COVID-19 Policy Responses for the Caribbean [1]

Governments around the world are in the midst of trying to contain the Coronavirus disease 2019 (COVID-19) outbreak. Governments around the world have taken steps to reduce the rate of infection and morbidity associated with the virus by asking their citizens to refrain from congregating, or from going out, unnecessarily. Many have taken extreme steps including closing their borders and halting social and economic activity to encourage social distancing. This practice of social distancing, as it is now known, is meant to flatten the infection curve thereby reducing the probability and spike of infection, and the possibility of overburdening the healthcare system. Flattening the health pandemic curve is depicted in Figure 1, which shows the number of cases without Public Health Measures or social distancing (red line) and with Public Health Measures or with social distancing (blue line). The latter depicts the notion of flattening the curve.

Social distancing is not meant to eradicate all cases but to keep the amount of infections of the at˗risk population within the capacity of the healthcare system, until a vaccine becomes available, or enough of the population becomes immune to the virus. The Appendix gives a brief epidemiological discussion on social distancing.

It is important to understand that unless a significant amount of the population becomes immune to the virus or that a vaccine is developed soon, the need for social distancing might have to continue for a long time or there could be repeated episodes of viral outbreaks and hence prolonged or repeated episodes of social distancing over the next twelve to eighteen months. The mandate of policy makers at this time must be to permanently flatten the health pandemic curve and to return society to normal activity within the shortest possible time.

However, there will be trade-offs associated with the flattening of the pandemic curve. This note discusses the economic implications of COVID-19 for the Caribbean and the policy response that governments in collaboration with other domestic agencies, such as central banks and private sector chambers of commerce, other regional governments and regional organizations such as The Caribbean Community (CARICOM), The University of the West Indies (UWI) and the Organization of Eastern Caribbean States (OECS) should consider.

The financing requirements to support the economy during the initial phase of the pandemic crisis and then further financing requirements for the recovery will also be discussed. Here the international community including the multilateral financial institutions such as the International Monetary Fund, the World Bank, Inter-American Development Bank and Caribbean Development Bank must play a coordinated and significant role. Bilateral partnerships will also be necessary.

Finally the note discusses an implementation framework that governments in collaboration with all relevant stakeholders could use to deliver on the policy priorities that the COVID-19 crisis currently requires and the inevitable economic recovery and resuscitation plan that will need to be delivered after the health pandemic subsides.

ECONOMIC IMPACT

Enforced social distancing will save lives. Inevitably, with public health measures or social distancing policies that are currently in place, economic activity will decline during this phase of trying to contain the transmission of COVID-19[2]. The economic impacts of social distancing are not restricted to the effects of domestic social distancing, but include the wider global impacts of other countries implementing social distancing policies at the same time. With global social distancing taking place, Caribbean goods and services supply chains will be impacted. We have already begun to see the effects of this on the wider tourism industry, including the airline industry, cruise ship industry, hospitality industry and commodity sectors (the main industries and sectors of Caribbean economies). There will also be spillover effects on the retail and wholesale industries and eventually all other sectors of the economy. The impacts on the financial sector will need to be monitored closely as the percentage of loans that are non-performing could increase and capital requirements could also be strained. Government fiscal accounts will also be stressed as fiscal deficits expand due to a reduction in tax revenues and the necessary expansion of expenditure to fight the health pandemic and provide fiscal support for the economy. Therefore debt levels as a percent of GDP will increase. These macro stresses will lead to higher levels of unemployment and higher levels of poverty and other social deprivations.

Not only are supply chains expected to be compromised, but productivity in countries which practice social distancing will likely be severely undercut as a large swath of the labor force are at home and not fully engaged in productive activity. Even in cases where working from home is an option, the closing of schools means that parents who work from home would have to split their normal working time with parenting duties.

Therefore, both aggregate demand and eventually aggregate supply in the economy will shift inward leading to overall output reduction and a change in the overall price level. Figure 2 shows the likely impact on aggregate demand and aggregate supply in all Caribbean economies. Equilibrium would have initially been at E1 where the original aggregate demand curve (AD1) intersects with the original aggregate supply curve (AS1) and where output would have been Y1. Due to the COVID-19 shock, initially the AD curve shifts inward but as demand drops so too would supply causing the AS curve to also shift inward leading to a consequent fall in output to Y2 and a new lower level of equilibrium at E2, with a likely impact on the overall price level as well and employment.

