Avaliação de sentenças e jurisprudências relacionadas a ações judiciais envolvendo cirurgias plásticas estéticas / Evaluating judgments and decisions related to lawsuits involving aesthetic plastic surgery

Introdução: É consenso no meio jurídico que os resultados referentes às atividades médicas sejam obrigação de meio, e não de resultado. Contudo, há grande discussão quando se trata de procedimentos estéticos. A Resolução nº 1621/2001, do Conselho Federal de Medicina, define que o objetivo do ato médico na cirurgia plástica também constitui obrigação de meio. O estudo avaliou, entre novembro de 2015 a novembro de 2017, 106 casos, para verificar se o entendimento do Judiciário se alinha à Resolução do CFM [Conselho Federal de Medicina]. Foram quantificados o número de processos e a porcentagem dos casos julgados como procedentes ou improcedentes, além de verificar as principais posições doutrinárias e jurisprudenciais que embasaram as sentenças admitidas como procedentes. Foi, ainda, quantificado o número de casos cuja decisão do magistrado foi relacionada com o posicionamento do laudo pericial médico. Métodos: Foi feita busca no banco de sentenças do site do Tribunal de Justiça do Estado de São Paulo (SP), por meio da palavra-chave "Cirurgia Plástica", de todos os processos de indenização relacionados a cirurgias plásticas estéticas. Resultados: Foram sentenciados como improcedentes 61 casos (58%). Foram sentenciados como procedentes 45 casos (42%). Em 96% dos casos (102) a sentença relacionou-se positivamente com a análise pericial. Conclusão: Foram 102 sentenças concordantes aos laudos periciais e apenas quatro casos cuja sentença divergiu do entendimento do laudo. Estes dados mostram a importância crucial da análise pericial para a definição das sentenças judiciais. Analisando todas as sentenças, observou-se que em nenhum caso os juízes levaram em conta a Resolução do CFM [Conselho Federal de Medicina].

Introduction: There is a legal consensus that the results of medical activities represent obligations of means, not results. However, there is ample discussion when it comes to aesthetic procedures. Resolution 1621/2001 of the Federal Council of Medicine also defines the objective of a medical act in plastic surgery as an obligation of means. This study evaluated 106 cases between November 2015 and November 2017 to verify whether the decisions of the Judicial Power agree with the Resolution of the Federal Council of Medicine. The number of lawsuits and the percentage of claims granted or denied were quantified, and the opinions of jurists and courts that supported the claims granted were verified. The number of cases in which the judge's decision was related to the opinion of a medical expert was also quantified. Methods: The authors searched the judgment database located on the website of the Court of Justice of the State of São Paulo (SP) for damage related to aesthetic plastic surgery, using the keyword "Plastic Surgery" for all actions. Results: A total of 61 claims (58%) were denied, and 45 (42%) were granted. In 96% of cases (102) the judgment was positively related to the expert report. Conclusion: There were 102 cases in which the judgment agreed with the expert reports and only four cases in which the judgment did not agree with the reports. These data show the crucial importance of experts' reports in defining judicial judgments. The analyses of all judgments showed that there were no cases in which the judge considered the Resolution of the Federal Council of Medicine.

Notas sobre redes, Estado e políticas públicas / Notes on networks, the State, and public policies / Notas sobre redes, Estado y políticas públicas

Resumo: Esse artigo apresenta sucintamente e problematiza a utilização da análise de redes sociais como método para a investigação de políticas públicas. Amplamente disseminada a partir dos anos 1970, a análise de redes permite o estudo das políticas com a consideração simultânea dos vários atores que influenciam a produção de políticas. A matriz pluralista da literatura de policy networks, entretanto, a distancia das premissas da sociologia relacional e dificulta a utilização da perspectiva para casos como o brasileiro, marcado pela multiplicidade de atores estatais e societais conectados por diversos tipos de vínculo, com destaque para os informais. Essas particularidades podem ser solucionadas com a articulação de categorias desenvolvidas recentemente como tecido relacional do Estado e governança, desde que devidamente integradas à análise. O quadro conceitual resultante representa uma ferramenta poderosa para a compreensão da influência de padrões relacionais sobre a produção de políticas públicas.

