The Challenges in Healthcare That We Must Overcome

Caribbean Currents invites you on a journey through the Caribbean’s healthcare landscape. Not a tour of clinics and operating theaters, but a story of systems, policies, and bold choices. Picture a small clinic perched on a coastal hillside, its nurses arriving at dawn to find the lights still glowing. Overnight, a tropical storm knocked out power across the island. Yet this clinic, retrofitted with solar panels and rainwater tanks, remains open—a lone beacon of resilience amid the darkness. Scenes like this highlight both our region’s vulnerabilities and the innovative solutions within reach. 

The Caribbean faces urgent healthcare challenges that run deeper than any one patient’s illness. They are systemic, requiring leaders and policymakers to craft visionary reforms. In this narrative-driven exploration, we briefly shine a light on those challenges—equity and access, workforce and investment, sustainability and collaboration—and share inspiring examples of Caribbean initiatives showing the way forward.

Challenge Unequal Access: Bridging the Health Divide

On one island, an expectant mother in a remote village must travel hours—by bus, then boat—to reach the nearest maternity ward. On another, a diabetic elder skips clinic visits because he cannot afford the bus fare to town. These personal stories echo a larger truth: access to healthcare in the Caribbean often depends on where you live and what you earn. Nearly three in ten people in our region have unmet health needs today, and poorer households suffer far worse outcomes. For example, the lowest-income Caribbean mothers face a maternal death rate seven times higher than the richest (PAHO, 2024). Geography is also fate—small islands and rural districts may have only a handful of clinics or a lone doctor serving far-flung communities. The result is a health divide: care is not reaching many who need it most.

System leaders recognize that closing this gap is both a moral and practical imperative. Some have invested in bringing care closer to communities—literally. Mobile clinics now rumble along country roads, bringing doctors and meds to the doorsteps of those in need. Public-private partnerships are stepping up to support these efforts.

Likewise, telemedicine pilots are connecting island patients with specialists abroad, reducing the need for costly travel overseas for consultations. And on the financing side, countries like Barbados have adopted policies to remove cost barriers—providing essential medicines free of charge to all who need them. In Barbados, the Drug Service’s Special Benefit program ensures that life-saving medications for chronic diseases are available at no cost in public and private pharmacies (Healthy Caribbean Coalition, 2022). These measures are about fairness: nobody in our Caribbean family should be denied care due to distance or poverty. 

Investing in Health: Breaking the Cycle of Underfunding

With limited budgets stretched across education, security, and debt payments, too often healthcare in the region is left underfunded. The COVID-19 pandemic was a harsh teacher in this regard. It exposed how chronic underinvestment left hospitals struggling and public health systems fragmented. In 2021, Caribbean nations on average spent only about 4.5% of GDP on health, well below the 6% benchmark recommended by PAHO/WHO. The shortfall shows up as outdated equipment, medicine stock-outs, and citizens paying unaffordable out-of-pocket costs for services. In fact, households in our region shoulder over 28% of total health spending from their own pockets. 

4.5%
of GDP

Average Caribbean health spending vs. 6% target
(PAHO/WHO, 2024)

The good news is that our leaders are increasingly acknowledging health as the backbone of sustainable development. Countries are responding with higher budget allocations and creative financing reforms. Several have embarked on the road toward Universal Health Coverage (UHC), aiming to guarantee a basic package of services for all. Caribbean governments are also learning from each other. In June 2023, policymakers from across CARICOM came together to share strategies on health financing and “clearly define the components of resilient health financing” (World Bank Group, 2023). Their goal: identify how to diversify funding sources and improve pooling of resources so that a health crisis doesn’t break the bank. 

The Growing Burden of Chronic Disease

In a health center in Trinidad, the Monday morning line often winds out the door. The patients aren’t there for emergencies or rare diseases—most are managing chronic conditions like diabetes, hypertension, and heart disease. Across the Caribbean, noncommunicable diseases (NCDs) have quietly become an overwhelming wave, straining our health systems and budgets. In some hospitals, it is estimated that treating NCDs like heart disease, strokes, and diabetes now consumes over 70% of healthcare expenditures (Government of Barbados, 2020). 

