(2017) Initiatives nationales, principaux défis et rôle des activités de collaboration : La CSU en Haïti en marche vers

[page 1] 8 S Moving toward (a) 2 re} a °°, ° Haiti NATIONAL INITIATIVES, KEY CHALLENGES, AND THE ROLE OF COLLABORATIVE ACTIVITIES DT N 2 o a © 3 A 2 Fe} Eu | [page 2] Moving toward UHC: Haiti seu n°7 Haiti's snapshot 1 Haiti's snapshot Existing national plans and policies to achieve UHC 2 Key challenges on the way to UHC 4 UHC Service Coverage Results of Joint External Evaluation Collaborative efforts to accelerate progress toward UHC 6 Index (SDG 381 2015) of core capacities for pandemic preparedness References and definitions 8 A 8 4 Score (for capacity) # of indicators (out of 48) O 5 Sustainable NO DATA | 4 Demonstrated NO DATA Catastrophic OOP health expenditure incidence at the 10% threshold 3 Developed NO DATA (SDG 3.8.2) 2 Limited NO DATA NO DATA 1 No capacity NO DATA Health results Performance of service delivery - — ——————— selected indicators LMIC Maternal Mortality Under-Five Mortality (PHCPI, 2012-2015) Haiti average Ratio (WHO) Rate (WHO) ———————— Per 100,000 Live Births Per 1,000 Live Births Care-seekine f te ofpreumonia | 37.9% | 61.5% 625 Dropout rate between 1st and 3rd DTP vaccination 25% | 75% TT < = Access barriers due to o 146 treatment costs 76% | ATA% =. D © fr hriemduet 491% | 35,8% 1990 2015 1990 2015 —_—___—_—_—_—_—_—————————_ — 70 (SDG target) — 25 (SDG target) Treatment success rate for new TB cases 78% | 801% Life Expectancy Wealth Differential ET at Birth (WHO) on Under-Five Provider absence rate NO DATA | 28.9% Mortality (PHCPI, 2012) Caseload per provider NO DATA | per 2 59 64 42.2 Diagnostic accuracy no para | 47.9% More deaths in lowest than highest ———————————— wealth quintile Adherence to o 2000 2015 per 1,000 live births clinical guidelines NO DATA | 33.6% See page 8 for References and Definitions. 1 [page 3] Moving toward UHC: Haiti Moving toward UHC: Haiti e e e < RU SE À . LACET Existing national plans and Fe si Be 225 e _e e e LL ESS ET St À à TAUIT ESS 2ZZ) | policies to achieve universal RER" = à An er health coverage (UHC) CR FX D 5 ai es ON er UT SERVICE DELIVERY REFORMS HEALTH FINANCING REFORMS = é p) = è RS p | Since 2011, Haitis Ministry of Health (MOH) Haïti faces challenges in terms of equitable and Pl : service delivery model has included a focus on affordable access, financial protection from . ee _ LL ] Î. community care. Family Health Teams have excessive payment of user fees, catastrophic 9 À. " | à Ad FOX been introduced to jointly deliver essential health expenditures, and an overall reduction in k CAS " Le Ta , 11] # health care, particularly in poor, underserved, the availability of resources, both from domestic SANT 4] s 7 nu. ! 1. and remote areas. For example, vaccination and external sources. Since there is not yet an | j Le La ” d” I activities were recently added to the Community official health financing policy, the government | ES | 1 "| Health Worker (CHW) curriculum, one of a and partners are reforming the financing system E— ue” 2. 4 range of services as part of the generalized CHW to reduce financial barriers to care, improving % + À H model. This model exists alongside “specialized” planning in the use of resources, establishing F) 5 CHWs who implement vertical programs, as stronger donor coordination mechanisms, and « ? \ | on # well as local CHW networks managed by aligning government and partner priorities. = 2 > ‘ nongovernmental organizations (NGOSs) or In the context of declining resources, the ——+* 4 = { faith-based organizations. The government government and partners are discussing ; _ would like all CHWS to deliver a broad range of different pathways to improve the efficiency of E a services, but not all partners are willing or able the health system and increase fiscal space and >» à to change their approach. With the objective of innovative policies to reduce financial barriers « Er achieving an efficient service delivery model, the to care. With donor assistance, Results-Based ee government is leading a dialogue with partners Financing (RBF) programs have increased € to reduce fragmentation, foster coordination, accountability, efficiency, and performance. 