These remarks were delivered at the opening ceremony of the 39th OECS/PPS Policy Board Meeting and Twelfth Meeting of the Council of Ministers: Health at the Montserrat Cultural Centre on October 26, 2026.
There is no better place in our region to speak about resilience than Montserrat. Thirty years ago, this island watched a volcano take its capital, its hospital, its airport, and much of its land. Plymouth lies buried just a few miles from where we sit, and on Thursday our Ministers will stand there and see it for themselves.
Yet Montserrat did not disappear. Its people rebuilt their health services, their schools and their sense of themselves in the north of the island. That is the lesson Montserrat teaches the whole OECS. Resilience is not a slogan we print on banners. It is a decision a people makes, every day, about who they are and what they will build.
To the Government and people of Montserrat, thank you for your welcome, and for reminding us of that truth. Minister Telesford, thank you for your stewardship this past year. Minister Buffonge, the Commission stands with you as you take the Chair.
We meet under the theme A Shared Vision: Strengthening Regional Health Systems Through Strategic Partnerships. Every word of that theme matters. A vision that is shared, because no island can carry this alone. Health systems that are regional, because our people move, and so do the threats to their health. And partnerships that are strategic: chosen by us, for purposes we define.
Let us be honest about the world we are operating in.
We are small island states facing large forces. Hurricanes arrive stronger and more often, and each one can wipe out years of investment in clinics and hospitals in a single night. Diabetes, hypertension, heart disease and cancer now take more of our people than any other cause, and they strike earlier in life than they should. New and old diseases cross our borders on the same planes and ships that carry our visitors. And the global system of aid and cooperation that we have relied on for decades is contracting before our eyes, as larger countries turn inward and redraw their priorities.
None of these threats respect the boundaries between ministries. A hurricane is a health emergency, a housing emergency and an economic emergency all at once. A diabetes epidemic begins on the farm and in the supermarket, long before it reaches the clinic. That is why the Revised Treaty of Basseterre treats health not as a side matter but as a foundation. Without healthy people there is no productive economy, no meaningful free movement, and no human capital to build on. Integration is not polite diplomacy. It is how small states survive together.
So tonight I want to put one question at the centre of this meeting: who sets the agenda for the health of our people?
For too long, the honest answer has been: someone else. We have lived under a model of disparate project funding. A partner arrives with its own priorities, its own timelines and its own reporting forms. We get a project on this disease, another on that system, a third on some other gap. Each comes with its own consultants and its own steering committee. Our small ministries spend precious hours servicing the paperwork of partners when they should be serving patients.
Then the funding cycle ends. The consultant leaves. The equipment has no maintenance budget. The staff we trained are recruited away. And the problem the project was meant to solve is still there, waiting for the next proposal.
Short-term project money tastes sweet on signing day. The bitterness comes later, when we discover we have built an archipelago of projects = islands of activity that never connect into a system.
That model cannot carry us through what is coming. The OECS must set its own agenda. Our partners remain welcome, and we value them deeply. But from now on we invite them to our table, to support our plan, built on our priorities, measured by results in the lives of our people.
What does setting our own agenda mean in practice? It means moving from scattered projects to one converged regional health and social programme - multidimensional, integrated, and focused on directly improving people's lives.
Think of it as the difference between a house plan and a pile of bricks. Today, partners deliver bricks of every shape and size, and we try to make a house from whatever arrives. Tomorrow, we draw the plan ourselves, and every partner knows exactly which room their contribution builds.
This year the OECS Commission began what we call the Pivot: a deliberate change in how the Commission itself thinks and works. Its principles apply with full force to health.
First, convergence over silos. Health cannot be fixed by the health ministry alone. Diabetes is also an agriculture question and a school-feeding question. Disease surveillance is also a tourism question. A hospital that floods is also a climate question. Our programme will join these pieces deliberately, not by accident. The One Health approach, which links human, animal and environmental health, is exactly this thinking at work.
Second, region first. Before we sign on to any initiative, we will ask one plain question: does this advance a priority that the Member States set together? If the answer is yes, we welcome it with open arms. If the answer is no, we will have the confidence to say thank you, but not now.
