• National Association Reports
    Harmonization and Reciprocity in Nutrition and Dietetics Training and Practice in Caribbean Common Market Countries
    2009
    Vol. 16 Issue 1
     
    Country – Caribbean 

    Meeting Requirements for Harmonization and Reciprocity in Nutrition and Dietetics Training and Practice in Caribbean Common Market (CARICOM) Countries

    Nutrition and Dietetics professionals in the Caribbean region have recognized the need for harmonization of titles, competencies, and registration and licensure procedures. This has arisen because of the region’s progress to identify the countries as a single Caribbean space with free movement of professionals. 

    Several preliminary surveys were carried out among the members of the Caribbean Association of Nutritionists and Dietitians (CANDi) in eleven English speaking countries to provide background information for decision making. This culminated in a Harmonization workshop held as a satellite meeting of the 30th Regional conference of the Caribbean Association of Nutritionists and Dietitians (CANDi) in Montego Bay, Jamaica in 2007.

    The activity was sponsored and facilitated by the Caribbean Food and Nutrition Institute (CFNI), the specialized centre on nutrition and dietetics of the Pan American Health Organization (PAHO) in the Caribbean. 


    The objectives of the workshop were: 
    1. To define professional titles and qualifications.
    2. To agree on core competencies for entry-level Nutritionists and Dietitians.
    3. To harmonize the didactic education program and supervised practice at the tertiary level.
    4. To recommend Registration and Licensure procedures.

    The workshop entailed two general presentations on CARICOM’s requirements made by their Program Manager and Nutritionist at the Health Desk, followed by the findings of the chairpersons of four working groups who had reviewed the survey data. 

    Outcomes and decisions of workshop 
    The two existing titles of Nutritionist and Dietitian were retained. A Nutritionist was defined as a professional who manages dietary and nutritional needs related to groups of individuals and populations primarily in public health and community settings. The definition of a Dietitian was a professional who manages the nutrition care process including food service systems in diverse settings. It was felt that the title Nutritionist should not require the M Sc. Degree as stipulated in some countries but should apply also at the Bachelor’s level. 

    A total of 71/70 competencies grouped under nine/eight objectives were agreed on for the Nutritionist and Dietitian respectively. The general consensus was that whether the preference was for working in hospital or community, the dietitian or nutritionist needed to complete a period of supervised practice followed by an examination to qualify as a registered dietitian or nutritionist. 

    The Education and Training group recommended that all tertiary educational programs in the Caribbean should be evaluated by a trained professional to harmonize the content. The available registered nutritionists and dietitians to provide supervised practice could facilitate countries without these professionals. Alternately, Government funding could support coordinated programs, accredited to meet international standards. Since no examination was currently available in the region, an alternative to registration would be continuous assessment at the end of each rotation during the internship using the competencies developed. 

    The process for harmonization of registration and licensure was discussed. There was general agreement that Nutrition and Dietetics professionals should be regulated by their own Council, and not by joint paramedical or allied health councils, as pertains in Jamaica, Barbados and British Virgin Islands. Because of financial constraints however, independent councils may not be feasible so that legal and administrative matters would need to continue under a joint Council. Countries with more than 20 registered members should however seek to have independent technical Boards established as is already done in Trinidad and Tobago.

    Conclusions
    In the plenary discussion a majority agreed that a person with a BSc. in Nutrition and/or Dietetics, Food and Nutrition or equivalent training should be registered as an Entry level Nutritionist. It was cautioned however that these graduates should still have some practicum or supervised practice built into their training and the extent of this should be determined by the committee on training and education.

    To clarify the concern that individual country regulatory Boards would preclude the need for CANDi, the CARICOM Program Manager emphasized that CANDi would have a greater role, if the harmonization was to be effective. CANDi would set the standards for the national boards and determine the criteria for registration, although each country would implement its own licensure system. CANDi should also be responsible for developing and enforcing the Code of Ethics and should interface with the Ministers of Health through the CARICOM Secretariat. 

    Yvonne Davis 
    Immediate Past President, CANDi