14360 increase coverage, and eventually move closer Health providers commit to providing a certain 5 5 to UHC by increasing access to affordable care number of services, are evaluated by an external à j through sustainable mechanisms. These efforts agency, and receive payments for reaching Ù £ include developing a basic essential benefits certain performance standards. Initial results La ; . € : package to be provided through an Integrated are promising, but further assessments over a |. D 7 Health Services Network and several ongoing longer implementation period are required. à fi : pilot interventions, with MoH's leadership and support from international partners. GOVERNANCE REFORMS established a Commission for Health There are several ongoing efforts to strengthen Sector Reform in Haïti, intended to produce stewardship and governance of Haiti’s health recommendations within a year. Finally, in system. The MoH Organizational Law is September 2017, the MoH launched the ‘Assises currently under revision. In 2017, the MoH Nationales de Santé’ to analyze health sector © 76% of women declared they had problems reinvigorated coordination with partners challenges in a participatory manner and in accessi ng health care due to the cost of through regular Table Sectorielle roundtables, update the Strategic Plan, looking forward to which bring all partners together to discuss 2030. UHC, governance, service delivery, and (©) treatment, 43% due to distance (D HS 201 2). strategic issues and work toward sustainable human resource development were key topics. solutions. In May 2017, the President 2 3 [page 4] Moving toward UHC: Haiti Moving toward UHC: Haiti : ï EU Me nt D 7 Key challenges et M mener ! We PE A im | ——— + Lnmssmaeens pas on the way to UHC PL es D 5 | CHALLENGES IN SERVICE DELIVERY has been identified is the need to further L l ji LATE TE nant de ol nas Access and coverage of essential health strengthen the CHW model in Haïti, and to pe 2 de. FO ve, +? services. Haiti faces substantial challenges increase its coverage. nu ES ee mes. LS — 7. gui a related to maternal and child health. Antenatal il . s | ER er TE à care, in-facility births, and DTP3 vaccinations THE STATE OF HEALTH FINANCING ! ÿ 4 A ss 0 ASS HR" mes are all much lower than the averages for the Overall funding for health. Government RL 7 CET" , 2" D / LE TT Latin America and Caribbean non, funding for health is 1-2% of GDP, lower than £ | + _ mn. Le "0 >". ES LR = 4 AB in most other low-income countries (LICs); the | =) 4 Éd vf 14 ‘az 3 É— Quality of care. In part, quality of care is government spent just US$13 per capita on RES ue ù ZA «4 Ù = > ELA == affected by an insufficient health workforce and health in 2014 (WHO, 2016). In the 2016-17 ge cer ‘ | Ca + té poor infrastructure. The number of medical budget, the government’s contribution to the staff (physicians, nurses, and midwives) per health sector has further declined, leaving Financial protection schemes. Haïti has few mechanisms to track the performance of capita in Haiti is low compared to WHO very limited resources for drugs, supplies, experienced several natural disasters, political providers. Although the RBF program is currently recommendations. Haiti has substantially and other operating costs. Haiti has been instability, and declining external funding, strengthening provider accountability, this does less basic infrastructure and equipment than highly dependent on external funding for thereby preventing the articulation of clear not cover the whole country. While providers other low-income countries, contributing to health, particularly after the devastating 2010 policies on financial protection for vulnerable are required to report health indicators through a relatively low proportion of health facilities earthquake which displaced many people, populations. At present, very few people benefit the Health Management Information System meeting international standards. At the center damaged infrastructure, and shifted scarce from financial protection schemes, and most of (SISNU), there are no clear incentives for accurate of efforts to improve quality, there is a need resources toward the delivery of emergency the population continues to pay out of pocket or timely reporting, aside from the RBF program. to strengthen health care and health services services. Furthermore, 90% of external funding for most