National Health Research Agenda | Page 1

National Health Research Agenda

Trinidad and Tobago

March 2024

National Health Research Agenda | Page 2

TABLE OF CONTENTS

AUTHORS 4
ACKNOWLEDGMENTS 5
BACKGROUND 6
OBJECTIVE 8
METHODS 9
FINDINGS 10
RESEARCH AGENDA 17
1. Regulation, Leadership and Governance 18
2. Human Resources 19
3. Digitalisation of the Health Sector 20
4. Prevention, Care and Treatment of Non-Communicable Diseases 21
5. Prevention, Care and Treatment of Communicable Diseases 23
6. Mental Health and Wellness 24
7. Maternal and Child Health 25
8. Healthy Ageing 27
9. Health Emergencies 28
10. Diversification and Medical Tourism 29
NEXT STEPS 31
REFERENCES 32

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AUTHORS
• Caribbean Centre for Health Systems Research and Development, The University of
the West Indies
• Research Sub-Committee, Senior Joint Planning Committee

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CONTRIBUTORS

• Ministry of Health, Trinidad and Tobago

• Regional Health Authorities
• Faculty of Medical Sciences, The University of the West Indies
• University of Trinidad and Tobago
• University of the Southern Caribbean
• Trinidad and Tobago Association of Nutritionists and Dietitians
• Trinidad and Tobago Medical Association
• Trinidad and Tobago National Nursing Association
• Trinidad and Tobago Association of Psychologists
• The Diabetes Association of Trinidad and Tobago
• Mamatoto Resource and Birth Centre
• National AIDS Coordinating Committee
• Pan American Health Organization

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BACKGROUND

Research plays a pivotal role when developing effective health policies and improving practice in
clinical care, public health and at the level of the health system (1). Research evidence helps
decide what health services and programmes are needed; how to deliver the required services;
the financial and governance arrangements needed to support and sustain service delivery; as
well as how to implement change – implementation considerations (2). Ultimately, an evidence-
informed approach to health systems challenges including healthcare delivery can lead to an
improvement in the effectiveness, efficiency, and equity of health systems, as well as improved
accountability and transparency (1).

However, in developing countries, health policies, programmes and healthcare interventions are
often not well-informed by research evidence. Consequently, (i) health services and programmes
fail to reach those most in need; (ii) health indicators are often off-track while countries struggle
to achieve developmental targets and goals; and (iii) health systems are inefficient, ineffective,
and inequitable (2). It is estimated that as much as 85% of research is wasted1 and one critical
reason for this waste is the failure to align research to the needs of policymakers, clinicians, and
patients, that is, the needs of the end-users of research are ignored (3,4). Other reasons for the
limited use of research in policy/practice (or the research to policy/practice gap) include the: (i)
ineffective communication of research findings to end-users in a format that is user-friendly; (ii)

1
Fails to advance scientific understanding or provide a social return on the resources invested.

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unavailability of research evidence when needed by end-users; (iii) lack of a mechanism to prompt
end-users to utilise research evidence in decision-making (i.e., the institutionalisation of
evidence); and (iv) lack of forums where challenges can be discussed with end-users and
researchers. Strategies that can be used to remove these barriers include engaging the users of
research evidence when setting research priorities and developing research agendas, and in the
co-production of research, while simultaneously promoting and building capacity to find, appraise
and utilise research evidence in decision-making processes.

The identification of research priorities (research agenda) for health and the coordination of
adherence to them have also been recognised as crucial components of the stewardship attribute
of a well-functioning National Health Research System (NHRS) (5). Research priorities are
essential to guide the production of research that can provide the evidence needed to: (i)
contribute to the strengthening of health systems, (ii) guide research expenditure, (iii) facilitate
the achievement of developmental goals, and (iv) ultimately improve health equity and outcomes
(6). Other benefits include the promotion of science, technology and innovation for health and the
stimulation of human resource development for research (7).