Caribbean leaders were early to recognize that NCDs constitute not just a health issue, but a development crisis. In 2007, CARICOM heads of government held the world’s first-ever summit on NCDs, issuing the landmark Port-of-Spain Declaration and committing to united action (PAHO, 2018). That bold move spurred global awareness and set in motion national plans to curb risk factors. Many countries established multisector NCD commissions and rolled out public education campaigns urging healthier lifestyles. Yet progress is uneven, and the NCD epidemic continues to exact a heavy toll, especially on the poor and marginalized. 

What’s needed now is reinvigorated leadership and investment on prevention. This means treating NCD prevention like we do hurricane preparedness—as a permanent priority. From redesigning our cities to encourage walking, to integrating nutrition and exercise in school curricula, to incentivizing farmers to grow healthier local foods, policy choices outside the health sector are just as critical. Tackling chronic diseases will not be an overnight victory; it’s a generational fight. But by learning from early wins (and missteps), and sustaining the momentum from that momentous 2007 summit, the Caribbean can turn the tide on NCDs and ensure these illnesses no longer steal our loved ones in the prime of life.

Sustaining the Workforce: From Brain Drain to Brain Gain

Walk into any public hospital in the Caribbean and you will meet dedicated doctors, nurses, and technicians working long hours—often understaffed and overextended. Our health workforce is the backbone of the system, yet it’s a backbone under stress. For years, the Caribbean has faced an exodus of its trained medical personnel, a “brain drain” driven by better pay and opportunities abroad. The scope of the challenge is staggering: in the English-speaking CARICOM countries, only about 1.25 nurses per 1,000 people are practicing locally, roughly one-tenth the ratio in North America (World Bank Group, 2010). An estimated 30-40% of nursing positions are vacant across the region (Salmon et al., 2007)—wards and clinics simply unable to fill posts—and many hospitals rely on a handful of overworked veterans to keep services running. Meanwhile, it’s estimated that the number of Caribbean-trained nurses working in the US, UK, and Canada is three times the number working at home. 

Our health workforce is the backbone of the system, yet it’s a backbone under stress.

There’s a push to expand local training opportunities: nearly every Caribbean nation now has its own medical or nursing school or partners with the University of the West Indies, meaning more young professionals are being trained regionally than ever before. But training more people only helps if we can keep them. This is where collaboration and smart policy come in. CARICOM’s Managed Migration Program for nurses was one pioneering approach: a regionally coordinated strategy to balance nurse training with international exchange, aiming to “develop and maintain an adequate supply of nurses for the region”. Under this framework, agreements were explored whereby destination countries might compensate Caribbean nations for the nurses they hire or support training of additional nurses—essentially sharing the benefits. 

Another promising avenue is tapping into the diaspora. Many talented Caribbean doctors abroad are eager to contribute back home through short stints or telemedicine consultations. Initiatives like “brain circulation” have emerged, matching diaspora specialists with local needs for a few weeks a year, or involving them in curriculum development for our medical schools. 

~30–40%

Estimated vacancy rate for nursing posts across the region
(Salmon et al., 2007)

Climate Resilience and Sustainable Health Systems

Each year, the threat of storms, floods, and other natural disasters looms over our health infrastructure. Caribbean policymakers and partners have embraced the concept of “climate-smart” health facilities in response. The idea is simple but powerful: make hospitals and clinics both disaster-resilient and environmentally sustainable. A flagship initiative in this arena is the PAHO Smart Hospitals project, piloted in 2012 and since expanded. The results have been remarkable.

The “smart” approach marries structural safety with green technology. Solar panels and battery backups keep the lights on when the grid goes down, energy-efficient designs cut costs and carbon footprints, and reinforced roofs and windows protect against high winds. Many Caribbean states are now committed to applying these standards to new facilities and retrofits. Importantly, this is not just about infrastructure—it’s about planning and policy. We must also consider environmental health threats such as vector-borne diseases that climate change worsens (think of dengue or Zika surges in warmer, wetter conditions). Building a sustainable system means strengthening public health surveillance and regional cooperation to respond to these outbreaks quickly. 

