Millennium Declaration

INTRODUCTION

The adoption of the Millennium Declaration and the Millennium Development Goals (MDGs) come against a background of unprecedented global economic growth. Despite this however, the majority of the world’s population continues to live in poverty, existing on less than USD 1.00 per day. The MDGs therefore provide an unparalleled opportunity for stocktaking and recommitting to the achievement and implementation of the goals in a context where the development agenda is at the forefront. Thus far there has been varying degrees of success, however there is a consensus that much remains to be done, and with a fair degree of urgency to bring an end to poverty, improve access to good education and healthcare, secure freedom from violence, enhance reproductive rights, and protect sustainable livelihoods.

THE MILLENNIUM DEVELOPMENT GOALS

The commitment to the Millennium Declaration by more than 180 of the members of the United Nations marked a turning point for the international community as it renewed focus on practical strategies and targets to alleviate the suffering, and advance the well-being of the majority of the world’s population. The emphasis of the MDGs is the objective of reducing by half the number of people living in absolute poverty throughout the world by 2015, with a core focus on sustainable development.

The MDGs along with their key targets as follows:

 Eradicate extreme poverty and hunger:

• Reduce by half the proportion of people living on less than a dollar a day; Reduce by half the proportion of people who suffer from hunger.

 Achieve universal primary education:

• Ensure that all boys and girls complete a full course of primary schooling.

 Promote gender equality and empower women:

• Eliminate gender disparity in primary and secondary education preferably by 2005, and at all levels by 2015.

 Reduce child mortality:

• Reduce by two thirds the mortality rate among children under five.

 Improve maternal health:

• Reduce by three quarters the maternal mortality ratio.

 Combat HIV/AIDS, malaria and other diseases:

• Halt and begin to reverse the spread of HIV/AIDS;
• Halt and begin to reverse the incidence of malaria and other major diseases.

 Ensure environmental sustainability:

• Integrate the principles of sustainable development into country policies and programmes;
• reverse loss of environmental resources;
• Reduce by half the proportion of people without sustainable access to safe drinking water;
• Achieve significant improvement in lives of at least 100 million slum dwellers, by 2020.

 Develop a global partnership for development:

• Develop further an open trading and financial system that is rule-based, predictable and non-discriminatory. Includes a commitment to good governance, development and poverty reduction;
• Address the special needs of least developed countries’. This includes cancellation of official bilateral debt; and more generous official development assistance;
• Address the special needs of landlocked and small island developing States;
• In cooperation with the developing countries, develop decent and productive work for youth;
• In cooperation with the private sector provide access to affordable essential drugs and new technologies—especially information and communications technologies.

The MDGs therefore identifiy practical targets that can be realised within a specific time frame, with an emphasis on both qualitative and quantitative assessment, with a series of steps thought to be critical to achieving the specific goal. Critically, each of the MDGs is interrelated and strategic efforts must be made to achieve all of the targets at the same time.

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TRINIDAD AND TOBAGO – A SITUATIONAL ANALYSIS

Trinidad and Tobago is one of the Small Island Developing States (SIDS) that make up the Caribbean, and is typical of the unique configuration of socio-cultural, economic and political features [1]. Macroeconomic indicators for Trinidad and Tobago are positive, with moderate rates of growth, low inflation, and low budget deficits being dominant features of the landscape. The level of development relative to the rest of the region is high, with GNP per capita at US$4,520. Successive Human Development Reports have ranked Trinidad and Tobago high on the index [2].

Despite positive indicators in Trinidad and Tobago unemployment rates are still relatively high, at 15 percent [3] among the highest in the Caribbean region. The incidence of unemployment varies among various subgroups of the population, but it tends to be highest among young females and males, with women as a constituency representing an average of 23 percent of those unemployed. This is reflected in a recent report [4], which puts some 21 percent of the population living below the poverty line.

Unemployment due to downsizing has placed substantial sectors of workers on the “bread line”. Coupled with underemployment, the high cost of living, the inadequate provisions of the social safety net, insufficient retraining programmes, and the lack of access to financial resources for micro-entrepreneurs, the reality becomes clearer. Further, lower government expenditure on social services has led to increases in poverty, leading to marginalisation among the social classes becoming more intense, and growing disparities in people’s standards of living.

Selected Population Statistics - Trinidad & Tobago	#
Total Population	1.3 millions
Crude Birth Rate	14
Crude Death Rate	7
Annual Growth Rate	0.7%
Population doubling time	103 years
Infant mortality rate	16.2
Total Fertility rare	1.7
% of population less than 15 years old	28%
Contraceptive prevelance rate	53%
Population References bureau (2000) World Population Data Sheet

Additionally, there is little evidence to suggest that the majority of the population enjoy the benefits of easy access to essentials like water, adequate healthcare services and living above the poverty line. Current estimates are that some 40% of the population live below the poverty line [5] in real terms. Thus, despite the fact that Trinidad and Tobago can boast of continuous economic development and a fairly sophisticated social welfare system in comparison to many parts of the world, the reality is that significant sections of the population remain largely unaffected by these transformations . In addition, violent crimes, violence against the person, domestic violence and violence in schools seem commonplace.

As a result, issues related to social equity, including gender equity, employment, poverty eradication and the provision of adequate social infrastructure and efficient social security systems remain major development priorities. These are reflected in the social and economic issues including poverty, unemployment, dramatic increases in crime, drug abuse and the HIV/AIDS pandemic.