The Research Sub-Committee of the Cabinet-appointed Senior Joint Planning Committee has
been tasked with the development of a National Health Research Agenda (NHRA), a key step
towards facilitating the generation and utilisation of research evidence in decision-making and
strengthening the country’s national health system.

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OBJECTIVE

To facilitate the production and utilisation of research evidence that is aligned to the Strategic
Pillars and Priority Areas of the Ministry of Health (MOH):

Figure 1: Ministry of Health’s Strategic Priority Pillars and Areas

* Non-Communicable Diseases
** Communicable Diseases

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METHODS

01 SITUATION ANALYSIS
In 2021, a rapid Situation Analysis of the health status, health
care systems and health research system was conducted.
This was updated and aligned to the MOH’s Strategic Pillars
in 2023. Subsequently, a Stakeholder Map was drafted.

02 REVERSE RESEARCH DAY

In 2022, the Caribbean Centre for Health Systems Research
and Development, in collaboration with the MOH, hosted a
Reverse Research Day (RRD) to generate initial research
priorities that will inform the National Health Research
Agenda (NHRA).
This event provided the opportunity for policy actors
(policymakers, health planners, project and programme
managers and civil society) to share their research needs
with research and academic organisations.
> Click here to access the full report.

03 PRIORITISATION
To facilitate stakeholders’ input to ensure that the list of
research topics was inclusive, as well as to rate and rank the
topics, two surveys were conducted.
The Council on Health Research for Development
(COHRED)’s Criteria for Priority Setting – Mini Module was
used to facilitate the rating of topics in terms of: (i)
Relevance, (ii) Appropriateness, (iii) Feasibility, and (iv)
Impact of Outcome.
> Click here to access the manual.

04 VALIDATION & ENDORSEMENT

A Stakeholder Consultation was hosted on February 28,
2024, to present and validate the penultimate draft of the
NHRA. Both qualitative and quantitative data were collected
to assess stakeholders’ feedback on the relevance,
inclusivity, and transparency of the process and on how
relevant, implementable, and complete the resultant lists of
research priorities are.
> Click here to access the meeting report.

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FINDINGS

Snapshot – Situation Analysis of Health Status and Health System

The MOH’s 2021-2025 Health Sector Strategy aligns with the Government’s Recovery Plan 2021-
2025, the National Development Strategy 2016-2030, and key focus areas for the Ministry. The
Strategic Plan outlines pillars and priority areas, emphasising the crucial role of research evidence
generation within each Strategic Priority Area (SPA) to guide decision-making at the Ministry.

1
DEMOGRAPHICS
T&T has a population of 1.4 million (8). The country has a
population density of 272 people per square kilometre (km2) and
a fertility rate of 1.6 live births per woman (9). Males account for
50.2% of the population, while females account for 49.8% (8). Life
expectancy at birth is 76.1 years, while healthy life expectancy is
66.2 years (10).

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2
PREVENTION, CARE AND TREATMENT OF CHRONIC NON-
COMMUNICABLE DISEASES (NCDs)
The total number of deaths for 2016 was 12,100 and NCDs were estimated to
account for 81% of all deaths; with communicable, maternal, perinatal, and
nutritional conditions and injuries accounting for the remaining 19% (11).
Cancer: The highest incidence and mortality rates observed for cancers
related to women (namely, breast, cervical, and uterine cancers); and
prostate, lung, and colorectal cancers among men, revealed average
incidence rates were highest in areas covered by the TRHA (188 per 100,000),
while average mortality rates were highest in areas covered by the NWRHA
(108 per 100,000) (12).
Hypertension: Between 2008 and 2011, two studies were completed which
conveyed that 26-30% of the participants were hypertensive (13).
Diabetes: The Ministry of Health (MOH) estimates that 14.5% of the
population has diabetes and 88-90% of patients have Type 2 diabetes. In T&T,
diabetes is a leading cause of blindness (14).
Cardiovascular Disease (CVD): CVD accounts for approximately one-third
(32.6%) of all NCD-related deaths (15).

