CARIBBEAN HEALTH PROMOTION WORKSHOP

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1 WORKSHOP REPORT CARIBBEAN HEALTH PROMOTION WORKSHOP St. Vincent, July 30 - August 3, 2007 December 2007

2 List of Acronyms CNHPS CSO FBO GIS HP HPR HPS ICT MDGs MDGs Plus MoE MoH NCD PAHO SDOH TOT WHO YPHS Caribbean Network of Health Promoting Schools Civil Society Organization Faith-Based Organization Geographic Information Systems Health Promotion Health Promoting Schools Information Communication Technology Millennium Development Goals Millennium Development Goals Plus Ministry of Education Ministry of Health Non-communicable Diseases Pan-American Health Organization Social Determinants of Health Train-the-Trainer World Health Organization Youth Friendly Primary Health Services Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

3 Table of Contents List of Acronyms... 2 Executive Summary Background Mainstreaming Health Promotion (July 30 th and 31 st ) Opening Session Hon. Dr. Douglas Slater, Minister of Health and the Environment, St. Vincent Ms. Laura Brown, Permanent Secretary, on behalf of the Minister of Education, St. Vincent First Technical Session Assistant Director, Dr. Carissa Etienne (by video) Dr. Eduardo Guerrero, Unit Chief, PAHO/SDE/DS Ms. Yvonne Lewis, Deputy Director of Health Promotion, Trinidad and Tobago Capacity Building Roundtables Health Promotion Strategies Capacity Building Roundtables: Experience Sharing interactions Capacity Building Roundtables: Changing Environments, Empowering Communities Mainstreaming Health Promotion in the Caribbean Parallel Working Groups Utilizing the 6 CCH Cross Cutting HP Strategies for Mainstreaming / Integrating / Institutionalizing Positive Change Parallel Working Groups: Exploring Key Health Promotion Cross-Cutting Strategies Conclusion and Recommendations Training in HP program evaluation (August 1 st and 2 nd ) Second Caribbean Health Promoting Schools Network (August 3 rd ) Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

4 Executive Summary 1. Background Non-communicable diseases (NCDs) are an increasingly important health issue in the CARICOM region. The CARICOM Heads of Government convened on September 14, 2007 to determine appropriate responses from government and civil society organizations (CSOs) to NCDs in the region. In the lead up to this meeting, the Pan-American Health Organization (PAHO) hosted the Caribbean Health Promotion Workshop. The workshop was intended to strengthen institutional capacity to mount a health promotion response to priority health concerns, including NCDs, among government ministries and CSOs in the region. The 5-day workshop was divided into three sections: Mainstreaming Health Promotion, Training in Health Promotion Program Evaluation, and Caribbean Health Promoting Schools Network. 2. Mainstreaming Health Promotion 2.1 Opening The Workshop was opened by the Hon. Dr. Slater, Minister of Health and the Environment, St. Vincent. He drew attention to the extent of the NCD crisis in the Caribbean and the impact NCDs have on individuals, families, and nations in the region. Dr. Slater emphasized that the response to NCDs must go beyond focusing on individual-level change to create supportive environments through healthy public policy. He appealed to the media and others to help depoliticize and build support for healthy public policy, emphasizing the impact of NCDs on the long-term economic health in the CARICOM region. His remarks were followed by supportive words from Ms. Laura Brown, Permanent Secretary, Ministry of Education, who emphasized the need for multi-sectoral collaboration in achieving health promotion goals. 2.2 First Technical Session The First Technical session provided delegates with an overview of the global and regional context in which the Workshop was taking place and the important role that health promotion can play in achieving regional health and social goals. Speakers illustrated how the widening and deepening income gap, globalization processes, linking of health to development goals, and increased interest in the social determinants of health (SDOH) heighten the importance of health promotion. Speakers also emphasized the need for health promotion specialists to evaluate interventions and contribute to the growing body of evidence for health promotion. The mainstreaming of health promotion within Trinidad and Tobago was used as case study to illustrate how mainstreaming can be achieved and the outcomes of doing so. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

5 2.3 Capacity Building Roundtables Delegates participated in Roundtable discussions focused on building capacity in health promotion strategies through experience sharing. Each table was lead by a health promotion expert who provided a brief overview of the topic under discussion and then engaged delegates in sharing their ideas and experiences. Monday s roundtables included: Changing Environment: Policy Coherence; Reorienting Health Systems and Services: Primary Health Care; Reorienting Health systems: A Decade Implementing the CCHP; Changing Behavior: Controlling Chronic Diseases; Changing Behavior: Media as Partners; and Changing Environment: Healthy Settings. Tuesday s Roundtables explored health promotion strategies for changing environments and empowering communities; This included Mainstreaming Health Promotion in Schools; Community Mapping; Social Marketing and the Healthy Lifestyles Campaign; Better Living Health Centre; and Health Promotion in Rural Communities. 2.4 Mainstreaming Health Promotion in the Caribbean Delegates heard from three health promotion specialists on issues affecting the mainstreaming of health promotion in the Caribbean. Dr. Alafia Samuels, Health Promotion, WDC provided insight into the context, evidence and framework for health promotion priorities. Mrs. Renee Franklin-Peroune spoke to the challenges and advances in mainstreaming health promotion in the Caribbean. Dr. Suzanne Jackson, Consultant, discussed mainstreaming health promotion within PAHO. 2.5 Parallel Working Groups Delegates participated in parallel working groups designed to share best practices in the region. The theme for the parallel working groups on Monday was Utilizing the 6 CCH Cross Cutting HP Strategies for Mainstreaming/Integrating/Institutionalizing Positive Change. Each group explored how health promoters were using the six action areas of the Caribbean Charter to address one of five health issues, namely Healthy Eating, Active Living, Safer Sex and Alcohol, Tobacco, and Violence Prevention and Road Safety. The theme for the parallel working groups on Tuesday was Exploring Key HP Cross-Cutting Strategies. Groups explored how building political support, engaging citizens, determinants of health, engaging other sectors, and building capacity can be used to accomplish a range of health promotion goals. 2.6 Conclusion and Recommendations The Mainstreaming Health Promotion component of the Caribbean Health Promotion Workshop was concluded with identification of a number of recommendations. Recommendations focused on mechanisms to enable the continued sharing of health promotion strategies and evidence in the region; Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

6 ongoing capacity development and skills building in health promotion at the regional and national level; enhanced access to health promotion tools and policy frameworks; and mainstreaming health promotion into other key networks in the region. 3. Training in HP program evaluation (August 1 st and 2 nd ) On Wednesday, August 1 st, participants received an overview of evaluation in health promotion and participatory evaluation, divided into small groups of 3 to 6 people by country and identified a program relevant to that country to evaluate, and then went through three mini-lectures and three sessions of small group work. The first workshop was Getting ready to evaluate: Identification of Stakeholders, the second was Getting Ready to Evaluate clarifying program objectives, strategies and indicators, and the third was To Develop Evaluation Questions. Each team worked through worksheets with the support of Marilyn Rice and Suzanne Jackson. On the second day, August 2 nd, participants learned about evaluation design and methods, how to develop an evaluation survey instrument or focus group guide, and analyze, interpret and communicate the results. Each small working group presented a summary of their evaluation plan at the end of the day. 4. Second Caribbean Health Promoting Schools Network (August 3 rd ) The final day of the Caribbean Health Promotion Workshop was dedicated to a meeting of the English-Speaking Caribbean Network of Health Promoting Schools (CNHPS). This was the first meeting held since the Network was formed in The purpose of the meeting was to facilitate the exchange of knowledge, experiences, and resources to support the health and development of school-aged children and adolescents. The workshop aimed to strengthen the organizational structure of the CNHPS at both the international and at the national level. Comment [LD1]: What is the correct name and acronym of this network? The objectives for the meeting were to map the implementation of health promotion within school settings, identify best practices in health promoting schools, to assess and strengthen the current state of the Network and its organizational systems, and to define the needs and priorities for implementing the Health-Promoting Schools Initiative throughout the Caribbean. Delegates determined that there currently is not a functional network in place to support school health promotion. The primary explanation for the deterioration of the CNHPS was a lack of sufficient human resources and discontinuity among staff responsible for school health promotion in several countries. This was complicated by a weak coordinating mechanism that relied on personalities rather than structures. The delegates identified a number of recommendations to revitalize the CNHPS and support health promoting schools within the region. This includes adopting the consensus agreement on core components of health promoting schools that emerged at the Vancouver meeting of Health Promoting Schools, held during the World Conference on Health Promotion and Health Education. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

7 Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

8 1. Background Non-communicable diseases (NCD) are an increasingly important health issue in the CARICOM region. The CARICOM Heads of Government convened on September 14, 2007 to determine appropriate responses from government and civil society organizations (CSOs) to NCD in the region. In the lead up to this meeting, the Pan-American Health Organization (PAHO) hosted the Caribbean Health Promotion Workshop. The workshop was intended to strengthen institutional capacity to mount a health promotion response to NCD among government ministries and CSOs in the region. The workshop included staff from Ministries of Health (MoH), Ministries of Education (MoE), and CSOs. Health promotion is a relatively new approach to public health. The World Health Organization s (WHO) 1986 Ottawa Charter for Health Promotion defines health promotion as:.health promotion is the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social well-being, an individual or group must be able to identify and to realize aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy life-styles to well-being The Ottawa Charter was adapted to the Caribbean context in 1993 Caribbean Charter on Health Promotion (1993), mandated by the 13 th Conference of Caribbean Ministers of Health. The Caribbean Charter expands upon the goals and strategies of the Ottawa Charter to also address the pursuit of health in a wider development agenda. Health promotion focuses not only on disease prevention and control, but on health and wellness and advocates that people s health is a positive resource for their living (Caribbean Charter, 1993). Caribbean Charter for Health Promotion The wellness of the Caribbean people that health promotion seeks to enhance will depend on the actions of individuals and communities to modify crucial ecological and behavioral factors and to provide efficient and effective systems of health care. The strategies that will ensure the understanding, planning and implementation of the kind of health promotion that adheres to the overriding principles of equity in matters of health include, the following: 1. Formulating health public policy 2. Reorienting health services 3. Empowering communities to achieve well-being 4. Creating supportive environments 5. Developing/increasing personal health skills 6. Building alliances with special emphasis on the media Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

9 Effectively promoting the health of populations in the Caribbean means working with individuals to develop healthy lifestyles and with communities to achieve equity and the Millennium Development Goals Plus (MDG Plus). 1 Achieving health promotion goals in the region requires multi-level strategies, targeting the social, behavioral and biological determinants of health. The Caribbean Health Promotion Workshop was held to provide ongoing strengthening and improvement to health promotion practices and capacity in the Caribbean region. In addition to the below objectives, the workshop provided a forum for countries to share their successful health promotion interventions and to advance technical cooperation between countries: Analyze the Caribbean Charter for Health Promotion (1993) in relation to the major declarations and charters that have been developed regionally and globally since its inception; Identify and share practices that mainstream health promotion strategies in the Caribbean. Provide training in participatory evaluation to contribute to the documentation and evidence base for health promotion interventions. Build capacity among PAHO/WHO staff as well as key counterparts in government and CSOs to mount a health promotion response to NCD, in preparation for and response to the mandate from the CARICOM Heads of Government Summit on Non Communicable Diseases. The 5-day workshop was divided into three sections: Mainstreaming Health Promotion, Training in Health Promotion Program Evaluation, and Caribbean Network of Health Promoting Schools. 1 PAHO uses MDG Plus to refer to the expansion of the MDGs (particularly MDG 6 - combat HIV, malaria, and other diseases) to include NCD and injuries. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

10 2. Mainstreaming Health Promotion (July 30 th and 31 st ) 2.1 Opening Session The Caribbean Health Promotion Workshop was opened on July 30 th, The delegates were welcomed by Dr. Alafia Samuels and lead through a prayer by Ms. Andrea Robin. Dr. James Hospedales, Unit Chief, NCDs presented opening remarks on behalf of Dr. Eduardo Guerrero, Unit Chief, DS and welcomed high level leaders from participating countries. Dr. Mirta Roses, PAHO Director, highlighted the importance of the gathering for supporting the mandate from the impending historic September 15 th meeting of the CARICOM Heads of Government on NCD. The significance of the multi-sectoral nature of the gathering was highlighted, given that many determinants of health lie outside the health sector Hon. Dr. Douglas Slater, Minister of Health and the Environment, St. Vincent After welcoming the Minister of Health from Turks and Caicos and health partners from the rest of the CARICOM, Hon. Dr. Slater provided an overview of the health accomplishments and challenges in the CARICOM region. He emphasized that while there is a tendency to gravitate towards visible diseases such as HIV, it is NCDs that are the top killers in the region accounting for more than 50% of deaths and impacting individuals, families, and nations. Hon. Dr. Slater highlighted that there have been numerous reports to governments in recent years that illustrate the magnitude of the problem, its economic impacts, and necessary policy measures. The Hon. Dr. Slater emphasized that the prevention and control of NCDs must not simply focus on individuals and lifestyle choices, but also recognize the importance of the environment and healthy public policy, which are frequently politically charged issues. He appealed to the media to actively support health promotion efforts in the region by building public awareness, understanding, and support for healthy public policies within the context of individual freedom, human rights, and the right to advertise. The Hon. Dr. Slater called upon delegates to be advocates for the policy changes, recommended by health and economic experts, challenging people to consider the long-term economic impacts of NCD in the region. He highlighted the role of Ministries of Health, Agriculture, Education, and Finance play in preventing and controlling NCDs and promoting health in the region Ms. Laura Brown, Permanent Secretary, on behalf of the Minister of Education, St. Vincent Ms. Brown brought remarks on behalf of the Minister of Education, St. Vincent. She emphasized that the Ministry is proud of its collaboration with the Ministry of Health to promote health, particularly by building health literacy and fostering healthy lifestyles. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

11 2.2 First Technical Session Assistant Director, Dr. Carissa Etienne (by video) Dr. Carissa Etienne, PAHO Assistant Director, contextualized the Workshop in light of health priorities in the region, the complex and changing array of factors affecting health, and developments within the health promotion sector. The CARICOM Heads of Government have identified chronic disease, HIV and AIDS, violence, and injuries as their health priorities and have named three cross-cutting themes to address these priorities: health promotion, information systems, and the management of health human resources. Dr. Etienne identified a number of factors affecting health in the Caribbean and around the world. These included the positive and negative effects of globalization; widening inequities and deepening poverty; rapid social, economic, and demographic changes; the (re)emerging interest in the social determinants of health; affirmation of the relationship of health and development through the MDGs; the expansion of the MDGs to target and prioritize NCD through the MDGs Plus; demonstration of governments commitment to health through the Global Framework on Tobacco Control; and increased attention to health system renewal with a focus on primary health care. Dr. Etienne illustrated the connection between these broad factors and the Sixth Global Conference on Health Promotion, convened by the WHO in Bangkok in 2005 to explore the theme of Policy and Partnership for Action Addressing the Determinants of Health. The Bangkok Charter for Health Promotion built on the Ottawa Charter by emphasizing the need for strong political action, broad participation and sustained advocacy as well as providing a heightened awareness that all sectors are critical to the achievement of health - the private sector, civil society, and all of government. Dr. Etienne encouraged the participants to use the Workshop to rethink the role of the health sector generally and health promotion approaches specifically to respond to these changes. While recognizing the achievements of the health promotion sector in the Caribbean including the development of the Caribbean Charter she identified an over-reliance on strategies targeting individual change. Dr. Etienne encouraged delegates to intensify the application of strategies that target the social determinants of health and move the responsibility for health promotion beyond the health sector Dr. Eduardo Guerrero, Unit Chief, PAHO/SDE/DS Dr. Guerrero s presentation challenged us to look for the root causes of diseases and to focus our energies on these up-stream, social determinants of disease. He emphasized that social decisions, communities decisions and personal decisions are different the latter depends on psychosocial determinants - factors such as culture, education, gender, and income level. All people need: love (feelings) to change; and need guarantees for basic social rights (space and respect for others) and opportunities (to hope to develop essential life capabilities, self realization) Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

12 Dr. Guerrero also shared his view that it is also important to develop local opportunities to integrate actions in many different settings, but we must link our vision and propose with those of the people. We should listen to the people and help to empower them, while working with different sectors our governments. Requirements for reducing social inequalities in health over the coming years: Capacity-building with governments includes health sector and other sectors Empowerment of society Identify goals and challenges and work for universal solutions with rich and poor populations. Social inclusion is imperative. New opportunities for development and health: income, primary health care and health promotion Social management is a challenge Dr. Gauden Galea, Coordinator, Health Promotion WHO/HQ (by video) Dr. Galea s presentation illustrated the central position that health promotion occupies within the WHO Constitution and strategic documents for achieving health and social outcomes. Dr. Galea emphasized the important connection between health and broader development goals affecting the social determinants of health (SDOH), and the challenges created by current forces such as globalization to health and development. Dr. Galea discussed how health promotion has been a rising star in public health but has been challenged by the discipline s difficulty in defining itself. He emphasized the need to contribute to the growing body of evidence supporting health promotion interventions and strategies. Dr. Galea went on to look at health promotion in island settings. He emphasized the need to take the socio-cultural, economic, and human resource context into consideration when developing health promotion plans for islands. Using an intervention from Fiji, Dr. Galea explored how competing values can lead to unforeseen outcomes in health promotion interventions. Dr. Galea ended his presentation by emphasizing that every health promotion initiative should look at coverage, sustainability and side effects Ms. Yvonne Lewis, Deputy Director of Health Promotion, Trinidad and Tobago Ms. Lewis discussed the experience of implementing the Caribbean Charter for Health Promotion in Trinidad and Tobago. Health promotion was introduced in the health system during its restructuring in 1994 and the Caribbean Charter was adopted by the country. Much work was required to build awareness and understanding of health promotion and how it goes beyond health education. Training in health promotion was first offered to health professionals and students, and was later expanded to teachers and community leaders. Training is now offered intersectorially. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

13 Trinidad and Tobago developed a 5-year national implementation plan to address the SDOH through healthy public policy. This plan recognized that healthy public policy is not the sole domain of the Minister of Health but required a multi-sectoral approach. The country established a Directorate of Health Promotion and Public Health in 2001 with a mandate to operationalize health promotion nationally. This led to the formation of the National Council on Health Promotion by the national cabinet, comprised of all ministries plus representations from both the private sector and CSOs. The Council applies a multisectoral approach to national development and monitors programs based on the Caribbean Charter. Ms. Lewis illustrated the need to engage a broad base of stakeholders in achieving health promotion goals and the role that ongoing monitoring and evaluation plays in achieving health promotion goals. Community engagement and local ownership were identified as particularly important in identifying pressing health concerns as well as innovative and sustainable solutions. 2.3 Capacity Building Roundtables On both July 30 th and 31 st, delegates participated in roundtables focused on building capacity in health promotion strategies by sharing experiences. Each Roundtable was led by a health promotion expert who provided a brief overview of the topic under discussion and then engaged delegates in sharing their ideas and experiences Health Promotion Strategies Capacity Building Roundtables: Sharing Experiences Roundtables on Monday explored health promotion strategies. They included: Changing Environment: Policy Coherence (Dr. Suzanne Jackson); Reorienting Health Systems and Services: Primary Health Care (Dr. Carme Nebot); Reorienting Health systems: A Decade Implementing the CCHP (Ms. Yvonne Lewis); Changing Behavior: Controlling Chronic Diseases (Dr. James Hospedales); Changing Behavior: Media as Partners (Ms Claire Forrester); and Changing Environment: Healthy Settings (Ms Marilyn Rice). Only those Roundtable discussions where notes were available are represented in this section. A. Changing Environment: Policy Coherence with Dr. Suzanne Jackson Dr. Jackson spoke briefly about the different types of policy coherence (internal, vertical, horizontal and inter-country) and asked the participants to talk about their own experiences with policy coherence in the Caribbean. Participants spoke about the National Nutrition Council in St. Vincent and the Grenadines which provided advice about food security to Cabinet. Although the government developed a national policy, a value-added tax and wanted to look at the impact of trade on nutrition, their capacity to monitor the impact and the coherence between policy Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