Collaboration and Innovation: One Caribbean, One Health

Faced with these daunting challenges, no Caribbean nation needs to go it alone. If there is a silver thread running through our healthcare story, it is the power of collaboration and collective innovation. Our countries are stronger together—a fact recognized decades ago when the foundation was laid for institutions like the OECS Pharmaceutical Procurement Service (PPS). Since 1986, the OECS PPS has pooled the medicine purchases of its member states, proving that unity is strength. Caribbean collaboration goes beyond buying power. It extends to harmonizing policies and sharing human expertise. The creation of CARPHA in 2013 amalgamated five regional health agencies into one, streamlining our collective response to issues from epidemiology to health research. Through CARPHA, for instance, Caribbean states have a single regional laboratory and surveillance system that monitors outbreaks and guides action—something that proved invaluable in coordinating the fight against mosquito-borne diseases and COVID-19. 

Perhaps the most inspiring collaborative effort has been how Caribbean voices united on the global stage to address health inequities. Our region’s advocacy was key in pushing the agenda for cheaper HIV medications in the 2000s and later for the international recognition of NCDs as a development issue. 

Innovation is flourishing as well, often out of necessity. In some places, digital health solutions are leapfrogging traditional limitations—for example, mobile apps for appointment scheduling and medication reminders are being rolled out in Jamaica and Barbados to improve efficiency and patient engagement. There’s also the rich potential of tapping into our academic institutions like UWI and regional centers of excellence to drive research tailored to our context. At the heart of all these collaborative and innovative efforts is a simple truth: we are too small to be divided, and too strong together to fail. By sharing resources, knowledge, and even healthcare services across the Caribbean, we multiply our capabilities many times over. 

Conclusion: Charting a Healthier Future

The narrative of Caribbean healthcare is still being written. In these pages, we briefly confronted some of the toughest chapters—systemic challenges that have persisted for years or even decades. Yet, we have also encountered sparks of hope and ingenuity lighting the path ahead. Each challenge carries the seeds of opportunity: the gaps in access pushing us to design more inclusive systems; the tight budgets forcing us to innovate and prioritize; the exodus of workers reminding us to value and invest in our homegrown talent; the threats of climate change compelling us to build stronger, smarter facilities; the shared struggles nudging us toward deeper regional solidarity.

For policymakers and system leaders, the call to action is clear. The time for piecemeal fixes is over—we must embrace comprehensive reform and bold investments. This article is meant to provoke discussion, yes, but also to inspire collaborative action. Let the conversations begin, and let the solutions emerge—for a healthier Caribbean for generations to come.

Sources:

1. ECLAC/PAHO Joint Report on post-pandemic health investment (2024): urges prioritizing health spending to reduce inequalities (Link).
2. PAHO data on health financing: Caribbean public health spending about 4.5% of GDP vs 6% target; high out-of-pocket burden about 28–35% leading to inequity (Link). 
3. World Bank feature on Caribbean UHC (2023): regional cooperation to strengthen health financing and invest in resilient systems (Link).
4. Healthy Caribbean Coalition report (2022): Barbados Drug Service provides free essential NCD medicines via public/private pharmacies (Link).
5. PAHO/WHO Smart Hospitals Initiative: climate-resilient “smart” hospital in St. Vincent was the only facility functional after a severe storm, serving as a water source with reserves. In Belize, five smart-retrofitted clinics stayed fully operational through Hurricane Lisa (2022). (Link).
6. World Bank Press Release (2010): English-speaking CARICOM faces nursing vacancies of about 30% (3,300 posts) and only 1.25 nurses per 1,000 population; nurse emigration is triple local workforce (Link). Average nursing vacancy about 42% noted in regional assessments (Link).
7. Samuels et al. (2019): Evaluation of 2007 CARICOM NCD Summit: landmark Port-of-Spain Declaration was the world’s first Heads of Government NCD summit spurring regional NCD prevention efforts (though implementation gaps remain) (Link).
8. OECS Pharmaceutical Procurement Service: over 30 years of pooled regional drug procurement, globally recognized for improving access and saving costs (Link). During COVID, OECS pooled procurement ensured timely supply of test kits/PPE and yielded about 20% cost savings for member states on medical purchases (Link).