Third, lasting value. We will ask a second question: what does this leave behind that we own? A trained and retained workforce, a functioning data system, an institution, a budget line. If the answer is nothing, then it is not development. It is a visit.
Fourth, pooled capacity. The Commission exists to be the shared capacity that no single Member State can build alone - one team, one platform, one negotiating voice. When we buy together, plan together and negotiate together, a small region gains the strength of a large one.
Fifth, measured by people, not paperwork. The test of this programme will not be how many reports we file or workshops we hold. It will be shorter waiting times. A diabetic grandmother who keeps her foot. A child whose eyesight is checked in time. A family that does not go bankrupt because of a cancer diagnosis.
That is the programmatic agenda. Partners fund parts of a whole they help to strengthen but do not dictate. That is what strategic partnership, in the spirit of Sustainable Development Goal 17, actually means.
Some may say this is ambition without evidence. I say look at what we have already done.
This year the OECS Pharmaceutical Procurement Service celebrates forty years. Forty years of small states buying medicines together, at prices none of us could get alone. And it has done so on a self-financing model - not dependent on any donor's cycle, owned and sustained by us. If anyone doubts that the OECS can set and run its own agenda, the PPS is the answer. It is the template for everything I am describing tonight.
We have strengthened quality assurance through accredited testing, so that the medicine in the bottle is the medicine on the label. And we continue to update our harmonised Essential Medicines List and Essential Diagnostics List, so that every Member State works from the same standard.
Our partnerships, too, increasingly follow our lead:
Each of these is a partnership on our terms, serving our priorities. That is the model we must now make the rule, not the exception.
The agenda for the next few days is built around that converged programme.
We will consider the OECS Child Policy, which brings health, education, social protection and justice together around the child.
We will look at investment in climate-resilient health facilities, at adolescent and community health, and at preserving the eyesight of our people.
We will review our work with PAHO/WHO under the Pandemic Fund, and with CARPHA on disease surveillance and biosecurity.
We will examine shared regional services in cancer care and paediatric care, because no island should have to build alone what all of us can share.
We will look ahead to genomics and precision diagnostics, so that our region is not left behind by the next revolution in medicine. And we will test our emergency preparedness and readiness for acute care.
In their caucus, Ministers will focus on three urgent matters: foot care for people living with diabetes, so that fewer of our people lose limbs to a preventable complication; emergency medicine; and streamlining the many separate cancer control initiatives into one coherent regional effort. That last item says it all. Even in cancer, we have too many projects and not enough programme.
To make this week count, I put four imperatives before you.
One: leave Montserrat with a binding consensus. Not another communiqué that gathers dust, but clear decisions on health and medicines that every Member State owns and acts on. Mandates must become action.
Two: protect what we have pooled. The PPS has lasted forty years because Member States kept their commitments. Its future depends on each of us continuing to pay on time and buy together. A pooled mechanism is only as strong as the weakest commitment to it.
Three: finance preparedness, not just emergencies. We cannot keep scrambling for money after the disaster has struck. Public health infrastructure and climate-resilient facilities need dedicated, sustained lines in our national budgets. That is what owning our agenda looks like in a budget speech.
Four: own our health data. We need standard ways of collecting health information and agreements to share it across our borders, so that decisions are made on real-time regional evidence. Data about our people should be collected by us, governed by us and used for us. Without our own data, someone else will always define our problems, and someone else will always set our agenda.
Honourable Ministers, ladies and gentlemen: a shared vision demands shared responsibility.
The Commission is changing how it works so that it can serve you better - less paper, more partnership across our own divisions, and every effort judged by what it delivers in the lives of our people. We stand ready to turn the decisions you take this week into operational, life-saving reality in every Member State.
But the Commission cannot do it alone, and neither can any one of our countries. Only together can our Member States have the strength, the voice and the scale of a unified health system.
On Thursday, when you stand above Plymouth, remember what you are looking at. Not only a city that was lost, but a people who refused to be defined by what happened to them, and chose instead to decide what they would build.
That is the choice before us in health. We can keep waiting for others to decide our priorities, one project at a time. Or we can draw our own plan, invite our partners to build it with us, and measure ourselves by the health and dignity of our people.
Let Montserrat be the place where we chose the second path.
I thank you.
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