3
MATERNAL AND CHILD HEALTH
The maternal mortality rate dropped from 65 per 100,000
live births in 2015 to under 30 per 100,000 between 2017
and 2019. The neonatal mortality rate has reduced from
12 per 1,000 live births in 2015 to a high of 7 per 1,000 live
births in 2019 (16). The child mortality rate (deaths per
1,000 live births) for 2019 was 15.5 in children under 5
years and 13.2 in children under 1 year old (17).

4
MENTAL HEALTH AND WELLBEING
T&T has the third highest prevalence of mental illness (schizophrenia, mood
disorders, mental and behavioural disorders, and substance abuse) in the
Caribbean (18). Depression constitutes a burden of disease of 13.2% in T&T,
contributing to 3.35% of Disability-Adjusted Life-Years (DALYs) in the region.
It represents the highest proportion among all sources of total disability. T&T
also has the third highest suicide rate in the Caribbean, with men accounting
for about 82% of all 587 suicides reported between 2015 and 2018 (19). In
2021 from January to August, 86 persons died by suicide. This marked a 9%
(80% to 89%) increase during a similar period in 2020 (20). The occurrence
of dementia in individuals aged 70 to 89 in Trinidad stands at 23.4%,
surpassing estimates from both the 10/66 surveys and consensus predictions
by approximately 1.5 to 3 times (18).

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 5
HEALTHY AGEING
T&T’s projected national number of people with dementia (18,206) is
70-100% higher than most recent estimates of regional consensus
prevalence (21). Dementia in persons with high levels of cardiovascular
risk factors was present in 442 (23.4%) of 1,832 participants and had a
significant association with diabetes and reported stroke (21). In
Trinidad, falls are the most common mechanism of injury in the elderly,
accounting for 71% of injuries (22). Fallen elderly patients often
sustained fractures, with an increased likelihood of injury to the limbs
and head, resulting in hospital admission (22). Injuries are directly
linked to disabilities, for which moderate-to-severe deprivations (needs
denied due to disabilities) exist among older persons in Trinidad; related
to food, healthcare, information, and transportation (23).

6
LEADERSHIP AND GOVERNANCE; REGULATION AND
SYSTEM GOVERNMENT; AND STRATEGIC ALLIANCES
The MOH provides governance and leadership, “policy setting, quality
assurance and regulations, monitoring and evaluation, and public health
services for the population” (13). The MOH contracts the clinical health
care services to the five (5) Regional Health Authorities (RHAs) which
comprise 105 health centres and 8 hospitals. Even though the MOH does
not manage the health facilities, they participate in policy and target setting
and goal development for each RHA. Parallel to the RHA, there are several
governmental departments, statutory boards, and bodies (13).

7
DIGITALISATION OF THE HEALTH SECTOR
The fourth goal of the Vision 2030 National Development Strategy –
The Healthcare System of T&T will be sustainable and modern and
deliver higher standards of healthcare – comprises three underpinnings
which hinge upon the modernisation of the health system, through the
implementation of Information and Communications Technology (ICT),
which can provide patients and health and administrative teams with
access to relevant information to function (24).

8
MEDICAL TOURISM
The Trinidad and Tobago Coalition of Services Industries (TTCSI) drafted
a National Strategy for Medical Tourism (NSMT) in 2012. The strategy
encompassed four goals: (i) Sector Wide Awareness and Promotion; (ii)
Promotion of Mainstream Medical Tourism; (iii) Promotion of Medical
Tourism Diaspora; and (iv) Promotion to Vacation Medical Tourists. The
objective of the draft NSMT was “…to increase the number of foreign
patients visiting Trinidad and Tobago by 6,500 contributing an additional
US $37 million to services exports and the economy as a whole after 3
years and then grow at 20% per annum thereafter” (25).

