With a history of relatively poor performance by its health system, Trinidad

and Tobago introduced radical reform under a new Decentralisation Act of

1994, which was intended to be patient-driven, bottom-up, flexible and

close to customers, as well provide effective management to achieve the

goals of the Ministry of Health (MOH). A critical analysis of the reform in

decentralisation and its performance is the subject of this article.

Essentially, we challenge through empirical field research the claims of the

This paper’s central theoretical and empirical thrust is to examine the

processes of racial/ethnic group formation of early first-generation AfroCaribbean1

immigrants and African Americans in New York City in the

early decades of the twentieth century. These processes, generally called

“ethnogenesis”, turn primarily on the dynamics of social identity

boundary construction. Intersecting race with ethnicity, as I do mostly in

this paper, is an attempt, first, to discern the saliency of race and ethnicity

The Caribbean is at the heart of the Americas in many ways. Yet its

historical and contemporary effect on the US, and traffic between the two

is sometimes reduced in magnitude or scope because of a reliance on

demographic data that highlights the small numbers of its diaspora relative

to other racial and ethnic groups in the US. Those small numbers seem to

justify the use of comparative approaches in which a pan-Caribbean

categorisation is used to represent the Anglophone, Francophone, and

A number of theories have been put forward to explain the existence of the

matrifocal family in Jamaica. One of the most widely accepted is that it is

the result of changes wrought by the plantation system. One searches in

vain, however, to uncover any similar attempt to explain the development

of the prestige system of working-class men. Rather than follow the

conventional anthropological approach, which has been to document how

pervasive male peer groups are in the English-speaking Caribbean, I