Abstract: This article briefly presents and analyzes the use of social network analysis as a method for studying public policies. Widely disseminated since the 1970s, network analysis allows the study of policies with simultaneous consideration for the various stakeholders that influence policymaking. The pluralistic matrix of the policy networks literature and the difference with the premises of relational sociology hinder the use of the approach for cases like Brazil, marked by the multiplicity of state and civil society actors with various types of links, especially informal ones. These specificities can be solved by linking the categories developed recently as the relational fabric for the state and governance, as long as properly integrated into the analysis. The resulting conceptual framework is a powerful tool for understanding the influence of relational patterns on the production of public policies.

Resumen: Este artículo presenta sucintamente y problematiza la utilización del análisis de redes sociales como método para la investigación de políticas públicas. Ampliamente difundido a partir de los años 1970, el análisis de redes permite el estudio de políticas con la consideración simultánea de los varios actores que influencian la producción de políticas. La matriz pluralista de la literatura sobre policy networks, no obstante, la aleja de las premisas de la sociología relacional y dificulta su utilización para casos como el brasileño, marcado por la multiplicidad de actores estatales y societarios interrelacionados por diversos tipos de vínculos, destacando los informales. Estas particularidades se pueden solucionar con la coordinación de categorías desarrolladas recientemente como el tejido relacional del estado y su gobernanza, siempre que estén debidamente integrados en el análisis. El marco conceptual resultante representa una poderosa herramienta para la comprensión de la influencia de patrones relacionales en la generación de políticas públicas.

Communications in public health emergencies

Recent experience with famine and cholera outbreak in Somalia has shown that communication, whether with affected communities, among public health response actors, or with the media, is a critical component of effective response to public health emergencies

Creation of Public Health Cadre in Karnataka State, India.

Background: Public Health is the science and art of promoting Health, preventing diseases and prolonging life through organized efforts of Society. The Government of Karnataka constituted a committee to revive the Public health system in state of Karnataka to provide recommendations for creation of Public health ca-dre. Objectives: To provide recommendations for creation of efficient public health system through creation of public health cadre. Methods: We reviewed several documents for studying the history and current struc-ture of the department regarding creation of public health cadre/department. We conducted 35 brainstorm-ing sessions involving in-depth discussions. We also conducted field visits and administered a pre-designed format for collecting the feedbacks from the officials of different levels. Results: The reviewed documents had a common finding of implementing public health cadre. Our analysis of current human resources in health department indicates that there is shortfall of qualified public health professionals in the department to opt and continue in public health cadre. Among the existing staff, 51% of the respondents wanted to up-date their skills through continued professional education. Our results from the study demonstrated to create a Public health directorate and public health cadre in Karnataka state. Conclusions: We recommend that there can be three levels in Public Health Cadre namely, Taluk level officers, District level officers and State level officers. We recommend time bound promotions of medical officers in accordance with published and updated common seniority list, which is the basis for all service matters.

Fatores de risco e presença de anticorpos para Toxoplasma gondii em cães do litoral do Estado de São Paulo / Risk factors and presence of antibodies to Toxoplasma gondii in dogs from the coast of São Paulo State, Brazil

Toxoplasmosis is caused by the obligate intracellular protozoan parasite Toxoplasma gondii and affects warm-blooded vertebrates, including pets and man. Dogs are epidemio-logically important since they act as sentinels for the infection in humans. The present study aimed to determine the presence of antibodies to T. gondii in 205 serum samples from dogs in Ubatuba, Sao Paulo state, Brazil, through indirect immunofluorescence reaction (IFAT), as well as the risk factors related to toxoplasmosis in the animals such as breed, age, sex, access to outdoors, homemade food ingestion, access to untreated water, and contact with rodents. Toxoplasmosis-positive samples accounted for 52/205 (25.4 percent), with titers ranging from 16 to 256. The serological results presented significant association (P<0.05) with homemade food ingestion (45/118; 38.1 percent; CI95 percent 29.9 percent-47.2 percent) (OR=7.0; CI95 percent 3.0-16.6), and with access to outdoors where those that do not have access to the street were prevalent (37/121; 30.6 percent; CI95 percent 23.1 percent-39.3 percent) (OR=0.5; CI95 percent 0.2-1.0). These results show that toxoplasmosis in this region is related to problems of sanitary education, mainly concerning the appropriate cooking of foods, since most positive animals did not show significant association with the presence of rodents or untreated water consumption but showed, instead association with ingestion of homemade food. Thus, toxoplasmosis is a public health problem in the studied region, and sanitary measures are needed to control the infection due to the strict relationship between man and dog and the presented risk factors

