Purpose The purpose of this paper is to explore and assess barriers and opportunities for evidence-based management (EBMgt) and decision-making in healthcare systems of the small island developing states (SIDSs) of English-speaking Caribbean. Design/methodology/approach The study utilized grounded theory to collect and analyze data on experiences and perceptions of 20 senior managers/leaders from seven Ministries of health in the region. It used semi-structured, in-depth interviews comprising open-ended questions. Data analysis comprised open, focused and theoretical coding. Findings EBMgt and decision-making is not a prominent approach taken by top officials of health systems because of internal and external barriers to its use. Indeed the absence of a culture of decision-making based on evidence pervades the public services of Caribbean island states. Notwithstanding, there are opportunities for meaningful application of this management/leadership strategy. Originality/value To the author’s knowledge, this is the first assessment of the application of EBMgt to health systems of SIDSs of the Caribbean. This paper is concerned with the approach to decision-making in health systems across island states and lends support to the use of evidence in decision-making and policy development. It provides useful direction for policy makers, and senior managers/leaders of these systems.

PurposeThe purpose of this paper is to explore effective leadership based on information collected from leaders in the healthcare delivery system within the Caribbean. It assesses leadership challenges and the ability to perform based on balancing limited resources.Design/methodology/approachThe authors used grounded theories as the basis for data gathering and formulating a strategy for thematic analysis. The researchers analyzed the data through identifying, synthesizing and evaluating codes. The sample comprised 20 senior officials from 7 ministries of health, 7 permanent secretaries and 6 chief medical officers across the 12 island states in the Caribbean region.FindingsThe findings are broken down into two main areas: first of these is the competency areas and the second part is the personal characteristics. The first part highlighted the Leader's ability to lead others or projects. The second part assessed the leaders' personality traits and distinguishing qualities that are embodied in the individual leaders.Research limitations/implicationsThe study is exploratory; given that this is the first time that such research has been done within the healthcare sector of the Caribbean region. Because of the chosen research approach, interviewees' comments within the paper may be biased based on their specific situation and exposure.Practical implicationsThe study highlights that there is a need for more training in leadership and other management competencies to assist in the decision-making process within the healthcare section of the public sector.Social implicationsThe study highlights that there is a need for better understanding of the inter-connectivity of the public service culture, global health governance and healthcare delivery. This paper provides a basis to help academics and practitioners think through leadership styles and strategies; plus, identify suitable best practices to lead more effectively in a social care field.Originality/valueThe study assesses the effectiveness of the leadership styles in the healthcare sector within the context of the Caribbean and it contributes by adapting and extending the literature on leadership in the study. Further, the paper contributes to the discourse on the demands on leadership for developing countries.

Over the last decade, small island states of the English-speaking Caribbean have been embarking on health sector reform initiatives in order to strengthen the quality of the delivery of health services. The wave of health sector reform measures has not placed emphasis on the management/leadership of health care delivery systems which tend to be generally weak. This in turn affects the improved delivery of quality services and superior quality health care. Management and leadership are understood as the capacity to guide the health sector’s institutions and to mobilize stakeholders, organizations and social groups. The general idea is that there are a number of challenges that affect health management of the small island developing states (SIDS) and the efficient organization of these dynamic, complex health systems. These challenges are tied to the unique cultural, organizational and political characteristics of island states. In all of this, the competencies and unique roles required of senior managers/leaders in a SIDS setting are called to question. Objective This article provides an overview of the management/leadership of health systems in SIDS of the English- speaking Caribbean region. It highlights the weaknesses and challenges of management and organization of these systems which in turn impact the desired outcome of promotion of quality delivery of health care. It also examines roles of senior health managers/leaders in the economic, social, political and cultural context of SIDS. The article strongly advocates the need for in-depth study of the challenges that bedevil efficient and effective management of health systems in the region as well as the processes that constrain or facilitate the activities of senior health managers. It also highlights the need for an investigation into competencies that health managers/leaders demonstrate and perceive that they need in effectively managing these health care delivery systems. Method I wrote this article based on literature review, experience as minister for health of the Ministry of Health of Saint Lucia—one of the island states of the English-speaking Caribbean—and in-depth, semistructured interviews with senior health managers/leaders across the region.

Objectives. To identify the factors contributing to coronavirus disease 2019 (COVID-19) vaccine hesitancy in Grenada. Methods. A phenomenological study was conducted using semi-structured interviews at vaccination and pop-up testing clinics during a spike in COVID-19 cases on the island. Interview questions were developed using the health belief model related to perceived threat of COVID-19, perceived benefits of and barriers to COVID-19 vaccination, and cues to action. Data were analyzed using a deductive approach to identify themes, categories, and subcategories. Results. Twenty-five interviews were transcribed and coded. In all, 68% of participants were unvaccinated, 12% were partially vaccinated, and 20% were fully vaccinated. Data analysis revealed two main themes: facilitators and barriers. Factors more likely to encourage vaccination (facilitators) included trust in medical advice and vaccine efficacy, social responsibility, and vaccine mandates for travel, employment, and social activities. Factors hindering vaccination (barriers) included: perceived low threat of COVID-19; preference for natural remedies; concerns about contraindications because of underlying health conditions; fear; mistrust of vaccines and related messaging; vaccine accessibility; and the many different information sources. Conclusions. Overcoming vaccine hesitancy is key to combating the detrimental effects of COVID-19 in Grenada. Public health interventions and policies that address barriers and capitalize on facilitators can increase vaccine uptake.

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