This means that there would be a natural trade-off between economic activity and the preservation of life and the minimization of infection rates. There could be a sharp contraction of the economy because of social distancing and virus containment. The depth and length of the economic contraction would depend on how long containment must last and how long it would take to keep the virus at bay. The depth and longevity of the economic contraction or recession will also depend on the economic policies that are implemented during the social distancing phase of containment, and the economic stimulus provided after containment. Figure 3 describes how deep and long the economic contraction or recession could be without macroeconomic support measures (red line) and with macroeconomic support measures (blue line and area). Recovery from the containment phase of the virus will therefore depend on the economic support (mainly fiscal but also some monetary) policymakers provide to the economy during this time. The correct economic policy response during social distancing could reduce the depth and cost of the contraction by the orange shaded area in Figure 3.

In Caribbean economies, there is an additional constraint of foreign exchange reserves. Any support for the economy will have to be balanced against the need to maintain enough foreign exchange buffers since a large percentage of what is consumed, including the necessary medical supplies that are necessary to treat with COVID-19, are imported.

The impact on foreign exchange reserves will have to be monitored carefully since this important macroeconomic variable is vital for the proper functioning of Caribbean economies. In fact, sufficient foreign exchange reserves will need to be the anchor or benchmark macroeconomic variable against which any economic support that governments or the monetary authorities attempt to implement during and after the crisis.

Policymakers will have to respond in two phases. The first phase is during the containment period of social distancing, to keep their economies “above water”; and the second phase is after the health pandemic has subsided, to help kick start growth, with a particular focus on managing the demand and supply of foreign exchange reserves.

POLICY RESPONSE TO COVID-19

The correct economic policy response to COVID-19 therefore has two phases. The first phase of support will be during the health containment period of social distancing. Governments must provide “life support” for their economies at this time. During the second phase, after the health epidemic curve has flattened, economies will require strong economic policy stimulus. These two economic policy phases are:

Phase 1: Economic Triage.

Phase 2: Economic Resuscitation and Resilience.

It is my opinion that the phases must be separated and timed appropriately. Timing is essential, since providing the stimulus related to Phase 2 too early would not have the required effect, since no amount of tax cuts or interest rate reductions will mend supply chains or boost stock exchanges, while people are still unable or unwilling to move around, go to work, or to spend except for essential items.

Coordinated monetary policy could reduce interest expense on loans, if it is targeted properly. However, it is only in a few Caribbean countries that monetary policy could have this effect (and it is likely to be minimal); so monetary policy is likely to be less effective in the Caribbean as it would be in more developed economies with large reserves, or world currencies or flexible exchange rates.

During Phase 1, there will be too much uncertainty and a reduction in confidence to expect meaningful results from substantial stimulus. This is why the policy responses should be timed appropriately and in line with the flattening of the health pandemic curve. The focus during phase 1 should be on the preservation of life and prevention of an overburdened health system. On the economic front, the priority should be minimizing the depth and length of the economic contraction and the social fallout, i.e. keeping the economy “above water” or on “life support”, and not necessarily economic stimulus.

The second phase of economic recovery and stimulus comes after the health pandemic subsides. It is at this time that the structural damage to the economy as a result of social distancing can be assessed and when it is possible that some confidence begins to return to the economy.

Therefore, it is not until the health pandemic has fully subsided[3] and the structural damage to the economy has been fully assessed and analyzed can the necessary, coordinated and targeted economic rebuilding exercise and stimulus package be implemented. Figure 4 shows how the policy response should be timed and coordinated over the pandemic period and after the pandemic curve has been flattened.

PHASE 1: ECONOMIC TRIAGE

During the health containment period of the virus (now), policymakers need to support the economy. Many of these Phase 1 policies have been previously articulated. They are repeated here, and some additional policy measures added. An important caveat is that the menu of policy options presented below is not suggested for complete implementation by all countries, considering that countries have varying foreign exchange reserves, fiscal space and debt constraints. There will also have to be a careful balance between the policies that are required to keep the economies afloat and managing the demand and supply for foreign exchange reserves. Countries could consider selecting the options that are most practical to their individual cases and budget.

However, an important aspect during phase 1 is the need for increased expenditure associated with health care. Testing for the COVID-19 virus and infection should be increased considerably. Governments are encouraged to spend significantly on mass testing. The payoff associated with this policy is worthwhile since governments could make the most appropriate policy response, with the most comprehensive health and epidemiological data and analysis that is available[4].

