Four Years Later: Rebuilding Haiti’s Health System

photo of busy street scene in Port au Prince, HaitiThe January 10th earthquake that devastated Port-au-Prince, Haiti four years ago lasted for only about 35 seconds, and yet had severe impacts on the country’s already-vulnerable health system. Half of the Haitian population lacked access to basic health services prior to the earthquake, and when available, services were often not high quality. After the earthquake, 1.5 million were living in temporary housing without access to medical or social services, and over 300,000 were injured. At the same time there was a sudden and overwhelming demand for services, the health system suffered major losses ‒ medical professionals and students died, and critical infrastructures such as hospitals and health facilities were destroyed. The Ministry of Health (Ministère de la Santé Publique et de la Population or MSPP) building was also in ruins, displacing all ministry staff, who worked out of temporary quarters and tents until 2013.

USAID’s Health Finance and Governance (HFG) project is contributing to the rebuilding of Haiti’s health system through several targeted activities, including strengthening public financial management, improving the management of human resources for health, accrediting health worker training institutions, and developing a health financing strategy. HFG is also supporting the MSPP as it leads its second National Health Accounts (NHA) resource-tracking exercise. The new NHA results will offer the MSPP valuable information about how and where to allocate Haiti’s health resources. The NHA methodology captures past health spending by the country’s public sector, private sector (firms, insurance companies, households, nonprofit organizations), and international partners (NGOs and donors). It also tracks the flow of funds from one part of the health system to another over a defined period of time, usually one year.

The first NHA (2010-11) linked Haiti’s post-earthquake expenditures on health with indicators such as health demands, and allowed the MSPP to evaluate actual expenditures against the Post-Disaster Needs Assessment. With the support of HFG, the MSPP will conduct a second NHA (2011-12) using the new System of Health Accounts (SHA) 2011 methodology, which is similar to the original but has important improvements. The SHA 2011 methodology disaggregates health expenses by disease, provider type, and financing scheme. This critical additional information will enable the MSPP to better understand how resources flow from donor to MSPP to facility and whether the appropriate amount of resources are allocated to programs given the current disease prevalence and the priorities of Haiti’s National Health Strategic Plan. According to the State Department, the U.S. Government has disbursed over $2.9 billion since 2010 to support Haiti. Relief and recovery efforts have focused on the population’s immediate needs as well as rebuilding sustainable systems with positive, long-term effects for the country.

Over the past year, HFG has been working closely with the MSPP to identify cost-effective and collaborative methods of data collection for the NHA, which will allow the unit to conduct future NHAs with little or no external support. HFG and MSPP have partnered with the Ministère de la Planification et de la Coopération Externe to leverage data from their centralized NGO database, and explore how the MSPP can automate the regular collection of health expenditure data from NGOs. In addition, NHA questions have been added to the Living Standards Measurement Survey (LSMS) administered by the World Bank, which will collect primary data from households. The collaborative NHA process underway in Haiti demonstrates the MSPP’s significant leadership in the health sector and its ability to work with the many partners who support its efforts. HFG expects results will be available by Summer 2014. HFG is pleased to be working with Haiti’s Ministry of Health team to help rebuild the health system.    


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