VISION 2020 AND THE MILLENNIUM DEVELOPMENT GOALS – A ROAD MAP FOR DEVELOPMENT?

Trinidad and Tobago’s has integrated it’s response to the MDGs in its Vision 2020 development plan and policy. Vision 2020 places Trinidad and Tobago as a developed nation, as it relates to its level of human development, the enterprise and creativity of its people, the success and dynamism of its economy, the standard of living enjoyed by all segments of its population, the social and institutional structures, the quality of governance, as well as, the state of the natural environment [6]. Vision 2020 is based on the underlying philosophy that each and every citizen must be afforded equal opportunities for personal growth, self-expression, enjoyment of life and participation in the development process [7].

Beginning in June 2002, the Government through the Ministry of Planning and Development, commenced the process of establishing an effective planning machinery to design and implement the transformation required in almost every aspect of national, community and individual undertaking. The process is also focused on garnering support for national development initiatives. The planning machinery being adopted is participatory, interactive and integrative leading to the formulation of a Strategic Development Plan. It is an approach that is multisectoral and multidimensional in scope and involves the forging of deeper and more active development partnerships throughout the society.

The strategy for developing the Vision 2020 Plan involves the adoption of a sectoral focus through the establishment of sub-committees on the basis of a wide cross-section of themes/areas [8]. Each Sub-Committee has responsibility for developing a strategic plan for its defined focal area. The establishment and operation of the Sub-committees of the Multisectoral Group will engage the participation of government agencies, business, non-governmental organisations, community groups as well as knowledgeable individuals in society in the planning process. Using a process of dialogue and consultation each Sub-committee, will produce a strategic plan for their area, which will provide, inter alia, an appraisal of the current situation, an assessment of the needs of the future, analyses of global and regional trends and an identification of best practices that could be tailored to local circumstances, pitfalls to be avoided, opportunities to be pursued and critical success factors. The sector/area strategic plans will be integrated into the overall Strategic Development Plan in the context of a framework that establishes national priorities for action.

Four different horizons will be used in the planning process to achieve Vision 2020. The long-term horizon will involve the development of a seventeen-year perspective to the year 2020, which sets the aims of the development agenda and the targets through which the Vision and its aims will be achieved. Within the framework of this long term perspective, the medium-term horizon will provide for specific objectives and strategies at the national and sub-national levels over the first six (6) years of the planning period in two (2) three-year time periods, 2004-2006 and 2007-2009. For the shorter-term (2004-2006), detailed actions plans will be developed. The fourth horizon of one (1) year will provide the basis for the formulation of the annual budget. The annual budget will, in essence, be a central element in the overall implementation of Vision 2020. This four-tiered planning horizon is intended to be the foundation for a more responsive policy framework since as it provides opportunities for continuous review and adjustment.

Upon completion, the Draft Plan will be submitted to the Sub-Committee of the Cabinet for review before it is forwarded to the Cabinet. Thereafter, it will be presented to the Joint Select Committee of Parliament for consideration. The final step involves the tabling of the document in Parliament for adoption.

The Government’s response and positioning vis-à-vis the MDGs is clearly articulated in its Vision 2020 policy. This Vision is intended to meet the MDGs within the 2015 framework and by 2020 to surpass the goals bringing the nation-state to full developed country status. In conveying the Vision, Prime Minister Patrick Manning states “… [it] means a prosperous and progressive society catering to all the needs of its citizens – [adequate] housing, education, housing, the provision of basic amenities such as water and electricity and a proper health service, - unemployment reduced to 5%, and poverty reduced to an absolute minimum, [9]”

Section 1

1.1. CIVIL SOCIETY ANALYSIS OF PROGRESS TOWARDS THE MDGS

If we are to use these campaign goals as a yardstick to measure performance the position of this paper would be that a ‘jumpstart’ is necessary if not urgently required. This could be facilitated partly through cooperation between the State and NGO sectors, particularly where the Civil Society Organisations (CSOs) resolve to prioritise and integrate the MDGs in their work.

Based on the current trends the goals most likely to be achieved are the following:

 Promote gender equality and empower women

Within the last two decades, and particularly following Bejing (1995), the significance of Gender has emerged as a key development issue became emphasised. While there has been substantial progress on this goal, overall the situation of women particularly as it relates to HIV/AIDS, domestic violence and levels of poverty remains a complex and challenging dynamic. A key response to these issues is Gender mainstreaming, which if integrated at the core of all policy and programme initiatives, will be a critical component in addressing gender discrimination, and promoting opportunities for women, and men to achieve their full potential.

The main target for Government under this goal is the elimination of the gender disparity in primary and secondary education, by 2005 and in all levels of education by 2015. At the primary school level the ratio of boys to girls stands at 94, suggesting a disparity in favour of boys [10]. These changes at the secondary level, where the ratio of girls to boys is generally more than one, i.e. more girls than boys are typically enrolled in secondary schools, with particularly higher female participation at the upper secondary levels. This trend continues through to the tertiary level. This is demonstrated in the enrolment at the University of the West Indies St. Augustine Campus which presents an almost 1.4:1 [11] ratio of females to males, and is also reflected in the ratio of females to males graduating annual from the institution.