A toxoplasmose é causada por um protozoário parasita intracelular obrigatório, Toxoplasma gondii, e acomete vertebrados homeotérmicos incluindo animais de companhia e o homem. O cão apresenta importância epidemiológica por atuar como sentinela da infecção para o homem. O presente estudo objetivou determinar a ocorrência de anticorpos para T. gondii em 205 amostras de soro de cães do município de Ubatuba, SP, Brasil, pela reação de imunofluorescência indireta (RIFI), assim como os fatores de risco relacionados à infecção nos animais, como raça, idade, sexo, acesso a rua, ingestão de comida caseira, acesso a água não tratada e presença de roedores. 52/205 (25,4 por cento) amostras foram positivas para toxoplasmose, com títulos variando de 16 a 256. Os resultados sorológicos apresentaram associação significativa (P<0,05) com consumo de comida caseira (45/118; 38,1 por cento; IC95 por cento 29,9 por cento-47,2 por cento) (OR=7,0; CI95 por cento 3,0-16,6), e acesso a rua, em que aqueles que não tinham acesso a rua foram prevalentes (37/121; 30,6 por cento; IC95 por cento 23,1 por cento-39,3 por cento) (OR=0,5; CI95 por cento 0,2-1,0). Estes resultados demonstram que a toxoplasmose na região está relacionada com problema de educação sanitária, principalmente quanto ao adequado cozimento dos alimentos, visto que a maioria dos animais positivos não apresentou associação significativa com presença de roedores ou consumo de água não tratada, porém os mesmos permaneciam em casa aos quais fora oferecida comida caseira. Portanto, a toxoplasmose consiste em um problema de saúde pública na região estudada, sendo necessárias medidas sanitárias para o controle da infecção, visto a estreita relação homem-cão e os fatores de risco presentes.

Avaliação da cobertura assistencial de um sistema municipal de saúde / Evaluación de la cobertura asistencial de un sistema municipal de salud / Assessment of the assistance coverage provided by a municipal health system

A avaliação da cobertura assistencial é uma importante ferramenta de gestão do Sistema Único de Saúde no município. Este estudo teve como objetivo avaliar a cobertura assistencial e a produção do Sistema Municipal de Saúde de Alfenas-MG, em 2006, de acordo com a Portaria n° 1101/02, do Ministério da Saúde. Estudo descritivo e exploratório, retrospectivo, de delineamento transversal. Seguiram-se como etapas: a coleta de dados, utilizando-se relatórios de produção através do TabWin e relatórios dos prestadores de serviços relativos ao período de janeiro a dezembro de 2006; a distribuição de atendimentos por nível de complexidade; a tabulação e análise dos dados. Verificou-se superávit tanto na produção de consultas médicas de urgência como especializadas e menor percentual de produção nas consultas médicas básicas. Foi observada a inversão do sistema, a necessidade de adequação dos parâmetros assistenciais e o incremento da cobertura de consultas médicas na atenção básica no município.

The assessment of the assistance coverage is an important management tool of the Brazilian Public Health System on the municipal level. This study aimed at evaluating the assistance coverage and the production of the Municipal Health System of Alfenas, MG, Brazil, in 2006, according to Directive n. 1101/02 of the Health Ministry. This is a descriptive, exploratory, retrospective, and cross-sectional study. It had the following phases: data collection, on the basis of production reports on the TabWin and of service providers reports from January to December, 2006; distribution of health services by level of complexity; data computation and analysis. A surplus in the production of both emergency and specialized medical appointments has shown, and a smaller percentage in the production of basic medical appointments. Three other issues have been observed: the inversion of the system, the need to adequate the assistance parameters, and the increment of the medical appointments in the basic care coverage in the municipality.

La evaluación de la cobertura asistencial es una importante herramienta de gestión del Sistema Único de Salud del municipio. Este estudio tuvo como objetivo evaluar la cobertura y la producción de la asistencia del Sistema de Salud Municipal de Alfenas-MG, Brasil, en 2006, de acuerdo con la Portería n° 1101/02, del Ministerio de la Salud. Estudio descriptivo y exploratorio, retrospectivo, de delineación transversal. Las etapas fueron las siguientes: la colecta de dados, utilizándose informes de producción a través del TabWin e informes de los prestadores de serviços relativos al periodo de enero a diciembre de 2006; la distribución de atendimientos por nivel de complejidad; la tabulación y el análisis de los datos. Se verificó superávit tanto en la producción de consultas médicas de urgencia como especializadas y menor porcentual de producción en las consultas médicas básicas. Fue observada la inversión del sistema, la necesidad de adecuación de los parámetros asistenciales y el incremento de la cobertura de consultas médicas en la atención básica en el municipio.

