Medium-term growth prospects of Caribbean countries have weakened in recent years. We examine these trends by providing new estimates of potential GDP growth for the region. Our findings reveal a broad-based decline over time, driven by declining contributions from human capital and total factor productivity. Linking these factors to firm-level data, we identify significant scope for aggregate productivity gains through the efficient reallocation of resources between firms and the removal of firm-level structural obstacles. Addressing issues such as the cost and access to finance, workforce education, tax administration, and business licensing and permits are associated with higher aggregate welfare.