Although there is limited data available on the literacy rate of females to males aged 15 – 24, given the generally high degree of adult literacy, and the high ratio of females to males in secondary and tertiary level institutions it is projected that this ratio will follow a similar trend. However, for Trinidad and Tobago this stands at 99 suggesting a male advantage [12].

Thus, Trinidad and Tobago is well on course to eliminating gender disparity in all levels of education and has succeeded in achieving parity in female gross secondary enrolment. This is not however reflected in levels of employment or income. For instance in 2002, the estimated earned income of women was (US$5,532) [13] and that of men was (US$12,432). Women therefore earned 50% less than men in comparable positions despite their higher educational achievements at all levels of the education sector.

Thus, while the number of women in employment has increased, women still do not have equal access to the job market, nor are they rewarded equitably for their work, despite having attained higher education levels. For Trinidad and Tobago the percentage of women employed in the non-agricultural sector stood at 38% [14]. In terms of the Gender Empowerment Measure (GEM), Trinidad is ranked 21st among 173 countries. Additionally, the Ministry of Community Development, Culture and Gender Affairs has implemented a number of programmes targeted at addressing skills training, with a view to enhancing the employment potential of unemployed and underemployed women with low formal education [15].

The political level represents a platform on which there has been major change for women. At present women hold 20% of the seats in the Lower House of Parliament, where persons gain access through the electoral process. On the hand, women’s representation in the Upper House or Senate stands at 38%. (See Chart below). The level of participation at the Cabinet level remains low at 25%.

This suggests that fewer women are offering themselves for election and/or are being elected to the Parliament. There has also been marked improvement at the Local Government level where the number of women participating in the process, as well as being elected has increased. This level of women’s participation in politics gives an opportunity for their views to help shape laws and policies. Thus, while this represents substantive improvement, with a sustained upward trend, Government must implement specific initiatives (including quotas) to support the achievement of this goal, and gender sensitisation training for all Members of Parliament.

A critical component in the response to gender inequality and equity is the formulation of a National Policy and Action Plan on Gender. The Plan which was submitted to Cabinet in December 2004, was developed following a process of active participation through consultation across the country with individuals, groups, communities and sectors to ensure widespread ownership of the final document.

A great deal of progress has been made in bridging inequalities between men and women. There are still tremendous obstacles which individually and collectively require urgent action if this goal is to be achieved by 2015. The question of the feminisation of HIV/AIDS and poverty compounded with the issue of domestic violence present a complex challenge.

Several criticisms have been raised regarding the utility of these indicators in the Caribbean context, given the gap in translating women’s higher level of participation and completion in secondary and tertiary institutions, into real socio-economic benefits. Further, concern has been raised for the quantitative data reflecting general trends but not taking account of labour force participation [16] , and levels of wage differentials, decent work, underemployment and the unregulated informal sector. Therefore there is need to adopt more responsive, qualitative indicators.

Achieve universal primary education

Human resource development has been identified as a key platform for taking Trinidad and Tobago to developed country status. A major objective of this thrust is to improve the quality and equity of access to education and training at all levels of the society and to sustain a culture of life long learning. In keeping with this is the commitment to provide all citizens with free and universal access to basic and secondary education. Integral to this is the upgrade and expansion of educational facilities to accommodate new technologies and methodologies as well as different types of learning.

This effort is supported by the Fourth Basic Education Project, which includes provisions for Early Childhood Care and Education (ECCE), and the Secondary Education Modernization Programme [17], with special attention on expanding access to secondary school places.

Critically, reforms in the education sector are being undertaken at both the quantitative and qualitative levels. Priorities at the quantitative level also include the provision of a full range of student support services such as:

• Expansion of the School Nutrition Programme;
• Continuation of the School Transportation Programme;
• Provision of text books to primary school students;
• Provision of initial book grants to secondary school students and introduction of text book rental programme;
• Development of a National Guidance and Counselling Programme;
• Aural and Visual Testing; and
• Scholarship Programme.

At the qualitative level improvements in the education system will be pursued by means of:

• Curricula Reform;
• Upgrading of educational professions;
• Improvements in security and discipline;
• Continued computerization of schools;
• Modernization of libraries;
• Establishment of a school based management system; and
• Institutional strengthening of the Ministry of Education.

Historically, Trinidad and Tobago has enjoyed almost universal literacy. With an adult literacy of 98.5% and a youth literacy rate of 99.5% [18] , the country ranks favourably. Based on the trend suggested by the enrolment levels in early childhood and preschool programs, the target set of net enrolment ratio in primary education has been achieved. Similarly, the data suggest that the proportion of pupils starting grade 1 who complete grade 5, can reach the target of 100% by 2015, given the trend of a low drop-out rate at the primary level. Equally, with a level of primary school enrolment, it is expected that there would be a high literacy rate among 15 – 24 year-olds, again supporting the trend that this goal can be full achieved by 2015.

It must be noted however, that there has been criticism of the narrowness of the MDGs given its limited focus on quantitative measures. The challenge particularly for the Caribbean reality in the education sector is to provide students with skills to enable them to compete in a highly technical and volatile labour market. Thus, to be meaningful to the Caribbean the focus of the MDG should be that of overcoming the limitations of the existing reliance on traditional teaching methodologies, management, human and financial limitations which negatively impact on the quality of basic education. Further, given the country’s recent emphasis on expanding access to secondary and tertiary education measurements for these targets must also be incorporated to the monitoring of the goal.

