Status of Situation 2020 (country: Grenada)

Prior to COVID-19 Cabinet approved the composition of the HRH Planning Committee to guide the process. The committee included personnel from the Ministry of Health, Ministry of Finance, Ministry of Social Development, Department of Public Administration and St. George’s University. A draft TOR was developed to guide the committee’s functioning.

COVID-19 Steering Committee/Taskforce with responsibility for demand planning and forecasting in the context of COVID-19 Cabinet appointed a COVID-19 Taskforce which was responsible for advising on all matters related to the country’s response to the pandemic. The Taskforce was multisectoral in its composition. From this committee, the idea of contact tracing teams and the environmental health wardens were developed and then passed on to the Ministry for implementation.

Human Resource Audit of the Ministry of Health and the Human Resources in Health Policy of the Ministry of Health Grenada. The HR needs template received from PAHO was instrumental in helping the Ministry to develop its Hospital COVID-19 Management Plan.

Originally, there was no budget for management of the COVID-19 pandemic, however, EC $2 million dollars was approved by the Grenada Cabinet for reallocation to the Ministry of Health. These funds were diverted from other areas of the national budget for the year under review. Subsequent, the Prime Minister proposed that another EC $10 million dollars would be made available to support the management of the pandemic. Thus, through the National Transformation Fund at total of EC$12M was made available to the Ministry of Health to assist with its response to COVID-19.

A new category of health personnel was hired in the form of 81 environmental health wardens to assist primary healthcare sector. To augment the exiting personnel, the COVID-19 Committee coopted volunteers to assist with contact tracing and worked with environmental health officers and community health nurses in delivering such services in the community. Community health nurses were also engaged in completing rapid testing for screening and nasal swabs for diagnosis. Other health care workers continued their regular duties. Additionally, a team of six persons (4 Nurses and 2 Physician Specialists) from Cuba, were brought in to help with the COVID-19 response.

Human Resource Audit of the Ministry of Health and the Human Resources in Health Policy of the Ministry of Health Grenada. The Strategic Plan for Health 2016-2025 includes as a strategic goal: A cadre of competent, motivated health care workers providing quality health care. Strategic Objectives include: • To achieve equitable distribution, right mix of the right quality and quantity of HRH services. Additionally, in an attempt to institutionalize professional development a Training Unit has been established within the Ministry of Health.

Initially, the persons who were identified as part of team to provide health care services to COVID-19 patients were provided with accommodation/housing to ensure that they were kept separate from their families and to contain and limit the spread of the disease. Similar facilities were extended to the Cuban contingent who were also working with COVID-19 related patients/services. Discussions are ongoing with respect to the payment of an honorarium to the nurses and other frontline health service providers who worked during the time of the state of emergency and who continue to work in high risk situations such as those who perform the swabs on persons entering the country.

A new category of health personnel was hired in the form of 81 environmental health wardens to assist primary healthcare sector. A team of health personnel from Cuba which consisted of 6 nurses with skills in ICU and infectious disease management and 2 doctors, (an internal medicine specialist and an intensivist) were contracted. Nursing students from St. George’s University were coopted to provide services in contact tracing and PCR testing as needed. PAHO assisted the country in the area of surveillance, by facilitating the hiring of a surveillance officer. Three new technicians were added to the staff the laboratory to help deal with the increased need for laboratory services specific to COVID-19.

The environmental health officers and community health nurses delivered FLC services in the community. Community health nurses were also engaged in completing rapid testing for screening and nasal swabs for diagnosis, supported by volunteers. Other health care workers continued their regular duties. Port Health Officers formed a critical part of the COVID response team.

Grenada has established the Grenada Medical and Dental Council which is responsible for registering and licensing all medical practitioners on the island. It is also the accreditation authority for medical institutions/courses of study. Additionally, the Nurses and Midwives Council regulate the standards for the Nursing Profession. Also, the Grenada Allied Council is responsible for the registration and licensing of all allied health professionals as identified in the Allied Health Act. The Council works closely with the Grenada National Accreditation Board to verify the qualifications of persons.

The Public Health Act allowed for the mandatory quarantining of persons. The Act also gives the Chief Medical Officer (CMO) the authority to hire health care workers as needed.

Grenada has an existing bilateral agreement with Cuba through which it is able to access Nurses and Doctors to augment the local workforce (Cuban Brigade). Through this agreement a team of six Cubans were added to the existing team to provide much needed support for Grenada’s response to COVID-19. Prior to COVID-19, there has been a steady exit of nurses who are migrating to United Kingdom. The state of emergency brought on by COVID-19 and the consequent closing of the borders, prevented the migration of nurses from Grenada.

An MOU has been signed between the Government of Grenada through which SGU provides support for the Ministry of Health. Approximately 20 students from SGU’s Nursing Programme provided volunteer services to the Ministry of Health as part of its contact tracing team. SGU provided technical assistance to the Ministry of Health for PCR testing for COVID-19. While the Ministry of Health did not have the capacity to conduct its own PCR testing, SGU provided the support by conducting all PCR tests at its own laboratory. Additionally, SGU facilitated the training for personnel at the hospital laboratory to become competent in PCR testing. CARPHA also facilitated virtual training for the management of COVID in the area of Infection Prevention Control.

Initially there was no formal national training programme for management of the COVID-19. There was intensive training of the health care workers who had volunteered to work with the COVID-19 patients. These persons included 13 doctors and nurses from the public health sector who volunteered to work in the COVID-19 teams and received focused areas of training in the donning and doffing of PPE as well as infection control measures. Subsequent to the initial training, 196 persons across the health sector were trained in these areas as well. Training in Ethics and Confidentiality was facilitated by SGU and conducted with the volunteers and persons identified to conduct contact tracing. PAHO facilitated training in PCR testing for our laboratory technicians.

SGU is accredited by the Grenada Medical and Dental Council.