(2022) Determinants of Health Productivity in Haiti
Summary — This World Bank study analyzes health facility productivity in Haiti using data from 2017-2020 to identify key factors that influence health service utilization and efficiency. The analysis focuses on primary care facilities and examines productivity measured as patient visits or vaccines per health worker.
Key Findings
- Health facility utilization in Haiti is very low compared to other low-income countries despite relatively high facility density.
- Technical efficiency scores are extremely low: 4% for dispensaries, 9% for health centers without beds, and 30% for health centers with beds.
- Significant variability exists in productivity across health facilities, particularly among hospitals.
- Health facilities are managed by four types of authorities: government/public (42%), private not-for-profit (14%), private for-profit (23%), and mixed (21%).
- Primary care facilities show substantial differences in daily productivity metrics across facility types and management structures.
Full Description
This World Bank study examines the determinants of health productivity in Haiti, where utilization of formal health services remains very low despite a relatively high density of health facilities. The analysis aims to understand key factors that underlie the efficiency of specific health programs to improve population health outcomes. The study focuses on primary care facilities including health centers with beds, health centers without beds, and dispensaries, excluding private for-profit facilities to avoid bias.
The methodology employs mixed effects regression analysis using data from multiple sources including Haiti's National Unified Health Information System (SISNU), the Service Provision Assessment Health Facility Survey of 2017, and donor program databases. Productivity is measured as the ratio of outputs (institutional visits or pentavalent vaccine doses) to inputs (number of clinical health workers). The analysis covers the period from 2017 to 2019, excluding 2020 data due to COVID-19 and security situation impacts.
The study reveals significant variability in productivity across health facilities, particularly among hospitals. Technical efficiency scores are notably low across all facility types, with dispensaries showing 4% efficiency, health centers without beds at 9%, and health centers with beds at 30%. The analysis categorizes facilities by four management types: government/public (42%), private not-for-profit (14%), private for-profit (23%), and mixed (21%).
Key findings indicate substantial differences in daily productivity metrics across facility types and management structures. The study provides important insights for policy makers seeking to enhance primary health care utilization and outcomes in Haiti, with particular attention to the potential role of community health workers as determinants of health care utilization.