Combat HIV/AIDS, malaria and other diseases

The total number of adults infected 15 – 49 years is 28,000 [19]. HIV/AIDS is the leading cause of death among young people. 70% of AIDS deaths occur within the 15-44 years of age group. Available data indicates that the youth are particularly vulnerable, representing the majority of HIV infections. 50% of all infections occur in teen groups.

At the same time the percentage of women infected has increased significantly from 0% in 1983 to 37% in 2000, (See Chart 1). It should be highlighted that the infection rate for women increases dramatically for women between the ages of 15-24 with some 82% of reported cases falling in this age group. HIV/AIDS is the leading cause of death among young people. 70% of AIDS deaths occur within the 15-44 years of age group. The number of orphans, who have lost one or both parents to AIDS is 3,600 [20], this is likely to rise if access to anti-retroviral drugs is not expanded urgently.

Among high-risk populations such as men who have sex with men (MSMs), commercial sex workers, drug users and attendees at sexually Transmitted Infection (STI) clinics the prevalence rate is higher still. Among MSM group prevalence is estimated to be 40%.

Data from the Ministry of Health indicate that AIDS is now the leading cause of death among young adults. The disease exhibits a male to female ratio of 3:1. However, in the age group 15 – 24 years the number of infected females is higher than that of males. Fifty percent (50%) of new HIV/AIDS cases occur in the age group 15 – 24 years where it has become the leading cause of death. About 70% of all cases occur in the age group 15 – 44 years [21]

The GORTT intervention strategy is encapsulated in a Five-year HIV/AIDS National strategic Plan 2004 – 2008, which aims to reduce the incidence of HIVinfectionsinTrinidadand Tobago, and to mitigate the negative impact of HIV/AIDS on persons infected and affected. In addition, the National AIDS Coordinating Committee established in the Office of the Prime Minister to direct and coordinate the implementation of the Strategic Plan, focussed on halting the spread of new HIV infections, and reducing morbidity and mortality attributed to HIV/AIDS.

Progress on this objective is painfully slow. However, there is the anticipation that the establishment and strengthening of infrastructure through the Strategic Plan, along with the partnerships established with donors and other agencies, and the strengthening of the human capital in response to the disease, will provide the platform for effecting the desired results.

Ensure environmental sustainability

Environmental sustainability has traditionally not been high on the agenda of the GORTT. However in recent times the maintenance of the environmental integrity of Trinidad and Tobago, as a vital component of socio-economic growth and sustainable development has been emphasised. This has included the development and implementation of an institutional and legal framework, as well as the adoption of priority areas for action. These include:

• A National Re-forestation Project – this seeks to address the denudation, land erosion, watershed and ecosystem degradation, and wildlife reduction caused by poor environmental practices (including harmful agricultural activities, illegal logging, and forest fires) – restoring at least 5,000 acres of forest cover by 2008. This is critical since Trinidad and Tobago has been experiencing a negative change in its forested areas.

• Acceding to the Convention to Combat Desertification-aimed at implementing programs to address the underlying causes of desertification, as well as measures to prevent and minimize its effects.

• Signatory to the Koyoto Protocol – designed to cut greenhouse gasses has been ratified with commitment to reduce emissions of greenhouse gases in the atmosphere with special emphasis on the primary responsibility of the industrialized countries for global warming.

• Designation of protected Wetlands in keeping with the Ramsar Convention and promoting the involvement of the community in raising public awareness of wetland values and benefits in general and the Ramsar Convention in particular. This has been linked to the establishment of Environmentally Sensitive Area Rules, Environmentally Sensitive Species Rules and the Certificate of Environmental Clearance Rules, which will greatly enhance the legislative framework for the conservation and protection of the country’s biodiversity.

• Implementation of the Community-based Environmental Protection and Enhancement Programmes which aims to encourage community involvement and ownership in the maintenance and defence of the environment.

• The development of an integrated national solid waste management system – in response to the need for the cost-effective disposal of waste to environmentally regulated standards.

The GORTT has also embarked on a Water for All (and for Life) Programme which is intended to ensure that each citizen has access to a regular and safe supply of water. Generally, the research suggests that Trinidad and Tobago is close to universal supply of water and sanitation and will therefore meet the MDG target [22].

On the question of environmental sustainability it must be noted that there is need for more relevant targets, especially as it relates to issues of climate change and its likely impact on the Small Island Developing State. This is particularly acute given the reality that significant segments of the population rely on the environment for their source of income.

Reduce child mortality

In general, health care has improved, as evidenced by increased life expectancy and the eradication of communicable diseases such as polio, measles, and small pox. The target for this goal of eradicating child mortality is reducing by two-thirds the under five mortality rate. The indicators associated with this are the under five mortality rate, the infant mortality rate and the proportion of one year old children immunised against measles. Infant mortality rate (under 1 year old) [2003] – 17; Under-5 mortality rate, [2003] – 20; Under-5 mortality rank 120. According to the UNICEF classification, Trinidad and Tobago falls within the low category. However, with a rank of 120 [23] there remains work to be done to improve its performance on this indicator. Additionally, immunization rates for measles is over 90 per cent [24]. Severe malnutrition is very rare and low birth weight is 12 per cent or less.