Imagem-objetivo para a descentralização da vigilância sanitária em nível municipal / A framework for health surveillance decentralization

A descentralização das ações de vigilância sanitária não dispõe de critérios e padrões consensuais para sua avaliação. Objetivando formular e validar uma imagem-objetivo da vigilância sanitária municipal que corresponda à definição de um sistema municipal de vigilância sanitária adequado às necessidades da população, elaborou-se um modelo lógico do qual derivou uma matriz que contém dimensões e critérios para avaliar a gestão e as práticas. A matriz foi submetida a um grupo de especialistas, para validação, mediante conferência de consenso. Dos 54 critérios propostos, 59,3 por cento foram consensuais e 53 (98 por cento) importantes, o que correspondeu a validação da matriz. Considerando a provisoriedade de consensos assim obtidos, o instrumento produzido poderá ser modificado e adaptado. As autoras discutem o potencial da estratégia avaliativa aqui adotada que permite diversas possibilidades de redefinição de critérios e de renovação do consenso.

No consensus has been reached concerning the definition of criteria and standards for evaluating the decentralization of actions by municipal health surveillance systems. With the aim of developing and validating an objective image for municipal health surveillance that would correspond to an appropriate system for the population's health care needs, a logical framework was elaborated, from which a matrix containing dimensions and criteria for management and practices was obtained. The framework was submitted to an expert group for validation at a consensus conference. Of the 54 criteria, there was consensus for 59.3 percent, while 53 items (98 percent) were considered important, thus validating the matrix. In view of the provisory nature of the consensuses, the resulting instrument, which can be used either in its entirety or in part, enables modification and adaptation. The authors discuss the potential of the evaluation strategy adopted here, which allows various possibilities for redefining the criteria and renewing the consensus.

Integrated Diseases Surveillance Project (IDSP) through a consultant's lens.

India has long experienced one of the highest burdens of infectious diseases in the world, fueled by factors including a large population, high poverty levels, poor sanitation, and problems with access to health care and preventive services. It has traditionally been difficult to monitor disease burden and trends in India, even more difficult to detect, diagnose, and control outbreaks until they had become quite large. In an effort to improve the surveillance and response infrastructure in the country, in November 2004 the Integrated Disease Surveillance Project (IDSP) was initiated with funding from the World Bank. Given the surveillance challenges in India, the project seeks to accomplish its goals through, having a small list of priority conditions, many of which are syndrome-based at community and sub center level and easily recognizable at the out patients and inpatients care of facilities at lowest levels of the health care system, a simplified battery of laboratory tests and rapid test kits, and reporting of largely aggregate data rather than individual case reporting. The project also includes activities that are relatively high technology, such as computerization, electronic data transmission, and video conferencing links for communication and training. The project is planned to be implemented all over the country in a phased manner with a stress on 14 focus states for intensive follow-up to demonstrate successful implementation of IDSP. The National Institute of Communicable Diseases chosen to provide national leadership may have to immediately address five issues. First, promote surveillance through major hospitals (both in public and private sector) and active surveillance through health system staff and community, second, build capacity for data collation, analysis, interpretation to recognize warning signal of outbreak, and institute public health action, third, develop a system which allows availability of quality test kits at district and state laboratories and/or culture facilities at identified laboratories and a national training program to build capacities for performing testing and obtaining high quality results, fourth, there must be a process established by which an appropriate quality assurance program can be implemented and fifth, encourage use of IT infrastructure for data transmission, analysis, routine communication (E-mail etc) and videoconferencing for troubleshooting, consultations and epidemiological investigations. These five activities must be addressed at the national level and cannot be left up to individual states/districts.

Homelessness: a hidden public health problem.

Homelessness is a problem, which affects not only the people who are homeless but the whole society. This problem is not well recognized among the public health professionals. This paper attempts to discuss the issues in the context of homelessness starting from the definition used to methodology of estimation of their numbers as well as their health problems and health care needs. There is lack of data on the health problems of homelessness from India. There is no special health or social programmes or services for this subsection of the society. The existing number of shelters is inadequate and as there are multiple barriers, which prevent them to have proper access to the existing health care system. With the changing social and economic scenario, homelessness is likely to increase. We need to recognize homelessness as a public health problem and attempt to target this group for special care in order to promote equity in health system.