14 arenas is very limited. In Surinam, participants talked about how the Ministries of Health, Education and Sports are working on similar issues but they each work in separate silos. They identified that internal and horizontal coherence (making the connections across government departments) was missing around active living. Other points made by the participants were that there needs to be a handbook for policy-makers about healthy public policy and a national strategic plan that can coordinate the policy agendas that affect one another. B. Reorienting Health Systems and Services: Primary Health Care with Dr. Carme Nebot Participants in this Roundtable discussed the challenges of reorienting health systems and services, specifically as related to primary health care. These include: an insufficient pool of health human resources within the region and, within that pool, insufficient training in health promotion; a reliance on volunteers to fill the gap in health human resources; the tendency for politicians and the public to focus on curative medicine which tends to be more visible, spectacular, and expensive than health promotion strategies; the challenges of collaboration between primary health care and health promotion staff; misunderstanding around what health promotion is; barriers to intersectoral collaboration resulting from budgetary competition between ministries; and challenges to individual health choices created by broader economic and social forces. E. Changing Behavior: Media as partners with Ms. Claire Forrester Participants in this Roundtable agreed that the media is an important vehicle for promoting health. The participants, however, identified two key challenges in building strategic alliances with the media: 1) the public health community needs the media more than the media needs the public health community and 2) there are multiple interests competing for media attention. This is complicated by the public health sector s desire for free media attention and the media s need to generate income. A number of recommendations were generated to build strategic alliances and to get public health issues on the agenda (see appendices). F. Changing Environment: Healthy Settings with Ms. Marilyn Rice Participants in this Roundtable discussed a range of health promotion initiatives to encourage healthy eating, physical activity, smoke-free lifestyles, male health, and father involvement. Many initiatives focused on children and engaging the people and institutions that affect their development such as parents, schools, etc. Participants discussed the importance of community development approaches that foster local ownership and strategic alliances with leaders and the private sector in the success and sustainability of initiatives to create health settings. Male involvement and particularly father involvement was identified as a key challenge in the region. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

15 2.3.2 Capacity Building Roundtables: Changing Environments, Empowering Communities Roundtables on Tuesday explored health promotion strategies for changing environments and empowering communities. They included: Mainstreaming Health Promotion in Schools (Anthony Hunt and Lucy Anderson, Guyana); Community Mapping (Arthur Martinez, Belize); Social Marketing and the Healthy Lifestyles Campaign (Cheryl Thompson and Idamae Hanna (Bahamas); Better Living Health Centre (Dr. Idamae Hanna, Bahamas); and Health Promotion in Rural Communities (Renee Franklin-Peroune, Guyana). Only those Roundtable discussions where notes were available are represented in this section. A. Mainstreaming Health Promotion Schools with Mr. Anthony Hunt, Community Involvement Specialist, MoE and Ms. Lucy Anderson, HP Focal Point, Ministry of Health, Guyana This Roundtable examined school-based child health promotion programs in Guyana and St. Vincent. An educational access program has been implemented in Guyana s hinterland areas with both a school feeding program and providing housing to teaching staff. Efforts are currently underway to enhance collaboration between the MoE and MoH; The MoH is formulating an adolescent health strategy that will be submitted to the MoE for inclusion in their National Plan. St. Vincent s school health programs include a school feeding program that offers alternatives to unhealthy snacks and efforts to sensitize and support school staff to mitigate safety threats. B. Community Mapping with Mr. Arthur Martinez, Technical Officer, GIS, Belize This Roundtable examined how geographic information systems (GIS) can be used in health promotion, based on Mr. Martinez s experiences in Belize. 2.4 Mainstreaming Health Promotion in the Caribbean On Monday, delegates heard from three health promotion specialists on issues affecting the mainstreaming of health promotion in the Caribbean. Dr. Alafia Samuels, Health Promotion, WDC provided insight into the context, evidence and framework for health promotion priorities. Mrs. Renee Franklin-Peroune spoke to the challenges and advances in mainstreaming health promotion in the Caribbean. Dr. Suzanne Jackson, Consultant, discussed mainstreaming health promotion within PAHO. On Tuesday, delegates heard about specific examples of health promotion in action in the Caribbean. Yvonne Lewis from Trinidad-Tobago talked about the Plum Mitan Healthy Spaces Initiative, Alexi La Rose talked about Health Promoting Schools in Guyana, Cheryl Thompson talked about the Healthy Lifestyle Campaign in Bahamas, Dr. Idamae Hanna presented an Eight Weeks to Wellness program in the Bahamas, and Arthur Martinez talked about Community Mapping in Belize. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

16 2.5 Parallel Working Groups Delegates participated in two parallel working groups designed to share best practices in the region. Each group explored how health promoters were using the six action areas of the Caribbean Charter to address a range of health issues Monday - Utilizing the 6 CCH Cross Cutting HP Strategies for Mainstreaming / Integrating / Institutionalizing Positive Change The theme for the parallel working groups on Monday was Utilizing the 6 CCH Cross Cutting HP Strategies for Mainstreaming / Integrating / Institutionalizing Positive Change. Each group explored how health promoters were using the six action areas of the Caribbean Charter to address one of five health issues, namely Healthy Eating, Active Living, Safer Sex and Alcohol, Tobacco, and Violence Prevention and Road Safety. A. Healthy Eating Strategy Interventions Challenges Healthy Public Policies - Health survey - Formation of councils Reorientation Health Services - Develop dietary department within MoH Empowering Communities Supportive Environments Personal Health Skills Building Alliances - Community assessment of national poverty survey - Health fairs - Screening tools - School feeding programs - Gym within MoH - National sports programs - Workplace wellness programs - Outreach programs - Health education in schools and community - Train pre-service teachers and nurses to deliver health education - Work with chefs to teaching cooking - Regular radio programming - Regular print media programming - Engage business community - MoH relies on biomedical model - Nutrition education materials are developed in the US. - Conflict between content and private sector sponsorship - Teachers may not implement health education curricula Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

17 in providing screening for private sector employees Good Idea: Working group participants identified a 12-week wellness program in the Bahamas as being a particularly good idea, with the network producing good outcomes. An innovative proposal was the need to simultaneously work from the bottom up to address community needs and top down to ensure supportive policies. Key Challenge: A key challenge identified by the group was multisectoral action to promote healthy eating habits. The group also identified the need to sustain momentum, secure ongoing funding, engage in monitoring and evaluation, and market programs. B. Active Living Strategy Interventions Challenges Healthy Public Policies - School health policy with mandatory physical education. - Physical activity in schools depends on principal and staff. Reorientation Health Services - Mainstreaming the Caribbean Charter. Empowering Communities - Theme days to rally community. - Competitions. - Fun activities. - Culturally-specific activities (steel pan, jump up). Supportive Environments - Public playgrounds and parks. - Wellness Centres within health care centres. - Physical activity centres. Personal Health Skills - Promote housework as physical activity. - Asking people to do things without showing them how. - Supervision by trained personal. - Setting aside time for activity. - Target elderly people. - Health campaigns to promote activity. Building Alliances - Develop alliances with private gym. - Regular programs through the radio. - Health reporters share information from workshops and seminars. Good Idea: Working group members identified the Wellness Centre Initiative as a particularly good idea for promoting physical activity. Key Challenge: The absence of national policies around physical activity was seen as a key challenge. Innovative Idea: The working group identified the engagement of heads of state and government in physical activity as an innovative idea for health promotion. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

18 C. Safe Sex / alcohol Strategy Interventions Challenges Healthy Public Policies - National policy on HIV that engages many different stakeholders. - Not all sectors involved in policy development. Reorientation Health Services Empowering Communities Supportive Environments Personal Health Skills Building Alliances - Engage non-health partners in sexual health promotion, such as FBOs and other CSOs. - Health education programs. - Youth peer education programs. - Engage faith leaders in training others in the community. - Peer education training. - Family Planning Association. - Health Education Unit. - Faith-based organizations. - Availability of funding. - Alcohol rehabilitation services. - Substance abuse secretariat. - Health education. - Develop capacity to deliver health education. - Commercials on TV and radio. - Work with technical and implementing partners. - Sponsorship by the alcohol industry. - Most activity is done by CSOs. Innovative Idea: The working group identified Youth Friendly Primary Health Services (YPHS) as a particularly effective health promotion intervention. Key Challenge: Social norms and alcohol use were identified as key challenges for sexual health promotion. D. Tobacco Strategy Interventions Challenges Healthy Public Policies - National legislation is in progress. - Enforcement of policies at a local level. - Multisectoral approach to Tobacco Control. Reorientation Health Services Empowering Communities - Capacity building for focal Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

19 Supportive Environments Personal Health Skills Building Alliances points. - Community health workers. - Smoke-free spaces. - Smoke-free schools. - Community outreach programs. - Alliances with insurance companies. - Alliances with unions. - Collaborate with larger private sector employers. - Radio and TV programming Good Idea: The working group identified two particularly good interventions: Smoke-Free schools 100 schools at a time and dry free clubs. Key Challenge: The group identified political support and funding as the key challenge facing anti-tobacco health promotion efforts. Innovative Idea: The engagement of regional coordinating mechanisms, such as CARICOM, was identified as an innovative health promotion strategy. E. Violence Prevention / Road Safety Good idea: There were 3 ideas generated by the 11 people in this group. 1) A school program in Surinam developed a manual for students and teachers implemented by Police in 5 th grade about road safety (now in English in Guyana) 2) Peace and Love in Schools a program in Jamaica 3) National multi-sector response group around gender violence in Belize Challenge: The group identified data and surveillance systems as a key challenge and that even when they exist, the challenge is to get policymakers to use the information. Innovative Idea: The innovative proposal by this group was to build the capacity of family health care teams to detect and prevent family violence Tuesday - Parallel Working Groups: Exploring Key Health Promotion Cross-Cutting Strategies The theme for the parallel working groups on Tuesday was Exploring Key HP Cross-Cutting Strategies. Groups explored how building political support, engaging citizens, determinants of health, engaging other sectors, and building capacity can be used to accomplish a range of health promotion goals. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

20 A. Mobilization and sustainability Cross-Cutting Strategy Application Challenges Gaining political support - Enlist first lady as an advocate. - Have invitations come from first lady. - Invite head of government to announcement of research findings. - Engage head of government and ministers in role modeling healthy lifestyles. - Sustaining involvement. - Political support does not always result in increased funding. Engaging citizens Determinants of health Putting health on the agenda of other sectors, especially the private sector Building capacity - Involve community in development of sexual health education curricula. - Build support among other ministries and general public for healthy public policy. - Emphasize the impact of health outcomes on productivity and other people. - Schools are willing to implement smoke-free policies because of the impact on children. - Offer services without asking for compension. - Understand what other sectors are doing and look for a window. - Community leaders may lack knowledge and skills to advance agenda. - Turfism among ministries is common. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

21 B. Community Diagnosis / Community Assets Cross-Cutting Strategy Application Challenges Gaining political support - Engage faith leaders and youth group leaders. - Work with relevant Ministries. - Engage local political representative. - Get signed commitments from political leaders. Engaging citizens Determinants of health Putting health on the agenda of other sectors, especially the private sector Building capacity - Involve political leaders. - Get signed commitments from political leaders. - Use MDGs. - Include questions on surveys for managers on health. - Include non-health professionals on district and village health teams. - Invite private sector to participate in committees and consultations. - Involve NGOs and private health institutions. - Involve non-health professionals (peers) in providing health education within social networks. - Provide manuals. - Health Promotion units tend to be small with limited human resources available. - Political parties can have sting in the tail. Good Idea: Working group participants identified the use of lay persons to provide safe motherhood training to their local networks as a good practice. Key Challenge: A key challenge in community diagnosis and community assets is human and financial resource constraints. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

22 C. Developing Leadership Cross-Cutting Strategy Application Challenges Gaining political support - Encourage leadership position for health promotion within Ministry structures. - Engage political representatives from Health and Education. - Work as a coalition to build political interest. - Engage constituency in engaging political representatives. Engaging citizens - Draw on media and community groups to reach citizens. - Engage local community groups in planning processes. - Use materials geared to the general public. - Tap into different groups and associations where people already gather. - Use fun methodologies such as sports competitions. - Work with sporting associations and companies. Determinants of health - Health fairs in the community. Putting health on the agenda of other sectors, especially the private sector - Collaborate with private sector organizations that develop their own programs. Building capacity - Provide training for preservice teachers and health professionals (e.g., nurses, nutritionists, doctors, etc). Good Idea: The working group identified building strategic community partnerships and linkages as a good practice in developing leadership. Key Challenge: A key challenge faced by health systems is competing with marketing strategies used in the media. Innovative Idea: Community development strategies were identified as an innovative approach to leadership development. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

23 D. Healthy Schools smoke free spaces, health promoting environments, health promoting schools Cross-Cutting Strategy Gaining political support Engaging citizens Determinants of health Putting health on the agenda of other sectors, especially the private sector Building capacity Application - Embed health promotion in the MoH strategic plan and policies. - Caribbean Charter endorsed by Prime Minister. - Engage non-health leaders, Ministers, mayors, and gatekeepers. - Work with Village Council and other GPS. - Use a lifespan approach (e.g., youth, workers, elderly). - Work with churches. - Involve CSOs, civil society, and international agencies. - Bring in organizations, institutions, and sectors as needed. - Set up a SDOH committee to set objectives for overall health plans. - Form a multi-sectoral committee to put SDOH in their own terms. - Involve other sectors in committees and informal channels. - Make initiatives multi-sectoral. - Have people define their own roles. - Invite participation in strategic planning processes. - Train health workers in intersectoral setting. - Provide train-the-trainers (TOT) at all levels in HP skills and group and organizational management. - Train multidisciplinary and multisectorally. Challenges - Targets for DOH are difficult to define. - Challenge to put health in positive terms. - Encouraging health workers to focus on health rather than illness. - Participation. - Transportation to training locations. Good Idea: The working group identified the use of healthy spaces and healthy communities at the national and regional level and within multisectoral focus, as a particularly good idea. This approach encourages communities to identify problems and they work on them. Key Challenge: A key challenge for healthy settings is achieving sustainable financing and political support. Innovative Idea: An innovative approach to ongoing work in this area is to involve the opposition in the CARICOM Symposium on NCDs. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

24 E. Risk vs. Protective Factors Cross-Cutting Strategy Application Challenges Gaining political support - Use media and data to increase interest. Data must - Level of interest in issues. - Sustainability of interest. link to economic costs, ripple effect on other sectors and issues. - Support for HIV has opened conversations. - Use advocacy strategies such as media and community mobilization. Engaging citizens - Build capacity in vulnerable communities to participate in community response. Determinants of health Putting health on the agenda of other sectors, especially the private sector - Involve citizens in planning. - Make changes in the environment that enable healthy choices (e.g., microwaves and fridges in workplaces). - Use media, small groups, and one-on-one to build understanding. - Use evidence such as reports. - Find a success story that is dramatic, visible and affect sectors. Illustrate how private sector and other will benefit. - Work intersectorally to develop policies. - Lack of policies. - Time-consuming. - Inadequate resources. Building capacity - Training and sensitization - Lack of trained persons. - Lack of follow-up. - Lack of mandate. - Lack of ownership (sustained). Good Idea: The working group identified a collaborative initiative between the MoH and Ministry of Communications to reduce death and disabilities resulting from traffic accidents. Key Challenge: The key challenge in addressing risk and protective factors are shortages of trained human resources, monitoring and evaluation, and sustained commitment. Innovative Idea: An innovative idea is ensuring the availability and use of data for adequate/effective decision making. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

25 F. Health Promotion in all of society private sector, academia, NGOs, CBOs Cross-Cutting Strategy Application Challenges Gaining political support - Identify and build on Ministers interests. - Find connections between political platforms and HP. Engaging citizens Determinants of health Putting health on the agenda of other sectors, especially the private sector Building capacity - Work with CSOs, academia, multinational corporations, etc. - Hold community fairs. - Healthy lifestyle secretariat. - Involve agricultural, tourism, and disaster preparedness. - Workshops for health workers. - Political agenda changes as politicians change. - Difficult when issue is not on their agenda. Good Idea: The working group identified large-scale organized walks as a good idea to involve all of society to participate in health promotion. Key Challenge: A key challenge is that most people do not understand what health promotion is and how they can be involved. Innovative Idea: An innovative proposal is to implement Challenge Courses throughout the region. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

26 2.6 Conclusion and Recommendations. The Mainstreaming Health Promotion component of the Caribbean Health Promotion Workshop was concluded with identification of a number of recommendations. Recommendations focused on mechanisms to enable the continued sharing of health promotion strategies and evidence in the region; ongoing capacity development and skills building in health promotion at the regional and national level; enhanced access to health promotion tools and policy frameworks; and mainstreaming health promotion into other key networks in the region. Specific recommendations included: 1. Develop a mechanism for communication and inter-connectivity to continue sharing experiences, proposals, lessons learned, best practices, strategies, works in progress, feedback, etc. among the English-speaking Caribbean countries. This could be accomplished through a variety of Information Communication Technologies (ICTs), including the website for PAHO SDE/DS or the CARICOM Summit on NCDs, an e-network focused on Health Promotion in the Caribbean, reactive/revitalize/expand an existing NCD e-network, engage PAHO health promotion focal points in collecting and sharing experiences, and engage 3 countries to coordinate the documentation of experiences. 2. Document and publish country experiences in peer review journals. Marilyn Rice offered to facilitate the process of submitting articles for publication. 3. Publish a report of this workshop highlighting country experiences. 4. Develop tools and guidelines for countries to use in documenting their best practices. 5. Electronically register and share the materials brought to this meeting, many of which are tools unto themselves. 6. Use ICTs to communicate messages that raise Health Promotion on the CARICOM Subregional agenda. 7. Provide a framework for developing national Health Promotion policies. This can be done by providing a translation of policies developed in Latin American countries and requesting that Caribbean countries use them as a reference to modify and develop their own. 8. Conduct capacity-building workshops every two years in the Caribbean. 9. Replicate and enhance such workshops at the national level to build capacities of cadres of national staff. 10. There was a nutrition communication meeting for OECS that established a network between nutrition and agriculture. Link with them to incorporate Health Promotion. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

27 1. Training in HP program evaluation (August 1 st and 2 nd ) At the end of the two-day workshop given by Dr. Suzanne Jackson (Director, Centre for Health Promotion, University of Toronto) and Marilyn Rice (Regional Advisor in Healthy Municipalities, Cities and Communities, PAHO) on health promotion program evaluation and participatory evaluation, it was anticipated that the participants would: 1) Understand an evaluation process specific to health promotion programs and settings 2) Practice working through the steps of a participatory evaluation process for a program of interest to them, 3) Have the outline of an evaluation plan for a specific topic or program applicable to their local setting. On Wednesday, August 1 st, participants received an overview of evaluation in health promotion and participatory evaluation, divided into small groups of 3 to 6 people by country and identified a program relevant to that country to evaluate, and then went through three mini-lectures and three sessions of small group work. The first workshop was Getting ready to evaluate: Identification of Stakeholders, the second was Getting Ready to Evaluate clarifying program objectives, strategies and indicators, and the third was To Develop Evaluation Questions. Each team worked through worksheets with the support of Marilyn Rice and Suzanne Jackson. On the second day, August 2 nd, participants learned about evaluation design and methods, how to develop an evaluation survey instrument or focus group guide, and analyze, interpret and communicate the results. Each small working group presented a summary of their evaluation plan at the end of the day. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