Trinidad and Tobago is well underway to achieving this MDG. There are however other critically relevant indicators to reduce child morality in the coming years, which must be integrated to this goal. These include mortality arising from HIV/AIDS; under-nutrition (linked to current poverty levels); and the impact of violence.

On the other hand the goals for which there has been insufficient progress are:

• Eradicate extreme poverty and hunger

While a prerequisite for development, economic growth is not a sufficient condition to ensure the sustained improvement in the quality of lives of a population is attained. This is evident in the reality that in Trinidad and Tobago, significant pockets of poverty continues to exist. From 1990 to 2002, approximately 12.4% of the population earned less than US $1 per day while 39% lived on US$ 2 per day [25]. On the whole 21% live below the national poverty line. This lethargy can be understood in the context of the development goals being pursued by the governments, which are externally influenced by the thrust to prepare for globalisation. Thus, as measured of the proportion of the population below USD $1 and the percentage of the population below the national poverty line, Trinidad and Tobago is performing poorly.

Consequently, progress on the economic front must be accompanied by significant advances in social development, the necessary policies, infrastructure and resources – financial, technical and human. Considerable emphasis needs to be placed on strengthening the social infrastructure particularly health, education (training), crime prevention and poverty reduction), thereby creating an enabling environment for the promotion of an equitable society.

Efforts have been made to increase employment, improve access to health and education and alleviate poverty, to improve gender equity through the implementation of policies and programmes, to improve the social and economic status of women in particular, yet the benefits have not reached the majority of the population. These issues also bring into sharper relief the need for expanding and improving available social services, particularly education, health and the social safety net.

Despite internationally accepted levels of education and increased expectancy, large sections of the population do not have regular access to potable water, adequate housing, or quality health care. Government has recently implemented a number of poverty reduction strategies. These social intervention programs target the most vulnerable groups in the society – single parents, women, the elderly, the unemployed, displaced workers and the youth – are intended to improve their quality of life and creation of sustainable employment opportunities. They include:

• The provision direct financial assistance to households – including the Home Improvement Grant Programme [26]);
• The introduction of a minimum wage - currently at $ 9 Trinidad and Tobago Dollars or USD 1.43);
• training and career enhancement programs – particularly targeting youth for example Helping Young People Earn (HYPE); and
• The dismantling of restrictions on the social service delivery.

On the issue of health, consistent with the decline in the county’s social investment is the neglect of the health and social sectors. For example, while a health centre is within three miles of most people, the service and the provisions are sadly lacking, this is exacerbated by inadequate supplies of drugs. Government’s efforts have centered on ensuring that regional hospitals are modernized and adequately equipped, and that primary care is available to the population at all community health centres.

Although the GORTT has been making continuous efforts to improve the welfare of the most at risk groups, there is insufficient data to suggest that there is a positive trend towards the achievement of this goal. There continues to be considerable income inequality. The reality as shown for Trinidad and Tobago is that the country is far behind in achieving MDG 1, given its strong economic performance. The poverty reduction target could however be achieved provided that the requisite changes in policies were implemented to facilitate a more substantial reduction in the levels of inequalities. These efforts are strengthened by the targets and indicators established by the MDG.

• Improve maternal health
  

There is a crisis in maternal mortality and morbidity characterised by very limited access to services, resulting in women making choices that are detrimental to their health. Although the percentage of deliveries attended by skilled health staff exceeds 95%, according to the latest data available, and women have some control over their fertility having only an average of 1.8 children during her lifetime, at 70 the maternal mortality ratio is still relatively high. More than half these cases of mortality were attributable to unsafe abortions.

For the majority of ‘ordinary’ citizens, the MDGs have not taken root in our consciousness. This is due to a number of factors, which include the medium in which information on the MDGs are present. Given the society’s emphasis on the spoken or oral the messages need to be coded in attractive, culturally relevant and exciting music, interactive activities and literature, in order to impact the awareness of the people. Secondly, the messenger must be credible, using public figures who capture the respect and interest of the population at large. Additionally, the timeliness of the message must be complemented with programmes and strategies which target the improvement in the well-being and survival initiatives of the focus groups.

Trinidad and Tobago has traditionally had a high level of civil society advocacy. The MDGs, and the Millennium Declaration with its development agenda provides an opportunity for more focussed engagement. NGOs have sought to engage the government in dialogue with the aim of participating in decision making, and have advocated that their active participation in decision-making is a key component of an effective state response. Thus, Civil Society Organisations (CSOs) must commit to sustain their actions to ensure adequate representation of the voices of ‘ordinary’ citizens on the issues affecting the lives and livelihood in areas such as, service delivery, mobilising resources, research and innovation, human resource development, public information and education, lobbying and advocacy.

Since there has been no attempt by governments to link the MDGs with citizens’ real lives, there is just not enough awareness on the importance of these targets to development. In fact, the lack of general public engagement on the MDGs throughout the region has been quite marked. This is also linked to the weak institutional capacity of existing government agencies responsible for achieving these goals and sustaining the advances. This provides a unique opportunity for CSO engagement, to not only act as advocates but to monitor government’s progress.

