Panel on health report
The panel on health was assigned the task to review the data presented by Mrs.
Shirley Coly, Haiti health Officer (United States Agency for International
Development). The panel made 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: 1.2
physicians, 1.9 nurses, 0.2 dentist per 10.000inhabitants dispense these
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. These century-old problems have been 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 at all surprising
that 70% of children with diarrhea cannot afford oral re-hydration solutions.
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 reach his fifth birthday. More
than 2/3 of women give birth at home unattended by a trained health care
professional.
Such a practice 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 two%,
due primarily to a fertility rate of 4.8%.
One of the major factors that
adversely affect these health parameters is the rapid spread of AIDS. HIV has
become a leading cause of death, beside diarrheas, acute respiratory diseases,
malaria and measles. Nationwide surveys have reported an HIV sero-prevalence 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 is devoted to employee¹s salaries.
Therefore health care depends on external assistance, which could amount to 60
millions dollars, to finance its programs. 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 health care 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 5 years. Innovative approaches that could duplicate some successful
initiatives all around the world and would mobilize large sectors of the country
human resources were mentioned. The list includes: The US Peace Corps, The
barefooted physicians 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 concluded that the condition of any Haitian heath care
system is dismal. Any significant change that could bring parity with its
immediate neighbors would require the infusion of very large amounts of
financial and human resources, as well as an innovative approach to planning and
health management. They acknowledge the negative impact of the AIDS epidemics
but they also recognize that preventable communicable diseases in general remain
the leading cause of morbidity and mortality in Haiti, thus making clear the
role of education in any sensible system.
The panel also strongly refuted
the current policy of conditioning American aid to the political climate. It
calls for the establishment of an independent advisory board that would oversee
the ³USAID² assistance to Haiti. Such a board shall include civilian
personalities inside Haiti and Haitian health Experts living in Haiti and
abroad.
EH/RO
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