28 4. Second Caribbean Network of Health Promoting Schools (August 3 rd ) The final day of the Caribbean Health Promotion Workshop was dedicated to a meeting of the English-Speaking Caribbean Network of Health Promoting Schools (CNHPS). This was the first meeting held since the Network was formed in The purpose of the meeting was to facilitate the exchange of knowledge, experiences, and resources to support the health and development of school-aged children and adolescents. The workshop aimed to strengthen the organizational structure of the CNHPS at both the international and at the national level. Comment [LD2]: What is the correct name and acronym of this network? The objectives for the meeting were to map the implementation of health promotion within school settings, identify best practices in health promoting schools, to assess and strengthen the current state of the Network and its organizational systems, and to define the needs and priorities for implementing the Health-Promoting Schools Initiative throughout the Caribbean. The CNHPS meeting was chaired by Dr. Alafia Samuels, PAHO. An overview of the Health- Promoting School Initiative was provided by Dr. Carmen Aldinger, from the Education Development Centre (EDC) - a WHO Collaborating Centre in School and Community Health. This was followed by a presentation by Ms. Glenda Rolle on the experience of health promoting schools in the Bahamas. Dr. Sofia Leticia Morales provided a report from the Vancouver meeting of Health Promoting Schools, held during the World Conference on Health Promotion and Health Education. It was determined that while different countries and international organizations use a range of terms to describe health promoting schools, they include the same components: policy, skills-based health education, supportive social and physical environments, community partnerships and health services. A country roll call was undertaken to determine awareness of the CNHPS, activities that were being implemented in relation to the objectives of the CNHPS, and the supports received through the CNHPS. Health promoters from five of the eleven countries were aware of the CNHPS, even though all countries were involved in school health promotion programs to some extent. Delegates reported receiving little to no support from external sources to implement and evaluate their school health promotion programs. Delegates agreed that there currently is not a functional network in place to support school health promotion. The primary explanation for the deterioration of the CNHPS was a lack of sufficient human resources and discontinuity among staff responsible for school health promotion in several countries. This was complicated by a weak coordinating mechanism that relied on personalities rather than structures. Staff responsible for school health promotion faced challenges in implementing health promoting schools at the country level due to lack of support from the regional office. Many people identified a lack of understanding of the health promoting schools model and its relationship to HFLE. The delegates identified a number of recommendations to revitalize the CNHPS and support health promoting schools within the region. These included: Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

29 1. Situate the health promoting schools network within the health promotion umbrella; 2. Build national networks or other suitable mechanism as determined at country level (MoE and MoH); 3. Caribbean network would be made up of representatives identified by MoE and MoH; 4. Identify national focal points and alternates (MoH and MoE) for National health promoting schools network for follow-up; 5. Amend pg 44 of the First CNHPS Meeting to include components from presentation from Dr. Morales regard the consensus of core components of an effective school program and fundamental evidence and principles (see annexes); 6. The component of the CPC office to offer support to the network needs to be revisited; 7. Define short-term and long-term plans to reestablish network; 8. PAHO should create a portal on existing website to post activities/reports from countries (e.g CEPIS) and have contact/resource persons for support on website; 9. Identify internal resource persons and strengthen their capacity to support the region; 10. Identify human and financial resources to support HPS; 11. School health promotion programs can have other names as long as they have the components of HPS; and 12. Use WHO rapid assessment to assess needs of the Health and Education sector as it relates to HPS including mobilizing resources to support this assessment. Caribbean Health Promotion Workshop, St. Vincent - July 30, August 3,

30 Caribbean Health Promotion Workshop 1 Annexes 1. List of Participants 2. Background and Objectives: Caribbean Workshop on Health Promotion 3. Executed Agenda 4. Participants Self-Declaration for Advancing Health Promotion in their Countries 5. Evaluation Plans of Participants: Working Group Presentations in Plenary 6. Participants Commitments for Implementing Evaluation Programmes 7. Summary and Analysis of Participants Evaluations 8. Meeting Notes - Mainstreaming Health Promotion 9. List of Participants - Second Caribbean Network of Health Promoting Schools 10. Meeting Notes - Second Caribbean Network of Health Promoting Schools

31 Caribbean Health Promotion Workshop 2 Annex 1: List of Participants Caribbean Health-Promotion Workshop 30 July 3 August 2007, St. Vincent Name Job Title Address1 Address3 Phone: Fax: Antigua and Barbuda Mr. Charlesworth Daniel Health Educator All Saints Antigua and Barbuda The Bahamas Name Dr. Yitades Gebre Job Title PAHO/WHO Address1 Union Court Address2 Elizabeth Avenue Address3 Nassau, Bahamas Phone: Fax: gebrey@paho.org Name Ms. Cheryl Thompson Job Title Deputy Chief, Health Education Division Address1 Ministry of Health and Social Development Address2 Nassau Address3 New Providence, Bahamas Phone: Fax: cherylthompson@bahamas.gov.bs Name Dr. Idamae Hanna Job Title Better Living Health Centre and Address1 Adventist Health Professionals Association Address2 South Beach Estates Address3 Bahamas Phone: Fax: idamaehanna@coralwave.com Name Mrs. Glenda Rolle Job Title Senior Education officer Address1 Health and Family Life Education Address2 Ministry of Education Address3 Bahamas Phone: Fax: grolle54@yahoo.com

32 Caribbean Health Promotion Workshop 3 Barbados Name Mrs. Larone Hyland Job Title Health Promotion Officer Address1 Ministry of Health Address2 Yonnotts Lane Address3 St. Michael, Barbados Phone: Ext Fax: laronehyland@hotmail.com Name Job Title Address1 Address2 Belize Ms. Sandra Jones PAHO/WHO No. 168 Newtown Barracks Belize City, Belize Address3 P.O. Box 1834 Phone: Fax: jonessan@blz.paho.org Name Ms. Erica McGregor Job Title Ministry of Health Address1 HELO PAB Address2 St. Thomas St. Address3 Belize City, Belize Phone: / Fax: unerdatsme@yahoo.com Name Mr. Arthur Martínez Job Title Ministry of Health Address1 Belmopan city Phone: amertinez@health.gov.bz Name Job Title Address1 Address2 Address3 Dominica Alestina James Health Educator Health Promotion Resource Centre Ministry of Health and Social Security Margot Village, Commonwealth of Dominica Phone: health@cwdom.dm Name Job Title Address1 Address2 Marynese Titre Education Officer Ministry of Education Roseau, Commonwealth of Dominica Phone: mtitre@hotmail.com

33 Caribbean Health Promotion Workshop 4 Guyana Name Dr. Kathleen Israel Job Title PAHO/WHO Representative Address1 Lot 8 Brickdam Stabroek Address2 Georgetown, Guyana Address3 P.O. Box Phone: israelki@guy.paho.org Name Job Title Address1 Address2 Ms. Renee Franklin-Peroune PAHO/WHO Lot 8 Brickdam Stabroek Georgetown, Guyana Address3 P.O. Box Phone: Fax: perouner@guy.paho.org Name Ms. Lucy Anderson Job Title Ministry of Health Address1 Brickdam, Stabroek Address2 Georgetown, Guyana Phone: anderson.lucy@gmail.com Name Dr. Marcia Bassier-Paltoo Job Title Ministry of Health Address1 1 Brickdam, Stabroek Address2 Georgetown, Guyana Phone: mpaltoo@yahoo.com Name Mr. Anthony Hunte Job Title Community Involvement Specialist Address1 Ministry of Education Address2 21 Brickdam, Stabroek Address3 Georgetown, Guyana Phone: hunte_118@hotmail.com St. Kitts/Nevis Name Ms. Petronella Edwards Job Title NCD Coordinator Address1 Health Promotion Unit Address2 Ministry of Health Address3 Church St. Basseterre, St. Kitts Phone: / Fax: skncc_prevention@yahoo.cm

34 Caribbean Health Promotion Workshop 5 Name Job Title Address1 Address2 Address3 Phone: St. Lucia Mrs. Pat Joseph Director Bureau of Health Education Ministry of Health, Waterfront Castries S.t. Lucia [w] [C] patjoseph_wi@yahoo.com Name Mrs. Sophie Edwards-Gabriel Job Title HIV/AIDS Prevention and Control/Project Focal Point Address1 Ministry of Education and Culture Address2 Hibiscus Cresent Address3 Sans Souci Saint Lucia (World Bank) Phone: / Fax: sofie_edwards@yahoo.com Name Job Title Address1 Suriname Ms. Johanna Lakhisaran Focal Point Health Promotion and Health Promoting Schools PAHO/WHO Address2 Burenstraat 33 - P.O. Box 1863 Address3 Paramaribo, Suriname Phone: Tel: Fax: Fax: lakhisaj@sur.paho.org Name Ms. Pearl Playfair Job Title Health Information and Education Bureau of Public Health Address1 Ministry of Health Address2 Rode Kruislaan 22 Address3 Paramaribo, Phone: Suriname irplay@yahoo.com Name Job Title Address1 Mr. Michael Watson Deputy Director Recreation and Sport Ministry of Education Address2 Marowijnestraat #15-17 Address3 Paramaribo, Suriname Phone: / Fax: mikewatson@sr.net Name Job Title Address1 Address2 Ms. Nita Ramcharan Member Stg. Backlot Suriname Flamboyant Steet18 Suriname nramcharanw2001@yahoo.com

35 Caribbean Health Promotion Workshop 6 Name Job Title Address1 Address2 Address3 Trinidad and Tobago Dr. Carol Boyd-Scobie PAHO/WHO Representative PAHO/WHO 49 Jerningham Avenue Port-of-Spain, Trinidad boydscoc@trt.paho.org Name Dr. Avril Siung-Chang Job Title Advisor Environmental Health Address1 PAHO/WHO Address2 49 Jerningham Avenue Address3 Port-of-Spain, Trinidad Fax: changavr@trt.paho.org Name Ms. Yvonne Lewis Job Title Ministry of Health Address1 8 Sixth St. East Address2 Delomorre, Trincity, Trinidad & Tobago Phone: Ext 238 / Fax: yvon_lewis@yahoo.com Turks & Caicos Name Hon. Lillian Elaine Boyce Job Title Minister of Health and Human Services Address1 Turks & Caicos Phone: Fax: irboyce@gov.tc Name Job Title Address1 Ms. Desiree E. Brooks Personal Secretary to the Minister of Health Turks & Caicos ddbrooks@gov.tc Name Ms. Alrisa Gardiner Job Title Public Health Nurse Address1 Long Bay Address2 Providenciales Address3 Turks & Caicos Phone: Fax: gardinerrisam@hotmail.com Name Mrs. Charlene Higgs Job Title Health Services Manager Address1 Grand Turk Address2 Turks and Caicos Island Phone: charlenehiggs@hotmail.com

36 Caribbean Health Promotion Workshop 7 St. Vincent Name Ms. Leonora Ambris Job Title Health Educator Address1 Ashton Union Island Address2 St. Vincent Phone: / ackie2000@yahoo.com Name Ms. Joyce Burgin Job Title Dietetic Technician Address1 MCMH Address2 Kingstown Address3 St. Vincent Phone: Ext. 171 Fax: realjoyce_ok@hotmail.com Name Mr. Harvey Farrell Job Title Family Life Educator Address1 Lowmans Hill Address2 St. Vincent Phone: harveyfarrrell@yahoo.com Name Job Title Address1 Address2 Address3 Ms. Hazel-Ann Hadaway Family Life Educator Green Ville Largo Height, Kingstown St. Vincent Phone: louviee@hotmail.com Name Ms. Cecile James Job Title Family Nurse Practitioner Address1 Environmental Health Complex Address2 Kingstown, St. Vincent Phone: / cecile7575@hotmail.com Name Job Title Address1 Address2 Mr. Cuthbert Knights Administrative Officer Ministry of Health and the Environment Kingstown, St. Vincent Phone: / jarrahk@yahoo.co.uk Name Ms. Carolyn Nedd Job Title Community Nutrition Officer Address1 Kingstown Address2 St. Vincent Phone: Fax: drapeyplus@hotmail.com

37 Caribbean Health Promotion Workshop 8 Name Ms. Celoy Nichols Job Title Health Educator Address1 Ministry of Health and the Environment Address2 Kingstown, St. Vincent Phone: Fax: drewching@yahoo.com Name Ms. Andrea Robin Job Title Nutritionist Address1 Nutrition Unit Address2 Ministry of Health and the Environment Address3 Arnos Vale, Kingstown, St. Vincent Phone: Fax: arobin.health@ .gov.vc Name Job Title Address1 Address2 Address3 Ms. Rosalind Thomas Health Nursing Supervisor Ministry of Health and the Environment Environmental Health Building Kingstown, St. Vincent Phone: rosie_revt@yahoo.com Name Job Title Address1 Address2 Address3 Ms. Patsy Wyllie Chief Health Educator Ministry of Health and the Environment Kingstown St. Vincent Phone: patsyvw@yahoo.com Name Job Title Address1 Address2 Address3 Ms. Jillian Primus Departmental Sister Milton Cato Memorial Hospital Ministry of Health and the Environment Kingstown, St. Vincent Phone: or Jilly1383@hotmail.com Name Ms. Karen Gilgeours Job Title Registered Nurse Address1 Milton Cato Memorial Hospital Address2 Ministry of Health and the Environment Address3 Kingstown, St. Vincent Phone: or Name Ms. Merlene Allen Job Title Registered Nurse / Certified Midwife Address1 Milton Cato Memorial Hospital Address2 Ministry of Health and the Environment Address3 Kingstown, St. Vincent Phone: or

38 Caribbean Health Promotion Workshop 9 Name Ms. Emily Ryan Job Title Ward Sister Address1 Milton Cato Memorial Hospital Address2 Ministry of Health and the Environment Address3 Kingstown, St. Vincent Phone: Name Job Title Address1 Address2 PAHO/WHO - Washington, DC Dr. Eduardo Guerrero, Unit Chief Health Determinants and Social Policies, SDE/DS rd Street, NW Address3 Washington D.C Phone: Fax: Name Job Title Address1 Address2 Dr. Alafia Samuels Advisor, Health Promotion Health Determinants and Social Policies, SDE/DS rd Street, NW Address3 Washington D.C Phone: Fax: samuelsa@paho.org Name Job Title Address1 Address2 Mrs. Marilyn Rice Regional Advisor in Healthy Municipalities, Cities and Communities Health Determinants and Social Policies, SDE/DS rd Street, NW Address3 Washington D.C Phone: Fax: ricemari@paho.org Name Dr. Carl James Hospedales Job Title Unit Chief Address1 Health Surveillance & Disease Management Address rd Street, NW Address3 Washington D.C Phone: hospedaj@paho.org Name Dr. Carme Nebot-Adell Job Title Regional Advisor on Primary Care Services Address1 Technology and Health Services Delivery Address rd Street, NW Address3 Washington D.C Phone: nebotcar@paho.org

39 Caribbean Health Promotion Workshop 10 Name Job Title Address1 Address2 Mr.Joseph Obeng-Baah Intern Health Determinants and Social Policies, SDE/DS PAHO, rd Street, NW Address3 Washington D.C Phone: Fax: Name Ms. Pilar Vidal Estévez Job Title Technical Cooperation Assistant Address1 Health Determinants and Social Policies, SDE/DS Address rd Street, NW Address3 Washington D.C Phone: Resource Personnel Name Dr. Suzanne Jackson Job Title Director, Centre for Health Promotion Address1 Department of Public health Sciences Address2 University of Toronto, 155 College St. Suite 400 Address3 Toronto, Ontario M5T 3M7 CANADA Phone: Fax: Name Ms. Clare Forrester Job Title Media Consultant Address1 12a Widcombe Road Address1 Kingston, Jamaica Phone: Guests Hon.. Minister of Health, Dr. Douglas Slater Ministry of Health and the Environment Kingtown, St. Vincent Name Job Title Address1 Address2 Address3 Dr. St. Clair Thomas Chief Medical Officer Ministry of Health and the Environment Kingstown St. Vincent Name Job Title Address1 Address2 Address3 Ms. Odette Barrrow Principal Secretary (Ag.) Ministry of Health and the Environment Kingstown St. Vincent

40 Caribbean Health Promotion Workshop 11 Phone: Fax: Name Ms. Laura Browne Job Title Principal Secretary Address1 Ministry of Eeducation Address2 Kingstown Address3 St. Vincent Phone: Fax: Name Job Title Address1 Address2 WHO Collaborating Center to Promote Health through Schools and Communities Dr. Carmen Aldinger Project Director Health and Human Development Programs Education Development Center, Inc. Address3 55 Chapel St., Newton, MA Phone: , ext Fax:

41 Caribbean Health Promotion Workshop 12 Annex 2: BACKGROUND and OBJECTIVES CARIBBEAN WORKSHOP ON HEALTH PROMOTION Background: On September 14 th, 2007, the CARICOM Heads of Government will convene to discuss Non Communicable Diseases, and the appropriate response from all of Government and civil society. This Workshop on Health Promotion Evaluation is one part of the process that will build institutional capacity and strengthen key counterparts in the Ministries of Health and Education, and civil society in preparation for, and response to the mandates from that conference. Promoting the health of populations also requires considerations of equity, increasing healthy life and achieving the Millennium Development Goals plus (MDG plus regional goals include Non Communicable Diseases and Injuries), in this region. Effective interventions should target the social, behavioral and biological determinants of health status of our Caribbean populations. Health Promotion has been defined and refined over 20 years by six global conferences which generated two health promotion charters, 1986 Ottawa Charter, and the 2005 Bangkok Charter. The Caribbean Charter on Health Promotion (1993) built on the Ottawa Charter strategies by adding building alliances with special emphasis on the media, and states Health promotion focuses not only on disease prevention and control, but on health and wellness and advocates that people s health is a positive resource for their living Caribbean countries have had many successful health promotion interventions, and this workshop also seeks to advance technical cooperation between countries by providing the avenue for direct sharing between countries. Evaluation of health promotion programs is essential is establishing and validating this approach, and training in participatory evaluation of these programs is a priority. Purpose: To continue the strengthening and improving Caribbean health promotion capacity and practices. Objectives: 1) To provide training in participatory evaluation of health promotion interventions so as to strengthen the regional capacity in this domain. Capacity building for PAHO/WHO staff and institutional strengthening of key counterparts in Ministry of Health and Education in preparation for and response to the mandates from the CARICOM Heads of Government Summit on Non Communicable Diseases on September 14 th At the end of this workshop, participants will: 1) Understand an evaluation process specific to health promotion programs and settings 2) Practice working through the steps of a participatory evaluation process 3) Have the outline of an evaluation plan for a specific topic or program applicable

42 Caribbean Health Promotion Workshop 13 to their local setting Expectations of Participants: Have a framework for evaluating health promotion (policies, planning, etc.) How to create good evaluations tools How to work on evaluation plans with stakeholders How to build evaluation into planning Different types of evaluation strategies When NOT to evaluate Why evaluate How to use evaluation findings for future program planning How to do participatory evaluation What do you need for evaluation How to incorporate evaluation into program implementation so it is not separate What should be involved

