Haiti - Politics : World Bank calls for increased health budget
The report, titled "Better Spending, Better Care: A Look at Haiti's Health Financing", highlights that public spending on health care per capita is US$13 per year, which is below the average of US$15 in low-income countries and substantially lower than the average in neighboring countries, such as the Dominican Republic (US$180) and Cuba (US$781).
In the context of repeated emergencies faced by the country, more than half of total health expenditure goes toward curative rather than preventive health care. In fact, 38 percent of total health expenditure is devoted to the hospital sector, owing primarily to the large number of hospitals, which is significantly higher than in countries such as Burundi (23 percent) and Tanzania (26 percent). The hospitals are often under-equipped to provide the level of care required, and the current level of expenditure has not led to increased service delivery. Costs for in-patient care are much higher than those in primary health centers. The nationwide ratio of clinics to inhabitants is 0.3 per 10,000, significantly below the standard set by Haiti's Ministry of Public Health and Population.
"The decline in international assistance means that unless primary health care is prioritized with greater access to essential treatment for the people most in need, universal health coverage will not be possible," said Eleonora Cavagnero, Health Economist for Haiti at the World Bank and lead author of the report.
Life expectancy increased and infant and maternal mortality were halved between 1990 and 2015. However, Haiti remains vulnerable to many heath challenges: infant and maternal mortality rates are four or five times higher than those of Latin America and the Caribbean. Only 68 percent of children under 24 months have received the three vaccines to prevent diphtheria, tetanus, and pertussis, compared to 80 percent in countries in a similar economic bracket.
World Bank Special Envoy to Haiti, Mary A. Barton-Dock, points out that "investments have not been made in areas crying out for them. In the current environment of severe budgetary constraints, what is required is a results-based financing mechanism to make the health care system more efficient and more equitable."
The report proposes options to achieve better care through better spending, and improve health coverage for the poorest :
Increase public spending in health: Despite the country's health needs, the government's budget allocation for health declined significantly over the past twelve years, dropping from 16.6 percent of the national budget in 2004 (above the average for Latin America and the Caribbean) to 4.4 percent of the current budget. Given the sharp reduction in donor funding in recent years, the government must plan for an immediate increase in public expenditure in health and improved coordination of international assistance. The creation of special taxes—on tobacco and alcohol, for example—could help raise funds for the health sector.
Prioritize primary and preventive health care: This will involve redirecting funds to primary care, while prioritising and calculating the cost within the current Health Master Plan. Bolstering service delivery in primary and preventive health care will greatly assist in reducing the leading causes of mortality in Haiti. Development partners should finance technical assistance to help hospitals achieve financial sustainability, strengthen existing infrastructure, and put in place a licensing policy. This shift in investments in the heath sector should be evidence-based.
Improve equitable access to quality health care: This will be achieved by mapping health facilities and reclassifying them to improve their operational capacity and establish a functioning referral network. This reclassification exercise will help improve the distribution of medical equipment and medicines. A policy that promotes a more equitable geographic access to primary health services needs to be implemented. Among households that did not consult a health professional, 49% responded that they did not do so for financial reasons. This policy also promises to increase efficiency and cost-effectiveness in service delivery at the primary health care level by linking funding of health personnel and institutions to results.