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Identification of Research Priorities –
Reverse Research Day

The country’s 1st Reverse Research Day (RRD) was held on July 18, 2022, at the Hyatt Regency
Hotel, Port of Spain, and 50 persons from relevant organisations (producers and users of
research) were in attendance (see Figure 2). The focal points from the Ministry of Health (MOH)
delivered brief presentations on the Ministry’s Strategic Priority Areas (SPAs). These were
followed by group breakout sessions to identify/discuss:
• the research needs related to the SPAs, and determining the most urgent;
• research that had been completed, was being conducted, or was being planned; and key
researchers at the various organisations;
• potential research questions related to the current research needs within the SPAs; and
• a follow-up plan to complete research proposals for the top priority issues.

More than 90 research priorities, linked to the Ministry of Health’s Strategic Pillars and Priorities,
were identified during these breakout sessions.

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 Figure 2: Breakdown of Reverse Research Day Attendees

Following this, I hope that a

database of collaborative
projects can be set up with the
opportunity for persons to join
research that they are
interested in supporting.
- RRD Participant

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The RRD:

Increased sensitisation/awareness of the MOH’s research needs

Increased awareness of the types of research being conducted at research organisations

Achieved agreement on the highest research priorities

Facilitated the development of draft research questions related to the top research
priorities within each SPA

Eight (8) Working Groups were convened to voluntarily collaborate on the preparations of
research proposals.
Click here to access the full RRD Meeting Report.

Prioritisation of Research Topics

Online surveys were used to get wider stakeholder input on the prioritisation process. The Tobago
House of Assembly, Eastern Regional Health Authority, North Central Regional Health Authority,
North West Regional Health Authority,
South West Regional Health Authority,
RELEVANCE
Tobago Regional Health Authority, The
University of the West Indies, University
of Trinidad and Tobago and the
01 To what extent does it address an important
issue in terms of the burden of illness?
To what extent does it address equity and
community concerns/demands?
University of the Southern Caribbean
APPROPRIATENESS
were asked to identify focal points within
their organisations for each SPA. A
survey was shared with the identified
02 To what extent are there ethical or
moral issues?
To what extent is there available
pre-existing data?
focal points, who were required to review
and add additional research priorities FEASIBILITY
that were part of the organisation’s
research agenda, to the initial list
03 To what extent does capacity to
undertake the research exist?
To what extent are the research
generated at the RRD. costs justified?

IMPACT OF OUTCOME
The list was then updated with additional
priority topics from the stakeholders. 04 To what extent will there be
implementation based on findings?
To what extent will it contribute to a
In the second online survey, focal points reduction in the burden and cost to
manage diseases?
were asked to rate each research priority
(using a five-point scale) based on the
Council on Health Research for Figure 3: The Council on Health Research for Development
Development (COHRED)’s “Criteria for (COHRED)’s “Criteria for Research Priority – Mini Module”
Research Priority – Mini Module” (see
Figure 3). The maximum attainable score was 20 while the minimum was 4. The research topics
within each SPA were then ranked using the mean scores.

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Validation and Endorsement – Stakeholder Consultation

The penultimate draft NHRA was shared with stakeholders, and they were invited to a
consultation on February 28, 2024, at the MOH Administrative Headquarters. Thirty-seven
persons from relevant organisations (producers and users of research) were in attendance (see
Figure 4). Data were collected to assess stakeholders’ feedback on the process utilised to develop
the Research Agenda and the resultant lists of research priorities linked to the MOH’s Strategic
Priority Areas.

Presentations were delivered on the importance of developing a NHRA; an overview of the

process used in its development; the MOH’s Strategic Priority Areas; and recommended next
steps based on the international best practices/guidelines.

These were followed by group discussions to provide feedback on:

• the priority-setting process;
• the penultimate draft of the NHRA (including the addition of research priorities that were
omitted/overlooked);
• strategies to promote the NHRA; and
• implementation considerations (barriers to implementation and proposed
counterstrategies).