43 Caribbean Health Promotion Workshop 14 Annex 3: Executed Agenda WORKSHOP PART 1 Day 1: Monday July 30 th, am 9.15 am Opening Session Chairperson: Dr. Alafia Samuels National Anthem Prayer Permanent Secretary, Ministry of Education, Ms. Laura Brown Hon Minister of Health, Dr. Douglas Slater Keynote Address Remarks 9.15 am 10.00am First Technical Session Dr. Gauden Galea (by video) Health Promotion, A Global View Ms. Yvonne Lewis A Decade Implementing the Caribbean Charter for Health Promotion am am Coffee Break and viewing of Exhibits from Countries am am HP strategies Capacity Building Roundtables: Experience Sharing interactions Participants can choose 2 or 3 roundtables, each will last 30 minutes Dr. Suzanne Jackson Dr. Carme Nebot Ms. Yvonne Lewis Dr. James Hospedales Ms. Claire Forrester Changing Environment: Policy Coherence Reorienting Health systems and services: Primary Health Care Reorienting Health systems: A Decade Implementing the CCHP Changing Behavior: Controlling Chronic Diseases Changing Behavior: Media as partners pm 1.30 pm LUNCH 1.30 pm 2.15 pm Mainstreaming Health Promotion in the Caribbean Dr. Alafia Samuels, Health Promotion, WDC Context, Evidence and Framework for HP Priorities Mrs. Renee Franklin-Peroune Challenges and Advances in Mainstreaming Health Promotion in the Caribbean Dr. Suzanne Jackson, Consultant Mainstreaming Health Promotion 2.15pm 5.00 pm Parallel Working Groups: Utilizing the 6 CCH Cross Cutting HP Strategies for Mainstreaming / Integrating / Institutionalizing Positive Change **Participants should sign up for which ever group they prefer, but the Secretariat reserves the right to adjust groups for consistency. A. Healthy Eating B. Active Living C. Safe Sex / alcohol D. Tobacco E. Violence Prevention / Road Safety Each work group should discuss their topic using the 6 Caribbean Charter Actions: Formulating Healthy Public Policies

44 Caribbean Health Promotion Workshop 15 Reorienting Health Services Empowering Communities to achieve well-being Creating Supportive Environments Developing/Increasing Personal Health Skills Building Alliances, especially with the media And how these should be advanced within Healthy Settings (Ad hoc break for Coffee and viewing of Exhibits from Countries) 7.00 pm Cocktails 7.30 pm Welcome Dinner Day 2: Tuesday July 31 st, am 9.00 am Assistant Director, PAHO Dr. Carissa Etienne, (by video) Ms. Marti Rice Shaping the Future of HP: Challenges from Vancouver & London Each workgroup reports back on Day 1 discussions (5 minutes each) One Good Idea - Best Practice / Lesson learned; One Key Challenge for Caribbean countries One Innovative Proposal for Action 9.00 am am Mainstreaming Health Promotion: Country Reports (7 minutes each) Trinidad & Tobago: Community Empowerment Ms. Yvonne Lewis, Deputy Director, Health Promotions, MOH Guyana: Mainstreaming HP Schools Mr. Anthony Hunt, Community Involvement Specialist, MoE Belize: Community Mapping Mr. Arthur Martinez, Technical Officer, GIS, MOH Bahamas: Social marketing & healthy lifestyles campaign Ms. Cheryl Thompson, MOH, Bahamas Bahamas: Better Living Health Centre Dr. Idamae Hanna, Community Based Organization Dr. James Hospedales Update on Caribbean Heads of Government meeting on NCDs, Sept 15 th am am Coffee Break and viewing of Exhibits from Countries am pm Capacity Building Roundtables: Changing Environments, Empowering Communities Participants can choose 2 or 3 roundtables, each will last 30 minutes Mainstreaming HP Schools Mr. Anthony Hunt, Community Involvement Specialist, MoE and Ms. Lucy Anderson, HP Focal Point, Ministry of Health, Guyana Community Mapping Mr. Arthur Martinez, Technical Officer, GIS, Social marketing & Better Living Health Centre Ms. Cheryl Thompson & Dr. Idamae Hanna, Bahamas Health Promotion in rural communities Mrs. Renee Franklin-Peroune Changing Environment: Healthy Settings Ms. Marilyn Rice

45 Caribbean Health Promotion Workshop pm 1.30 pm LUNCH 1.30 pm 3.30 pm Parallel Working Groups: Exploring Key HP Cross-Cutting Strategies A. Mobilization and sustainability B. Community Diagnosis / Community Assets C. Developing leadership D. Healthy Settings smoke free spaces, health promoting environments, health promoting schools E. Risk vs. Protective Factors F. Health Promotion in all of society private sector, academia, NGOs, CBOs a. Gaining political support b. Engaging citizens c. Determinants of health d. Putting health on the agenda of other sectors, especially the private sector e. Building capacity 3.30 pm 4.00 pm Coffee Break and viewing of Exhibits from Countries 4.00 pm 5.00 pm Working Group Reports: Summary of Lessons and Discussion (5 minutes each) One Good Idea - Best Practice / Lesson learned; One Key Challenge for Caribbean countries One Innovative Proposal for Action Wrap Up, Evaluation, Follow-Up Closing of Part 1 of the workshop 7.00 pm Cultural Evening

46 Caribbean Health Promotion Workshop 17 WORKSHOP PART 2 Day 3 & 4: Wednesday and Thursday August 1 & 2, 2007 Dr. Eduardo Guerrero, Unit Chief, Health Determinants and Social Policy, SDE/PAHO WDC Health Promotion Program Evaluation/Participatory Evaluation Training Suzanne F. Jackson, Ph.D. and Marilyn Rice M.A. At the end of this workshop, participants will: 4) Understand an evaluation process specific to health promotion programs and settings 5) Practice working through the steps of a participatory evaluation process 6) Have the outline of an evaluation plan for a specific topic or program applicable to their local setting. Wednesday, August 1, :00-10:30 Overview of Evaluation in Health Promotion and Participatory Evaluation - Introductions, small group assignments Workshop #1: Getting Ready to Evaluate Identification of Stakeholders Mini lecture about Getting Ready to Evaluate Small group work on identification of stakeholders 10:30-11:00 BREAK 11:00-12:30 Workshop #2: Getting Ready to Evaluate Clarify program objectives, strategies and indicators Mini lecture about Clarifying program objectives and indicators Small group work to identify indicators linked to program plans 12:30-1:30 LUNCH 1:30-3:00 Continue small group work on clarifying program objectives, strategies and indicators 3:00-3:30 BREAK 3:30-5:00 Workshop #3: Developing Evaluation questions Mini lecture on Developing an evaluation question Small group work to identify an evaluation question for their programs 5:00 END Thursday, August 2, :00-10:30 Workshop #4: Evaluation Design/methods and information sources Presentation about evaluation design Small group time to select evaluation methods 10:30-11:00 BREAK 11:00-12:30 Workshop #5: Developing an Evaluation Survey instrument or Focus Group guide Mini lecture about developing survey instruments and focus group guides Small group work to develop either a survey instrument or focus group guide related to small group topics or cases provided

47 Caribbean Health Promotion Workshop 18 12:30-1:30 LUNCH 1:30-3:00 Workshop #6: Analysis, Interpretation and Communication of Results Mini lecture about the analysis, interpretation, dissemination and action phases of evaluation Small group time to finish work on an evaluation plan for presentation in plenary 3:00-3:30 BREAK 3:30-5:00 Group Presentations and Wrap-up Very short presentations of evaluation plans from each small working group Reflection and discussion on both days of evaluation work 5:00 END

48 Caribbean Health Promotion Workshop 19 Part 3: II Meeting of the English Speaking Caribbean Network of Health-Promoting Schools Day 5: Friday August 3 rd, 2007 Purpose: To facilitate the exchange of knowledge, experiences, and resources, for the harmonious and comprehensive development of young people and their health. Goal: To strengthen the organizational structure of the CNHPS at both the international level (General Council, Technical Secretariat, and Working Committees) and at the national level (Mixed Commissions of each Member State: schools coordinating groups and network.) Objectives: 1. To examine the status of implementing Health Promotion strategies in the school setting in the Caribbean Region; 2. to identify best practices for implementing Health Promotion in the school setting that strengthen the capacity of systems to promote the health of students, teachers, families, and communities; 3. To assess the utility of the organizational structure, functions, mechanisms, and membership of the Network and define a plan of action to attend to countries needs; 4. To define needs and priorities for implementing the Health-Promoting Schools Initiative throughout the Caribbean Region. Agenda: Chairperson: Dr. Alafia Samuels Rapporteurs: Ms. Yvonne Lewis, Ms. Lucy Anderson, Dr. Carmen Aldinger 8.30 am Expectations / Objectives for the Day 8.45 am Dr. Carmen Aldinger, EDC (Education Development Center, A WHO Collaborating Center in School and Community Health), an overview 8.55 am Ms. Glenda Rolle, Bahamas, HFLE/HP in Bahamas 9.05 am Country Roll Call Knowledge of CNHPS Sharing from Participants in 1st CNHPS meeting in 2001 Activities of CNHPS in their countries 9.30 am By phone from WDC, amplified by microphone Dr. Sofia Leticia Morales Report from the Vancouver meeting of Health Promoting Schools Faces, Voices and Places and Schools Discussion am Coffee Break 11:00 am Review report of 1 st CNHPS meeting, Barriers / reasons for nonimplementation of CNHPS am Next Steps and Recommendations 1:00 pm Adjourn

49 Caribbean Health Promotion Workshop 20 Annex 4: Participants Self-Declaration for Advancing Health Promotion in their Countries Antigua and Barbuda Mr. Charlesworth Daniel Health Educator All Saints List 3 new ideas that you got from this conference that you are going to try in your country (i) Involve other sectors in HP, (ii) Get legislations re: voilence prevention List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Survey to determine the practice of HL Styles (ii) Prepare HP materials What Kind of follow-up should we arrange following the workshop? Training in HP Recommendations for future health promotion capacity buiding in your country Hold PAHO to conduct PH training

50 Caribbean Health Promotion Workshop 21 The Bahamas Ms. Cheryl Thompson Deputy Chief, Health Education Division Ministry of Health and Social Development List 3 new ideas that you got from this conference that you are going to try in your country (i) Work with PAHO in produce three one-minute video similar to that of Suriname as a part of the Healthy Lifestyle Program. (ii) Work with PAHO on moving forward the Worksite Program (iii) Introduction of Wellness Clinics as a part of the National Healthy Lifestyle Program List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Develop/Complete and implement a National Physical Activity Policy (ii) Complete 2 comprehensive worksite program (iii) Prescription referral to wellness centre programs (iv) Mainstreaming of HP What Kind of follow-up should we arrange following the workshop? 1. Work with PAHO in developing and implementing a (National) Worksite Policy 2. Work with PAHO in coordinating a high level meeting to sensitize decision makers/policy makers re Health Promotion 3. PAHO to assist with a TCC in Trinidad and Canada in Health Promotion for at least three Health Promotion Managers from The Bahamas 4. Work with PAHO in coordinating a special training for managers of health promotion directorate at regional level - looking at operations, integration of health promotion and mainstreaming of same. 5. Work with PAHO in introducing a Continuing Education Program for Health Promoters (CEPHP). Recommendations for future health promotion capacity buiding in your country (i) Best Practices - criteria for lpresentation (ii) Policy development for physical activity (iii) Skills development - leadership, sustainable development and collaboration (iv) setting foundations for mainstreaming HP Dr. Idamae Hanna Better Living Health Centre and Adventist Health Professionals Association South Beach Estates List 3 new ideas that you got from this conference that you are going to try in your country (i) I need to build linkages with other health programs for sustainability (ii) Health promotion should facilitate collaboration of all agencies that may impact health outcomes directly or indirectly List 3 things you would like to do if you had the right support, and specify what support you would need (who could help)

51 Caribbean Health Promotion Workshop 22 (i) Include an obesity camp with the 8 weeks to wellness program in school. Need financial support and government participation. (ii) I would like to do a diabetes wellness program that utilizes a multi-disiplinary team. (iii) Help from government and private organisation. What Kind of follow-up should we arrange following the workshop? Not sure Recommendations for future health promotion capacity buiding in your country Teaching how to net work, build linkages and collaborate when building programs so that they are better sustained. Mrs. Glenda Rolle Senior Education officer Health and Family Life Education Ministry of Education List 3 new ideas that you got from this conference that you are going to try in your country (i) Community maping for health promotion programmes (ii) Healthy spaces - focusing on health promotion at the Malls (iii) Social marketing List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Implement a Healthy Schools Initiative Programme (technical support) (ii) Coordinate Government and NGO's partnerships (technical support PAHO) (iii) Evaluate the HFLE programme to access its impact in schools and communities (technical and financial support (PAHO, UNESCO, UNICEF) What Kind of follow-up should we arrange following the workshop? (i) Develop a website for countries to share resources (ii) Submit report to the Permanent Secretary, Ministry of Education and request for support for Health Promotion strategies (iii) Hold a follow-up workshop within 12 months to determine the level of countries success / challenges. Recommendations for future health promotion capacity buiding in your country (i) Ensure ongoing collaboration with Government & NGO's (ii) Formulate a National Network to promote capacity building, advocacy and policy development. Stakeholders will include representatives from Ministry of Health and Social Services, College of the Bahamas, private sector, NGOs PTAs and student council

52 Caribbean Health Promotion Workshop 23 Barbados Mrs. Larone Hyland Health Promotion Officer Ministry of Health List 3 new ideas that you got from this conference that you are going to try in your country (i) Health passport (ii) A shopping mall as a centre to promote health for youth (iii) health promotion initiative for Ministry of Health staff List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) A Nation wide awareness of health promoting schools concept (ii) Wellness centres in communities - Political & Financial support would be critical (iii) Spread the health promotion concept to all sectors - I don't think it is well understand as yet. What Kind of follow-up should we arrange following the workshop? A comprehensive directory of resources could be complied with example of best practices eg. A manuel Recommendations for future health promotion capacity buiding in your country Training on the concept in needed for working people and other groups eg. CBO's, NGOs FBOs etc

53 Caribbean Health Promotion Workshop 24 Belize Ms. Sandra Jones PAHO/WHO Ms. Erica McGregor Ministry of Health Mr. Arthur Martínez Ministry of Health List 3 new ideas that you got from this conference that you are going to try in your country 1. The better living health center program from Bahamas 2. Media as partners that was facilitated by Ms. Forrester 3. Road Safety program from Suriname List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) 1. The better living health center would need more information about the program so as to be able to review critically and determine which component will be applicable to the Belize situation and financial support would also be critical to the implementation of it. 2. Media as partners Ms. Forrester had some excellent ideas re; this particular area would appreciate if she can recommend resource materials that can provide specific guidelines as to how to improve this partnership. 3. Road Safety program from Suriname will follow-up with Suriname to get more information about the program and adopt program to fit the Belize context What Kind of follow-up should we arrange following the workshop? 1. It would be good if a contact information sheet is provided so that we can directly reach certain participants to get more information regarding some of the programs they are implementing. 2. It would be great if a report can be generated documenting some of the programs from each country that are seen as best practice initiatives in the region. Recommendations for future health promotion capacity buiding in your country 1. Training of health promoters in the area of behviour change particularly as it relates to chronic diseases. 2. Facilitate the development of a health promotion strategy document utilizing the Caribbean Health Promotion Charter as the main point of reference.

54 Caribbean Health Promotion Workshop 25 Dominica Alestina James Health Educator Health Promotion Resource Centre Ministry of Health and Social Security List 3 new ideas that you got from this conference that you are going to try in your country (i) Smoke free schools and the need for focal points in all ministries (ii) Healthy work places (try at Ministry of Health first) (iii) Advocating for policies to increase tax on cigarettes and use procedes collected to fund community programmes on CNCD prevention List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Strengthen Healthy Community iniative, need the necessary resources from PAHO (ii) Implement the nutrition/exercise component of healthy workplace program at government head quarters. Need administrative support from Ministry of Health for provision of space for exercise. Also support from PAHO re: the benefits to ministries What Kind of follow-up should we arrange following the workshop? Consultation arranged with Ministers of Health, Finance and Permanent Secretaries as to the benefit of smoke free institutions and the benefits of health workplace programmes Recommendations for future health promotion capacity buiding in your country All heads of department of health and other sectors be trained on health promotion Marynese Titre Education Officer Ministry of Education List 3 new ideas that you got from this conference that you are going to try in your country (i) 8 weeks wellness programs (ii) Mapping community (iii) Healthy places initiative List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Healthy places - wellness centre at work (ii) 8 weeks wellness program at school (iii) Healthy places initiative What Kind of follow-up should we arrange following the workshop? Island grouping meeting to support programs Recommendations for future health promotion capacity buiding in your country Meeting of the stake holders in the various sectors to support HP programs

55 Caribbean Health Promotion Workshop 26 Guyana Ms. Renee Franklin-Peroune PAHO/WHO List 3 new ideas that you got from this conference that you are going to try in your country (i) Diet & Physcial activity interventions - school, community (ii) Methods to strengthen community participation for HMC List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Develop edutainment programs for school populations in keeping with HFLE curriculum (funding needed) (ii) Develop HP checklist from the Caribbean Charter to be used by practitioners to guide integration of HP in programs/sectors - Dr. Samuels (iii) Develop NCD programs both preventative and treatment -Dr. Samuels & Hospedales What Kind of follow-up should we arrange following the workshop? (i) focal point(s) to coordinate support to countries by subject/area of interest at PAHO / CPC level (ii) Explore formulation of Caribbean Network of Health Promotion Recommendations for future health promotion capacity buiding in your country (i) opportunity re: NCD summit (ii) ongoing sensitization of stakeholders and parties on HP in relation to the determinants of health (iii) HP module for training of health workers Ms. Lucy Anderson Ministry of Health List 3 new ideas that you got from this conference that you are going to try in your country (i) one minute health ads (low cost) to ensure participation in national challenge day (ii) 8 to 12 weeks to wellness List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) develop and implement the National HP plan (ii) Gain political support to develop polices What Kind of follow-up should we arrange following the workshop? Use HP capacity profile to follow progress or develop other monitoring tool Recommendations for future health promotion capacity buiding in your country Mainstreaming Health Promotion workshop for MOH staff, Government Ministries and other sector (faith based organisation, NGOs, Private sectors

56 Caribbean Health Promotion Workshop 27 Mr. Anthony Hunte Community Involvement Specialist Ministry of Education List 3 new ideas that you got from this conference that you are going to try in your country (iii) 8 weeks to wellness (iv) Country mapping List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) Introduction of health and safety assessment across all level of education. Support from Chief Planning Officer, Chief Education Officer Ministry of Health What Kind of follow-up should we arrange following the workshop? To be sent a list of other best practices initiatives that were not mentioned Recommendations for future health promotion capacity buiding in your country Health promotion by other countries from other countries/exchange visits Marcia Bassier-Paltoo Director, Adolescent Health Unit List 3 new ideas that you got from this conference that you are going to try in your country (i) Active Living in schools and workplaces, especially Ministry of Health (ii) 12 weeks to health, using Health Passports (iii) Mapping of communities (translating from malaria to other areas or aspects) List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Monitoring and evaluation of health promotion programs (technical and financial support) (ii) Baseline studies to get situational analysis on HP (technical and financial support) (iii) IEC materials (technical, resources documents, printed materials) What Kind of follow-up should we arrange following the workshop? (i) Follow up to check understanding and effective implementation. (ii) Follow up workshop / communications Recommendations for future health promotion capacity buiding in your country (i) Similar workshop and support for stakeholders in Guyana (ii) Involving other stakeholders (not just Education and Health) (iii) More frequent and systematic capacity building trainings / sessions

57 Caribbean Health Promotion Workshop 28 St. Kitts/Nevis Ms. Petronella Edwards NCD Coordinator Health Promotion Unit Ministry of Health List 3 new ideas that you got from this conference that you are going to try in your country (i) Better Living Health Centers from the Bahamas (ii) Healthy communities Having community members identify their needs and deciding solutions for themselves List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Introduce health promotion / wellness into programs for persons with CNCD need support of health administrators and care providers (ii) Have all nursing graduates and doctors trained in Health Promotion. Need experts in health promotion practice, training schools and University of Toronto Centre for Health Promotion (possibly on-line training also) (iii) Workplace physical activity initiative with the management of some businesses and support of the Labour Department. Funding opportunities to initiate activities What Kind of follow-up should we arrange following the workshop? Access to experiences / programmes that worked well in other countries Recommendations for future health promotion capacity buiding in your country HP training for health care providers and key stakeholders with attachments, for experience within the region.

