Caribbean health systems are often described by what they lack: scale, specialists, funding, infrastructure.

I left the inaugural KPMG Caribbean Healthcare Summit (“CariHealth”) thinking about a different question: What can small systems do because they are small?

CariHealth brought together leaders from government, health systems, funding institutions, nonprofits, and the private sector representing Caribbean countries and territories. Despite the diversity of Caribbean health systems, many of the same challenges surfaced across the region: workforce constraints, the growing burden of noncommunicable diseases, climate vulnerability, supply-chain dependence, and financing pressures. What I appreciated was that much of the conversations focused on how health systems are responding: leveraging the proximity that comes with small scale, collaborating across borders where greater scale is needed, and developing solutions around the realities of island systems rather than importing models built elsewhere.

In my work, I spend a lot of time helping organizations think through complex problems, engage the people affected by them, and translate ideas into implementable strategies. As someone from the Virgin Islands, hearing those same themes explored in the context of Caribbean health systems made them personal.

A few things are staying with me:

Small scale can create a different kind of access

Putting people at the center of strategy and policy development matters in any context, but one thing that stood out at CariHealth was how the scale of smaller Caribbean systems can create different opportunities for that engagement.  

In smaller Caribbean jurisdictions, the distance between communities and national decision-makers can be remarkably short. One speaker joked about leaders and residents shopping at the same grocery stores. Another shared how, after extensive formal stakeholder engagement, a casual conversation with a stakeholder’s aunt helped secure one of the final “yeses” needed to move an initiative forward.

These stories were a reminder that formal processes matter, but so does trust. Smaller systems may have fewer financial and human resources, but proximity can create opportunities for more direct engagement, shorter feedback loops, and deeply relational approaches to change.

Proximity doesn’t automatically translate into meaningful engagement. It still has to be intentional. One speaker described having 100–200 coffee chats with a wide range of stakeholder including people directly affected by the issue, community members and experts. Those conversations built the relationships and feedback loops the policy would need to be sustainable and have real impact.

This resonated with me because stakeholder engagement is central to my own work. Across sectors and issues, I keep seeing that a good strategy is about understanding people’s experiences, building trust, and creating enough ownership for an idea to work in practice.

Shared scale can strengthen resilience

No individual island needs to solve every challenge or build every capability alone.  

In some cases, regional collaboration can create scale that individual health systems cannot. Pooled pharmaceutical procurement, for example, can aggregate demand and strengthen collective purchasing power rather than requiring each country to approach suppliers as a relatively small market. Similar opportunities exist around workforce development, specialized expertise, research, and other capabilities that may be difficult for smaller systems to build or sustain independently.  

Partnerships beyond the region can extend that capacity further. Direct Relief discussed its work with Caribbean governments and health providers to strengthen disaster preparedness and establish relationships and mechanisms for support before a hurricane or other emergency occurs. When a crisis hits, the goal is not to begin figuring out who can help and how, but to activate partnerships that are already in place.  

Collaboration also requires leaders to be intentional about where shared scale adds value and where local context should drive the approach. Pooled procurement may make sense regionally, for example, while the way a new service is delivered or a policy is implemented may look very different in Barbados, the British Virgin Islands, The Bahamas, or Cayman Islands. Different populations, infrastructure, resources, and health system structures mean that collaboration can create shared capacity without requiring identical approaches.

For smaller health systems, resilience may depend less on having every capability in-house and more on knowing what to build, what to share, and who to build with.

Solutions can be built from within the region

There will always be value in learning from health systems elsewhere. But the answer doesn’t always have to be finding a model developed for a larger system and figuring out how to make it fit. There is also an opportunity to invest in Caribbean innovators, institutions, and partnerships that can develop approaches around our own realities and potentially create models that other small systems can learn from.

FutureHEALTH in Barbados offered one example of what that can look like. Co-funded by IDB Lab and FutureBARBADOS, FutureHEALTH is building an ecosystem around citizen-led health innovation, including initiatives to support early-stage entrepreneurs developing solutions across digital health, medical technology, and health services, and build local capacity.  

Seeing glimpses of the innovations coming out of FutureHEALTH was exciting, but I was even more drawn to the work they're doing to build an enabling environment that allows solutions to emerge and be adopted within the region. For example, FutureHEALTH partnered with the Faculty of Medical Sciences at The University of the West Indies to bring healthcare professionals, academics, and innovators together to map Barbados’ health system and identify where technology-driven solutions could have the greatest impact. That kind of work helps create a shared understanding of the system and the conditions needed for locally developed innovations to move from promising ideas to implementable solutions.   

The questions I'm carrying forward

I left CariHealth with questions I'll bring into my own work. Where does scale matter, and where might being smaller be an advantage? What relationships need to be built before they're urgently needed? What can we build collectively rather than recreate organization by organization, or country by country? And are we designing strategies around the realities of the people who will actually implement them?

Those questions extend well beyond health and beyond the Caribbean. But hearing them explored in and about the region that shaped me made them feel especially tangible. I left optimistic, not because the challenges are small, but because there is already so much expertise, creativity, and connection to build from.  

Caribbean health systems are often defined by what they lack. Maybe the real opportunity is building systems that are defined by what smallness makes possible.

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