Port of Spain, Trinidad and Tobago. September 2026. The Caribbean Public Health Agency (CARPHA), in collaboration with the Ministry of Health and Human Services of the Turks and Caicos Islands (TCI), advanced implementation of the Regional Integrated Early Warning and Response Surveillance System (RIEWSS) during an intensive four-day technical mission held in TCI from September 7-10, 2026.
The mission strengthened TCI's national surveillance architecture and its connection to CARPHA's innovative, Caribbean tailored and CARICOM Council of Health and Social Development (COHSOD) approved RIEWSS digital surveillance platform. It focused on translating national surveillance priorities into practical public health action, including strengthening syndromic surveillance, improving data exchange between systems, enhancing laboratory and environmental health surveillance, expanding vessel surveillance, and reinforcing preparedness and response arrangements.
"This mission is about strengthening preparedness and ensuring that information moves rapidly from detection to decision-making and response," noted Dr. Lisa Indar, Executive Director of CARPHA. "Through RIEWSS, we are building a Caribbean-tailored approach that connects surveillance, laboratory, environmental and other critical information so that our Member States can identify threats earlier and act faster. The progress made with the Turks and Caicos Islands demonstrates what can be achieved when national commitment is matched by strong regional cooperation."
The interconnected nature of the Caribbean makes strong national surveillance systems an essential part of regional health security. RIEWSS brings together information from multiple surveillance systems to support earlier detection, timely alerts and evidence-informed public health action. These include syndromic and laboratory surveillance, antimicrobial resistance, visitor-based tourism and health, mass gatherings, environmental health, vector-borne and foodborne diseases, and other emerging public health threats. There was the successful issue of tiered user access to national authorised users of the RIEWSS live data platform for TCI.
During the mission, CARPHA and TCI technical teams reviewed existing surveillance and reporting processes and identified opportunities towards more integrated digital reporting.
Technical sessions addressed the optimisation and national hosting of key CARPHA end capture DHIS2 single domain surveillance systems; the SENAITE Laboratory Information Management System; dataflow mapping and interoperability; environmental health surveillance; water quality and pesticide monitoring; and the Caribbean Vessel Surveillance System.
A central component of the mission was CARPHA's Tingua Tabletop Simulation Exercise, which used scenarios relevant to TCI to test priority early warning and response processes. Participants from surveillance, clinical services, laboratories, environmental health, emergency preparedness, health promotion, animal health and other sectors worked through evolving public health situations to assess decision-making, information-sharing, escalation arrangements and operational coordination. The exercise identified bottlenecks and enabling factors and highlighted practical opportunities to strengthen reporting and response pathways.
Dr. Horace Cox, Director of Surveillance, Disease Prevention and Control at CARPHA, underscored the importance of ensuring that surveillance information leads to timely action. "Effective early warning depends not only on having data, but on ensuring that the right information reaches the right people quickly enough for action to be taken. The Tingua exercise allowed us to test that entire chain - from detection and notification to verification, decision-making and response - under realistic conditions. The lessons identified will help TCI further strengthen coordination across surveillance, laboratory, environmental health and emergency response functions, while improving the speed and effectiveness of its response to future public health threats."
The mission also applied CARPHA's Caribbean Timeliness Metrics to examine the pathway from detection and notification through verification and response. This approach helps countries identify operational delays and improve the speed with which surveillance information is translated into public health action.
The teams also developed a roadmap for the next phase of TCI's surveillance architecture and the expansion to non-Early Warning Surveillance Systems, CARPHA will continue working with the Government of the Turks and Caicos Islands to implement the agreed roadmap, strengthen national surveillance capabilities and further integrate TCI into the Region's early warning and health security architecture.
The initiative forms part of CARPHA's wider Regional Health Security agenda to strengthen preparedness and response across its 26 Member States. CARPHA serves as the CARICOM health lead and regional coordinating agency for public health, supporting Member States in building their capacity to prevent disease and protect the health of Caribbean populations.
CARPHA acknowledges the support of the United States Centers for Disease Control and Prevention, whose partnership has supported this initiative and CARPHA's wider work to strengthen regional health security.
Photo Captions:
Photo Caption: Members of the CARPHA and TCI team at the training
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