In developing a proposal for the study of the effect of user fees on access to preventive care, a team, comprising researchers and policy-makers, initiated interaction with key policy implementers in the Jamaica's Ministry of Health to ensure that their perspectives were considered at the preliminary stage. There were many pressing events occupying the minds and energies of the implementers, but the team was able to capitalize on existing good relationships to capture attention. In the interviews that followed, agreement was reached on the necessity for the study, its focus and methodology. The process of consultation achieved notable successes and can be regarded as a model for successful research and policy interaction.

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Objective To investigate the feasibility of addressing the public health concerns of tobacco consumption through increased taxation, while preserving or augmenting government revenues in Grenada. Methods Purposive sampling methods were used to ensure data availability and geographical representativeness. Average price per 20-pack of the most-sold brands of cigarettes was calculated using data from three major supermarkets. The World Health Organization's Tax Simulation Model was used, with excise tax rates adjusted to effect 5%, 10%, and 15% consumption decreases. Results A 17% to 117% excise tax increase on the cost, insurance, and freight (CIF) value would achieve a 5% consumption decrease. Total government revenues would grow 8.7% and excise tax revenues would increase 11%. The average excise tax per 20-pack would move from EC$ 3.24 (2014 US$ 1.20) to EC$ 3.80 (US$ 1.41), while the average price per pack would increase to EC$ 9.21 (US$ 3.41) from EC$8.48 (US$ 3.14). In the 10% and 15% consumption reduction scenarios, excise taxes would have to be increased by 33% and 50% (to 133% and 150% of CIF, respectively), pushing the average excise tax per pack to EC$ 4.37 (US$ 1.62) and EC$ 4.90 (US$ 1.81), respectively. Conclusion In Grenada, consumption can be reduced alongside growth in government revenues, making available additional resources for health. This aligns with the literature, which indicates that taxation can be effective in pursuing the public health objective of reduced incidence of smoking-related illnesses via reduced consumption.

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Stakeholders formulating policies on national health insurance (NHI) in the Eastern Caribbean have circled the abstract concept called NHI like the proverbial blind men explaining the elephant. De®nitions of NHI have shifted depending on their perspectives and philosophical leanings, their understanding of the issues, and their degree of in¯uence on the process. Based on NHI feasibility studies, market research, and stakeholder analysis conducted in ®ve countries, this article analyses the policy formulation stage of NHI development in these tiny countries. Given the level of economic development and the existing administrative capacity of the governments, this`phase one' NHI could be a pragmatic ®rst step in introducing a health insurance component into the social security systems of the countries, and gradually reforming other aspects of the health sector. The article is structured around key questions which help to de®ne the positions and relationships of key stakeholders, and then evaluate NHI plans in terms of economic viability, equity, administrative feasibility and eciency, cost containment incentives, and political palatability. These are the elements thatÐin combination with economic and political contextÐwill determine the success or failure of NHI in the Eastern Caribbean. #