According to a World Bank report, health must no longer be treated as poor parents. More public investment and an allocation of expenses to improve access to care for all Haitians should be considered.
The report “Better Spending for Better Care: A Look at Health Financing in Haiti” highlights that public per capita health spending is only $ 13 per year, which is below the average of $ 15 per country low income and well below the average of neighboring countries such as the Dominican Republic ($ 180) or Cuba ($ 781). On the other hand, a significant increase in funding for NGOs and the international community followed the earthquake, but this funding is falling significantly, calling into question the sustainability of investments in the sector.
In the context of a succession of emergencies facing the country, more than half of total health expenditure corresponds to curative rather than preventive care. In addition, 38% of total health spending is devoted to the hospital sector, in particular due to the high number of hospitals – far more than in other countries such as Burundi (23%) or Tanzania (26%). However, these hospitals are often not sufficiently equipped for the required level of care and therefore this level of expenditure does not translate into an increase in the provision of services. Hospital treatment costs are much higher than in primary health centers and the country has only 0.3 dispensaries per 10,000 inhabitants, a ratio well below the standard established by the Ministry of Health and Population of Haiti.
“With the decline in international aid, universal health coverage can only be achieved by prioritizing primary health care and expanding access to essential treatment for the poorest,” said Eleonora Cavagnero, Health for Haiti to the World Bank and lead author of the report.
Despite the progress observed in increasing life expectancy and reducing infant and maternal mortality by half between 1990 and 2015, Haiti faces many health challenges: infant and maternal mortality remains four to five times higher than for the entire Latin America and the Caribbean region. Only 68 per cent of children under 24 months of age received the three doses of diphtheria, tetanus and pertussis vaccine, compared to 80 per cent in countries of similar economic status.
“Investments were not made where they were most needed,” said Mary Barton-Dock, World Bank Special Envoy to Haiti. “In these times of heavy budgetary constraints, a results-based funding mechanism is needed to make the health system more efficient and equitable. ”
Increasing public resources for health: Despite health needs, the share of Haiti’s health budget has declined steadily over the last 12 years, falling by 16.6% of the national budget for health. 2004 – a figure above the Latin American and Caribbean region average – to 4.4% of the current national budget. With the sharp decline in donor funding in recent years, the government must urgently plan an increase in public funding for health and better coordination of international aid. The development of special health taxes, such as a tax on tobacco and alcohol, could help mobilize funds in the sector.
Prioritizing primary and preventive health care: This involves redirecting part of the funding towards primary health care, prioritizing and quantifying the current Health Master Plan. Strengthening the delivery of preventive and primary health care services would contribute to maximizing the reduction of the leading causes of death in Haiti.
Increasing Equitable Access to Quality Care: This requires the mapping of health institutions by reclassifying them to improve their operational capacity and facilitate the implementation of a practical reference network. This reclassification should allow a better distribution of medical equipment and medicines.