Results-Based Financing in Haiti's Health System: Baseline Study 2016
- Finds only 10 percent of health institutions holding the basic medicines set, against an average availability of 65 percent across individual tracer medicines, so the gap is in completeness rather than in any single product.
- Records medicine availability item by item, from paracetamol tablets at 81 percent down to tetracycline eye ointment at 27 percent, with oral rehydration salts at 49 percent and non-amoxicillin antibiotics at 51 percent.
- Records facilities applying an average 14 percent profit margin on medicine prices, which puts cost alongside stock as a barrier.
- Finds transport availability collapsing in three departments, the Artibonite at 14 percent, the Nord at 11 percent and the Nord-Ouest at 6 percent.
- Finds annual work planning almost absent where it is most needed, at 20 percent in the Nord-Ouest and Centre, 15 percent in the Sud-Est and 5 percent in the Artibonite.
- Records information systems more common in dispensaries (62 percent) and health centres without beds (69 percent) than in health centres with beds (44 percent) or community reference hospitals (50 percent), inverting the referral hierarchy.
- Records secure sharps containers in 78 percent of institutions, more often rural (83 percent) than urban (60 percent), which is one of the few indicators where rural provision leads.
The 2016 baseline for the impact evaluation of results-based financing in Haitian health, conducted by the MSPP's Unité de Contractualisation with USAID, the LMG project and the World Bank. It combines a household survey with a facility survey, so the state of provision and the experience of using it are measured at the same moment, before the financing mechanism changes anything.
The facility findings are the ones that bind. Availability of basic medicines is the weakest link: 10 percent of institutions hold the basic medicines set, against 81 percent for paracetamol tablets, 79 percent for vitamin A, 78 percent for folic acid, 77 percent for iron tablets, 74 percent for amoxicillin syrup, 72 percent for amoxicillin tablets or capsules, 66 percent for mebendazole, 51 percent for antibiotics other than amoxicillin, 49 percent for oral rehydration salts and 27 percent for tetracycline eye ointment, averaging 65 percent. Facilities apply an average 14 percent margin on medicine prices, so availability and affordability move together.
The evaluation also measures the management capacity the mechanism depends on. Transport availability scores very low in the Artibonite (14 percent), Nord (11 percent) and Nord-Ouest (6 percent). Annual work plans are rare in the Nord-Ouest and Centre (20 percent each), the Sud-Est (15 percent) and the Artibonite (5 percent). Information systems are more common in dispensaries (62 percent) and health centres without beds (69 percent) than in health centres with beds (44 percent) or community reference hospitals (50 percent), which is the opposite of what the referral hierarchy would suggest. Secure sharps containers are held by 78 percent of institutions, more often in rural (83 percent) than urban (60 percent) settings.
How to cite
Ministry of Public Health and Population (MSPP); World Bank, Results-Based Financing in Haiti's Health System: Baseline Study 2016, https://microdata.worldbank.org/index.php/catalog/2840