During Phase 1, the supportive policies can be broadly lumped into one of seven main categories: a) Health systems support; b) Social systems support c) Fiscal Prudence; d) Labour market support; e) Private sector support; f) Financial sector support and g) Supply side balance of payment support. All policy recommendations below must be anchored against the need to maintain sufficient foreign exchange reserves.

POLICIES

Health Systems Support

1. Mass testing for the COVID-19 virus to identify the appropriate policy response as the pandemic curve rises and then flattens. Ideally this should be globally coordinated so that the global all-clear can be given.

2. Governments should sufficiently resource hospitals and primary health care facilities with labour and financial resources, which includes strengthening the response capacity of key hospitals — including the preparation of facilities for potentially infected patients — purchase equipment and materials for health professionals, and train nurses and paramedic staff.

3. Governments should provide temporary health insurance coverage, if this is required, or consider paying medical bills associated with the virus[5].

4. Encourage where possible a repurposing or retooling of manufacturing capabilities towards the manufacture of key medical equipment and supplies that are required for the immediate COVID-19 domestic and regional health related response. European and American firms are already doing this[6]. Some Caribbean firms are already using their distilling capabilities to make alcohol for hand sanitizers.

5. Encourage Medical digital services including online and tele consultations, the online and tele filling of prescriptions and remote collection and drop off services for prescriptions.

During this time of social distancing for the entire community and the immense pressures placed on health professionals, psycho-social support will be necessary to ensure that there is not a looming mental health crisis after the pandemic curve has flattened.

Social Systems Support

1. During the first phase governments must ensure that the most vulnerable are protected, including the elderly, children and disabled.

2. Ensure that policies account for gender imbalances so that there are no adverse impacts on gender equality.

3. Domestic violence should be monitored and prevented.

4. The longer social distancing continues there will need to be support for citizen security and prevention of crime.

5. Special consideration should be given to the poor and most vulnerable in society.

6. Accurate data on household status would be necessary at this time to ensure that required interventions and welfare support can be properly targeted to those most in need of assistance[7].

Fiscal and financial Prudence

1. As governments seek to support their economies, many Caribbean governments would have had existing debt and fiscal obligations. In particular the need to roll over existing debt instruments such as bonds and treasuries that were due this year. Governments and creditors would need to collaborate so that there could be a tidy roll over of debt instruments or the provision of new refinancing options.

2. During this unprecedented time, discussions between governments and credit rating agencies would be critical. There could be a new normal re the global credit landscape due to the need for credit forbearance and a possible relaxation of some rules.

Labour Market Support

1. Demand side support is critical at this time. Therefore governments might have to consider direct fiscal actions to support their economies. These actions could support business operations, particularly in the tourism sector, to preserve employment. Similar to actions taken in the wake of the 2008 Great Depression.

2. Governments should be encouraged to support, or guarantee, paid sick leave so that the adverse impact of quarantine on aggregate demand is minimized. Paid sick leave also helps cut the spread of COVID-19, since workers have an incentive for self-quarantine.

3. Governments might also want to consider paying a fixed percentage of employee income up to the median income threshold in every country.

4. Encourage a redirection of labour towards satisfying short term demand needs in new supply chains like online or tele demand and home delivery, medical manufacturing, pharmacies and agriculture.

5. Helicopter drop money to boost short-term demand and avoid households falling into poverty or severe deprivation, i.e. cheques or money for every household or targeted at lower income groups to help maintain minimum income and expenditure levels.

Private Sector Support

1. Firms are likely to suffer a liquidity crunch because of falling demand. Governments should be encouraged to provide temporary tax and wage tax relief as automatic stabilisers. However, this policy must account for possible moral hazard challenges.

2. Governments might also want to encourage financial intermediaries to provide relief or forbearance to borrowers at this time to ease the obvious liquidity crunch that firms are likely to experience. However, this policy must account for possible moral hazard challenges and capital requirements of banks to prevent unnecessary insolvency of financial intermediaries.

3. Loan guarantees for businesses to support their operations during the contraction.

4. Encourage a public-private-partnership approach during this phase of support.

Financial Sector Support

1. Stress test of all financial intermediaries and provide the necessary support (or encourage mergers in the medium term).

2. Guarantee bank capital adequacy requirements (within stress test limits) to help extend credit to customers in cash flow distress.

3. Provide guaranteed lines of credit to banks or access to significant central bank support to help maintain credit from banks to customers, and to protect banks’ capital adequacy ratios.