Civil Society participation in the process of achieving the goals is high as there is significant representation throughout the process on each Multi-sectoral Committee. Additionally there have been examples of active partnership particularly on the issues of gender, HIV/AIDS and the environment. In the former case, CSOs have been collaborators, supporting the work of the state mechanisms to fulfil its MDG, as well as international commitments, providing expertise and skills. CSOs have also challenged the state through lobbying and advocacy to better utilise resources and in some cases to ensure these issues were kept on the forefront of the agenda.

In the case of HIV/AIDS, the National Strategic Plan requires the close collaboration of government agencies and CSOs to achieve the goals of reversing the prevalence of the virus and its effects. Consequently, funding is provided in support of the work of NGOs and community groups working to address the scourge of HIV/AIDS.

1.6 ENHANCING THE ROLE OF CIVIL SOCIETY IN DELIVERING THE MDGS

SECTION 2 – HUMAN RESOURCES AND DOMESTIC CAPACITY FOR MEETING THE MDGS: HIV/AIDS

The picture of the impact of HIV/AIDS in the Caribbean is devastating. Approximately 360,000 people in the English-speaking Caribbean are living with HIV/AIDS. The infection rate is estimated to have reached twelve percent in some urban areas, indicating that the prevalence of the disease is generalised. As a region, the Caribbean’s estimated 2% prevalence among adults is second only to that of sub-Saharan Africa, with 8% - that translates to the second highest prevalence of HIV/AIDS in the world. The Joint United Nations Program on AIDS (UNAIDS) has reported that of the 12 countries in the Americas with the highest HIV prevalence, nine are in the Caribbean region – making it the area with the highest prevalence rate in the world and the worst affected region outside of the African continent.

2.1 PREVALENCE OF HIV/AIDS

Trinidad and Tobago (T&T), with a population of only 1.3 million, is ranked 17th in the world, 5th among the English-speaking Caribbean countries and 1st among the larger Caribbean countries, with regards to the incidence of HIV/AIDS. Using the UNAIDS classification, HIV/AIDS in Trinidad and Tobago is generalised. This means that HIV has spread far beyond the sub-populations with high-risk behaviours, which are now heavily infected, and the prevalence among pregnant women is above 1%. Trinidad & Tobago is experiencing an acceleration of its HIV/AIDS epidemic, particularly in the infection rate of women.

Since HIV/AIDS was first diagnosed in Trinidad and Tobago in 1983, over 9,000 cases of HIV have been reported to the National Surveillance Unit. 3,500 of these have been reported cases of AIDS (MOH: 2003). It is estimated that the adult prevalence rate is 3.2%, among persons 15 – 49 [27]. This means that there would be 16,217 HIV positive persons in Trinidad and Tobago. It is also estimated that the HIV prevalence rate among pregnant women is 2.5% in Trinidad and 2.7% in Tobago (NSU/MoH (2000). Based on this date the total could be higher than 17,000 persons actually living with HIV/AIDS [28]. Furthermore, the highest registered cases of HIV positive persons are concentrated in the urbanised hub of the Country, in which is located the capital – Port of Spain - and commercial hub of the country.

Key socio-economic, cultural and institutional issues influencing the spread of HIV/AIDS are: Multiple partnering; Use and abuse of alcohol, drugs and other illegal substances; Increased incidence of violence among males and between men and women; Inconsistent use of condoms among the sexually active population; Other socially deviant and risky behaviour; Gender inequalities among poorer groups; Powerlessness among women to change cultural norms around multiple partners and child rearing; Regional and extra regional migration particularly around the festive seasons; An environment in which homosexuality remains illegal; Discrimination and stigmatisation against PLWHAs; Unemployment among the youth; and Tourism: transactional sex.

Additionally, there is a false sense of security informed by the perception that HIV/AIDS is still largely thought to be a homosexual disease, thus the practice of heterosexual sex, including serial monogamy is perceived as non-risk behaviour. Additionally, according to the Family Planning Association of Trinidad and Tobago the age of sexual initiation is between the ages of 12 to 13 years, compared to the United States of America, which is between 15 to 16 years – with obvious implications for risks of infection due to the likelihood of a high number of sexual partners. This is also reflected in the high incidence of teenage pregnancies.

Further, condom [29] use continues to be low, with many men reporting that they did not like the feel of condoms, and women expressing embarrassment and feelings of disempowerment to negotiate condom use with their partners or controlling their own sexual health. As well, discussions of sex and sexuality remain taboo, often leading to persons continuing to engage in risky sexual practices – particularly at Carnival.

The current situation and development impact of the HIV/AIDS is now recognised as the most pressing development issue facing the country. The Five-Year National HIV/AIDS Strategic Plan (MoH: 2003) outlines an expanded and comprehensive response at the country level. However, it is clear that the strategy requires the commitment and effort of all sectors in society. The role of national government in leading the response is outlined, but its effectiveness will come from a partnership between all public and private sector organisations, civil society and communities.

2.2 ECONOMIC AND SOCIAL COSTS AND IMPLICATIONS FOR THE MDGS

Against the backdrop of evidence that infections are on the rise, the impact of the disease and the challenges it poses remain acute. According to the World Bank the situation in the Caribbean shows that “more new cases of HIV/AIDS were reported in the Caribbean between 1995 and 1998 than had been reported since the beginning of the epidemic in the early 1980’s”. Moreover, current data suggest that the HIV/AIDS epidemic has been moving steadily into younger and younger population groups. Eighty-three per cent of the reported cases were in the age group 15-54 years, and 50 per cent in the group 25-34 years. Since it takes 5 to 10 years for the progression from HIV infection to AIDS, it means that the latter group contracted the infection between the ages of 15 and 24 years.