services. management processes and for human resource is off-budget, creating inefficiencies in the Unexpected costs from natural disasters. Haiti (HR) development (number of workers, skills system and difficulties in coordination between GOVERNANCE CHALLENGES has experienced recurrent natural disasters, mix, distribution, performance evaluation, the government and partners. Coordination among stakeholders. Improved including a recent earthquake (2010) and major and incentives). Among other efforts, targeted coordination between key actors in the Haitian hurricane (2016) that significantly affected improvements in the workforce and investments Financial barriers. People in Haïti face two health sector is needed to increase progress infrastructure, the delivery of essential supplies, in basic infrastructure and equipment will be important barriers to accessing care: cost and toward UHC. Public and private stakeholders and the number of functioning health care essential to improve quality of care. geography. Out-of-pocket expenditures have must better align interventions and funding, facilities. Furthermore, natural disasters increase increased to approximately 35% of total health and efforts are needed to foster the participation the risk of infectious conditions, as seen with Pandemic preparedness. Existing plans for spending (WHO, 2016) and almost 93% of of civil society organizations, academia, and the increase in cholera cases in 2016, which infectious disease control have primarily facilities charge user fees (WB, 2017). With associations of health professionals to increase claimed 70 lives and infected over 5,000 people focused on cholera, which has plagued Haïti in over half the population living in poverty, many awareness and build consensus around key within a few weeks. Both natural disasters recent years. A National Plan for the Elimination people are unable to access care. In addition, approaches to reach UHC. and subsequent proliferations of infectious of Cholera in Haïti (2013-2022) has been many people seek help from traditional healers, diseases divert existing resources from regular developed. However, a Joint External Evaluation who charge high fees without necessarily Accountability. The large amount of external care toward the management of emergency (JEE) of International Health Regulations (IHR) improving health outcomes. Also, many people funding that is off-budget (90% of the total) is care. Developing national and sectoral plans to core capacities has not yet been conducted. One do not access care because they lack transport to not linked to specific outcomes or reporting, effectively address recurrent emergencies are key important aspect of pandemic readiness that distant health facilities. making it difficult to assess how effectively steps to addressing this challenge. resources are utilized. Furthermore, there are 4 5 [page 5] Moving toward UHC: Haiti Moving toward UHC: Haiti e Collaborative efforts toward UHC EXISTING INITIATIVES SUPPORTED PLANS FOR FUTURE pandemic preparedness activities within the to health system strengthening. Considering BY EXTERNAL PARTNERS COLLABORATIVE WORK National Health Sector Plan; (iii) resource that other sectors, such as nutrition and water External partners are engaged in Haïti to mobilization for pandemic preparedness; (iv) and sanitation, compose the foundations of build national capacity and strengthen the Policy and Human Resources Development support for governance, accountability, and heath for all, challenges in these fields also will health system. The Tokyo Joint UHC Initiative, (PHRD)-funded advisory support appropriate institutional arrangements; and (v) be considered under the joint work. The PHRD supported by the government of Japan and The activities under the Tokyo Joint UHC enhancement of community-level health care support will also help increase the impact of led by the World Bank (WB), in collaboration Initiative fall within two broad categories: for pandemic preparedness and response. current and future World Bank investments with the Japan International Cooperation moving toward UHC and pandemic in the health sector, in particular under IDA18. Agency (JICA), United Nations Children’s Fund preparedness. Several activities will contribute Furthermore, the joint work will closely Among other objectives, this will help identify (UNICEF), and the World Health Organization to achieving UHC: (i) enhancing service cooperate with other investments in health, suitable approaches for moving toward UHC (WHO), is supporting the government of delivery capacity at the health provider level; such as the Global Fund and Gavi, to contribute and effective pandemic preparedness. Haïti and strives to accelerate progress toward (ii) improving access to maternal health : : _ _ UHC. This support will enable strengthening care through a focus on lower levels of care; 7 L Ÿ 5. .' 