Haiti Case Study - The Department of Global Health and Social ...

Haitians continued working in the public sector, a significant loss of staff did occur in the
public sector through the hiring of staff by foreign response organizations, a practice referred
to as “poaching” which, combined with emigration of Haitian doctors and nurses, continues to
contribute to a shortage of indigenous health professionals.
50. Communication systems which might ordinarily enable the healthcare system to
coordinate patient triage and transfers were also not functional: landlines were inoperable
(for weeks, ultimately); all three principal cell phone networks were down or overloaded;
internet connections, which would rely on both electricity and a functioning infrastructure,
were inoperable (except for satellite dish-served users who had residual power). 48
51. The PROMESS warehouse fortunately had been restocked in the months before the
earthquake and it sustained little structural damage. However, the roads and
communications to the warehouse were disrupted or damaged. Also, the warehouse was
unprepared to deal with the massive influx of medical aid supplies channelled through it
during the earthquake response.
52. With respect to health system financing, while care was provided without charge for the
first few months after the earthquake, little reform of the health payment arrangements has
taken place since then. The World Bank assumed the role of fiscal agent for the Haitian
government and temporarily took over payroll functions for federal employees. 49 However,
sustained donor funding for direct budget support has been difficult to maintain. Several
unique arrangements to fund the salaries of public sector health employees materialized
including one scheme whereby the American Red Cross temporarily paid the salaries of
Haitian public health sector employees. This process was fraught with administrative and
bureaucratic difficulties. 50
53. The subsequent cholera epidemic did not in itself massively degrade the health
system, but it showed that the health system strengthening following the earthquake had not
reached a stage where the health system could cope with a threat of such magnitude.
54. In order to summarize the changes the disasters' caused to the state of the Haitian
national health system, we used the WHO Health System Building Blocks Framework as
depicted in the following table.
Table 2: Summary of impacts to Haitian national health system
WHO Framework
Component
Service Delivery
(Infrastructure)
Before After
Perhaps the most significant dynamic
in Haiti’s health sector—one typical in
fragile states—was the leadership’s
limited influence over the planning
and activities of the health sector
relative to numerous foreign actors,
including NGOs that provide about
35% of the health services in the
country.
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60% of the hospitals were severely
damaged or destroyed, including
the only national teaching and
reference (tertiary) hospital.
The international responders
brought a wide spectrum of care:
primary (most of the providers),
secondary and very little tertiary
care. This surge of care capability
was limited to the disaster
response. There is progress in
restoring and developing health
service delivery but basic health
needs remain unfulfilled.