4. Commercial Insurance policies do not cover pandemics. This might need to be examined so that insurance companies could also assist with the economic triage effort.

5. Thus government support for insurance company balance sheets might be required.

6. Encourage other online services including digital payments. This might include an expansion of fintech sandboxes that have already been implemented in some Caribbean countries like Barbados and Jamaica.

7. Regulators might have to begin discussions about relaxation of some regulatory rules (within prudent limits) to free capital and allow banks to lend more. However, this must be done very carefully to ensure that the financial intermediary remains viable over the long term.

8. Regulators should consider setting up special purpose vehicles (SPVs) to temporarily house non-performing loans. This could be matched by a regulatory guarantee on the SPVs balance sheet. The loans, which are assets of the financial intermediary (FI) and which are transferred to the SPV could be replaced on the FI’s balance sheet by a permanent or temporary matching asset of similar value that is provided by the regulator or government (asset swap). After the crisis subsides and as loans begin to perform, those loans can be transferred back to the originating bank. Transferring these assets to an SPV (asset swap) could free the FIs’ balance sheets to allow them to provide new prudent loan products and assist with the FIs’ longer term sustainability.

Supply Side Balance of Payments Support

1. During this phase of economic support, managing foreign exchange reserves is critical. Thus supply side measures that support import substitution could be very important. Thus, Caribbean governments could seek to coordinate their response to help improve the value of the fiscal multiplier. Beginning the process of deepening the Caribbean single economic space would be useful at this time.

2. Related to point (iv) under Health Systems support, governments should seek to work with the private sector to repurpose some manufacturing capacity towards the manufacture of urgently needed medical supplies and equipment for domestic, regional and international markets at this time. This could be a public-private-partnership arrangement initially so that the correct incentives are put in place to encourage the retooling and repurposing of manufacturing capacity. This initiative could then be sustained over the long term as new industries for the Caribbean.

3. Governments should work with the private sector to implement policies that would boost local production of some goods including food via support for the domestic agriculture sector for example. These import substitution measures should be continued into the second phase of recovery.

4. Governments, Central banks, and the private sector should actively seek to build on the work of the Caribbean Settlement Network to have a true pan-Caribbean settlement system as regional governments attempt to keep their economies afloat and to manage the demand and supply of foreign exchange reserves. Again this initiative should be continued after the first phase of economic triage.

PHASE 2: ECONOMIC RESUSCITATION AND RESILIENCE BUILDING

Caribbean economies are likely to be scarred and left with permanent damage after the worst effects of COVID-19 subside. Business closures during this period may become widespread leading to mass job losses. Those who would be temporarily laid-off during Phase 1, may never be re-employed or fully-employed as they were before the COVID-19 crisis. There are likely to be severe structural scars left in our economies such as reduced tax revenues, loss of human capacity through health related illnesses or death, and a higher natural rate of unemployment. Further, mass closures of small businesses may undo many of the gains made in poverty reduction and gender equality across the Region. Particularly hard-hit will be small entrepreneurs tied to the tourism industry and service workers in restaurants and hotels. These new structural challenges will be layered on top of those that existed before COVID-19, such as: unsustainable debt levels; widening government fiscal deficits; uncompetitiveness; lack of diversification; and the overall vulnerability to exogenous shocks.

Caribbean countries and their governments, therefore, have an opportunity (as much as a responsibility) to “build back better”, to implement structural adjustments that would boost economic resilience particularly to exogenous shocks, such as a global economic shock, a natural event shock, global pandemics like COVID-19, and domestic epidemics. As we consider Phase 2, we must think about it as a “Marshall Plan” for the Caribbean. This Plan would require significant technical assistance support for the necessary policy interventions, and significant financial resources. However, the mantra for our countries must be resilience.

It is also important, as mentioned before, to ensure that foreign exchange reserves are at adequate levels. Therefore as governments seek to resuscitate their economies they must pay particular attention to foreign exchange reserves and therefore supply side measures that seek to improve the balance of payment accounts. Therefore these reforms will include, but not be limited to:

a) Fiscal resilience including building fiscal buffers.

b) Private sector resilience through diversification and ease of doing business improvements.

c) Social resilience through equality of opportunity and equity.

d) Natural hazard and climate change resilience.

e) Institutional resilience and continuity planning for national and regional entities.

f) Regional integration.

g) Adoption of digital transactions including digital payments and E-government.