Within this group, females are particularly vulnerable and are affected four to six times more frequently than their male peers. This epidemic therefore targets young people, particularly young females, and selectively affects the labour force. The situation of these groups is heightened by their lack of ownership and access to resources, the prohibitive cost of antiretroviral drugs, and expenses associated with the necessary lifestyle changes caused by the virus.

This scenario is set to worsen even further as infection rates continue to rise, and where the cycle of poverty, poor health systems and limited resources for prevention and care, fuel the spread of the virus. This also creates a scenario in which scarce State resources are being diverted from otherwise productive pursuits, to areas from which there is no economic return. This therefore presents another major constraint to the pursuit of sustainable development and exacerbates the vulnerabilities of the small island states.

The economic impact of the disease has been estimated by the Health Economics Unit, UWI at US$20M in 1995 and is projected to reach US$80M by 2020, which, at that time, will represent 6 per cent of the Region’s Gross Domestic Product (GDP). This is due to direct (for patient care and support) as well as some indirect costs (from lack of productivity). At the household level, incomes are reduced, savings are eroded to pay for care, and dependency is increased, as a result of both those infected and the orphans left behind. At the community level, the burden is felt as a consequence of increased poverty and declining productivity in all areas of the economy.

HIV/AIDS impacts heavily on human, physical and social capital. The National HIV/AIDS Strategic Plan paints a graphic picture:

1. By the year 2005 the Gross National Product (GDP) of Trinidad and Tobago will be at least 4.2% lower than it would have been in the absence of HIV/AIDS.
2. Employment in key sectors will fall by 20% if the disease is left unchecked.
3. The pool of skilled labour will be reduced 5.2% by 2005.
4. National savings could fall as much as 10.3%.
5. At the household level the economic impact is 30% higher compared with deaths by other diseases, reducing the ability of households to pay for necessities such as food, housing, basic utilities and education.

Additionally, it has been found that of the people living with HIV/AIDS most were unemployed and many had lost their jobs, or had voluntarily left the workplace due to the high level of discrimination and abandonment – exacerbating the economic consequences of the disease. The HIV/AIDS epidemic is seriously undermining the development advances by selectively reducing the workforce through sickness, absence from work, voluntary and forced redundancy, or death.

This also reflects the bi-causal relationship between HIV/AIDS and poverty – in that HIV/AIDS causes poverty through loss of income and increased healthcare and other related expenses. Poverty on the other hand increases vulnerability to the disease through risky sexual behaviour, exposure to abusive and exploitative and abusive relationships, a scenario worsened with the prohibitive cost of medicine.

The age group most affected are 15-49, which is the productive labour force, presenting an alarming scenario for the productivity in the he near future. The current information on the pandemic also draws to our attention the reality that women tend to become infected far younger than men largely as a result of socio-economic, cultural, gender-related risk factors and biological reasons. These factors include early sexual initiation, inadequate access to healthcare, harmful traditional expectations regarding sex roles, and economic dependency on male partners. Recent studies have shown that girls between 15 – 19, are four to five times more likely to become infected than boys at that age. Current estimates show that this ratio can be five to six, with a high of seven to one for females in the 15 – 34 age range.

The pandemic therefore, has further exposed how women’s sexual agency is undermined due to custom as many women are forced into staying in relationships that are abusive and un-rewarding. The power relations between men and women need to be challenged even more in the quest to understand the rapid spread, and how women’s subordination and powerlessness affects the entire society, economically, socially and otherwise.

2.3 REQUIREMENTS FOR COUNTERING CURRENT TRENDS

Recent estimates are that there is an adult prevalence rate of 1 in 100 adults. UNAIDS reports that the spread of HIV/AIDS, in Trinidad and Tobago, is contributed to by the fact that there is low contraceptive (condom) use inspite of more than 90 percent contraceptive knowledge. Additionally, another driving force is the phenomenon of age mixing – i.e. younger women having relationships with older men – resulting in an HIV infection rate that is five times higher in girls than in boys 15 – 19 years old.

Cumulatively, this results in those within the age group 15 to 49 – their most productive years – being substantially at risk for infection and therefore not able to be fully active participants in society, arising from HIV/AIDS infection, and the unavailability or inaccessibility of antiretroviral treatment. Understanding the current trends and status of the epidemic as well as patterns of risks and vulnerability and its effect on the population and potential impact on current and future employees is therefore extremely important for business.

The National Strategic Plan (NSP) for HIV/AIDS in Trinidad and Tobago is the blueprint for the country’s response to the HIV/AIDS pandemic that first emerged in 1983. The Plan outlines the strategies to be implemented over a five-year period. It is based on the findings of the Situation and Response Analysis conducted in 2001 and consultations at both the sectoral and national levels, which provided the basis for the development of the overarching goals and guiding principles.

