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Fostering Progress: Strengthening Health Sector Reforms for Better Health in the Caribbean

From Lilia Burunciuc, World Bank Director for Caribbean Countries

Nurse Gabriel in Saint Lucia’s Anse La Raye Wellness Centre looks satisfied as she conducts a nutritional demonstration, where she teaches her clients who have diabetes and high blood pressure how to prepare their meals healthily. She has demonstrated alternative meal preparation, and her clients seem to be excited to try them at home.

The Wellness Centre where Nurse Gabriel works is one of the health facilities supported by the World Bank’s Health Systems Strengthening Project. The project’s goal is to improve the accessibility, efficiency and responsiveness of key health services in Saint Lucia.

When it comes to health issues, non-communicable diseases, such as diabetes, high blood pressure, and heart disease are a major concern in Saint Lucia. The mortality rate from diabetes is approximately 60 percent higher than the regional average. The majority of deaths on the island – 80 percent – are due to non-communicable diseases.

Yet, Saint Lucia’s health facilities are inadequately equipped to cope with the growing burden. In primary care services, a first point of contact for the patient, there’s a significant lack of basic technologies and procedures to support patients with non-communicable diseases, forcing them to seek help in other, costlier instances, such as hospitals.

Recognizing the critical need to address the issue, the Government of Saint Lucia has initiated a series of reforms in the health sector. A World Bank-financed project is part of this push. 

The project introduced a Performance-Based Financing mechanism, an approach where healthcare providers are rewarded for achieving desired outcomes, such as improving patient health or increasing the number of people accessing services. This approach incentivizes providers to deliver improved quality care and meet specific performance targets.

The Performance-Based Financing pilot for Saint Lucia was designed with the support of the Korea World Bank Partnership Facility, which included study tours to South Korea and Colombia, expert advice from Argentina, and several regional knowledge exchanges.

Performance-based financing was initially implemented in eight wellness centers across the island. The second phase of the program, now underway, expands the scheme to an additional nine wellness centers. Following the pilot under the Health Systems Strengthening Project, the scheme will be scaled nationwide, covering all thirty-four primary care health facilities in the country. The initiative is expected to improve access to quality health services for hypertension and diabetes at the primary health care level.

The Performance-based pilot focuses on reforming how primary health care is financed and delivered to progress to more equitable and sustainable universal health coverage. The project invests in creating the foundations for scalable reform to provide valued essential services to the population.

It is reassuring to see how projects like this, and other similar initiatives we are implementing in the region are yielding positive results. However, there is still much more to be done.

As we have recently marked Health Day, I see three key priorities in the health sector for Caribbean countries going forward:

First, continue accelerating progress on universal health coverage which provides affordable access to quality health care. In the case of Saint Lucia, those with non-communicable diseases spend an average of 36 percent of their household budget on health care every year. However, the numbers vary significantly with some data suggesting that the poor spend almost 50 percent of their budget, while the rich spend less than 20 percent. The picture may be similar in other countries of the region. Universal health coverage will enable equal access to critical healthcare services.

Second, strengthen national health information systems. Our research has found that in many countries medical charts are paper-based, unstructured, and reside with the patient, making it difficult to retrieve health information efficiently, monitor and evaluate whether best practices are followed. Strengthening national health information systems and strengthening data analytical capacity will be crucial to facilitate data-driven decision-making, improve public health interventions, and enhance healthcare delivery for the region’s diverse populations.

Third, ensure consistent availability of safe and affordable medicines and supplies. In some countries, critical medicines are not available due to financial and logistical issues. Limitations in human resources in the area of drug policy and pharmaceutical services, procurement and forecasting are also found to be obstacles. These issues can be addressed through supply-chain management, international collaboration, capacity strengthening and regulatory reforms among other things.

In the current fast-paced world, the age-old adage “health is wealth” holds a profound truth. It underscores the importance of well-being as the foundation of prosperity and economic resilience – extending beyond the individual level: a healthy population is critical for the overall well-being and economic success of a nation.

With concerted efforts from governments, healthcare providers, communities, and international partners, I believe the Caribbean can pave the way toward a healthier future.


LILIA BURUNCIUC, World Bank Director for the Caribbean Region

Lilia Burunciuc is the World Bank Director for Caribbean countries. Ms. Burunciuc, a Moldovan national, is responsible for maintaining the partnership with the countries to address their development challenges.

Since joining the World Bank in 1996, she held a range of increasingly challenging positions: Director for Central Asia; Manager in Operations Policy and Country Services; Country Manager for Macedonia; Country Program Coordinator for Southern Africa and Central Asia; Senior Country Officer for Ukraine and Belarus.

She has extensive experience on leading policy dialogue with governments on various aspects of development.

Prior to joining the Bank, Ms. Burunciuc was a Deputy Governor of the National Bank of Moldova (Moldova’s central bank).

She has a Master’s of Public Administration degree from George Washington University (USA) and a degree (Master’s level) in Economics, Management and Planning from the Technical University of Moldova.


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