MAXIMIZING POSITIVE SYNERGIES - World Health Organization

Background
The Republic of Haiti occupies the western third of the island of Hispaniola, sharing its 360
kilometre eastern border with the Dominican Republic. Haiti is home to more than 9.6 million
people (see Table 1), up from just over three million in 1955 [1]. As of 2007, approximately 1% of
the population controlled nearly half of Haiti’s wealth [2]. In 2005, Haiti ranked 146 th out of 177
countries on the UN Human Development Index [3].
Official Development Assistance (ODA) to Haiti in 2006 was US$ 581.4 million [1], but the country
remains highly indebted due largely to loans incurred from 1964 to 1986 [4]. At the end of 2007,
Haiti’s total external debt was US$ 1.463 billion or 24% of gross domestic product (GDP) in 2006
[5].
Widespread deforestation, soil destruction, and poor agricultural output contribute to food
insecurity; the island’s vulnerability to natural disasters, including floods and hurricanes,
exacerbate the situation. A 2004 hurricane killed approximately 3000 people and caused damage
estimated at 3.5% of GDP [6], while a 2008 series of hurricanes killed over 800 people, displaced 1
000 000, and wiped out 60% of the year’s harvest [7].
Haiti has some of the worst health statistics in the Americas (see Table 1), including the highest
infant mortality and maternal mortality rates in the Western hemisphere (60.0 per 1000 in 2006
and 670 per 100 000 live births in 2005 respectively). WHO estimated that incidence of smearpositive
pulmonary TB in Haiti was 133 per 100,000 in 2006; prevalence was 402 per 100 000. First
identified in Haiti in 1981, HIV/AIDS became the leading cause of death in 1999. In 2007, 120 000
people in Haiti were living with HIV [8].
In 2003, health services reached only 60% of the population. In addition to the public sector, which
comprises about 35.7% of the health infrastructure, the health system includes for-profit service
providers catering to urban professionals; private non-profit organizations; and mixed non-profit
facilities, including Ministry of Health (MOH) personnel working in private institutions or religious
organizations [9]. About 40% of the population—mostly in rural areas—relies on traditional
medicine, lacking access to other services [9]. Physicians are concentrated in the capital city of
Port-au-Prince and in other large towns. In some provinces, there is one physician for every 67 000
people [10]. Nearly 30% of health professionals left the country between 2005-2008 for the U.S. or
Canada [11]. The government has regularly increased the health budget, but the recent funds are
lower in real terms than in the 1980s due to inflation [12]. Currently, 18.9% of the country’s total
health budget comes from external sources [11,13].
Haiti was among the first set of grant recipients from the Global Fund in 2003, and since then, the
country has received two additional grants for HIV/AIDS and one for TB, with a total approved
funding amount of approximately US$ 248 million, though only US$ 130.1 million has been
disbursed (see Table 2). The U.S. government began funding HIV/AIDS prevention, treatment, and
care interventions in Haiti through PEPFAR in 2004, working largely with existing USAID contracts
and partners, half of which were faith-based organizations (FBOs) [14].
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