Four countries, one health agenda, what the November 2025 Four-Country Consultation decided in St. Maarten

In late November 2025, the governments of St. Maarten, the Netherlands, Aruba, and Curaçao met in St. Maarten for the sixth Administrative Four-Country Consultation on public health. The conclusions document reads like a practical scorecard, what has been built since the pandemic years, what still has gaps, and what the four governments want their working groups to deliver next.

This was not written as a big vision statement. It is written as a list of systems that have to exist if the next crisis hits, or if everyday public health problems like chronic disease, staff shortages, and mental health capacity keep worsening. Across the text, the consistent message is that cooperation must move away from ad hoc favors and toward shared infrastructure, with clear timelines, assigned leads, and repeat reporting.

A regional public health network is established, but funding after 2027 is a major question

One of the headline achievements is the continuation of the Caribbean Hub for Public Health under its newer name, the Dutch Caribbean Public Health Expertise Network (DuCaPHEN). The network is framed as a shared capacity-building structure, meant to strengthen infectious disease control, pandemic preparedness, information sharing, and surveillance across the islands.

The issue is durability. The document signals that support financing is expected to stop after 2027, and it instructs the official-level four-country consultation, together with DuCaPHEN, to explore in 2026 how funding after 2027 can be organized. It also points to the need for a cooperation agreement to make it easier to share information and data for surveillance and research among the public health services and with the Dutch public health institute.

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Pandemic preparedness is narrowed to what is feasible, then reopened for next steps

The pandemic preparedness track reflects a lesson many governments learned after Covid: you can list ten priorities, but capacity determines what you can actually deliver. A steering group that had been working across multiple themes narrowed the work to two priorities that were judged achievable, legislation and supply security for medical products, starting with medicines. Now that those two streams are well underway, the steering group is asked to meet again and propose what should come next, including whether other themes should be taken up and how continuity should be organized ahead of the 2026 consultation.

On legislation specifically, the document lays out a clear deadline. The CAS countries commit to moving their national approval processes forward so draft pandemic legislation can be submitted to their Councils of Advice by December 31, 2026.

Medicine supply is handled with a time-limited workaround and a push for a permanent fix

A strikingly practical section deals with the supply of certain medicines produced by compounding pharmacies. The document describes a temporary approach, the Netherlands will not enforce certain licensing requirements for three years, starting July 1, 2025, to allow Dutch compounding pharmacies to supply the Caribbean countries without immediate regulatory barriers. The catch is that it is explicitly temporary. The working group is tasked to develop a structural long-term solution within that three-year window and bring a proposal for approval at the 2026 consultation.

Emergency preparedness becomes more formal, including updated evacuation manuals and patient tracking

The conclusions formalize the medical assistance working group under the name Healthcare Emergency Preparedness Kingdom Working Group (HEP). The document confirms that, in principle, countries will accept cross-border medical referrals within the Kingdom for crisis evacuations, with special conditions for highly infectious diseases.

Then it sets deliverables with deadlines. The existing crisis manual on medical pre- and post-evacuation, currently focused on the SSS islands, must be expanded to include the ABC islands and crisis care locations by June 1, 2026. The group is also tasked with developing modular manuals that can be adapted into country-specific manuals, meeting physically or hybrid at least once per year, and maintaining a training and exercise cycle. The document also notes work on a methodology for a victim information system to track evacuated patients and connect them with family, and a longer-term plan for patient distribution across hospitals and institutions.

Mental health law modernization, with a cross-border arrangement while reforms are implemented

Mental health appears as both a legal modernization project and a cooperation project. The document describes work toward aligned legislation on compulsory mental healthcare, replacing outdated frameworks that are not modern human-rights compliant. It also describes an arrangement intended to secure cross-border collaboration and temporary treatment capacity while new laws are implemented, with safeguards for patient rights. The process includes consultation with the Joint Court of Justice, and coordinated advice requests to relevant advisory bodies.

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Prevention shifts toward data systems, including cancer registry and chronic disease surveillance

The prevention section targets non-communicable diseases with a very specific emphasis, systems that can actually measure what is happening. The document speaks to structured registration and coding, standardized reporting, and comparability across islands. It references building elements of a harmonized NCD surveillance system, including mortality data, cancer data, and general practitioner registries, while stressing that medical data exchange must follow privacy and legal requirements.

This section also acknowledges constraints, shortages of public health staff with data skills, the need to train healthcare providers to enter and code data properly, and decisions about ICT systems and financing. Beyond data, the prevention agenda also includes strengthening lifestyle intervention programs, strengthening sexual and reproductive health programs, and developing best practices for “health in all policies,” which requires coordination across ministries.

Workforce planning, education access, and hospital cooperation, with audit requirements

The document addresses the healthcare workforce challenge with a focus on workforce planning methods, education pathways, diploma recognition, and retention of local professionals. It also discusses the Dutch Caribbean Hospital Alliance as a platform that grew out of Covid-era cooperation, with the transfer of remaining funds and a requirement to reserve part of those funds for an independent audit beginning by Q2 2026, with reporting later in 2026.

One notable removal, slavery-legacy public health work is taken off the agenda

One of the shortest but most politically significant decisions is the removal of the agenda item on mitigating public health impacts of the slavery past. The document describes that a working group was formed and an action plan was submitted, but the effort stalled due to uncertainty about financing procedures. The countries agreed to remove the topic from the agenda and dissolve the working group.

All topics are to return to the agenda for the seventh consultation, scheduled for November 2026 in Aruba. Progress reporting is meant to happen through monthly official-level meetings. The document assigns lead countries by theme, including the Netherlands on DuCaPHEN and workforce capacity, St. Maarten on prevention and quality, Curaçao on emergency preparedness and mental health, and Aruba on pandemic preparedness and the hospital alliance.

For St. Maarten, the practical signals to watch are the ones that turn a document into capacity: whether DuCaPHEN financing after 2027 is secured, whether the data-sharing agreement is completed and used, whether draft pandemic legislation reaches the Councils of Advice by the end of 2026, and whether the expanded evacuation manuals and patient tracking systems are actually implemented and exercised, not just written.

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