Haiti Approves Health Plan to Expand Access

Much of Haiti’s population lacks access to health services. Only 10% of the population lives less than 1 kilometer from a health facility, while 42% of Haitians must travel more than 10 kilometers to reach the closest facility. These long distances prevent many individuals from seeking the medical care they need. Additionally, hospitals continue to be the most frequently used health care facilities in Haiti, despite the fact that they should only be used after a consultation or for emergency care. According to the plan directeur, hospital visits increased from 37% in 2005–2006 to 52% in 2016–2018. Yet during the same time frame, health centers and clinics saw a decrease in visits from 34% to 21%.

Expanding access to all health care services and raising awareness about the benefits of visiting health centers and clinics will help prevent overcrowding in hospitals and improve Haiti’s overall health system.

Purpose and implementation of the plan directeur

The Ministère de la Santé Publique et de la Population (MSPP), through the Unité d’Etude et de Programmation (UEP), indicated the need to develop a new plan directeur for 2021–2031, which will serve as a follow-up to the 2012–2022 plan directeur. Far from being a bureaucratic formality, the plan directeur defines key areas of Haiti’s health care system that need improvement. It then goes a step further by identifying strategies that can be implemented to reach these goals.

The development process of the new plan was led by the UEP from September 2020 to July 2021. MSH, through the USAID Health Leadership Project (HLP), provided financial and technical support to the UEP to develop this plan and worked with consultants to perform several activities over 15 months. These activities included assessing the 2012–2022 plan directeur, conducting a situational analysis of the Haitian health system, facilitating meetings and the content development process, and suggesting a budget and payment method for implementation.

Along with the collaboration between the UEP and HLP, several stakeholders were also involved in developing the new plan directeur, including USAID; the World Health Organization (WHO); the World Bank; and several services of the MSPP (the directorates responsible for human resources, organization of health services, family, and pharmacy and medicines).

An ambitious and multisectoral plan to improve health results

The new plan directeur was approved on July 15, 2021, in the presence of the Minister of Public Health and Population in Haiti, Dr. Marie Gréta Roy Clément. The plan includes several guidelines to help eliminate barriers to health care services at the community level. Its mission for the next decade is to address weaknesses in the health system to improve access and quality of care and achieve the overarching goal of establishing universal health coverage (UHC). Dr. Clément emphasized the importance of this plan and stated that it will help “guide all our approaches to provide quality care everywhere it will be needed.”

The plan directeur will also focus on safeguarding maternal and child health. It aims to decrease the current maternal mortality ratio from 529 to 350 deaths per 100,000 live births and to decrease the child and newborn mortality rates from 65 to 25 and 25.3 to 12 per 1,000 live births, respectively. Additionally, the proportion of health institutions offering emergency obstetrical and newborn care should almost double from 35% to 60% to increase the number of supervised deliveries from 42% to 60%.

Regarding UNAIDS’ 95-95-95 strategy, under the plan directeur the percentage of people living with HIV who know their HIV status should increase from 79% to 95%; the percentage of people living with HIV on treatment should increase from 75% to 95%; and the percentage of people on treatment with a viral suppressed load after 12 months should increase from 64% to 95% (Source: Monitoring and Evaluation and Integrated Surveillance/MESI-database, March 2021).

Mobilizing financial, organizational, and human resources is required to reach these objectives. The plan directeur aims to double the number of key staff members, from 0.7 health staff per 1,000 inhabitants to 1.5 for 1,000 inhabitants in 2031. While this still leaves much more work to be done, this increase of key staff members would bring Haiti one step closer to meeting the minimum recommended by WHO for UHC of 4.5/1,000.

The plan directeur will also develop a health financing strategy to improve the availability and management of financial resources. Currently, the Haitian government allocates 4.8% of the budget to health, which is an insufficient amount given that the Abuja Declaration suggests countries dedicate 15% of their budget to health. To achieve this objective, the MSPP has committed, with HLP’s support, to implement solidarity-based financing of health care and services by developing innovative mechanisms for resource mobilization and for the MSPP’s financial resource management systems. Several strategies will accompany this objective, including policies for strategic procurement of services and prepayment, by focusing on risk pooling and solidarity to protect families.

As we look to build on the progress of the last decade, the new plan directeur redevelops our shared mission and provides us with a clear direction moving forward to improve the Haitian health system.