Participants were also asked to complete an online survey to assess the relevance, inclusiveness,
and transparency of the priority-setting process and how relevant, implementable, and complete
the research priority lists (NHRA) are.

Figure 4: Breakdown of Stakeholder Consultation Attendees

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 RESEARCH AGENDA

The ranked lists of research topics for each SPA are presented in Tables 1 – 10.
Additional research priorities identified during the Stakeholder Consultation are
included at the end of each table.

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 Table 1: Ranked List of Priority Topics for the Strategic Priority Area –
Regulation, Leadership and Governance

Regulation, Leadership
and Governance
Average
Ranked List of Priority Topics
Score

Health Needs Assessment 19

Evaluation of Regional Health Authorities' operation and the alignment to their mandate 19
and international standards

Assessment of the customer (client) needs in relation to regulatory services. 18

Identify the gaps in existing regulatory oversight/control required by the Ministry of Health 17

Assessment of the governance structure and the alignment of the vertical services with 17
national priorities

Transformational leadership in the context of a resilient, agile, and highly responsive 17

public health care sector

Determine whether the Ministry of Health's role and mandate are in alignment with its 17
current functions

Policy reform and business process transformation 16

Assessment of the Ministry of Health regulatory framework in alignment with World 16

Health Organization (WHO)

Review of existing relationships (behaviours) between the different Inspectorates 16

operating under different legislations

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 Table 2: Ranked List of Priority Topics for the Strategic Priority Area –
Human Resources

Human Resources

Average
Ranked List of Priority Topics
Score

Needs Assessment focusing on Human Resource for Health (HRH) capacity, resource 18
allocation and utilisation

Needs Assessment for new health services 18

Assessment of accredited educational institutions for specialised programmes for 18

Nursing, Clinical and Allied staff

Best practices / models that facilitate an integrated approach to strengthen health 17

systems

Public perception of the health institutions 17

Health systems resilience for future pandemics 17

Audit of the services available in the public healthcare systems 17

Assessment of the accreditation of institutions in both public and private health care 16
systems

The impact of strategic plans on health systems strengthening 16

Additional topics received during the stakeholder consultation:

• Health and well-being of health care providers and professionals
• Competing with international demands for staff
• Recruitment process – experience and knowledge/training, succession planning policies
• Assessing competencies

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 Table 3: Ranked List of Priority Topics for the Strategic Priority Area –
Digitalisation of the Health Sector

Digitalisation of the
Health Sector

Average
Ranked List of Priority Topics
Score

Evaluation of Information & Communication Technology (ICT) implementation 19

Security, confidentiality, interpretability, and standardisation in ICT implementation 19

The use of ICT in the management of pandemics, disease control and prevention, and 19
self-management

The use of ICT to track and monitor patients with non-communicable diseases and other 19
diseases/conditions

An assessment of training needs in ICT literacy (basic and advanced, health informatics 19
and data analytics)

The use of ICT in managing the distribution and allocation of health sector resources 19
towards improvement in health outcomes

Cost benefit and cost effectiveness analysis of the ICT implementation in the health sector 18

The use of digitalisation for improved patient experience and outcomes in healthcare. 18

Barriers to and facilitators for telehealth (with a focus on HRH) 18

An assessment of ICT capacity to determine usage: 17

(i) by Regional Health Authority (RHA);
(ii) in public vs. private sector; and
(iii) per service digitalised

The integration of public and private health care systems using ICT 17

An assessment of the availability of ICT hardware for healthcare users 17

Human Resources for Health (HRH) resistance to change related to ICT implementation 17

The level of ICT usage/application within the public health care sector vs. "whole of 16
government"

Perception of healthcare workers on ICT literacy, infrastructure, and implementation 14

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 Table 4: Ranked List of Priority Topics for the Strategic Priority Area –
Prevention, Care and Treatment of Non-Communicable Diseases

Prevention, Care and

Treatment of
Non-Communicable Diseases
Average
Ranked List of Priority Topics
Score