Overarching Goals

• To reduce the incidence of HIV infections in T&T and
• To mitigate the negative impacts of HIV/AIDS on persons infected and affected in T&T
  

Guiding Principles:

• Inclusion: the strategic response will reflect the voices of all major interest groups in particular PLWHA, youth and women
• Sustainability: the method and supply of financing for the expanded response will be in keeping with the resources required to reduce and eliminate the disease
• Accessibility: there will be continuous monitoring, evaluating and reporting to civil society
• Respect for Human Rights: basic human rights for HIV positive persons will be protected.
  
  

The Ministry Of Health’s (MOH) work plan consists of activities designed to implement the health sector’s “five year national HIV/AIDS strategic plan, 2003-2007.” This strategic response to HIV/AIDS will be implemented through five priority areas with a total of 15 objectives which will be pursued across the priority areas. Multiple strategies are required for the MOH and its partners to accomplish these objectives. The priority areas and distribution of objectives are as follows:

• Prevention,
• Treatment,
• Care and support,
• Advocacy and Human Rights,
• Surveillance and research,
• Programme management, coordination and evaluation.

(Health Quest, quarterly newsletter of MOH, vol 1, 2004)

It is widely accepted that the impact of HIV/AIDS on the life of an individual from the time of diagnosis is often worsened when he or she begins to endure negative social and economic experiences related to the disease. Persons who are known to be HIV positive are frequently the subject of stigmatisation, discrimination and harassment within the community and at work, especially where education about the disease is minimal and misinformation is high. This often results in infected persons being forced to leave their jobs, It is virtually impossible for persons known to be HIV positive to obtain of sustain employment, particularly in small communities such as Trinidad and Tobago where information of their status maybe easily circulated.

One impact of this is a drastic fall in their economic circumstances, often forcing them to accept jobs below their qualifications and experience or to remain unemployed. This loss of income inevitably affects people’s ability to obtain treatment and other necessitiesto care for themselves or their families. Protection of the human rights of persons infected with HIV/AIDS is therefore a critical policy area for governments, firms and the community on the whole.

The stigma associated with HIV/AIDS actually fosters the spread of the disease and is a very real obstacle to both prevention and care, since denial and ignorance perpetuates misinformation and stereotyping. Strategies that specifically challenge this behaviour are therefore critical to ensuring the human rights of each citizen is protected and to curb the tendency to drive the epidemic underground.

Both government and the NGO movement have focussed their programmes on youth, voluntary counselling and testing and access to free condoms. Discrimination is discouraged, although there is no government policy on AIDS in the workplace. Training on specific HIV/AIDS issues is provided for medical professionals, to make possible a higher standard of care for people living with HIV and AIDS.

Prevention programmes target men who have sex with men, youth and pregnant women. NGOs offer services and information and one NGO has just completed a study on commercial sex workers while another has introduced a youth friendly sexual and reproductive health service directly to young people.

In order to reduce the risk of HIV transmission from parent to child, the Ministry of Health introduced a programme in collaboration with the Medical Research Foundation of Trinidad and Tobago. The goal of this programme is to improve the quality of life of infants/children exposed to HIV, by reducing their risk of transmission from mother to child through the use of antiretroviral and other interventions. It is expected that through these programmes all women attending prenatal clinics, HIV exposed infants and their families in Trinidad and Tobago will achieve and maintain optimal health.

Another area of focus for the government has been the tourism sector. Their rationale for the HIV/AIDS education programme for this sector is that in order to maintain a sustainable and stable hospitality industry, we must have a well educated workforce with the goal of preventing HIV infection. In addition, the industry must maintain an environment that supports the continued education of its workforce and the prevention of discrimination against PLWHA.

Public education, access to counselling and testing, prevention programmes, provision of health care and drugs, homes for persons infected and legislation to protect persons living with HIV/AIDS from discrimination have been the response mechanisms implemented in the countries under study in this paper. The national education campaigns have been endorsed by all Ministries and Government agencies, all of which have identified a focal point who lead the implementation of programmes to address the problem.

Further programmes focused on consistent outreach to men, rural communities and women living in poverty in an effort to inform. New legislation and amendments have been spearheaded by human rights departments and the ministries with responsibility for drafting legislation.

CONCLUDING REMARKS

This focus is not only timely for the region, but central to its current development thrust. In general, however, the actions of Government have not been aggressive or demonstrative of the political will necessary to achieve the goals outlined. The results while mixed at best are indeed hopeful – requiring political commitment (and action) and sustained investment of the necessary resources to ensure the goals are achieved. Critically, the issue of gender equality needs to be explored in all of the MDGs, including an analysis of how gender inequality manifests itself in the issues that are central to development.

REFERENCES

http://hdr.undp.org/statistics/data/cty/cty_f_TTO.html

htttp://opm.gov.tt.initiatives/vision2020

http://www.sela.org/public_html/AA2K3/ENG/docs/Coop/Coop-Inter/Di26.htm

http://www.undp.org.tt/press/ - UN System launches Millennium Project Report in Trinidad and Tobago; PORT OF SPAIN, 27 January 2005.

www.vision2020.info.tt

• Regional Report on the Millennium Development Goals in the Caribbean Community, UNDP. September 2004. pg. 29
• UNAIDS Epidemiological Fact Sheets, 2004 Country Updates.
• The Official Summary of The State of the World’s Children 2005
• Social and Economic Framework 2005 – 2007 – Ministry of Finance, October 2004; pg. 16.
• UNAIDS Epidemiological Fact Sheets, 2004 Country Updates.