2,5 2 MAP à L % 5 of nationally-led strategic health systems to (iii) costing and prioritizing the national \ + = td » : S A, é É achieve UHC, as well as pandemic preparedness. Health Sector Plan; (iv) analyzing supply- LÀ Mu, 3 & PE it: Partners are providing both financial and side deficiencies, particularly in lower-level L ; . LL a technical support to the government, aiming health facilities; (v) mobilizing resource as 7 ‘Tel 4 M fl + to address key challenges in maternal and efforts specific to UHC; and (vi) supporting ) * fe = child health, community health strategies, governance and accountability. In the area of - à health financing, infrastructure, and overall pandemic preparedness, efforts will focus on: SR - » * A coordination mechanisms. The government (i) assessment of existing pandemic plans and n La ‘ | and partners are jointly engaged in innovative pandemic responsiveness, including cholera; (ii) "7 e Pl | | = approaches such as the RBF program to address technical assistance for costing and prioritizing Lo L Z J key UHC bottlenecks. a) . D É / à Re: Haïti has experienced recurrent natural disasters, ND: L | ] including a recent earthquake (2010) and u 4 ] VA major hurricane (2016) that significantly çæ “ : { 4 affected infrastructure, the delivery of essential L La 228 supplies, and the number of functioning À (ll {ll NE à ==|\|\ À _ 4 health care facilities. - 4, r<e = —_— | NE x 6 7 [page 6] Moving toward UHC: Haiti References & Definitions (page 1 indicators) UHC Service Coverage Index (2015) - Life Expectancy at Birth (2000-2015), WHO/World Bank index that combines 16 Maternal Mortality Ratio (1990-2015), tracer indicators into a single, composite Under-five Mortality Rate (1990-2015) - metric of the coverage of essential health WHO Global Health Observatory: services. For more information: WHO/World http://appswho.int/gho/data/node.home Bank (2017). Tracking UHC: Second Global Monitoring Report. Wealth Differential in Under-five Mortality (Single data point, year varies by country) Catastrophic out-of-pocket (OOP) health - Indicator used by the Primary Health Care expenditure incidence at the 10% threshold Performance Initiative (PHCPI) to reflect equity (Single data point, year varies by country) - in health outcomes. For more information: WHO/World Bank data from Tracking UHC: https://pheperformanceinitiative.org/indicator/ Second Global Monitoring Report (2017). equity-under-five-mortality-wealth-differential Catastrophic expenditure defined as annual household health expenditures greater than Performance of service delivery - selected 10% of annual household total expenditures. indicators (Single data points, years vary by country) - Indicators used by the Primary Health Results of the Joint External Evaluation of Care Performance Initiative (PHCPI) to capture core capacities for pandemic preparedness various aspects of service delivery performance. (2016/17, year varies by country) - A voluntary, PHCPI synthesizes new and existing data from collaborative assessment of capacities to validated and internationally comparable prevent, detect, and respond to public health sources. For definitions of individual indicators: threats under the International Health https://pheperformanceinitiative.org/about-us/ Regulations (2005) and the Global Health our-indicators#/ Security Agenda. 48 indicators of pandemic preparedness are scored using five levels (1 is no capacity, 5 is sustainable capacity). https://www.ghsagenda.org/assessments ES 6: Photo credits: Ædr is Page 3 & 5: Dominic Chavez / World Bank MS | : " Page 7: Christelle Chapoy / World Bank EN WE Co-authored by: f &) World Health : ®) €) THE WORLD BANK Kay Organization unicef & JICA 8 [page 7] à, ,