Barriers to treatment and management of NCDs 19

Assessment and streamlining of NCDs care at primary health care facilities 19

Establishment of a National NCDs surveillance system 19

The effect of a healthy lifestyle clinic model employing primary care initiative for NCDs 19
prevention, care, and treatment

Promoting self-care: A behaviour change approach in the prevention, care, and treatment 19
of NCDs

Re-engineering NCDs services in the public health care system 19

Evaluation of the HEARTS algorithm 18

Diabetes monitoring and control: A Clinical Audit 18

Targeted multi-disciplinary and multi-dimensional interventions (addressing social and 17

mental health issues) to treat and manage NCDs patients

Alcohol as a risk factor for NCDs 17

Development of standardised clinical guidelines for Non-Communicable Diseases (NCDs) 17

treatment and management

The effect of structured diabetes education program for persons living with diabetes. A 17
multidisciplinary approach.

Peers as health change agents: The effect/impact/benefit of implementing peer-led 17

prevention, care, and treatment of NCDs programs to tackle NCDs within organisations.

Evaluation of the NCDs Strategic Plan 2017 16

Impact of a comprehensive school nutritional health promotion programme on dietary 16

choices in school age children

The efficacy and effectiveness of medications (i.e., polypharmacy) used to treat and 16
manage NCDs in the public and private health care sectors

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The impact of the sugar sweetened beverages (SSBs) policy on childhood obesity 16

Morbidity and mortality of NCDs pre- and post-COVID-19 15

The effect of Gestational Diabetes Mellitus (GDM) on nutritional status and metabolic 15
outcomes in children

Facilitators and barriers to COVID-19 vaccine uptake in NCDs patients 14

Prevalence of risk factors for NCDs and its effect on quality of life for university employees 13
and students

NCDs and climate change 13

Faculty and students' perspectives on their institutions' health clinic readiness to prevent 12
and treat NCDs among university students and employees

Additional topics received during the stakeholder consultation:

• Prevention and treatment of cancers
• Systemic disease
• Oral health care and periodontal disease
• Genomic Medicine:
o Pharmacogenomics
o Polypharmacy
o Molecular and genetic diagnostic testing to determine cancer subtypes and the
most effective treatments.
• Injury surveillance
• Nutrition analysis available to the public
• Palliative care
• Impact of wellness targeted programmes (e.g. TT Moves)

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 Table 5: Ranked List of Priority Topics for the Strategic Priority Area –
Prevention, Care and Treatment of Communicable Diseases

Prevention, Care and

Treatment of
Communicable Diseases
Average
Ranked List of Priority Topics
Score

Evaluation of the response of the local health system to: detect; assess and report during 18
a public health event (International Health Regulation 2005)

An assessment of the healthcare system to respond to emerging infectious diseases 18

(e.g., Monkey Pox)

Antimicrobial resistance (Methicillin-resistant Staphylococcus aureus (MRSA)) 18

COVID-19 (lessons learnt, vaccine hesitancy and uptake) 17

Guidelines for the prevention and treatment of communicable diseases 17

Surveillance of emerging and re-emerging infectious diseases 17

Prevalence of emerging and re-emerging vector-borne diseases 16

Assessment of the use and impact of the WHO/ Centers for Disease Control (CDC) 16
recommended strategies or guidelines (e.g., Geographic Information Systems
(GIS)surveillance)

Evaluation of the impact of interventions (surveillance, materials, staffing) on the burden 16

of communicable diseases

Human Immunodeficiency Virus (HIV) 16

Standardisation of a laboratory information system (LIS) within the healthcare sector 15

Sexually Transmitted Infections (syphilis) 14

Tuberculosis (TB) 14

Additional topics received during the stakeholder consultation:

• Non COVID-19 vaccine hesitancy
• Prevalence of HIV and other Communicable Diseases among non-nationals

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 Table 6: Ranked List of Priority Topics for the Strategic Priority Area –
Mental Health and Wellness