Acquaintance with the actuality: community diagnosis programme of Kathmandu Medical College at Gundu village, Bhaktapur, Nepal.

INTRODUCTION: In Nepal, various field programs such as community diagnosis programmes (CDP) have been initiated to make the education of doctors, nurses and dentists more community oriented and relevant and suited to the health care scenario. Community diagnosis refers to the identification and quantification of the health problems in a community and identification of their correlates for the purpose of defining those individuals or groups at risk or those in need of health care. The article presents the main activities of community diagnosis as a core component of community-based education for the medical students at Kathmandu Medical College, Kathmandu, Nepal. METHODOLOGY: A 4 weeks' Community Diagnosis Programme was conducted by MBBS II students (9th Batch) of the Kathmandu Medical College under the supervision of the Department of Community Medicine in November 2006 in the rural community of Gundu VDC (village development committee). The tools used included pre-tested questionnaires, weighing machines, measuring tapes, stethoscopes and sphygmomanometers. After the data collection and compilation, the students presented their findings in oral presentations, accompanied by a written report, including essential recommendations for improving the health status of these communities. RESULTS: The students benefited from the necessary process of integrating clinical skills and a public health approach, so as to enhance their epidemiological thinking and be of greater use to the communities where they will practice. The community also benefited by achievement of behavioral changes leading to healthier lifestyles and increased awareness of health-related matters and their role in quality of life. CONCLUSIONS: CDP is a way to practically demonstrate that the link between a medical college and society is possible. That is, a medical college can serve the community and thus society, with specific activities to improve health and the skills of students who will serve as future health professionals.

Do controle social à gestão participativa: perspectivas pós-soberanas para a participação política no SUS / From the Social Control to the Participative Management: post sovereignty perspectives for political participation in the SUS

Este trabalho parte da hipótese de que discutir a participação política no SUS exige a problematização das opções e concepções que orientam sua definição como controle social, operacionalizado por meio de mecanismos de representação de interesses. Desta forma, a intenção de promover uma reflexão sobre a participação política no SUS é remetida ao cotidiano institucional, como desafio de construção de modos de gestão participativos. A proposta metodológica baseia-se em uma abordagem filosófica, que tem por objetivo delinear os conceitos e dispositivos de gestão propostos no campo da Saúde Coletiva, as inovações teóricas que ofertam ao debate sobre a gestão em saúde, tendo por marcador o tema da política. Nesse sentido, elegemos como perspectiva de análise as rupturas e os planos que constituem este campo, procurando mapear o que essa produção faz emergir como oportunidade de constituição de novas práticas sociais e dispositivos institucionais de gestão. Denominamos matrizes conceituais os dois planos filosóficos que selecionamos para estudo no campo da Saúde Coletiva, a saber, o Planejamento em Saúde e o Modelo Assistencial em Defesa da Vida. Por fim a pesquisa procura dialogar com as produções teóricas analisadas, tendo por referência a definição de política como experimentação, invenção de territórios existenciais, criação de valor inerente às implicações normativas da atividade, o que nos coloca o problema da transformação dos espaços institucionais e a produção das normas que os determinam...

This work is based on the hypothesis that discussing the political participation at the SUS requires problematization of options and concepts that guide its definition as social control, operated by mechanisms of interests’ representation. The promotion of a reflection on thepolitical participation at the SUS is referred to the institutional routine, as a challenge to build participative management modes. The methodological proposal is based on a philosophicalapproach, whose aim is to outline management concepts and devices proposed by Public Health, their theoretical innovations in the debate on healthcare management, marked by thetheme of politics. Conceptual matrixes are the two philosophical plans selected for study in the field of Public Health, i.e., Health Planning and the Assistance Model in Defense of Life. The concept of Politics adopted here is defined not in terms of (formal) equality as opposed to(social) differences, but as co-production of the reality built within the relations between Equality and Difference, as access and use of common goods, in their indefinite and open capacity to create values. Thinking about participation in these terms means to build participations as means of setting rules, and not only controlling the fulfillment and inspection of current rules. So we propose considering management as co-production of healthcare, from the publicization and reticulated articulation of the normative dimension of human activity, what means arguing the concrete production (thus local) of public politics and interventions. Among the main theoretical issues discussed here, we point out the articulation of cooperationnetworks and the construction of knowledge, technical support and devices that allow the production and legitimacy of the Health-value as common good. This perspective explains the implications we want to incorporate to the concept of participative management as a possible government post-authoritative technology...

