Is Haiti's Health System Any Better?

A report by Merlin, then a UK medical relief charity, published a year after the January 2010 earthquake as part of its Hands Up for Health Workers campaign. Its argument is that the international response, while vital, failed to support the health capacity that already existed, and that this is the lesson to act on rather than a detail of one operation.

It sets out what the system was before the disaster: a health sector chronically underfunded at less than 5 percent of the national government budget, only 40 percent of the population served by any kind of health service, most workers and facilities concentrated in urban areas, and the lowest ratio of nurses to physicians of any country in the Americas. Then the scale of the event, a magnitude 7.0 earthquake that killed an estimated 230,000 people and left more than 1.5 million homeless, with nearly 70 percent of buildings falling in the worst affected areas, over 60 percent of hospitals destroyed there, and a cost to the health sector of almost 200 million US dollars.

The report's own recommendations follow from that: humanitarian assessments based on a comprehensive analysis of national health worker capacity, international responses that complement and support existing local and national capacity, and health playing a leading role in disaster risk reduction. It sets Haiti's experience against rapid urbanization, noting that 2008 was the first year in which more people lived in cities than in rural areas, and names Kathmandu as another city at risk. The text of this copy is degraded by the scan of a magazine layout, so it should be read for its figures and argument rather than quoted verbatim.