Mental Health and

Wellness
Average
Ranked List of Priority Topics
Score

National prevalence study and the risk factors for mental health disorders, including children 18
and adolescents

Lived experiences and the resulting mental health challenges and support needs of 18
women/female survivors of Intimate Partner Violence (IPV)

Mental Health and Psychosocial Impacts on health care workers of the COVID-19 pandemic 17

Leading causes of self-harm or non-suicidal self-injury 17

Trauma (childhood trauma) and grief specifically related to dimensions of abuse, violence, 17
natural disasters, and their impact throughout the lifecycle

Substance abuse, including alcohol 17

Availability of support services for postpartum depression 17

Incidence of peripartum depression and psychosis 16

Effects of burnout and stress on the mental health of working and student populations (due 16
to work or academic pressures) and coping mechanisms utilised

Effects and incidence of Domestic abuse in pregnancy 15

Intellectual disabilities 15

Mental health impacts of the COVID-19 pandemic among patients accessing care 15

Prevalence of depression/anxiety in persons who suffer with epilepsy 14

Inpatient admissions associated with the decriminalisation of marijuana 14

The psychosocial impact of the COVID-19 pandemic on the mentally ill population 14

Effects of marijuana on the mental health of persons with epilepsy 14

(Couple) Stress and anxiety in COVID-19 lockdown 14

Students' perceptions of readjustment to the University environment after the resumption of 13

on campus activities after COVID-19 restriction measures were lifted

Relationship between the onset of stress and age 13

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 Table 7: Ranked List of Priority Topics for the Strategic Priority Area –
Maternal and Child Health

Maternal and
Child Health
Average
Ranked List of Priority Topics
Score

Factors to decrease maternal, perinatal and new-born morbidity and mortality 19

Cervical, endometrial, and ovarian cancer 19

Association between staffing levels and health outcomes of mothers and neonates at 19
healthcare facilities

Analysis of "near miss" obstetric cases 18

Obesity among reproductive-aged women 18

Equity and access to maternal and child health services 18

Prevalence, causes and consequences of delays in decision making for caesareans 17

section births

Assessment of obstetric adverse events and recommendations for improvement 17

Incidence of Gestational diabetes mellitus in primary care 17

Neonatal infection in relation to preterm premature rupture of membranes 17

Special healthcare needs in children and adolescents 16

Elimination of mother to child transmission of HIV and syphilis 16

Prematurity and pre-term birth 16

Analgesia in labour 16

Autism and developmental disabilities 16

The effect/impact of Quality Improvement initiatives on postpartum contraceptive 15

counselling for women who experienced high-risk pregnancies

Effects of substance abuse in pregnancy and postpartum 15

Prevention of unintended pregnancy and sexually transmitted infections (STIs) 15

Causes of infant (< 1 year) and child (< 5years) mortality 14

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Outcomes of Induction of labour for women with a Bishop score of less than 4 14

Drug and alcohol use during pregnancy 14

The association between growth and development and obesity in infants and children 13

Environmental exposures associated with reproductive and developmental outcomes 13

Breastfeeding and complementary feeding 13

Prevalence of inherited diseases 13

Social and commercial determinants of maternal health and birth outcomes 13

Reproductive care for girls and women with disabilities 12

Social and commercial determinants of health in childhood 12

COVID-19 in pregnancy: effects on maternal and neonatal outcomes 12

Contraceptive Use Dynamics 10

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 Table 8: Ranked List of Priority Topics for the Strategic Priority Area –
Healthy Ageing

Healthy Ageing

Average
Ranked List of Priority Topics
Score

Planning for retirement 18

Elder abuse and caregiving 18

Mental health and healthy ageing 18

Leadership and ageing 17

Technology and healthy ageing 17

Challenges associated with the 'The Sandwich Generation'* 17

Nutritional needs for healthy ageing 16

Workplace provisions for healthy ageing 16

Work life balance and ageing 16

Financial management and ageing 16

Long-term care of the elderly 15

Effect of Alzheimer's Disease on families and support systems 14

Health management – An appreciation of the ageing process 13

The effects of retirement structures on the health of the ageing population 13

Additional topics received during the stakeholder consultation:

• Menopause

*“…mostly female, mostly middle-aged persons who serve as caregivers for both older and younger family members at once” (26).