58 Caribbean Health Promotion Workshop 29 St. Lucia Mrs. Pat Joseph Director Bureau of Health Education Ministry of Health, Waterfront List 3 new ideas that you got from this conference that you are going to try in your country (i) 8 weeks to wellness initiative (ii) Male health initiative (iii) Health dozen club List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Develop health promotion policy - would need help with a framework (ii) Develop a "Healthy Space" initiative (iii) Capacity building for other sectors for HP - training support with materials and technical expertise needed. What Kind of follow-up should we arrange following the workshop? (i) report submitted to policy ideals at country level (ii) Monitor change/outcomes expected from workshop Recommendations for future health promotion capacity buiding in your country (i) training of personnel - locally & regionally (ii) Assistance with policy development (iii) Help with mainstreaming HP Ms. Sophia Edwards-Gabriel HIV/AIDS Focal Point List 3 new ideas that you got from this conference that you are going to try in your country (i) 8 weeks to wellness program - I need more information (ii) Mainstreaming HP in school - Guyana's whole school approach (iii) Health clubs in schools - Guyana List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Start health clubs - ideas of activities, support and interest from staff and students (ii) Adopt wellness programs - resources, human and financial and support What Kind of follow-up should we arrange following the workshop? Since my portfolio is only HIV/AIDS I will pass on some of the information to relevant parties. Follow-ups can then be arranged Recommendations for future health promotion capacity buiding in your country Training of school personnel to develop and implement health promotion programs in schools

59 Caribbean Health Promotion Workshop 30 Suriname Ms. Johanna Lakhisaran Focal Point Health Promotion and Health Promoting Schools PAHO/WHO List 3 new ideas that you got from this conference that you are going to try in your country Setting up HP schools network List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) What Kind of follow-up should we arrange following the workshop? PAHO professional could advise which countries can support each other in TCC Recommendations for future health promotion capacity buiding in your country (i) hands on tools (ii) Workshop HP at the country level (supported by PAHO staff Ms. Pearl Playfair Health Information and Education Bureau of Public Health Ministry of Health List 3 new ideas that you got from this conference that you are going to try in your country (i) Better living health centre (ii) Use the "setting"approach List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Clarification WS that HOP is not just Health Education (ii) Draft PH plan integrating sectors and partners. Support: Preparatory support and guest speaker/facilitator What Kind of follow-up should we arrange following the workshop? Regular/quarterly?? Communication followed by next year July '08 - Achievement challenges Recommendations for future health promotion capacity buiding in your country (i) Training of partners (ii) Setting rules and responsibilities Mr. Michael Watson Deputy Director Recreation and Sport Ministry of Education List 3 new ideas that you got from this conference that you are going to try in your country Implementation of HP Charter of the Caribbean

60 Caribbean Health Promotion Workshop 31 List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) Make HP a top priority of the Government policy What Kind of follow-up should we arrange following the workshop? International training of HP Officers, framework or blue print for different strategies Recommendations for future health promotion capacity buiding in your country More practical sessions, video material of lessons learned. (How is it being done?) Ms. Nita Ramcharan Media Specialist List 3 new ideas that you got from this conference that you are going to try in your country (i) More attention in TV programs for health (ii) Live TV discussion on the conference next week (7 th August 2007) (iii) Promote programs on healthy schools List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Every quarter a program on health (ii) interview with minister of Health/education and agriculture What Kind of follow-up should we arrange following the workshop? National support/more attention for the head of government meeting September 2007 Recommendations for future health promotion capacity buiding in your country (i) better understanding and coordinating of good listing of HP projects

61 Caribbean Health Promotion Workshop 32 Trinidad & Tobago Ms. Yvonne Lewis Ministry of Health List 3 new ideas that you got from this conference that you are going to try in your country (i) Develop and implement a workplace wellness initiative in the Ministry of Healt (ii) Establish a network of Health promoting schools (iii) Establish a physical activity day to get the nation moving for health - physical activity challenge to move for at least 30 mins List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Establish a healthy communities fund to support communities, civil society groups, schools and other organisation to develop and implement health spaces/health communities initiatives (HELP: help in setting up mechanism for managing and administering the fund) What Kind of follow-up should we arrange following the workshop? Establish/develop communicaiton mechanism to foster continued collaboration between Caribbean countries Recommendations for future health promotion capacity buiding in your country

62 Caribbean Health Promotion Workshop 33 Turks & Caicos Ms. Alrisa Gardiner Public Health Nurse List 3 new ideas that you got from this conference that you are going to try in your country (i) Assessment/targeting of obesity in children 0-5 (ii) Take a fruit to work day List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (iii) Same above (iv) Human resources What Kind of follow-up should we arrange following the workshop? In country assessment of progress of ideas from above Recommendations for future health promotion capacity buiding in your country Introduction of health promotion throughout the islands both in private and public sectors

63 Caribbean Health Promotion Workshop 34 St. Vincent Leonora Ambris Health Educator List 3 new ideas that you got from this conference that you are going to try in your country (i) Community Mapping (ii) Road Safety (iii) The idea of getting person health oriented rather than disease List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) Forming of exercising club What Kind of follow-up should we arrange following the workshop? the use of the internet through s and website Recommendations for future health promotion capacity buiding in your country Countries could exchange ideas of works done and their failures and success Joyce Burgin Dietetic Technician List 3 new ideas that you got from this conference that you are going to try in your country Wellness in 8 weeks from Bahamas List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Project writing and coordination. (ii) Health life style program What Kind of follow-up should we arrange following the workshop? Portal, list serv. And coordination and sharing Recommendations for future health promotion capacity buiding in your country Implementation of Healthy lifestyles at the political level in SVG Harvey Farrell Health Educator List 3 new ideas that you got from this conference that you are going to try in your country (i) Community mapping (ii) Youth friendly health centre (iii) road safety initiative List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Have health promotion ideas introduced as live item on national budget (ii) support of Ministry of Health, cabinet, min. of finance

64 Caribbean Health Promotion Workshop 35 What Kind of follow-up should we arrange following the workshop? (i) Arrange the means where by countries would share and dialogue with each other Recommendations for future health promotion capacity buiding in your country Build greater alliances with the media Hazel-Ann Hadaway Community Nutrition Officer List 3 new ideas that you got from this conference that you are going to try in your country (i) Round table discussions (ii) Creating a health and wellness programme in out clinics (iii) Better awareness with media and private sector. List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) social afternoon (ii) Reading of labels in supermarket and train the persons suffering with chronic diseases to take of their foot, self management and need help from nursing service in the community. What Kind of follow-up should we arrange following the workshop? Recommendations for future health promotion capacity buiding in your country Need to train our political directorate in health promotion Cecile James Family Nurse Practitioner List 3 new ideas that you got from this conference that you are going to try in your country (i) Safe motherhood - Belize (ii) Health space - Trinidad (iii) Safe schools - Guyana List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) conduct obesity survey among youths - financial (ii) The opportunity to observe the Safe schools program in Guyana (iii) The opportunity to observe the Safe motherhood initiative - Belize Safe School program in Guyana and Safe Motherhood program in Belize referred to as good practices in these countries. What Kind of follow-up should we arrange following the workshop? Distribution of programmes identified as best practices from other countries eg. T&T, Belize, Guyana Recommendations for future health promotion capacity buiding in your country The involvement of all stakeholders across the board to include government, non-governmental, private sectors, civil society i.e. inter sectoral

65 Caribbean Health Promotion Workshop 36 Carolyn Nedd Community Nutrition Officer List 3 new ideas that you got from this conference that you are going to try in your country (i) HP in rural communities - Keeping NCD groups vibrant through creating lay facilitators by training (ii) Appointed councils to be given a stipend to keep up work attendance (iii) Improving the holistic wellness/healthy lifestyle and a more physically active employees in the work List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Support with in the public service (multisectoral partnerships) (ii) financial/sponsors from NGO's What Kind of follow-up should we arrange following the workshop? Recommendations for future health promotion capacity buiding in your country Rosalind Thomas Health Nursing Supervisor List 3 new ideas that you got from this conference that you are going to try in your country (i) Community mapping (ii) Safe motherhood (iii) Programme for gender abuse List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) safe motherhood imitative as in Belize (ii) Programme for gender abuse as in Belize What Kind of follow-up should we arrange following the workshop? Kindly send programme for the above mention Recommendations for future health promotion capacity buiding in your country multisectoral involvement of all stakeholders eg. Teachers, police, community personnel, agricultural worker etc. Patsy Wylie Chief Health Educator List 3 new ideas that you got from this conference that you are going to try in your country (i) Incorporating evaluation in programmes (ii) The Trinidad community empowerment programme (iii) Health promotion in rural communities programme (Guyana experience)

66 Caribbean Health Promotion Workshop 37 (iv) Road Safety programme in Suriname List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Healthy setting programme focusing on the following a. Health promoting schools b. Health promoting workplace c. Smoke free spaces (ii) Support needed: Assistance to visit Guyana to observe their programme What Kind of follow-up should we arrange following the workshop? Follow up workshop to continue networking Recommendations for future health promotion capacity buiding in your country Only one member of staff has received formal training in Health Promotion Recommendations for workshop / inservice training for staff members, if overseas training is too costly Celroy Nichols Health Educator List 3 new ideas that you got from this conference that you are going to try in your country (i) How community mapping can help to save on resources on various health issues (ii) Community Wellness Centers (iii) Safe School environments List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Creation of Wellness Centers in St. Vincent & the Grenadines (ii) Equipment and health team staff What Kind of follow-up should we arrange following the workshop? Copies of successful school and community programs for the region including wellness centers Recommendations for future health promotion capacity buiding in your country Andrea Robin Nutritionist List 3 new ideas that you got from this conference that you are going to try in your country (i) Policy coherence (horizontal) for food and nutrition security (ii) Making multisectoral committees work (iii) Analysing the level of functioning using 5 HMC pillars List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) (i) Mainstream multisectoral / intersectoral mechanisms by strengthening the National Food and Nutrition Security Council and National Infant and Young Child Nutrition Committees in applying the strategies of the Caribbean Charter on Health Promotion

67 Caribbean Health Promotion Workshop 38 What Kind of follow-up should we arrange following the workshop? Recommendations for future health promotion capacity buiding in your country Workshops in St. Vincent on healtah promotion and evaluation of HP for the National Food and Nutrition Security Council and National Infant and Young Child Nutrition Committees

68 Caribbean Health Promotion Workshop 39 Guests WHO Collaborating Center to Promote Health through Schools and Communities Dr. Carmen Aldinger Project Director Health and Human Development Programs Education Development Center, Inc. List 3 new ideas that you got from this conference that you are going to try in your country (i) Invite HHD/EDC colleagues to Sept. workshop (ii) Share healthy setting work group* List 3 things you would like to do if you had the right support, and specify what support you would need (who could help) What Kind of follow-up should we arrange following the workshop? (i) share presentations and contact information (ii) make the workshop annual or bi-annual Recommendations for future health promotion capacity buiding in your country

69 Caribbean Health Promotion Workshop 40 Annex 5: Evaluation Plans of Participants: Working Group Presentations in Plenary Group 1 Bahamas: Reduction of Risky Behaviours in HPS through Healthy Bodies, Healthy Minds Program Glenda Rolle BAH Celoy Nicols SVG Sophie Edwards ST. LUCIA Key Stakeholder (s) evaluation is for: Grade 8 Junior Secondary School Students Brief Program Description Goal: Create an environment that contributes to the healthy development of 8 th grade students in junior high school Audience: 8 th grade junior high school students Key Objectives (list up to three): 1. Students practicing healthy sexual behaviours 2. Students making healthy choices relating to drugs Key Strategies/Activities (List up to three): 1. Develop supporting material for students with regards to sexual health and drug use and abuse 2. Organize information, education, communication competition among students 3. Develop and implement a safe school policy in the schools Evaluation Question: What is the impact of the Healthy Bodies Healthy Minds Programme on 8 th grade junior high school students? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: The data collection methods: (including what kind of information, how collected, how often,

70 Caribbean Health Promotion Workshop 41 Grade 8 junior high school students when and where): Information on sexual health and substance abuse collected through self administered questionnaires at the beginning and end of the programme which is scheduled to begin in September and end in December. This will be done among grade 8 students in 4 junior high schools Human and technical resources (indicate whether you need them or have them): a) To help with data collection Have: limited human resources Need: Additional human resources Incentives Technical Support Transportation b) To help with analysis and interpretation Need: Technical support Training, software for analysis and interpretation Result or action you anticipate: Reduced rates of STIs and alcohol and drug abuse among 8 th graders in junior high (positive behaviour changes) Increased knowledge and skills and improved attitudes relating to substance abuse and sexual practices

71 Caribbean Health Promotion Workshop 42 Group 2 Suriname: Safe and Healthy Schools Michael Watson, Johanna Lakhisaran, Pearl Playfair, Nita Ramcharan Key Stakeholder (s) evaluation is for: Ministry of Education Ministry of Health Brief Program Description Goal: Create safe and healthy environments in 30 primary schools Audience: School staff Key Objectives (list up to three): 1. Increase knowledge and awareness 2. Stimulate action by school staff and communities/parents/private sector Key Strategies/Activities (List up to three): 1. Establishment/strengthening of health promoting school community 2. Assessment of priority needs/baseline and discussions 3. Implementation of school action plans: training/awareness raising, construction of facilities Evaluation Question: Why should this project be implemented in all primary schools in Suriname? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: School staff: principals, teachers, maintenance personnel Community: workers, parents The data collection methods: (including what kind of information, how collected, how often, when and where): One focus group per site When: At the end of the project Topics: 1. What are the changes in the physical environments in schools and in the behaviour of audiences 2. What is the involvement of actors in these changes? 3. How can we guarantee the continuation/ sustainability of the project? 4. What should we do differently to upgrade

72 Caribbean Health Promotion Workshop 43 the project? Human and technical resources (indicate whether you need them or have them): a) To help with data collection Training data collectors university students b) To help with analysis and interpretation Need to hire consultant Result or action you anticipate: Government/Ministry of Health/Ministry of Education will adopt this project at national level Group 3 Belize: Road Safety Arthur Martinez, Erika Goldson McGregor, Sandra Jones Key Stakeholder (s) evaluation is for: To conduct an evaluation of the one year action plan to improve road safety in Belize Brief Program Description Goal: To reduce the number of deaths and injuries as a result of road traffic accidents Audience: Road users (drivers, pedestrians and cyclists)/general population, policy makers, legislators, civil society, community-based groups, insurance companies, police/transport/traffic department, health care providers and National Road Safety Committee Key Objectives (list up to three): 1. To develop the capacity of the national road safety committee so as to ensure a public health approach in the reduction of road traffic injuries. 2. To establish a national and functional road traffic surveillance system within the Ministry of Health which will provide reliable information to guide policy and legislation. 3. To develop appropriate policies and legislation which will serve to prevent road traffic injuries. Key Strategies/Activities (List up to three): 1. To identify and provide appropriate training to the national road safety committee

73 Caribbean Health Promotion Workshop 44 and key stakeholders involved in the national response. 2. Key stakeholders engaged in the process to develop national surveillance system 3. To review and revise existing legislation which will serve to reduce road traffic injuries and present to Solicitor General s office for approval Evaluation Question: How effective is the multisectorial approach to reducing the incidence of death and injuries as a result of road traffic accidents? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: Key agencies in the multisectorial committee All members of the multisectorial committee Road users (drivers, cyclists, pedestrians) The data collection methods: (including what kind of information, how collected, how often, when and where): Overall the evaluation period will be for 3 months. Face to face interviews would be conducted on a weekly basis until all agencies are reached A total of 4 focus groups will be conducted over a period of 6 weeks Surveys (questionnaire) will be conducted every Saturday for a period of 3 months Review of relevant documents Examples: Review of national plan to determine what activities were achieved and by which agency The strategy Minutes of meetings Surveillance report Human and technical resources (indicate whether you need them or have them):

74 Caribbean Health Promotion Workshop 45 a) To help with data collection Will train university students to assist in the data collection b) To help with analysis & interpretation Central Statistical Office Biostatistician from the Ministry of Health Result or action you anticipate: Disseminate the report of the evaluation to the general public and key stakeholders Utilization of results to modify and improve the multisectorial response, which will include future planning. Group 4 Guyana: Improve Health and Wellbeing of School-Aged Children Lucy Anderson, Marcia Bassier Paltoo, Anthony Hunte, Kathleen Israel, Renee Franklin- Peroune Key Stakeholder (s) evaluation is for: School Improvement Advisory Committee Core Group for Health Promoting Schools Graduates from the Institute of Hindsight Brief Program Description Goal: To improve the health and well-being of school aged children Audience: School community students, teachers, paents Key Objectives (list up to three): 1. Long Term: Achieving, maintaining and sustaining effective involvement of key stakeholders for health promoting schools 2. Short term: Increasing the number of partners for effective implementation of HPS 3. Short term: Strengthening partnerships for the effective implementation of HPS Key Strategies/Activities (List up to three): 1. Road show partner sensitization (on site) 2. Conduct strategic planning meeting Evaluation Question: How effective was the capacity-building training in planning for school improvement?