Within prudential guidelines, governments could seek to find ways to leverage the balance sheets of financial intermediaries to help support the economy. This could include selling public assets, or release equity in assets, to fund fiscal stimulus. Excess liquidity within the financial markets could be released by a “swapping” of assets between the government and financial intermediaries. Although values might not be the best at this time, governments might consider selling a percentage and not the whole of the asset.

Some of these necessary policy interventions are summarised in Figure 5. Much of these policy interventions were discussed in a CDB working paper entitled “A Policy Blueprint for Caribbean economies” which was published in 2018[8].

Resource requirements

To implement these economic resuscitation and resilience building reforms would require significant resources. We require new and innovative financial instruments that incentivizes ex-ante resilience building. There could be a regional coordinated stimulus. As a region we must consider coordinated reforms, whereby the Caribbean can be seen as a single economic space. The necessary factors of a successful single economic space reform programme are well-known through the many CARICOM Single Market and Economy (CSME) discussions. Therefore, a renewed CSME initiative must be considered with the free movement of people and capital as a corner stone. It is during this phase of economic reform, that governments could also reconsider lowering the high taxes on regional travel and trade to help boost productivity and growth. The Caribbean as a region we must be bold at this time[9].

On resources, any reform package of this magnitude will require the input and support of the international multilateral financial community and other multilateral partners[10]. Significant bilateral support will also be needed from major trading and diplomatic partners such as Brazil, Canada, United State of America, China, Mexico, Germany, United Kingdom, India, Kenya, other Commonwealth partners and other partner countries. Of course, this is an unprecedented time with many of these countries also having to deal with their own domestic economic losses from COVID-19, leaving fewer resources available for development assistance. However, while a regional coordinated approach is preferred, so too an approach that draws on and is coordinated with our many existing trade partners and long standing and new diplomatic partnerships should also be encouraged.

In addition to any international development assistance and support, significant financial resources would be required beyond what the international community could provide. A programme that also seeks to leverage domestic Caribbean resources could also be critical. Moreover, if new digital technology platforms are used, the ordinary investor could have the opportunity to invest directly in the rebuilding exercise. This could be an opportunity for governments to democratize investment for domestic and regional development. Furthermore, innovative financing mechanisms should be examined. This should also include blended finance options.

It would assist if the expenditures associated with all of these resources are well coordinated. The Region could consider leveraging resources to issue either national bonds or a regional bond to help raise domestic capital and international capital for the rebuilding exercise and reform programme. Therefore Caribbean countries could consider Debt-mutualisation to assist with the coordinated resilience and rebuilding effort. Debt-mutualisation means leveraging the national sovereign balance sheets of all for the interest of all. Since the economic resuscitation and rebuilding exercise should be coordinated debt mutualisation provides an additional incentive to maintain coordination and to ensure that all Caribbean countries are “rising simultaneously with the tide”. Countries could request assistance from investment banks, multilateral agencies, insurance companies and other partners to help underwrite such an issuance or issuances, and help manage the disbursement of these resources specifically targeted towards the necessary resilience building, the “build back better” economic structural reforms, or the resuscitation and resilience reform programme.

After the pandemic subsides it is an opportunity to turn the Caribbean economic challenges, those previously manifested, those that have been manifested again during this crisis and that have been exacerbated, into investment opportunities. An opportunity to build true resilience, diversified economies and to realize the potential of a truly single Caribbean economic space. This requires a true public-private-partnership approach with international support.

Natural hazard Risk

These policy recommendations are written against the back drop of the ever present threat and risks associated with climate change. For the region, this is manifest most prominently through the annual hurricane season[11] which begins on June 1st. As the region grapples with the effects of COVID-19 it is quite possible that some countries could experience “double jeopardy” this year if there is also a direct hit from a tropical storm or hurricane. Therefore the policy recommendations that have been proposed must be buttressed against the ever present threat of the upcoming and future hurricane seasons and the risk associated with natural events. This reinforces the need to build resilient economies.

Implementation

Implementation will be critical to the success of these recommendations. The Caribbean region does not have a good track record of implementation. The Caribbean needs to be bold with its response to COVID-19. The region therefore needs to avoid “culture eating the resilience strategy for breakfast”. To implement phase 1 and phase 2 of this process will require prioritization, expanded national and regional consultations, roadmaps with key performance indicators (KPIs) and a renewed focus on delivery. There will also need to be frequent communication between our leaders and the population and therefore a new level of accountability.

