on Sustainable Development and Environment at the organisation.

According to Vlugman, the five strategic priorities of the new strategy include strengthening health systems governance, organisation and management based on primary health care approach and addressing the social and environmental determinants for improved health outcomes. The reduction of the burden caused by diseases will also be addressed along with the enhancement of family and community health and leadership and management for results.

Vlugman noted that the peculiar geographic and cultural make up of Guyana posed certain challenges for access to health care and as a result the CCS is designed to address health systems strengthening based on primary health care. “This is critical since the vast majority of the indigenous population live in the hard to reach hinterland areas–-a consideration that was taken into account as the CCS sought to address issues of equity and social inclusion. For the same reason, the needs of other vulnerable and disadvantaged groups were also taken into account when developing the Strategy,” he added.

The CCS ends at a crucial time—2015—which represents the date for countries to report on achievements in relation to the Millennium Development Goals (MDGs). According to Vlugman, the areas of focus identified in the strategy as well as the emphasis placed on strengthening the country’s ability to report on the health-related MDGs should put Guyana in good stead by the due date for delivering on those goals and targets.

Guyana’s National Health Sector Strategy, which was coined in 2008, comes to an end in 2012.

Ramsammy described the strategy as important and said it means that for the next five years Guyana will continue to make of the deficit in terms of its national budget and its technical skills. “This strategy provides us with important support,” he said, adding that it has been recognised that health is affected in a very important way by the social determinants which do not fall entirely in the realm of the Ministry of Health. “We need support and we need contribution from different sectors…,” he explained, while pointing out that alcohol and substance abuse represent an important part of the social determinants that affect health.

But also importantly, the minister said, there is the emergence of the abuse of medicine and there is the age-old thorny issue of tobacco abuse, all of which are social determinants that are “significantly contributing to the disease burden in our country.”

Going into the specifics of the new strategy, he said the ministry looks to PAHO/WHO to work with them in an energetic campaign to eliminate tobacco as a substance use in Guyana and to prevent misuse of alcohol. He revealed that at the level of the WHO Guyana has played an important role in the global treaties and agreements on a global cooperation to address the issue of tobacco, alcohol and other substance abuse. Another area in the social determinants that fall under the strategy, is the behavioural patterns of people in the areas of reproductive and sexual health, the minister said there are significant issues that needs to be addressed. He said PAHO/WHO will work closely with Guyana in the area as part of the cooperation under the new strategy.

“PAHO/WHO as part of the country cooperation strategy will be working closely with the Ministry of Health to develop initiatives to address people’s behaviour,” he said.

He explained that one of the pillars of the new cooperation strategy is important collaboration with other UN agencies, such as UNICEF, which will focus on the continuing immunisation of citizens. Maintenance of the strong programme that already exists will be focused on while at the same time focus will be placed on introducing new vaccines.

According to Ramsammy, by next year Guyana will introduce the human papillomavirus (HPV) vaccine, which prevents infection with certain serotypes of human papillomavirus associated with the development of cervical cancer, genital warts, and some less common cancers.

“We will together will be monitoring the emergence of new vaccines, we are still hopeful that a vaccine against malaria will evolve in this period and that through the cooperation we would be able to quickly introduce any new vaccine that emerges,” he said.

And as part of the introduction of new vaccines, the minister said that the new strategy makes provisions for new researches being conducted.

Further, the strategy will see more cooperation in the area of mental health which will see this issue being accelerated and will focus on building human capacity for neuro-psychiatric  illnesses. Ramsammy noted that already they have begun working on developing a curricula for nurses and doctors in that area and over the few months the ministry will be working with the University of Guyana and the Guyana Nursing Council to conclude the agreements on the nursing curricula “so that a new cadre of nurses will become part of the health services of Guyana, this will be the mental health nurse practitioner.”

The minister said that a new cadre of specialist doctors with new competencies will also enter the health sector to diagnose and treat neuro-psychiatric illnesses. It is expected that between September and January the new training programmes will develop.

Meanwhile, another major cooperation in the period will be in the area of human resources for the health system. According to Ramsammy, Guyana has a health work force strategy that is being concluded with the assistance of PAHO/WHO which has seen the ministry estimating Guyana’s need of health workers in every catogary up to the year 2010.

“We know numbers and therefore we know what our training programme should be like and the size of those training porgramme,” the minister said.

He noted that in the area of communicable diseases various areas of cooperation are listed in the strategy including the elimination of mother to child transmission the HIV and this goal has been elevated high up on the priority list and it is hoped that this will be achieved by 2015. Significantly, the minister said as part of the strategy a team from Washington is at present in Guyana working on the “neglected tropical illnesses.” He said the country is making the “final push” to ensure that some of the neglected illnesses are eliminated including fialariasis and chagas. Also dengue and malaria will also be focused on.

Tuberculosis (TB) in the area of communicable diseases remains the most challenging problem that is faced even though it has been around longer than most other diseases, Ramsammy also noted. “I believe that TB remains the communicable disease that the global community will have to do more to address,” he said.

Also during the strategy period focus will also be placed on medicines for children as much work has already been done in terms of putting the list together and developing the supply chain for ensuring adequate supply of medicines. The strategy will also focus on environmental health and one of the areas to be addressed is disposal of biomedical waste and also the issue of sanitation and health.

The issue of chronic non-communicable diseases, which the minister said in terms of disease burden and in terms of mortality represents the most significant health problems that the country faces, will also be addressed.

“The chronic non-communicable diseases represent a barrier in terms of poverty reduction and all of us will have to elevate the attention and focus we pay on the chronic non-communicable diseases,” he added.

He said that the ministry along will PAHO/WHO will work in a robust fashion to address the issue and revealed that they have already had major developments in the creation of the guidelines.  Significant focus will be placed in the area of prevention.

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