75 Caribbean Health Promotion Workshop 46 EVALUATION PLAN Part II Data Collection Method (s): The Respondents: School Improvement Advisory Committee (trained members- teachers, parents, students) Regional SIP Assessment Committees The data collection methods: (including what kind of information, how collected, how often, when and where): Questionnaire and focus groups quantative and qualitative information - Submitted with the School Improvement for Assessment 3 months prior to the beginning of the school year with budget - Follow-up per term at the regional level Human and technical resources (indicate whether you need them or have them): a) To help with data collection Ministry of Education Planning Unit SIP Assessment Teams Ministry of Health Health Promotion (Adolescent Health Unit) b) To help with analysis and interpretation Health Promoting School Core Group Result or action you anticipate: Enhanced capacity of SIAC to plan SIPs More focussed School Improvement Plans

76 Caribbean Health Promotion Workshop 47 Group 5 Bahamas: Obesity and Lifestyles in Schools Idamae Hanna, Yitades Gebre, Cheryl Thompson, Joyce Burgin (SVG) Key Stakeholder (s) evaluation is for: Adventist Health Professional Association Diabetic Research PAHO Ministry of Health Ministry of Education Brief Program Description Goal: To promote and increase physical and activity levels and adopt healthy lifestyles in school children Audience: Students from 5 primary schools, ages 9 to 11 Key Objectives (list up to three): 1. Improve eating behaviour 2. 25% reduction in blood pressure 3. Increase physical activity 4. Key Strategies/Activities (List up to three): 1. Health screening of students 2. Educating students 3. Increasing physical activities Evaluation Question: Did the wellness program for school children have a positive effect on their health status and lifestyle? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: Students Teachers Parents The data collection methods: (including what kind of information, how collected, how often, when and where): Quantative and qualitative Questionnaire pre and post test) Log sheet Focus group Process and outcome evaluation

77 Caribbean Health Promotion Workshop 48 Human and technical resources (indicate whether you need them or have them): a) To help with data collection Pay for data collection Use students (college) to help with data entry b) To help with analysis and interpretation Ministry of Health Health Information Division PAHO Result or action you anticipate: Reduction in weight or obesity among school age children Group 6 Barbados: Healthy Lifestyles Primary Schools Fitness Club Slogan: One swallow does matter Larone Hyland (Barbados), Carmen Aldinger (USA), Marynese Titre (Dominica), Alrisa Gardiner (Turks and Caicos) Key Stakeholder (s) evaluation is for: Brief Program Description Goal: Reduce the incidence of obesity among school children School children will practice healthy lifestyles thereby reducing incidence of obesity in school-aged chilren Audience: Children 8-11 Key Objectives (list up to three): 1. Children will be better able to choose healthier snacks 2. Children will be able to participate in physical activity for at least 30 minutes 3. 70% of students will consume at least 5 servings of fruits and vegetables per day Key Strategies/Activities (List up to three): 1. Teaching sessions on healthy food choices 2. Aerobics, hiking, martial arts (after school activities)

78 Caribbean Health Promotion Workshop Discussion sessions. Food diary records. Food preparation demonstrations. Fruit and vegetables checklist. Evaluation Question: What effect did the programme make? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: Children 8 11 Parents Teachers Programme Facilitators The data collection methods: (including what kind of information, how collected, how often, when and where): Weight and height Pedometer number of steps/day Observation preparing healthy snacks Records height and weight charting, journal Focus groups Pre and post measurements 3 times/semester Follow-up weekly during the program and one time after school Human and technical resources (indicate whether you need them or have them): a) To help with data collection Teachers, nutritionists, exercise physiologist have the skills b) To help with analysis and interpretation Nutritionist and teachers have the skills. Need students from a college, university or post graduate Result or action you anticipate: Changes/alterations in attitude/behaviour toward a healthier lifestyle Continuity of the programme Programme duplication or modelling

79 Caribbean Health Promotion Workshop 50 Group 7 St. Vincent and the Grenadines: Breastfeeding Andrea Rollin, Jillian Primus, Karen Gilgeours, Emily Ryan, Marlene Franklin Allen Key Stakeholder (s) evaluation is for: Program participants. Brief Program Description Goal: More mothers breastfeeding their babies exclusively from birth to 6 months Audience: Pregnant women with HIV negative status Key Objectives (list up to three): 1. Mother s knowledge and skills in breastfeeding benefits/management increased 2. Public awareness and support for exclusive breastfeeding increased 3. Mothers get timely help on addressing breastfeeding problems Key Strategies/Activities (List up to three): 1. Breastfeeding care and counselling services 2. Social marketing plan 3. Mother support group Evaluation Question: How effective was the breastfeeding promotion, protection and support programme in increasing rate of exclusive breastfeeding at 6 months? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: Program participants and new program participants Program participants Program (participant) facilitators The data collection methods: (including what kind of information, how collected, how often, when and where): Face to face interviews at first antenatal visit and post delivery at 6 weeks, 3 months and 6 months Survey questionnaire, administrated, after the launch of the campaign Focus group discussions at 6 months post natal collection Process data documents on program Human and technical resources (indicate whether you need them or have them): a) To help with data collection

80 Caribbean Health Promotion Workshop 51 Instrument to develop programme and stakeholder team reproduce Conduct interviews (face to face with health centres staff) b) To help with analysis and interpretation Computer hardware - software Technical experts Result or action you anticipate: Increased rates of exclusive breastfeeding for 6n months with increased knowledge and skills Improved public attitudes toward breastfeeding Number of mothers with breastfeeding problems reduced Program weakness identified and improvements implemented Group 8 Dominica: Healthy Communities Initiative, small islands perspective Alestina James (Dominica), Harvey Farrel (SVG), Patsy Wyllie (SVG), Cecile James (SVG), Petronella Edwards (SKB) Key Stakeholder (s) evaluation is for: Community groups and individuals District officers Brief Program Description Goal: To improve living and working conditions (housing and farming) for local community Audience: Community of Dominica Key Objectives (list up to three): 4. Community engaged in making its own decisions regarding housing and farming 5. Community gains farming skills 6. Community has proper housing Key Strategies/Activities (List up to three): 3. Conduct consultation with community face-to-face and town hall meetings to assess needs

81 Caribbean Health Promotion Workshop Review of available data in relation to housing and faming 5. Conduct area meetings to prioritize identified needs 6. Establishing of committees to coordinate activities at community levels Evaluation Question: Are the activities being implemented appropriately? Meeting the needs of the community? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: Community members in all settings The data collection methods: (including what kind of information, how collected, how often, when and where): Combined descriptive and analytically designed tool will be used to collect data Interviewer assisted questionnaires will be used at households and work places Review of all documentation/rewards of programme activities will be done Human and technical resources (indicate whether you need them or have them): a) To help with data collection Additional human resource for data collection needed b) To help with analysis and interpretation Technical assistance Result or action you anticipate: To what extent was the community engaged in decisions related to improving their living conditions? Strengthening of community development programme in relation to participation of stakeholders

82 Caribbean Health Promotion Workshop 53 Group 9 Trinidad and Tobago: School Health Carol Boyd-Scobie, Yvonne Lewis Key Stakeholder (s) evaluation is for: Parents Teachers Nurses, Doctors, Health and Education Managers Brief Program Description Goal: Primary school students in Trinidad and Tobago have hearing and vision problems corrected and achieve improved performance levels at school Audience: Students, teachers, nurses and doctors Key Objectives (list up to three): 1. School screening services strengthened and quality improved 2. Parent participation in school health increased 3. Students receive timely screening and corrective intervention for hearing and vision problems Key Strategies/Activities (List up to three): 1. Capacity building (health and education staff, parents) 2. Standardisation of practice (protocols/guidelines) 3. Referral/counter referral system improved Evaluation Question: How effective is the school screening project in facilitating corrective treatment/management of school children with hearing problems? What s working/what s not? Why/Why not? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: The data collection methods: (including what kind of information, how collected, how often, when and where):

83 Caribbean Health Promotion Workshop 54 Parents Focus group discussion - Select a sample of schools from each county - Assemble one focus group per county (7 10 schools) with parents from sampled schools - Once per year Information: Qualitative data re parent s experience of accessing screening services Health personnel (DHV) Questionnaire - Once yearly survey - 100% health centres participating - Quantitative and qualitative data related to service delivery Human and technical resources (indicate whether you need them or have them): a) To help with data collection b) To help with analysis and interpretation Need help with data entry and analysis Result or action you anticipate: Sharing information with stakeholders (program review) Designing interventions addressing identified weaknesses and gaps Reduction of time between assessment and intervention Establishment of effective reporting mechanism Increased parent participation

84 Caribbean Health Promotion Workshop 55 Group 10 St. Lucia: HIV/AIDS in Schools Sophia Edwards (St. Lucia), Leonora Ackie-Aubria (SVG), Daniel Charlesworth (Antigua) Key Stakeholder (s) evaluation is for: Policy makers in Ministry of Education Students Parents Teachers School Administrators Brief Program Description Goal: Students and teachers will use life skills to make healthy choices as it related to HIV/AIDS prevention Audience: Students and teachers in public schools Key Objectives (list up to three): 1. Delayed sexual debut of students 2. Teachers and students using life skills to improve sexual behaviours 3. Schools supporting HIV and AIDS prevention programs Key Strategies/Activities (List up to three): 1. Training workshops 2. Curriculum development/materials 3. Peer education Evaluation Question: What are our critical outcomes and heave they been achieved? EVALUATION PLAN Part II Data Collection Method (s): The Respondents: Students Teachers Parents The data collection methods: (including what kind of information, how collected, how often, when and where): Surveys among students and teachers. One school from each district. 10% of the population Information on knowledge, attitudes and

85 Caribbean Health Promotion Workshop 56 behaviours as it relates to sexual health Enumerators will visit schools and administer survey to all participants in the particular school at the same time Will be conducted now, at the end of the program and about six months to a year after to measure sustained change Focus group discussions with participants Human and technical resources (indicate whether you need them or have them): a) To help with data collection Enumerators (trained) Trainer b) To help with analysis and interpretation Monitoring and evaluation officer Statisticians Data entry personnel Data analysis software Dedicated computer Result or action you anticipate: Policy and increased funding to support program More commitment from persons in sector Program being accepted by parents and other stake holders Increased knowledge and skills among participants Changes in attitudes and behaviours

86 Caribbean Health Promotion Workshop 57 Annex 6: Participants Commitments for Implementing Evaluation Programmes During the process of recording the program participants realized that they: Have not realized the importance of their projects Never really did post partum??? Needed to stress the importance of building evaluation into everything they do Need to get feedback in Guyana??? Related to budgets (Bahamas) Need at least 10% of the budget allocated to evaluation Has to be included while doing the planning When NOT to evaluate Support Ministry counterparts throuth PAHO Evaluation is a terrible weakness (SVG) It can be a very liberating and empowering experience The workshop gave ideas of the capacity we have It is important for advocating for evaluation and to request support for it in the future Break evaluation into components Some of the participants represent Ministries; they should (St. Lucia) Advocate or share with others at home the need to do evaluation and how to incorporate it Make suggestions and recommendations Include in work plans and hope it gets approved In Barbados HP programs are very fragmented They tried to bring people together for planning Now they are moving towards evaluation and they need to develop needs assessment tools The workshop will be useful to implement evaluation in their own programs The purple manual is available on the SDE/DS Web page and the green manual is available from all kinds of resources are downloadable for free When NOT to evaluate There are ways and methods to evaluate even when it looks impossible (Guyana) Don t ask a question you already have the answer to this is not the time to evaluate (Bahamas)

87 Caribbean Health Promotion Workshop 58 Annex 7: Summary and Analysis of Participants Evaluations PARTICIPANT EVALUATION OF CARIBBEAN HEALTH PROMOTION WORKSHOP July, 2007 Responses % Workshop met_overall_needs 25 83% Opening_quality 19 72% Opening_useful 18 72% Galea_quality 27 76% Galea_useful 26 76% Lewis_quality 30 88% Lewis_useful 27 87% PRESENTATIONS Samuels_quality 28 79% Samuels_useful 27 81% Peroune_quality 29 78% Peroune_useful 27 75% Rice_quality 25 78% Rice_useful 24 76% Jackson_quality 27 76% Jackson_useful 26 75% Working_gp_feedback_quality 27 84% Working_gp_feedback_useful 27 86% CountryReports_quality 31 85% CountryReports_useful 31 86%

88 Caribbean Health Promotion Workshop 59 PARTICIPANT EVALUATION OF CARIBBEAN HEALTH PROMOTION EVALUATION WORKSHOP 1 2 August, 2007 Responses % Meet_overall_needs_Quality 34 88% Overview of Evaluation_quality 36 86% Overview of Evaluation_usefulness 36 87% Workshop #1: Getting Ready to Evaluate Identification of Stakeholders_quality 36 91% Workshop #1: Getting Ready to Evaluate Identification of Stakeholders_usefulness 35 91% Workshop #2: Getting Ready to Evaluate Clarify program objectives, strategies and indicators_quality 35 87% Workshop #2: Getting Ready to Evaluate Clarify program objectives, strategies and indicators_usefulness 35 91% Workshop #3: Developing an Evaluation Question_quality 36 88% Workshop #3: Developing an Evaluation Question_usefulness 36 92% End of Day Check-in_quality 30 85% End of Day Check-in_usefulness 30 85% Workshop #4: Evaluation Design_quality 37 88% Workshop #4: Evaluation Design_usefulness 36 91% Workshop #5: Developing an Evaluation Survey Instrument_quality 37 86% Workshop #5: Developing an Evaluation Survey Instrument_usefulness 37 90% Workshop #6: Analysis, Interpretation and Communication of Results_quality 37 87% Workshop #6: Analysis, Interpretation and Communication of Results_usefulness 36 88% Group Presentations_quality 35 87% Group Presentations_usefulness 35 91% Wrap-Up_quality 34 84% Wrap-Up _usefulness 35 84% Materials Participatory Evaluation Guide (PAHO)_quality 36 93% Participatory Evaluation Guide (PAHO)_usefulness 36 94% Evaluating Health Promotion Programs Manual (THCU)_quality 36 93% Evaluating Health Promotion Programs Manual (THCU)_usefulness 36 93% Small Group Worksheets_quality 37 86% Small Group Worksheets_usefulness 37 88% Small Group work_quality 37 89% Small Group work_usefulness 37 90% Support of facilitators (Suzanne & Marti)_quality 37 94% Support of facilitators (Suzanne & Marti)_usefulness 37 94%

89 Caribbean Health Promotion Workshop 60 PARTICIPANT EVALUATION OF CARIBBEAN HEALTH PROMOTION WORKSHOP July, 2007 List 1 to 3 things you found were most useful about the Workshop 1. The round table discussion 2. The opportunity to share country experience 1. Meeting professionals of PAHO/WHO and Nationals 2. Experience sharing 1. Being able to broaden my horizon learning what kinds of health promotions are being done in the region 1. Sharing activities and experiences 2. Network established between countries 3. Discussion of new ideas and possibilities 1. Round tables 2. Work in groups 3. Bahamas Model/TST Model List 1 to 3 recommendations to improve future such workshops 1. Larger room for workshop 1. Make country profiles available prior to workshop 1. Continue using group session and sharing of information by different countries 1. Logistics - transportation can be improved 2. Space for exhibition should be longer N/A Other comments N/A 1. Mechanism to communicate - connect participants, maintain dialogue 1. Take home message 2. Collaboration, building linkages and working together for more sustainable programs 1. Build an experience to maintain (connection+collaboration+ support strength) The Caribbean visibility N/A 1. Sharing 1. Some of the work groups needed more leadership N/A 1. The country reports and sharing of experiences 2. The round tables 3. The materials provided for future use 1. More information prior to workshop on logistics 2. Seating with tables would be more comfortable 1. Great workshop, good facilitation. Opportunity to upgrade knowledge and learn new experiences 1. Healthy eating 1. I think the workshop was great N/A 1. Learning about countries experiences 1.Send the invitation earlier N/A

90 Caribbean Health Promotion Workshop Being able to network and collect ideas from other Caribbean Nationals 1. The sharing by colleagues from other sectors and countries about programs and challenges in operating health promotion 1. Round table discussions 2. Country presentations 1. Sharing of experiences 2. Country reports 1. A slightly less packed agenda 1. Include at least 1/2 day to experience the country N/A N/A 1. The was not enough time to absorb the displays and not enough space N/A N/A N/A 1. Group interaction 1. Participants didn't have hotel reservation 2. Time management of round table and presentations 1. Workshop too long 1. Round table session 2. PowerPoint presentation 1. Working in groups 2. Timelines 1. Sharing of experiences and programs which worked from the various countries. 2. The round table 1. The number of ideas that is new to me but other countries 1. Round tables 2. Country reports 3. Time allocated for group discussion 1. Dissemination of information (expand to include private sector organizations) 1. Daily session to end by 3-4 pm the latest. 2. Country reports should be spread among islands small and large 1. Countries participation 1. Multi-sectorial participation 1. More time for some of the round tables 2. Provide handouts of the presentation N/A 1. An interesting workshop where much was learned 2. More time to know the country and to interact with country participants N/A N/A 1. I like the idea of sharing best practices by displaying each country experience 2. It was well organized workshop despite the Liat ''slow'' air travel

91 Caribbean Health Promotion Workshop Country experiences 2. Work parallel groups 3. The presentation 1. More participants from other sectors/ NGO's be involved N/A 1. Working groups 2. round tables 1. Accommodations at hotel of workshop if possible 1. Very good workshop,, best one I have attended 1. Networking 2. Easy access to facilitations 1. Working groups discussion and sharing ideas 2. Projects developed and implemented in some countries 3. Trinidad and Bahamas were good and can get ideas to be used in St. Vincent 1. Suitable conference room space 2. More discussion on reports N/A 1. More space for pleasant discussion 2. Best practices N/A 1. Working groups 1. Give package before so you can familiarize yourself. Venue was uncertain N/A 1. Experiences 2. Networking 1. Information and experience shared 2. Working groups and round table sessions 1. Sharing of best practices and ideas 2. Provision of information and resources 3. Presentations on various issues 1. Round tables 2. Parallel working groups 3. The ability to interact with the facilitators of PAHO staff 1. More introduce exercise activity, prior to or post breaks 1. Larger main conference centre 1. Ensure more time to facilitate the activities and presentations 2. Provide a follow up workshop within the year 3. Provide ice breakers during the workshop 1. collect country reports and presentations before event (Be strict, if presentations are not N/A N/A N/A N/A

92 Caribbean Health Promotion Workshop 63 submitted before activity, then they can't present) 1. Opportunity for networking 2. Exchange of ideas N/A N/A 1. Presentation on relevant topics 2. Sharing form countries 3. Round tables 1. To know what the difficulties and achievements 2. Share experience from several countries 1. New ideas 2. Discussion 1. Learning from experiences of other countries 2. Similar changes existing countries and having solutions to them from various aspects 1. Access to more of the round tables 2. More sharing from technical staff (PAHO) during work group discussion 1. Report on goals in a year time period N/A N/A N/A 1. Shorter sessions N/A N/A

93 Caribbean Health Promotion Workshop 64 PARTICIPANT EVALUATION OF CARIBBEAN HEALTH PROMOTION EVALUATION WORKSHOP 1 2 August, 2007 List 1 to 3 things you liked about the Evaluation Workshop List 1 to 3 things you didn't like where changes could be made to improve future such workshops List 1to 3 ideas you will apply in your work as a result of this Evaluation Workshop Other comments 1. Working on our own project 2. The step by step working approach 3. Food facilitations 1. Speed was high 2. Conference room too little 1. Include evaluation in the planning stage 1. Compliments for exchange of country experiences 2. Send guides prior to the workshop 1. Brought out in no uncertain terms the importance of evaluation, the necessary steps and measurement of outcomes. Include evaluation in planning exercise N/A 1. Include evaluation in the planning of all programs 1. Facilitators were very clear in the explanation of each steps and was willing to help every step of the way 1. Method and presentation of information 2. Availability of reading material for full reference 3. Opportunity to interact and share ideas and experiences 1. Rush to discuss topics 2. Too much information to assimilate 1. The need to always evaluate 2. To ensure relevant people receive evaluation information 1. The workshop was very informative and timely 1. The content and logical order of presentations 2. How preparing to evaluate actually helped to clarify the goals and objectives of existing plans (program logical model) 1. The speed of evaluation and not enough time to assimilate vast quantity of information 2. Inadequate space 1 Developing an evaluation plan as part of further programs planning 2. Considering the special requirements of health promotion 3. Use evaluation techniques N/A 1. Materials N/A 1. Make use of the materials N/A

94 Caribbean Health Promotion Workshop Participators 2. Supportive facilitators 1. Evaluation is needed 2. Evaluation must build in from point 0 3. Very useful working with small groups 1. Very little time 1. Advocate for evaluation 1. The group members should be seen as equal 2. More specific and straight to the goal 1. Health promotion should be effective 2. Better understanding and coordination 1. The group must work together on a project in own country N/A N/A 1. Provision of relevant materials on various topics 2. Collaboration among countries 3. Excellent presentations by the facilitators and teams 1. More time for reflection and possible icebreakers between sessions 2. Workshop should be extended over three days N/A N/A 1. The format of the presentation 2. The group sessions 3. The coordination between facilitators 1. The size of the conference room 1. To use the evaluation format and implementation in program planning 1. Excellent work by facilitators, they were very accommodating 1. Interactive learning 2. It reinforce what I knew and increased knowledge in areas that were fuzzy and I didn't know 1. Room was too small 1. Make sure include evaluation in all programs 2. Apply the information learnt to make sure the tool I created will provide the information needed N/A 1. The opportunity to practice what was thought 2. The step by step approach taken in developing the evaluation tool N/A 1. Planning with evaluation in mind, have to build it into the whole planning process 1. The practical format took the tediousness out of the workshop N/A 1. Presentations seemed somewhat rushed 1. Thinking of evaluation design 1. The presentations were somewhat intense, perhaps more feedback and discussion might have been helpful