The eight step methodology of delivery is a useful mechanism that governments could consider for the implementation of their COVID-19 response of economic triage and resuscitation and rebuilding. The methodology was first developed by Sir Michael Barber of the UK and expanded upon by Idris Jala and his team at the Performance Management and Delivery Unit (PEMANDU) of Malaysia[12].

Figure 6 summarizes the steps in “Delivery”. We can leverage the Delivery Unit (DU) model to design and strengthen our institutions and regulations to make them effective and fit for implementation. It is important that priorities are set, by gathering stakeholders in government, business, and the community to develop a detailed National Development Plan; collaborating to determine the Strategic Direction for development; being open to redesigning institutions and infrastructure. Planning labs are then critical to establish detailed implementation plans for the priorities. It is then critical to publish a Roadmap for Delivery with specific objectives and action plans. After the roadmaps are published, the government must host open forums to share the Development Plan with the public and solicit feedback. After feedback has been solicited and incorporated into the Development Plans, there must be a meticulous execution of the Development Plan ensuring that targets are met within stipulated times and at uncompromising quality standards. Setting up a DU to oversee the implementation of the priorities of the Development plan is important. The DU reports directly to the Head of government ideally on a weekly basis, reporting on progress and challenges. The focus must be on implementation and delivery. This is done by setting KPIs for monitoring progress and encouraging accountability. The government must then communicate with their publics about the achievements and challenges associated with implementing the first phase of Economic Triage and then phase two — the Resuscitation and Resilience building programme after the pandemic curve has flattened. Having external validation of project outcomes and achieved targets will also be critical via external audits. DUs should be established at the national level and at the level of CARICOM for regional coordination of policy responses.

SOCIAL DISTANCING

Social distancing is meant to reduce the transmission or reproduction rate (R) of COVID-19. In epidemiology, R measures the amount of people one person with the virus will likely infect. For the seasonal flu, R is 1.4; while for COVID-19, R is between 2 and 3.

To control the pandemic, policymakers need to focus on reducing the R of COVID-19 to below 1. If there was a vaccine for COVID-19, this would mean vaccinating about two thirds of the population. However, since no vaccine would be available for a few months (some estimates are 12–18 months), policymakers will have to increase testing and advise people to self-isolate, or to practice social distancing.

Modelers in the UK have examined data to ascertain how different age groups could transmit the virus. For example, adults aged 20–50 have most of their contact with others at work, so a work from home policy for this age group would be very effective. In contrast, persons over the age of 65 make over half of their contacts at shops, restaurants and leisure centres.

In the absence of detailed points of contact data for each age group in every country, blanket social distancing (including banning large gatherings of people, avoiding unnecessary travel, and a change in behavior) is the best policy at this time of the crisis.

For frequent updates, research and commentary, follow Justin on LinkedIn https://www.linkedin.com/in/justin-ram-79942a2/

See my full interview with Marla Dukharan on these recommendations below:

Footnotes:

[1] This is a private note and opinions expressed in this note are those of the author and not necessarily those of any organisation.

[2] Pierre-Olivier Gourinchas (2020), “Flattening the Pandemic and Recession Curves”.

[3] Subsided at the global level.

[4] It would be ideal if there was global mass testing because of the openness and interconnectedness of our economies to global supply chains. It is important to have a “global all clear” on the pandemic and not only a “domestic all clear”.

[5] This depends on the capacity of the Universal Health systems that some governments already provide.

[6] https://www.theguardian.com/business/2020/mar/21/europes-companies-retool-production-to-fight-coronavirus-fallout

[7] This highlights the needs for frequent surveys of living conditions. Data and statistics are critical at this time.

[8] https://www.caribank.org/publications-and-resources/resource-library/working-papers/policy-blueprint-caribbean-economies

[9] Governments could consider a regional approach to delivery of national systems. In addition, there is a good case for a Regional Statistics Agency, regional procurement of medical supplies and equipment, regional border security (land and sea), and regional implementation of the Digital Agenda.

[10] This could include the IMF, CDB, the World Bank, the Inter˗American Development Bank, European Union, the Association of Caribbean States, the Organisation of American States and Mercosur, to name a few.

[11] Excess rainfall, drought and coral reef bleaching are other climate change manifestations.

[12] M. Barber(2015) “How to Run a Government: So that Citizens Benefit and Taxpayers Don’t Go Crazy”; and http://documents.worldbank.org/curated/en/318041492513503891/Driving-performance-from-the-center-Malaysia-s-experience-with-PEMANDU