Developing policy to support novel Caribbean Tourism and Health surveillance program
Authors: Indar Lisa , Hospedales Carl J. , Asin-Oostburg Virginia 
Published: October 2019

ObjectiveThe Regional Tourism and Health program (THP) is a novel program, comprising of a tourism surveillance system, training, standards and multisectoral partnerships. The objective was to develop regional mandate and policy to support this new program and its non-traditional surveillance system.IntroductionIn January 2016, the Caribbean Public Health Agency (CARPHA), serving 24 Member States(MS), began executing a regional Tourism and Health program (THP), recognizing that the health of Caribbean economies is closely related to the health of its tourism industry since the Caribbean is most tourism-dependent region in the world; that tourism is vulnerable to health, safety and environmental (HSE) threats; and that travel and tourism impacted on global health security. High and increasing visitors to the Caribbean can increase the health, safety and security risks by the introduction and spread of diseases, by both residents and visitors. This was exemplified by the H1N1 pandemic (2009), Chikungunya (2013), and the recent Zika epidemic. However, even though more people visit the Caribbean than reside, there is no regional visitor/tourism surveillance system. There is also no regional mandate and policy for the reporting of visitor/tourism illnesses. This coupled with inadequate training, lack of standards and collaboration between tourism health stakeholders have contributed to disease spread.The THP is an innovative, multifaceted, integrated, regional program with components of a web based real time Tourism and Health Information Surveillance and Response system (THiS), food safety and environmental sanitation training, standards and multisectoral health and tourism partnerships. It aims to promote the health, safety and security of Caribbean visitors and residents. The THP is novel in that it involves the implementation of a non- traditional, health information and surveillance system (visitor based illnesses), new data users (private sector, hotels, passenger ships, visitors), new partners (tourism sector) and at regional level. Given the novelty and the multisectoral nature of the THP, a critical factor to support its implementation and sustainability was the development of regional mandate and policy to facilitate real time surveillance and response to detect and reduce the spread of illness.MethodsA multiprong approach was used to develop regional mandate and policy for the unique multisectoral THP program, from January 2016 to October 2017. This consisted of (i) weekly advocacy meetings with national and regional tourism and health public and private stakeholders to gain buy-in, recognition and support (ii) requesting letters of commitment from MS (iii) seeking support from the Caribbean Chief Medical Officers of Health (CMOs), who advises the Ministers of Health, at their annual meeting and convening a special CMO meeting on the THP (iv) seeking Ministers of Tourism support through the Caribbean Tourism Organization(CTO) forum (v) inclusion of tourism and health as a priority in the Caribbean Cooperation in Health (CCH4) strategy (which sets health priorities for the Caribbean region) (vi) presenting the THP to the Council for Human and Social Development (COHSOD), consisting of Caribbean Ministers of Health requesting approval to develop a regional THP policy (September 2017) and (viii) convening of a regional THP stakeholders meeting (October 2017) with high level decision makers from national, regional and international health and tourism sectors.ResultsA multiprong approach was used to develop regional mandate and policy for the unique multisectoral THP program, from January 2016 to October 2017. This consisted of (i) weekly advocacy meetings with national and regional tourism and health public and private stakeholders to gain buy-in, recognition and support (ii) requesting letters of commitment from MS (iii) seeking support from the Caribbean Chief Medical Officers of Health (CMOs), who advises the Ministers of Health, at their annual meeting and convening a special CMO meeting on the THP (iv) seeking Ministers of Tourism support through the Caribbean Tourism Organization(CTO) forum (v) inclusion of tourism and health as a priority in the Caribbean Cooperation in Health (CCH4) strategy (which sets health priorities for the Caribbean region) (vi) presenting the THP to the Council for Human and Social Development (COHSOD), consisting of Caribbean Ministers of Health requesting approval to develop a regional THP policy (September 2017) and (viii) convening of a regional THP stakeholders meeting (October 2017) with high level decision makers from national, regional and international health and tourism sectors.ConcludsionsDeveloping regional mandate and policy is a complex and long, but critical necessity for the implementation and the sustainability of this novel, multisectoral, non-traditional, multi-country tourism and health surveillance and response program. While the regional policy will take time to finalize, CARPHA and MS now have regional mandate to support the implementation of the THP, to strengthen capacity to prepare for, mitigate and respond to public health threats, which can transcend national boundaries.