95 Caribbean Health Promotion Workshop Work group sessions 2. Freedom to choose group 1. No time to explore 2. Hotel should have been closer to a tourist site fro recreation after meeting 1. Evaluation 2 Develop program 1, Venue was almost perfect, just the location. Workshop very informative and well planned 1. The practical nature N/A N/A N/A 1. Organization of information 2. Participation in completing the evaluation 3. Feedback 1. Room temperature 1. Prepare a manual for technical personnel 1. Evaluation process 1. Provision of resources for implementing evaluation 2. Working sessions to apply various stages of evaluation 1. Workshop was rushed 2. At least 3 days 3. Send program before workshop 1. Review draft program to ensure evaluation is built in 2. Ensure that all annual plans for various programs have evaluation N/A 1. Reinforced existing knowledge 2. Skill building 1. Short time to work in groups N/A N/A 1. Interaction during work groups 2. Quality of information 1. Not enough time to attend group work 1. Built evaluation into the programs N/A 1. Participatory learning methods 2. Use of reflective techniques 1. Pace of moving through the presentation. More time can be allowed for feedback dialogue in the context of the presentation 1. Using workshop tools to plan evaluation in relation to program plan indicators N/A 1. The information was timely, relevant and useful 1. A lot of information to assimilate in short time 1. Plan for evaluation into all programs. Improve collaborative work between Ministries of Education and Health N/A

96 Caribbean Health Promotion Workshop Discussion among the groups 2. The feedback from the facilitators 1. Presentation too fast 1. Check evaluation and progress 2. Share the information learnt with people in Suriname N/A 1. The program planning 1. Time was too short 1. Incorporate evaluation into programs 1. Workshop very useful 1. The different programs talked about 2. The countries experiences N/A 1. Will develop a better questionnaire for my particular project 1. More time 1. Opportunity to practice what was shared during the presentation N/A 1. Include evaluation into my projects 1. Some presentations were rushed 1. Very informative 2. High level of participation 3. Clarity of context 1. More time 1. Clarification of material before actual implementation N/A 1. Importance of evaluation into planning N/A 1. To ensure that evaluation is used to improve planning N/A 1. Presentations were clear 2. Work groups 1. The time was too short 1. Identify stakeholders and involve them in planning 1. Could I contact you when doing our own evaluation? 1. Practical sessions to apply to rational situations 2. Participatory presentations 3. Handouts to follow N/A 1. Fast track formation of rational body to oversee the Health Promotion process 1. Educate others so skills can be develop in the Caribbean Region 1. Reference made form presentations to manuals N/A 1. Adapt the entire evaluation tool to programs being implemented N/A 1. Very informative 2. Timely 1. More space for the workshop 1. Reintroduce a research committee 1. How to create good evaluation tools and when not to evaluate 1. Space too little 1. Good documentation about programs. The 1. The workshop was great

97 Caribbean Health Promotion Workshop 68 outcome of your project that was carried out and how you must go about creating evaluation tools 1. Developing the framework through the resources with the key nationals 1. A better time use 1. I will share the resources and mechanisms with the staff 1. A lot of good implementation was exchanged in this workshop 1. Preparing evaluative guide 1. Produce final document from each working group for future reference 1. Prepare evaluation using questionnaire 1. Time control of sessions 1. Clarification of concepts 2. Support of facilitators 3. Worksheets 1. Some of the presentations could have been slower 1. Include evaluation in program planning and use evaluation results for information and the interest of stakeholders 1. I have acquired new knowledge and look forward to apply it in my work 1. Able to create an evaluation framework N/A 1. I will be able to create evaluation question and help to determine the effectiveness of the workshop N/A 1. The clarity of materials 2. The "Hands-on" experience 3. The support form the facilitators 1. A little more time would have been nice to have 1. The process integrated into existing programs as well as new ones 1. Great workshop! N/A 1. It was difficult to stay focus since I have been involved in the training for project development and evaluation methodology N/A 1. Good workshop, it was very basic but useful

98 Caribbean Health Promotion Workshop 69 Annex 8: Meeting Notes - Mainstreaming Health Promotion July 30 th 8.30 am 9.15 am Opening Session Welcome from Dr. Alafia Samuels, Chair Prayers from Ms. Andrea Robin Opening Remarks from Dr. James Hospedales, Unit Chief, NCDs representing Dr. Eduardo Guerrero, Unit Chief, DS (currently airborne) Dr. Hospedales welcomed all, and acknowledged the Hon Dr. Douglas Slater, Minister of Health and Environment, St. Vincent, Hon. Lillian Boyce, Minister of Health, Turks and Caicos Islands, Ms. Odette Barrow, acting Permanent Secretary, and Dr. St. Clair Thomas, Chief Medical Officer of the Ministry of Health and Environment, St. Vincent. We heard greetings from Dr. Mirta Roses, PAHO Director, who sent her wishes for a successful workshop as the region prepares for the historic September 15 th meeting of the CARICOM Heads of Government on the topic Non Communicable Diseases. This meeting will help in the preparation for responding to the mandates coming out of that meeting. The Caribbean Charter on Health Promotion (1993) states, that Health promotion focuses not only on disease prevention and control, but on health and wellness and advocates that people s health is a positive resource for their living. Because many determinants of health lie outside the health sector trade, commerce, agriculture this underscores the importance of the diverse representation here today NGOs, Ministries of Education, and others, as we strive together to improve the health of the Caribbean populations. Presentation from Hon. Dr. Douglas Slater, Minister of Health and the Environment, St. Vincent Special welcome to the Minister of Health from Turks and Caicos and to health partners from the rest of the CARICOM. St. Vincent accepted the challenge to hold the workshop and I am glad to see almost everybody one made it. The current situation is that in spite of all the knowledge, we are still not where we want to be. Promoting health is ensuring wealth and despite the many developmental challenges and hurdles (e.g. geography, water) faced by the CARICOM region, we have demonstrated successes in working together to expand health, e.g. immunization to control many childhood disease tetanus, measles, mumps, rubella etc. We have had gains in preventing, controlling and treating emerging diseases together with NCD and their complications, and even though it is complicated we have to take up this task. The work of health care workers must be commended. But challenges in new and emerging diseases e.g. SARS, Avian Flu, HIV/AIDS, NCDs are very onerous yet we have to take up the challenge. NCDs are the top killers in the Region, cancer, diabetes, hypertension, etc. are responsible for more than 50% of deaths in the region, even though we turn to gravitate towards the more visible diseases such as HIV/AIDS. Noncommunicable diseases impacts not only individuals and families but eventually whole nations. The health and political leaders of the countries are aware of the challenges. In 2001, Nassau declared that the health of the nation is the wealth of the action. Since then, several reports to governments have shown the magnitude of the problem, the economic impact and the necessary policy measures to confront it. A Subregional Summit has been scheduled to be held in Trinidad

99 Caribbean Health Promotion Workshop 70 & Tobago in September The prevention and control of NCDs requires proper health promotion and response from health authorities, policy measures, and individual commitment. A special word to the media Because NCDs are lifestyle related, the ability to influence behavior change is critical, ability to change diet, habits, etc. We also recognize the importance of the environment, yet policy issues regarding control of what is imported, smoking ban limitations, restrictions of sale of junk food, are very political issues. Increases in taxes in tobacco and alcohol have impact, but in order for people to understand and support these measures, the media needs to inform them: Smoking ban, restriction of junk food and mandatory physical exercise in educational institutions are largely influenced by political spin; (e.g. as in Cuba students don t graduate unless you have a satisfactory pass mark on PE); This can be done even in the context of individual freedom, human rights and the right to advertise but we, with a special role for the media, have the responsibility to inform and educate the public you can t just say people should have the right to choose what they want to eat. Hopefully, participants at this workshop will learn, internalize and be advocates in pushing these goals and measures identified by health and economic experts; convinced that human health is more important than the immediate economic gains. Ministries of Health have a role to play; But so do the Ministries of Agriculture, Education, Finance so as to benefit children s diets, promote a healthy workforce needed for economic gains, and increased productivity. Investment in health leads to enhancements in economic growth; so all of us are in this together. The media needs to play a role, needs to obtain and disseminate information to help behavioral change. This should be an active, not passive role. Heads of Governments are demonstrating the political commitment on September 15 th, and therefore need support from their citizens, so that their people understand why those decisions are being made and that they are important for the health of the nation. Politicians must be able to sell these policies and stop the politicization of these issues. The path ahead is not easy but necessary and possible. This workshop is the beginning of that path and I hope you will play your role. This workshop is part of the process to make it happen. We need to emphasize Health Promotion. Obesity is a serious and growing problem, tripling over the last decade in the Caribbean. We are not paying sufficient attention to Mental Health. With HIV/AIDS, we have not lost the battle but we still have a lot to do. Alcohol abuse/smoking of cigarettes needs action. St. Vincent has banned smoking in hospitals and other areas. The need for physical activity at all ages remains. Health is so necessary, health is worth promoting. Best wishes in your endeavors here today and I look forward to the results of this workshop. Remarks by MRS. BROWN ON BEHALF OF THE MINISTER OF EDUCATION, St. Vincent The Ministry of Education is proud of its collaboration with the Ministry of Health, particularly in areas such as HIV/AIDS. We are committed to collaboration in areas relating to health promotion. We want the focal points for HIV/AIDS to work closely with the Ministry of Health, especially healthy lifestyles. We will continue to collaborate with the Ministry of Health, particularly in some the controversial areas/ issues. Therefore education must do what is required in the future to collaborate. Sometimes getting the message out there is daunting and sometimes it is encouraging, but we have to persevere am 10.00am First Technical Session Presentation from the Assistant Director, Dr. Carissa Etienne (by video) Good morning,

100 Caribbean Health Promotion Workshop 71 I wish to welcome each of you to this important workshop on Health Promotion. As you meet at this time, it is against the setting of significant developments in health and development, all of which impact not only individuals health and well being, but also challenges the health sector to rethink its approaches and strategies. Some of these developments include: The increasing inequalities within and between countries. That is the poor is expanding and are getting poorer. Globalization with both its challenges and benefits. The rapid and adverse social, economic and demographic changes affecting persons and their environments and impacting health and well being. The reemphasis on the social determinants of health and the recognition that individual health was highly dependent on the social determinants. The affirmation of the intrinsic relationship of health and development at the Millennium Conference and which was clearly articulated in the Millennium Declaration and the subsequent Millennium Development Goals. The recognition that chronic, noncommunicable diseases constituted a major priority for health and development in poor or developing countries leading to the concept of MDG plus. The very strong commitment to health, which was demonstrated by governments coming together to adopt the Framework Convention for Tobacco Control. And, the realization that appropriate and well organized health systems were vital for the success of disease oriented or vertical programs leading to the call for the renewal of health systems based on Primary Health Care. In the Caribbean, the Heads of Government have unequivocally identified their priorities for health as chronic diseases, HIV/AIDS, violence and injuries and have named 3 cross cutting themes Health Promotion, Information Systems and the Management of Human Resources for Health for joint action. It is within this complex and changing milieu that we are challenged to rethink the role of the health sector. All of these prompted the World Health Organization to convene the Sixth Global Conference on Health Promotion in Bangkok in 2005, with the theme of Policy and Partnership for Action Addressing the Determinants of Health. This Global Conference charted the way forward going from the Ottawa Charter (1986) reaffirming its relevance and that of the subsequent global conferences towards Bangkok and beyond. Emanating from the Bangkok Conference was the Bangkok Charter for Health Promotion, and a heightened awareness that all sectors are critical to the achievement of health - the private sector, civil society, and indeed all of government. The Bangkok Charter emphasizes the need for strong political action, broad participation and sustained advocacy. The Caribbean Charter for Health Promotion adopted in 1993, provided the framework for action in the Caribbean, building on the developments in the subregion and responsive to the hemispheric and global plans and programs for the implementation of the Health Promotion Strategy. I want here to recognize the great efforts of our health promoters in the Caribbean and beyond for the tremendous efforts and achievements in implementing this new strategy and giving birth to this new discipline which we know as health promotion.

101 Caribbean Health Promotion Workshop 72 It is true to say that the major actions in the Caribbean have focused on affecting individual behavior change, creating supportive environments and building alliances with the media but less so, on the adoption of healthy public policies and the other strategies contained in the Caribbean Charter. The evidence suggests that the impact on individual health can be enhanced if we focus on the social determinants and enlist every health worker as a health promoter, every civil servant in all of government employ, civil society and the private sector. Our challenge therefore is how to ensure that these various sectors become engaged and recognize that the promotion of health is central to the development process and therefore must underpin all of their actions. This does in no way negate the importance of the work of the discipline known as health promotion. It would require however the change of approach to embrace others, to empower others, keeping the long term goal clearly in mind. The health sector and health promoters must be central to the process and constitute the champions of this new approach. As you deliberate over the next few days, I have no doubt that you will be dealing with these new directions. In September of this year the Heads of Governments will meet in a special summit to address the NCD s and to establish a framework for action. Health Promotion in the broad sense will be a major strategy in this framework. You will be called upon to work in this context to stem the tide of the epidemic of obesity and chronic diseases with its impact on individuals and families but also on the social and economic future of this region. I want to leave you with my best wishes for a very productive meeting and I look forward to the reports of this meeting. Thank you vey much. Presentation by Dr. Eduardo Guerrero, Unit Chief, PAHO/SDE/DS (Power Point Slides) Presentation by Dr. Gauden Galea, Coordinator, Health Promotion WHO/HQ (Power Point Slides) WHO Constitution HPR is Basic to WHO Constitution "The following principles are basic to the happiness, harmonious relations and security of all peoples: The achievement of any State in the promotion and protection of health is of value to all. Unequal development in different countries in the promotion of health and control of disease, especially communicable disease, is a common danger." Executive Board Global resolutions require: (1) to strengthen the capacity for health promotion across the Organization [ ] and the active engagement of other appropriate United Nations and international organizations; (2) to [ ] support Member States [ ] to strengthen national health systems [ ] to enhance the ability to tackle the serious threats [ ] including [ ] NCD; (3) to optimize use of existing forums of Member States for multisectoral stakeholders, [ ] in order to support the development and implementation of health promotion; (4) to encourage the convening of [ ] conferences on health promotion on a regular basis; (5) to monitor [ ] and identify major shortcomings in health promotion globally and report through a regular system; (6) to [ ] exchange of information with international nonhealth forums [ ]; (7) to report to the Sixty-first World Health Assembly,.

102 Caribbean Health Promotion Workshop 73 Domains of the promotion of health HP a basic element of health the promotion and protection of health by any state, etc. Overview of what constitutes health. Bangkok Charter (2005) response to the Ottawa Charter (1986) Many determinants of health lie outside the health system; next health promotion conference in 2009 will be in Africa for the first time in Nairobi, Kenya. A problem of HP over the years is its inability to define its own functions. A new emerging operational paradigm; in 1996 HP was the rising star of public health; what HP is and where it lies specifically within the healthcare continuum; interventions identified by a lot of evidence which has been growing; the work of HP must be supplemented by context specific needs; private sector role social responsibility. HEALTHY ISLANDS Yanuca Declaration (1995) of what constitutes a healthy island. Sociocultural context to be taken into consideration in developing any HP plan on any Island; their small size means challenges economic; human resource and difficulties not only in economic life but also health life. A CASCADE OF QUESTIONS Personal behavior Social networks Contextual factors e.g. reducing the price of vegetables will it lead to increased consumption? Socio-ecological approaches FIJI CASE STUDY increased in vegetable growth ended up in a situation where people grew, sold them and then used the money to buy unhealthy food ; western food. CONTEXT: VALUES Using western values in intervention always desired in say the island context? Lessons for settings (P.S. every setting is an island) EVALUATING SEMI-SUCCESSES Every program should look at coverage, sustainability and side effects. Presentation by Ms. Yvonne Lewis, Deputy Director of Health Promotion, Trinidad & Tobago A Decade Implementing the Caribbean Charter for Health Promotion Healthy Public Policy: This is where HP was started in 1994 when the health sector restructuring process started in T&T, and this led to the Caribbean Charter on Health Promotion being adopted in T&T. This progressed to sensitizing people about HP, by demystifying the ordinary held view that it is only another approach with a different name. Going to homes built an understanding of how different this approach was to the past. Lobbying resulted in training of medical students, dental nurses, university level, community colleges, doctors, etc; In 1995, training expanded beyond health-to include teachers, community leaders, etc. Since 2004 training and capacity building in HP intersectorially. Since 1994, work was done to operationalize HP, by fleshing it out, building healthy public policy. It took the year of 1996 to develop a 5-year national implementation plan which became a template to address determinants of health. Healthy public policy was realized as not exclusively Ministry of Health policy, but required a multisectoral approach.

103 Caribbean Health Promotion Workshop 74 In 2001 the health directorate of HP and PH was established, with a mandate to operationalize HP nationally; 2001 establishment of the national council on HP formed by the national cabinet to maximize a multisectoral approach for national development; sought to formulate/monitor programs based on the Caribbean Charter. All ministries plus private sector, NGOs/Civil society groups formed this broad council; intersectoral participation and collaboration to ensure consistency and success, including mental health and the formulation of mental health committees Thus, what started in 1996 has continued to produced fruit. HP was portrayed as an extension of health education and has had to highlight its unique approach which includes community partnership and ownership, and promoting the involvement of civil society and the corporate sector in community partnership. Challenges also came with opportunities, for example, reorienting health centers to health promoting centers so that all centers in TT now have a wellness and exercise area. However, the equipments often sat idle, so a partnership with trained exercise facilitators in the communities boosting patronage. Ongoing monitoring since 1997, and now the regional authorities employ exercise training professionals. Exercise is also provided for the elderly. These activities are supported by a HP Council for community participation. In 2002, the National Healthy Spaces initiatives began, with NGOs, civil society, and the community worked in partnership to act on determinants of health at the local level. Village health committees engaged the community to identify areas of health concern. Healthy Spaces has proven to be very successful. In one community (Plum Mitan), water was identified as the main issue, by engaging with the community, identifying their needs; and working with them to provide the need. Through this, water was brought to the community for the very first time. Other initiatives include community breastfeeding initiatives, counselors trained to function in health settings, Diabetes Support Groups as an attempt to raise public awareness, interest, improve self-management of diabetes; interest and skills in diabetes treatment to decrease complications like foot problems. In addition the National School Project provided screening for hearing and vision among school children. Health Quest is being produced. It is a magazine for school health program with assistance from PAHO and other organizations am pm HP strategies Capacity Building Roundtables: Experience Sharing interactions Roundtable: Changing environment: Policy Coherence with Dr. Suzanne Jackson Roundtable: Changing Environment: Healthy Settings with Ms. Marilyn Rice Suriname Sanitation and smoke free initiative: Women s Chapter of the Junior Chamber International worked with the HPS initiative to ban smoking in technical schools (comprised mostly of men); Challenge renovating sports buildings and recreation areas led to collaboration with private sports clubs to use school buildings, so that the schools have access to them in the mornings and the community can use them in the afternoons and evenings after school is out Inter-departmental tournament: sporting event among the 17 Ministries of the whole country, including football match between the Ministers and the Members of Parliament Future: structure for how to reach the work force Two weeks ago the Ministry of Health and the Ministry of Internal Affairs launched a law on no smoking in all governmental offices Decentralization of Local Government (DLG) have community meetings to create district plans to get health on the agenda and create opportunities for water and sanitation

