PANEL ON HEALTH REPORT

 

The Panel on Health was assigned the task to review the data presented by Mrs. Shirley Coly, Haiti Health Program Officer, United States Agency for International Development (USAID). The Panel makes some recommendations on Haitian American involvement in the Health Care system of Haiti.

 

BACKGROUND

 

In Haiti, 10 health services departments manage and provide care to multiple Community Health Units (CHU) distributed across the whole country: 1.6 physicians, 1.9 nurses, and 0.2 dentists per 10,000 population dispense these health care services.

 

Most published data on the state of Public Health in Haiti concur to depict a very somber picture. The low scores recorded on most health indicators seem to parallel the poor performance of a stagnant economy and a broken educational system. Now, these century-old problems are compounded by the staggering HIV epidemic. Notwithstanding Its dizzying pace in large metropolitan areas, it has been spreading quite rapidly among many rural communities.

 

In Haiti, 40% of the population has no access to health care. The proportion without running water exceeds 60% and 75% in urban and rural communities respectively. It is not surprising that 70% of children with diarrheal illnesses cannot afford oral rehydration solution, Chronic malnutrition affects one third of the childhood population, while the immunization, coverage against commonly preventable infectious diseases is a mere 33%. One in every eight infants will not live his fifth birthday. More than 2/3 of women give birth at home unattended by a trained health care professional. Such a practice partly explains the high maternal mortality rate of 1,000 per 100,000 live births. Despite these catastrophic mortality rates, the population grows at an annual rate of 2.3 percent, due primarily to the fertility rate of 4.8%.

 

One of the major factors that adversely influence these health parameters is the rapid spread of AIDS. HIV has become a leading cause of death, beside diarrheal illnesses, acute respiratory diseases, malaria, and measles. Nationwide surveys have reported an HIV seroprevalence of 10% in urban areas in general and 6% in the countryside. The latest statistics put at more than 300, 000, the number of Haitians living with HIV in 1995 and estimate at 160,000 the number of HIV-related orphans at the turn of the century.

 

Public sector, private organizations, philanthropic missions, and mixed partnership constitute the backbone of the healthcare system. The government allocates 8-10% of its budget to healthcare. However, 90% of that amount includes employee's salaries. Therefore, it depends on external assistance, which could amount to 60 million dollars, to finance its programs.

 

USAID CONTRIBUTION

 

USAID focuses on building a public-private partnership to provide primary maternal and pediatric care within the UCSs located in the department of Grande Anse, the

South, and the North East. In addition, USAID delivers services through non­governmental organizations( NGO) functioning around the country.

 

According to USAID and its 22 NGOs partners, their programs have benefited 2.3 million individuals. They report that in localities where their programs have been implemented, the contraceptive prevalence rate (CPR) is. twice the national average, measles immunization reaches a coverage of 65.5% compared to the national rate of 46%, and oral rehydration solution is available to 66.3% of children with diarrhea. Moreover, in one of these programs where Title 11 Food Aid Resources have been an integrated health intervention, chronic malnutrition declined to 30%.

 

In the fight against AIDS, USAID has adopted a three-prong approach: a) Syndromic, management of STDs, a well known risk factor for HIV transmission b) Promotion of disease prevention and distribution of condoms c) Conservative management of AIDS cases.

 

DISCUSSION

 

The approach toward improving the Health system in Haiti has been 1) To prioritize the different problems 2) Make an objective account of the resources available 3) Establish a timetable for the implementation of a sensible agenda.

 

This approach, which is half century old, has not produced significant results despite some readjustments made along the way in response to temporary political crises and acute problems such as natural disasters or the HIV epidemic.

 

Aside their monetary assistance to the Haitian economy, the Haitian diaspora has not significantly contributed to the Haitian Healthcare system, in spite of vast amount of human resources available. In fact, more Haitian health professionals are practicing outside their country. Some of them hold very important leadership positions in academia, western governmental administrations and international agencies. However, there is no structured program aimed at using their skills and contacts. The most recent special programs spearheaded by the Haitian government rather emphasized the creation of regional linkages between Haiti and other Caribbean countries.

 

We should also underline that the ongoing process of decentralization and the inclusion of some non-traditional sectors in the medical community seem to have produced a betterment of a few health indicators. Unfortunately, they fall short of bridging the enormous gaps between the Haitian healthcare system and that of its Caribbean neighbors. Those disparities will not evaporate, even if the Haitian economy were to surpass the record performance of the Dominican Republic in the next five years.

 

Novel approaches that could duplicate some successful initiatives all around the world and would mobilize large sections of the country human resources were mentioned. The list includes the US Peace Corp, The physicians without shoes from China, The Health Youth volunteer Program from Cuba and the Chilean Health system. Initiatives that reportedly have contributed to significantly increase access to Health care in developing countries.

CONCLUSION

 

Members of the panel conclude that the condition of any Haitian healthcare system is dismal, Any significant change that could bring parity with As immediate neighbors would require the infusion of very large amounts of financial and human resources, as well as a novel approach to planning and health management. They acknowledge the negative impact of the AIDS epidemic but they also recognize that preventable communicable diseases in general remain the leading causes of morbidity and mortality in Haiti, thus making clear the role of education in any sensible system.

 

The panel also strongly refutes the current policy of conditioning the American assistance to the political climate. It calls for the establishment of an independent advisory board that would oversee the USAID assistance to Haiti. Such a board shall include civil personalities inside Haiti and Haitian Health experts living in Haiti and abroad.