-sparked by new Barbados policy on non-nationals
BARBADOS has begun implementation of a new Health Care Act that restricts access to cost-free drugs/medical care to non-nationals who have neither Barbadian citizenship nor permanent residency status. And it has come as a reminder why CARICOM governments need to collectively speedily move towards a common strategy for shared medical benefits by all nationals of member states that have signed on to the Community’s Single Market and Economy (CSME) project.
In the current Barbados scenario, unless proof of citizenship or permanent residency status could be established when seeking medical care, then non-nationals could be denied health benefits previously freely accessed.
Even, that is, they hold valid work permits, have a Barbados ID card, pay income tax, and whose national passport carries the official stamp as an ‘immigrant’.
From inquires made of some governments this past week, including Guyana, Jamaica, St. Kitts and Nevis and St. Vincent and the Grenadines, there are concerns about the application of the new Barbados Health Care law that would require clarifications.
At the time of writing, I was unsuccessful in reaching the Chief Medical Officer of Trinidad and Tobago — a CARICOM state with a significant presence of nationals from other Community states — to ascertain official policy in relation to non-nationals accessing cost-free medical care that citizens may secure as of right.
It has been noted that implementation of the Barbados health care legislation, has come at a time when CARICOM is in the process of seeking to establish appropriate mechanisms consistent with arrangements for the CSME.
These arrangements, which would facilitate more than the estimated nine categories of skilled nationals to have freedom to live and work in any of the participating CSME member states, relate to outstanding issues like contingent rights and creation of a regional health insurance scheme that’s applicable across the region.
Prime Minister Dr. Denzil Douglas of St. Kitts and Nevis, who has lead responsibility among CARICOM Heads of Government for Health (including HIV/AIDS) and Human Resource Development, is of the view that the Community needs to prioritise arrangements for  “an enlightened common approach” in the provision of health care for ALL nationals of the Community.
As current chairman of the Organisation of Eastern Caribbean States, Dr. Douglas observed — as did his Vincentian counterpart, Dr. Ralph Gonsalves, in an earlier interview — that the OECS sub-region had already made “significant strides” towards the evolution of a common health-care programme for Community nationals, including non-citizens who live and work there.
Both Prime Ministers were of the view that access to health care for CARICOM nationals should be discussed at the coming Inter-Sessional Meeting in Grenada later this week.
Not only in relation to common health care benefits, but also bearing in mind the wide-ranging recommendations for action outlined in the report from the Caribbean Commission on Health and Development (that was headed by Sir George Alleyne), former PAHO Director and current Chancellor of the University of the West Indies.

‘Broader goals’
Understandably, as noted by Guyana’s Health Minister, Dr Leslie Ramsammy, there was “general understanding” that a member state of the Community “is free to pursue policies and programmes it considers to be in its national interest” while, at the same time, “we can hope for consistency in fulfilling the broader goals of the regional integration movement…”
So far as Guyana is concerned, said Dr Ramsammy, the government was “fully committed” to honouring its obligations in providing cost-free access to approved drugs and basic medical care to “all of our citizens, as well as nationals of CARICOM who either live and work here, as long as they deal with the state sector health system … Once they seek medical attention from the private sector, they have to bear whatever the costs may be…”
The Guyanese Health Minister said the government was proud of its health care programmes, and would continue the tradition of facilitating free access to CARICOM nationals for prescribed drugs and attention as recommended to be obtained through the public health system.
In Jamaica, as explained by its Health Ministry, no one, national or non-national, would be denied access to urgent medical attention, but a payment arrangement is normally discussed for non-nationals to make. If it is found that they cannot afford it, the cost is generally waived.
The Jamaica government is also keen on having a “common approach” by CARICOM for nationals to access cost-free drugs/medical care. It also shares the concern for progress to be hastened in CSME-readiness arrangements that include issues such as contingent rights and the creation of a regional health insurance mechanism to benefit nationals across the Community.

Barbadian scenario
In the current Barbados scenario, there are reports of many non-nationals with legal status (though without citizenship or permanent residency), as well as employees in the public health sector, yet to be fully sensitised to the implications of the new Health Care Act in relation to access to cost-free medication.
Consequently, there have been some unfortunate incidents of CARICOM nationals being subjected to embarrassing rejections when seeking medical benefits at State-run polyclinics at which they had become accustomed to receiving such care.
One such case was recently brought to public attention, with the Barbados ‘Weekend Nation’ reporting, under the headline ‘No citizen, so no care’, about the shocking experience of a 75-year-old St. Lucia-born national when she turned up at a State-operated polyclinic for customary medical care.
The elderly woman, who has been living in Barbados for the past 55 years, was denied the care she needed because she could not then produce proof that she was either a citizen or has permanent residency status.
On that same day, according to the ‘Nation’ report, some eleven other non-Barbadian CARICOM nationals were also denied access to medical care, although they HAVE permanent residency.
Health Minister Donville Inniss was to subsequently explain that he had “no knowledge” that polyclinics were turning away people with permanent residency seeking health care.
Well, part of the problem may reside in the government’s failure, to date, to have preceded its implementation of the new healthcare legislation with a public education campaign on its relevant provisions, in particular those applicable to immigrants — from CARICOM or else — who have neither Barbadian citizenship nor permanent residency.
We await the outcome of this week’s two-day Inter-Sessional Meeting of CARICOM leaders that begins on Thursday to learn what new plans they have for common approaches on healthcare programmes, consistent with CSME-readiness arrangements.
In particular, how Community nationals with legal status, and who are paying taxes, could be facilitated to also access free medical care in the CARICOM jurisdictions where they currently live.