104 Caribbean Health Promotion Workshop 75 Put in public bathrooms without consulting with the population. As a result the people did not consider them to be theirs and they did not clear or maintain them. After the floods there was an increase of worm infestation in the population and most villages did not have latrines. This led to the identification of the need for knowledge about the need for constructing and using latrines. Trinidad Would like more information about healthy island initiatives Would like more information on helping people to quit smoking Trinidad is doing health screenings in the malls Barbados Pilot in 3 secondary schools of media education, to give children analytical skills to support non-smoking; give both teachers and children the skills to unmask the glamorous messages; teachers did not feel they had the skills to teach about this; NEED TO MAINSTREAM THIS INTO TEACHERS COLLEGES CURRICULUMS AS WELL AS INTO SCHOOL CURRICULUM Barbados had a male health initiative but it only attracted older men St. Vincent The only HPS policy and program is health nurses doing screening (audio, visual, dental) in primary schools There is a school feeding program controlled by the Ministry of Education, in collaboration with the Ministry of Health, however the menus provided are not healthy which has led the schools to sell the foods to local shops, then buy fruits and vegetables for the children Some schools are working with the PTA to have children bring healthy snack foods once a week Ministry of Sports to involve the Ministry of Education to systematically allocate more time for this during the school day Surveillance of children aged 0 to 5 previously showed a problem of under nutrition and is now showing a 9% obesity problem which indicates problems for the future CFNI will start a HPS program with the Ministries of Health and Education Public Service Week a program of exercise in the park once a week, done in collaboration with the Ministry of Sports The issue of gender equity was raised and how to get more involvement from men Bahamas Has a program for male health screening at the health care centers, it is services driven and focused on NCDs; There is also a male health initiative in the schools where health issues are discussed with boys Have a mentoring program by fathers in schools for male 5 th and 6 th graders they conduct after school activities that can be enjoyed together, especially for boys with absent fathers (to keep them form getting involved in violent activities) Bahamas has used the shopping malls as a healthy setting to hold health promotion events Bahamas There is a center for community interventions where community members are recruited for certain activities, but there is still a need to engage counselors (mayors). St. Kitts Found that getting men involved in health issues worked better if they incorporated health into already established male gender led groups rather than the other way around; The challenge is to get leadership from other sectors Held parenting groups for men to deal with problems of violence

105 Caribbean Health Promotion Workshop 76 Conducted mentorship programs for boys in schools the Chamber of commerce has worked with boys out of school or after school There are also male oriented groups in churches organizing groups around NCDs, with panel discussions and presentations Jamaica Male groups called Fathers Inc. focus on parenting and how to raise boys defend the rights of males when it comes to custody St. Lucia What worked better was where there were mothers and fathers groups combined and the females helped to sustain the males uses the mall as a setting for health education activities car park jam whereby the private sector donations were distributed as incentives for young people to come and ask questions. There is a need to revitalize work with the mayors. There used to be an initiative called La Belle Village where prizes were given out to the best healthy community initiative. It helped to created pride by communities and they cleaned them up and this need to be revived. A road project was developed that widened and raised the sidewalks, built walkovers near bus stops, and installed street lights resulting in much fewer pedestrian traffic accidents. There was a project in a rural community of a young person foot path which identified the issue of pit latrines which led to a project focused on providing new bathrooms accompanied by education on how to use and maintain them In another area there were bathrooms put in for the community without consulting them and as a result the people did not use them. The same thing happened with a school lunch program. It was introduced without consultation of the students and children did not eat it as there was too much stigma attached to it. Turks and Caicos Based on the community s diagnosis, initiatives were taken to rebuild walls and roads, and clear side walks, including even cleared away areas on private property, which has totally transformed the community. This started out as a tourism project that resulted in making the community healthier. The previous administration focused on the issue of pit latrines and they put new bathrooms in each house (toilet and shower) The national insurance scheme for the elderly setting up a program to build better housing for them, which generates pride in their new houses and improved maintenance. Roundtable: Reorienting Health Systems and Services: Primary Health Care with Dr. Carme Nebot Main challenges: Human resources: o Human resources are both, trained on a curative approach and insufficient to provide universal care; o In the English Caribbean, health personnel have no skills to serve people speaking languages other than English; o o There is a need for job descriptions; Nurses are very important in HP but there is a shortage since they move to developed countries; As human resources are scarcely deployed, volunteers play an important role as health providers helping communities meet their health needs; There is a lack of leadership in health services;

106 Caribbean Health Promotion Workshop 77 During the last years, the second and third levels of health services have become very technical. The highest technical level is the one that shows the more spectacular results, which in fact, draws the attention from politicians, who provide more and more funds for medical care. In the meantime the social components of health care are ignored, they are not funded properly and the gap between community and high technology funds is getting worse; Politicians don t want to lose votes, so they don t make any decision that can endanger their mandates. For example: who is responsible for their own health? This is a very controversial question that many politicians fear to make clear so it remains without a clear definition; The top responsibility of PHC and HP are separate, which prevents their personnel from undertaken successfully integrated activities; PHC is a comprehensive, cross-cutting strategy; however it s not clear who should lead health promotion activities provided in primary health care. Likewise, there is a lack of coordination between health promotion and health services; There is a misunderstanding regarding the meaning of health promotion, since many people think that it is the same as health education and information, forgetting all other aspects that HP handles; Regarding information, many times messages addressed to the population are not clear enough for them; it s important that messages are conveyed in a comprehensible language so that people can fully understand their meaning; The fact that every ministry competes with each other for their own budget makes negotiations necessary to agree on intersectoral policies, which will facilitate intersectoral actions. For example: being highly recommendable for people to eat vegetables, the prices should be controlled so that everyone can consume them. Another example of the intersectorality as a policy is to make sure that messages provided by health personnel are the same as the ones provided by teachers. Eating habits are crucial in HP, but there are issues to face, such as rising prices of healthy foods, lack of skills on healthy nutrition, particularly in people who used to live in rural areas and have moved into cities, changing their lifestyle from a rural-style to an urban-style. Roundtable: Reorienting Health Systems: A Decade Implementing the CCHP with Ms. Ivonne Lewis Roundtable: Changing Behaviour: Media as partners with Ms. Claire Forrester Both groups agreed with the view that public health community needs the media more than the media need public health and that this is only one of the areas that is striving for media attention. Against this background the group examined the roles and expectation of both sides; public health mangers wanted their issues on the media agenda from a public heath perspective, and also primarily seek access to free space and airtime. Media entities in contrast operate as a business and so their practitioners (journalists, programme producers, editors, opinion writers) wanted news, preferably hard, (as against soft) news stories that were interesting and relevant to their audiences and so contribute to improved ratings to the satisfaction of their commercial sponsors. An understanding of this reality may temper the expectations of the public health managers and help those concerned to view the partnership in a more realistic light. It was generally accepted that public health should accept that such a partnership would inevitably be lopsided at best but still valuable in the effort to mainstream key public health issues in the media. Both groups examined roles and the expectations on both sides. Recommendations for both partnership building initiatives and for getting health issues on media agenda, based on their experience of what works and what doesn t:

107 Caribbean Health Promotion Workshop Consumerism: Public health planners, managers should seek to understand the media s needs and expectations, in terms of any proposed partnership, seek to address the what s in it for them factor 2. Approach the media gatekeeper(s) armed with information that would both sensitize and stimulate interest. 3. Impact: recognize the relevance of impact to media gatekeepers by using epidemiology data creatively. Media interest may not be based on mortality and morbidity rates e.g. interest in HIV vs NCDs. 4. Credibility; there is a great likelihood of positive media interest when the source of the public health information enjoys credibility with the media gatekeepers) 5. Clarity/Brevity: Hallmarks of media outputs and health planners and managers should ensure that information forwarded should be easily understood- avoid jargons, seek to interpret data for lay audiences, and also recognize that accommodation of their story is subjected to limitations of space and time in both the print and electronic media. 6. Seek involvement of media practitioner(s) in message creation 7. Plan and implement media sensitization initiatives on each issue to be promoted 8. Position relevant messages aimed at media at point of sale- where media practitioners are more accessible, e.g. doctors office, screen testing centres, etc. 9. Involve media gatekeepers in planning and seek their guidance in accessing space and time and addressing commercial interests 10. Target appropriate media time and space with credible, compelling, understandable messages 11. Show understanding that the media is a business by negotiating realistically and creatively for time and space 12. Listen carefully to attempts by gatekeepers to explain their own needs, and expectations, limitations etc when negotiating for time and or space and try to meet them at least part way. 13. Explore commercial support, with guidance from media gatekeepers, in accessing media time and space 14. Seek available research information on media audiences to be used in negotiations with gatekeepers 15. Target new and emerging electronic channels (radio and TV) who are likely to be more in need of material to fill their airtime. 16. Conduct assessment and prepare shopping list of media needs to enhance negotiations with individual entities 17. Provide incentives for media practitioners or media houses, e.g. awards for good and useful coverage. 18. Cultivate long term interest in health of media practitioners and implement confidence building initiatives for inexperienced practitioners who display an interest in health coverage. Roundtable: Changing Behaviour: Controlling Chronic Diseases with Dr. James Hospedales 1.30 pm 2.15 pm Mainstreaming Health Promotion in the Caribbean

108 Caribbean Health Promotion Workshop pm 5.00 pm Parallel Working Groups: Utilizing the 6 CCH Cross Cutting HP Strategies for Mainstreaming / Integrating / Institutionalizing Positive Change A.- HEALTHY EATING Questions related to the Caribbean Charter Strategies Dominica: National Food and Nutrition Council (NFNC) formed. Food-based Dietary Guidelines developed (FBDGs) Commitment from other stakeholders SVG: NPAN Document completed and tabled to Cabinet (Govt.); FNSC formed and adopted by Cabinet (Govt.); FBDGs developed and launched and communication strategy in draft; Commitment from other stakeholders Bahamas: 12 work wellness program health screening sponsored by business community improved eating habits Suriname: health survey done in the analysis stage CHALLENGES: Sustaining the momentum. Information & monitoring. Funding. Evaluation. Marketing. Creating supportive environments Bahamas: NAE adopted in classrooms Passport to healthy living as a screening tool. Needy children on feeding program. Gym in MoH Suriname: some needy children on feeding program in school. Dominica: school feeding program for needy children since the WFP ended. SVG: exercise in the park in collaboration with sports drive ongoing. Evaluation of national support program awaiting report. Strengthening community action SVG: Community assessment based on national poverty survey in 3 communities. Findings now being presented to communities. Annual week of activities. Bahamas: Annual health fair. Turks & Caicos: preparing initiative program at annual health fair. Developing personal skills Assistance can come from Govt. PTAS, social clubs, etc. SVG: Training in skills and knowledge through outreach programs annually as well as request made from Ed. and community. (Curriculum based) formal training at school of nursing and the pre school services. Dominica: HFLE tutors not well equipped to teach on the subject area. Bahamas: use of a chef to teach cooking skills to persons. Suriname: teachers give info, but do not practice. There is conflict with what is taught when sponsorship was received, e.g. soft drinks sold by talk shop given cooler, etc. Forming alliances, specially with the media Dominica: radio show: Power Breakfast 6:45 am 2 minutes. SVG: radio, print media Bahamas: private sector involvement but not collaborated with Govt. SVG: 8 min. Radio program 6:45 am sponsored by insurance; 3 min. program 6:45 am Monday and Thursday sponsored by a pharmacy. 8 min. radio on ½ hour magazine program every 4 th Wednesday. Newspaper article weekly (Friday) focus on nutrition; support groups and sporting organizations. Reorienting health services SVG: Still using and focusing on biomedical model of health care. Development of standards at the MCMH for dietary department (financial resources as well as human resources not available.)

109 Caribbean Health Promotion Workshop 80 Bahamas: still using American food pyramid in schools, etc. One good idea In the 12 weeks wellness program in Bahamas - networking produces good outcomes. One Key Challenge Multisectoral action in promoting healthy eating habits. One Innovative Proposal To introduce the bottom up and top down approach working in synergy to integrate all sectors of the society in the planning. Needs from the bottom and policy from top. B.- ACTIVE LIVING Questions related to the Caribbean Charter Strategies Jamaica: physical activity policy Trinidad: school health policy physical activity should not be optional St. Vincent: physical education at CXC level Challenge: physical activity in schools depends on principal and staff Success: active living Assist older people. Music and dance used for physical activity. Creating supportive environments Suriname: making playgrounds and public parks available for community. T&T: lobbying wellness centers as part of health care. Physical activity center different activity, soft ball, walking, gym. Strengthening community action Suriname: centered on a program called International Challenge Day Barbados: dancing, running, snorkeling competition, fun run, fun walk, fun ride; steel pan, jump up. Developing personal skills Household work as a form of physical activity. Supervision by trained personnel. Time for activity. We are asking persons to do things but not showing them how to build the skills. Forming alliances, specially with the media Sr. Lucia: private gym. Bahamas: alliance with MOH - every Tuesday and Wednesday column for health Barbados: Media to promote healthy lifestyle continuously. Trinidad & Tobago: media promoting health where health reporters share seminars/meetings on health promotion. Radio show 1 hour long. Suriname: radio show 15 minutes twice a week. Reorienting health services T&T: a decade implementing the Caribbean Charter on Health Promotion. One good idea Wellness Center Initiative. One Key Challenge Absence of national policy on physical activity. One Innovative Proposal Encourage heads of state and government to get moving. Visibly involving heads of state and governments in physical activity.

110 Caribbean Health Promotion Workshop 81 C.- SAFE SEX AND ALCOHOL Questions related to the Caribbean Charter Strategies St. Lucia: development of national policy for HIV/AIDS; stakeholders all over (public service responsibility & consistency from health.) Draft almost 1 year, not or ratified as yet; also for education sector; partners: UNESCO, PAHO, missing different sectors in policy development. ALCOHOL: no policies; restrictions on sale of alcohol: none in St. Lucia; not reprimand, parents allow children to drink alcohol. Creating supportive environments Peer education training (Guyana, St. Lucia) Health Education Unit Family Planning Association Funding for HIV/AIDS and promotion of safe sex Faith-based organizations Alcohol: Substance abuse secretariat (St. Lucia) Alcoholics: Turning Point (St. Lucia) (near psychiatric hospital!) no other place for rehabilitation (St. Lucia & Guyana) AA groups SVG (Marion House) support from government usually. Strengthening community action ALCOHOL: St. Lucia not much advocacy; MSE, FBO, NGOs safe sex education SVG: health education programs. SAFE SEX: SVG many more structured programs. TCI: -Rapport group of young people to target young people very proactive; population is 30,000 - great impact getting information to young people in teenage programme - Alcohol & Alcohol and Drug Unit: not so active but meetings active and advocacy. Guyana: ULT adopt health programmes, peer education program works well; outreach ULT; youth friendly health centers. St. Lucia: pastors trained ULT (community action) sensitized school counselors. Developing personal skills Training in these areas: TCI AIDS Unit: 20 school children to be peer counselors in schools. Continuous training, ongoing St. Lucia: network of HIV/AIDS coordinators (chairperson is Sophia Edwards); To develop capacity (Caribbean) MSC in Health Promotion (UWI) emphasis on HIV/AIDS first batch in December Forming alliances, specially with the media TCI unaware; media Guyana: run ads re: SRH; give spots to HP/Alliance with media; give spots on SRH Huge industry for alcohol/other products Focus is more on SRH/HIV/AIDS than chronic disease and alcohol St. Lucia: Project sponsorship of activities by alcohol producing industries/companies. Alliances with NGOs/funding/technical support for HIV/AIDS by World Bank/UNESCO. TCI: FBO/MOH alliance on drug support. Reorienting health services Led community netball association, alliances St. Lucia - very successful - including other health agencies under health sector St. Vincent FBO, civil society - a lot of support; even National Olympic Committee teamed up for drug free sports; ongoing health project

111 Caribbean Health Promotion Workshop 82 - radio sponsorship; insurance companies also offered sponsorship not exclusive to safe sex and alcohol - HP change in behavior open in addressing issue - MOH designated training health educators conduct training, reconciliation and place responsibility on those trained Guyana Moving HP to unit to coordinate separately from health training One good idea YPHS One Key Challenge On social acceptance and alcohol use One Innovative Proposal N/A D.- TOBACCO Questions related to the Caribbean Charter Strategies Building healthy public policies - Multisectoral approach to tobacco control - Legislation is at the formulation stage - Working on smoke-free spaces especially in schools - Enforcement at local level Creating supportive environments - Smoke-free spaces - Enforcement is needed Strengthening community action Capacity building workshop for focal points Community health worker training Developing personal skills Community outreach programmes Forming alliances, specially with the media - Insurance companies - Workers union - Private sector (banks, telephone companies, beverage companies) - Radio programmes funded by insurance companies; health tip during evening news; ½ hour programme on Health under the Microscope ; vital signs Reorienting health services - Community health worker training - Addition of cessation treatment to health services One good idea - Smoke-Free schools 100 schools at a time - Dry free clubs One Key Challenge Political support especially in the area of funding One Innovative Proposal Coordinating mechanism at regional level e.g. from CARICOM

112 Caribbean Health Promotion Workshop 83 Mainstreaming Health Promotion, July 31 st 8.30 am 9.00 am Assistant Director, PAHO Ms. Marti Rice Dr. Carissa Etienne, (by video) Shaping the Future of HP: Challenges from Vancouver & London 9.00 am am Mainstreaming Health Promotion: Country Reports am pm Capacity Building Roundtables: Changing Environments, Empowering Communities Roundtable: Mainstreaming Health Promotion in Schools with Ms. Lucy Anderson, Coordinator, Health Promotion, Ministry of Health and Mr. Anthony Hunt, Community Development Specialist, Ministry of Education Guyana: School Feeding Programme is funded through Education for All Fast Track Initiative (EFA/FTI), and has three sub initiatives: School Feeding Teacher Housing School Improvement Plans The EFA-FTI is an initiative funded through the Inter Development Bank where funds are targeted at students in the Hinterland Areas. The School Feeding Programme provides funding for catering equipment, produce for meals and salaries for School Cooks. The allocation is G$ 150 per child per day, which equates to U$0.75 cents, unfortunately, this subsidy does not include staff and teachers. The programme currently funds 32 schools comprising of 17 Multi- Grade and 15 Primary Schools across 4 of the 10 educational districts, with 6505 pupils currently benefiting. The continuation strategy is that the Ministry of Education will absorb the cost into its national budget at the end of the EFA-FTI term. It is envisaged that the communities will increase their farming capacity and be able to maintain the cost of produce at an affordable level for the participating schools. The programme also provides for the construction of purpose-built fully furnished Head Teachers facilities and duplex teachers accommodation.

113 Caribbean Health Promotion Workshop 84 St. Vincent: The school feeding programme partially subsidizes the cost of a meal which drastically increased the number of children eating cooked meals, as opposed to nutritionally inadequate snacks provided by vendors. Welfare Workers produced alternative menus, which can be prepared from very low cost produce and appear appealing to children, including a variety of food groups each day. Mainstreaming safety into education: Previously, the only safety consideration was under Premises & Equipment. Including Health & Safety in the School Improvement Planning Process, it brings safety issues to the fore. Support documentation will be available to provide guidance to Head teachers and School Advisory Improvement Committee s Members to increase awareness and greater understanding of issues that may well impact on the whole school community. Difficulties encountered in implementing HPS in Guyana: It was noted that the lack of coordination between Ministry of Health and Ministry of Education was a major issue but it is being worked on by both ministries. The Ministry of Health has identified the Adolescent Health Unit to coordinate all School Health Programmes and a comprehensive approach will be prepared to be submitted to Ministry of Education for inclusion in their National Plan that is currently under review. Roundtable: Community Mapping with Mr. Arthur Martinez, Belize There were seven people on the roundtable. Mr. Martínez showed in more detail what they do in Belize using the GIS. They have asked how they can start something like that in their own countries and he explained what they would need to do and offered his help to give them training in GIS. Roundtable: Social Marketing and Healthy Lifestyles Campaign with Ms. Cheryl Thompson, MoH Bahamas Roundtable: Better Living Health Centre with Dr. Idamae Hanna, Bahamas Roundtable: Health Promotion in Rural Communities with Mrs. Renee Franklin-Peroune, Guyana

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