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 Table 9: Ranked List of Priority Topics for the Strategic Priority Area –
Health Emergencies

Health Emergencies

Average
Ranked List of Priority Topics
Score

An assessment to determine to level of staff preparedness and resiliency for disasters 17

The use of Geographic Information Systems to improve the disaster operations within the 17
Health Sector of Trinidad and Tobago

Hazard mapping and vulnerability assessments using GIS 17

Infrastructure resiliency measures for hospital and other health facilities 17

Strengthening Regional Health Authority (RHA's) capacity for climate change mitigation 17
and adaptation

A comprehensive disaster risk assessment of the hazards and vulnerabilities (both 16

natural and anthropogenic) that contribute to health emergencies

Early warning systems for health emergencies including preparedness and response 16
systems

Flood mitigation measures that can reduce the loss of operational hours at Health 15
Facilities

The use of renewable energies to improve the operations of the health care facilities 15
while improving patient comfort

Climate Change Mitigation measures to reduce the carbon footprint at RHAs 14

The health impact of climate change and the associated cost 14

Additional topics received during the stakeholder consultation:

• Impact and preparedness – mass casualty training

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 Table 10: Ranked List of Priority Topics for the Strategic Priority Area –
Diversification and Medical Tourism

Diversification and
Medical Tourism
Average
Ranked List of Priority Topics
Score

Readiness of universities and tertiary institutions including Couva Medical and Multi-Training 17
Facility (CMMTF) to provide medical tourism education

Readiness of Tobago for medical tourist post-receipt of health care 17

Accreditation readiness of health care institutions 16

Readiness of public healthcare institutions to provide medical tourism services and 16

procedures

Improvement of public perception of healthcare institutions 16

Assessment and streamlining of medical tourism services in both the public and private 15
sectors in T&T

Case studies of the current medical tourism services, including an assessment of best 15
practices (e.g., Tobago's dialysis service)

Assessment of medical tourism services and procedures offered (regionally) and their 14
associated costs

National Health Research Agenda | Page 29

Other topics received during the stakeholder consultation:
• Impact of the country’s economic status on population health
• Adolescent services/programs
o Sexuality, violence/bullying
o Services available
• Bullying linked to social determinants of health
• Access to care for non-nationals
• Research ethics – approval process, time to approve, methods of approval, quality of
studies submitted

National Health Research Agenda | Page 30

NEXT STEPS

Dissemination
Stakeholders will be requested to disseminate the NHRA to their research teams/staff within their
organisations and networks, including funding agencies. Academic/research institutions will be
encouraged to align the research conducted by staff and students to the research priorities
identified in the NHRA, and that the topics with the highest score are prioritised. Stakeholders will
also be asked to share the NHRA via their websites and on social media.

Implementation, Monitoring and Evaluation and Updates

Implementation, continuous promotion, monitoring and evaluation and revisions to the Research
Agenda will be led by the Research Sub-Committee, Senior Joint Planning Committee.

Relevant indicators will be identified or developed to monitor the uptake and implementation of
the Agenda. The indicators will be reviewed by the stakeholders involved in the development of
the Agenda. The impact of the Agenda on the conduct of essential research should be the subject
of an independent review within five (5) years. The findings will be used to revise the Research
Agenda.

The tentative indicators which can be used to assess the progress or implementation of the NHRA
are:
§ The number of funding agencies utilising the NHRA
§ The number of institutions adopting/implementing the NHRA
§ The percentage of research produced aligned with the NHRA

National Health Research Agenda | Page 31

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