MSH Calls for Two-Pronged Approach to Development in Haiti: Restore Leadership Capacity of Government Ministries and Work in Partnerships with NGOs
On the eve of the International Donors' Conference Towards a New Future in Haiti to be held in New York on March 31, Management Sciences for Health (MSH), urged donors to consider a successful two-pronged development approach that has led to improved health in Haiti.
"The two-pronged approach is grounded in the principle that the Haitian government must ultimately lead the process but also work together in partnership with NGOs and the private sector," said Dr. Jonathan D. Quick, MD, MPH, President and Chief Executive Officer of MSH. MSH has worked in Haiti for over 30 years with the Ministry of Health and a network of dozens of Haitian NGOs to achieve health impact.
In Haiti, success in the health sector resulted from the approach developed by a four-way partnership between the Government of Haiti, the United States government, a network of Haitian and international NGOs (Sante Pour le Developpment et la Stabilite d'Haiti (SDSH), and MSH.
Applied to post-earthquake recovery, the two-pronged approach would include two key strategies:
(1) Strengthening the leadership capacity of the Ministry of Health to carry out policymaking, standard-setting, and coordination roles that uniquely belong to government. Begin at the national level, but quickly move to include departmental ('county') and local government.
(2) At the same time, preserve, respect, and build on existing local human resources, physical infrastructure, and health system elements already in place. Work with all existing service providers—public, NGO, and private sector- to support and build their capacity to provide responsive, quality, community-based and facility-based preventative and curative care.
Five Critical Actions for Success:
Over the last decade, this approach has been implemented through five critical actions:
1. Building leadership, governance, managerial capacity of the Ministry of Health at the national and departmental level. Decentralization through integrated department planning—moving from many plans and many actors in each department to one plan with committed partners.
2. Forming collaborative relationships between the Ministry of Health and Haitian community groups and NGOs working on health. A framework for coordination was established with groups organized into clusters by service area, but integrated into one national health strategy. "This framework managed by MSH worked well in Haiti in 2005 for implementing PEPFAR funds from the US government and should be utilized again after the donors' conference," said Dr. Quick.
3. Establishing a standard national package of basic health services with necessary training and capacity building of local groups to manage implementation.
4. Utilizing performance based financing for operating budgets. Giving NGO and public sector providers a modest incentive for achievement of targets improved quality and outcome of care, increased efficiency, and rewarded innovation for meeting service targets.
5. Developing public-private partnerships is crucial to success. In the past two years, more than $10 million was secured in leveraged contributions to the health system from multiple partners in Haiti's commercial sector. Cost-shared interventions on the ground should help to optimize resources and ensure sustainability.
"Haiti's Ministry of Health and Haitian health workers and community leaders can take pride in what they accomplished in the health sector, in partnership with the US Government, USAID, MSH and other partners," said Dr. Quick. "Donors should build on those successes. We do not have to start over."
In 2008-2009, over 4 million Haitians in all 10 departments (47% of the population) had access to primary health care services by 26 health NGOs, 147 MOH facilities and 4,000 community health agents and more than 4,000 traditional birth attendants.
The SDSH network made an impact on maternal health by training and supporting over 4,000 traditional birth attendants. Community-based prenatal care is reaching 8 times the number of women who deliver in a health facility and 83,889 women worked with a care provider to make a birth plan. 45% of pregnant mothers had three prenatal visits, and 40% received a home visit within three days after giving birth.
SDSH also tested 49,196 pregnant women for HIV, and saw over half of those who tested HIV positive through the entire course of treatment to reduce the risk of HIV transmission to their babies. The network also achieved significant improvements in child vaccination, increasing its coverage of DPT3 vaccines for infants by 26%. Vitamin A therapy was provided to over 250,000 children to combat malnutrition. By training and equipping 1.035 community health agents to promote family planning, the network contributed to a 24% increase in the use of modern contraceptive methods. And by the end of 2009, the SDSH network had scaled up antiretroviral treatment for AIDS to 2,077 patients and provided palliative care to over 11,000 people living with HIV & AIDS.
"The SDSH network has also contributed to Haiti's economic development by creating jobs," said Dr. Florence Guillaume, Deputy Chief of Party/Technical Director of MSH/SDSH. "Almost 4,000 community health agents were employed by public and private sector partners and the services of another 4,000 trained traditional birth attendants were supported. Additionally, salaries were paid for over 1,150 facility based health providers. In Haiti, the health system is not primarily about buildings or technical skills but it's about health worker motivation and support."
"Our partnership with the Haitian Ministry of Health has proven that it is possible to build on the complementary strengths of governments, civil society, and the private sector and achieve significant health impact," said Dr. Quick.
MSH encourages expansion of the health section of the Action Plan for Reconstruction and National Development of Haiti to include more comprehensive planning for primary care that includes maternal health, family planning and people living with HIV & AIDS and people infected with TB. MSH also encourages involvement of all stakeholders, including NGOs and service providers, in the discussions on health going forward.