Program issues in delivering targeted STI services through the public sector in the Greater Mekong region.

This review discusses the delivery of targeted STI services for both female sex workers (FSWs) and other high-risk groups through the public sector in the Greater Mekong region. Vaginal discharge algorithms for the general population are also discussed. High STI rates that justify targeted interventions have been reported recently amongst FSW in Cambodia, Lao PDR and Vietnam. Such interventions need to take into account the different patterns of sex work in the three countries. In Cambodia, there are large numbers of brothel-based FSWs although this pattern is changing as more brothels are closed by the authorities. In Lao PDR, services targeted towards reducing the burden of HIV/STI in FSW/service women are probably best delivered through NGO-led clinics. In Vietnam, commune based district health centers appear to offer better services for FSW than STI clinics. Male clients of FSW are an important group to target, but reaching such a heterogeneous population is difficult. Provision of quality STI drugs to those places where men present with STI symptoms should be a priority. The optimal way to manage STIs in FSWs is still unclear in this region. Clinical and laboratory specialists are keen to promote laboratory tests for STIs but there is an over reliance on direct staining techniques. In areas with high STI prevalences, periodic presumptive treatment could offer an effective option to reduce STI levels in high-risk groups until syndromic management algorithms are evaluated for local use. Social patterns of sex work are changing continually and require close monitoring in the future so that services can be adapted to these changes.

Manejo de las Complicaciones Obstétricas en los Casos de Muerte Materna Presentados en la Provincia de Pichincha, en los Servicios del Ministerio de Salud Pública, en los años 2004-2005 / I manage of the Obstetric Complications in the Presented Cases of Maternal Death in the County of Pichincha, in the Services of the Ministry of Public Health, in the years 2004-2005

Se ha identificado a la mortalidad materna como un problema grave de salud pública en el país.Con este antecedente se realiza una revisión general de mortalidad materna a nivel mundial y se detecta que las altas tasas afectan a laos países en vías de desarrollo.A lo largo de todo el estudio se intenta identificar los factores que más influyen en esta mortalidad y se observa que son múlitiples y diversos, sin embargo, se logra precisar que hay factores económicos, sociales y culturales que repercuten en la salud de las mujeres. Pero aparte de ellos existen elementos importantes como la educación a la comunidad, la capacitación al personal, el marco jurídico y la calidad de los servicios de salud que están incidiendo en las altas tasas de mortalidad materna.Se realiza un estudio de la evolución de esta mortalidad en el país en el transcurso de varias décadas pasadas y se observa que si bien es irregular, la tendencia se proyecta a la baja, sin embargo, sigue siendo en alta en comparación con otros países de América y el Caribe

Desafíos para el Caribe a 10 años de la Conferencia Internacional sobre la Población y el Desarrollo de El Cairo, Egipto / Challenges facing Caribbean countries 10 years after the International Conference on Population and Development in Cairo, Egypt

At the International Conference on Population and Development (ICPD) that was held in Cairo, Egypt, in 1994, participants acknowledged that population, economic growth, and sustainable development are concepts that are closely linked, and important strides were made in terms of increased recognition of sexual and reproductive rights. The Programme of Action ratified at that Conference was adopted as a platform for designing national and international policies in the areas of population and development for a period of twenty years. However, in Latin America and the Caribbean all types of obstacles-financial, institutional, and human-still stand in the way of attaining the goals of the Programme of Action, and some governments have established measures that undermine their people's exercise of sexual and reproductive rights. The Caribbean Subregional Meeting to Assess the Implementation of the Programme of Action of the International Conference on Population and Development 10 Years after its Adoption was held in Port of Spain, Trinidad and Tobago, in November of 2003. At the meeting, which was attended by representatives from 20 Caribbean countries and territories, a call was made for more rational use of available resources and for mobilization of additional funds for developing and implementing population and development programs and policies in the Caribbean. The meeting also saw the approval of the Caribbean Declaration, which lays out the challenges that should serve as the roadmap for taking actions to consolidate the progress achieved so far and come closer to attaining the goals established by the ICPD. In the Declaration, the countries and territories of the Caribbean asserted their commitment to continue legislative reforms at the national level while seeking to enforce these reforms in an effort to ensure implementation of the ICPD's Programme of Action and of the Caribbean Plan of Action for Population and Development that was adopted in 1996 by the Economic Community for Latin America and the Caribbean.