AIDS 2010 Update: Whole of Society Health Systems Approach to Addressing HIV in Haiti

AIDS 2010 Update: Whole of Society Health Systems Approach to Addressing HIV in Haiti

As we have heard, Haiti is the poorest country in Western Hemisphere and has some of the worst health statistics. Many things did not work well before the earthquake and the recovery effort has not progressed as many had hoped.

There is a perception among some, though, that nothing was working before the January 12th earthquake and that nothing has happened since.

Certainly in the health sector, and specifically in AIDS, this perception is simply wrong. The earthquake has been devastating for Haiti and its people, but in the health sector there were many good things going on before the earthquake and some real strengths to build upon. The government of Haiti, at both the national and department level, has been playing a strong leadership role.

MSH first began working in Haiti over 30 years ago. Over the last decade our nearly all-Haitian staff has worked intensively to develop leadership, management, planning, and service delivery skills within the Ministry of Health and Population, nationally and at the departmental and local levels. We also work to strengthen over two dozen service delivery NGOs.

Our team has taken “whole of society” perspective toward health systems strengthening – drawing on the unique strengths and contributions of the public sector, civil society, and the private sector. This has involved a two-pronged approach:

  • Working to build government capacity from the national level to the departmental and local level
  • Working at the service delivery level with both government and NGO service providers.

By the end of 2009, this collaboration included a network of 73 government health facilities, 74 NGO health facilities, and roughly 4000 community health agents. Together they provided access to primary healthcare for nearly 4 million Haitians across Haiti’s 10 local departments. Working through a system of performance-based agreements, these facilities achieved significant improvements in maternal and child health, family planning, tuberculosis, and expansion of AIDS-related services.

Before the earthquake, this network :

  • Trained and supported over 4,000 traditional birth attendants, who integrated AIDS and maternal health. They helped to substantially increase antenatal visits, ensured that nearly 50,000 pregnant women were tested for HIV, and saw over half of these testing positive through the entire course of PMTCT treatment.
  • A steady increase in provision of antiretroviral treatment and palliative care to People Living with HIV & AIDS.
  • Finally, a leadership development program in Cité Soleil – considered by many to be the poorest and most dangerous slum in the Western Hemisphere – to empower youth sensitize young people about HIV/AIDS prevention through inspiration, motivation and mobilization.

Ernancy Bien-Aimé from the Bois-Neuf zone of Cité Soleil is one of a dozen youth who completed the leadership development program. She and her fellow youth have trained 4,550 youth with HIV/AIDS prevention messages-four times their targeted goal.

After the earthquake,

  • Within 48 hours, the team that manages the supply chain cycle for PEPFAR provided ARVs and other supplies had assessed the warehouse, reorganized supplies, and began shipments of emergency medicines and supplies to 3 dozen hospitals and other health facilities in Port-au-Prince.
  • Another program distributed over 1.2 million condoms in the first month post-earthquake and by May 2010, had more than doubled monthly condom distribution.
  • 80% of Haitian women delivery at home. By working effectively through a combination of community health workers and traditional birth attendants, our service delivery partners have moved Prevention of Mother to Child Transmission (PMTCT) into the community and taken it into homes. Community-based PMTCT has increased both enrollment rates and completion rates. Despite the earthquake, during the six month period Oct’09 to Mar’10, 69% of women enrolled in PMTCT completed the program.

With respect to earthquake recovery, the Ministry of Health and Population has used planning skills developed over the last several years and tested in previous natural disasters to prepare an interim health plan for post-earthquake recovery and a specific interim plan for HIV&AIDS.

In-line with the Ministry’s decentralization process, which MSH has supported, all 10 departments now have their own detailed health plan, which includes HIV is one of its key elements. For this last component, some activities are moving toward implementation, but many are not.

Much has been achieved in Haiti for health and AIDS, both before and after the earthquake, but much more must be done, and much faster. Fortunately we have a lot of very bright, experienced, dedicated Haitian colleagues who are determined to build back better their country’s health system.

We know that Haitians want a strong health system, based on universal access to quality services as a human right – a health system that works across all levels from the household to the community, to the health facility, to national authorities.

Success will depend on three things:

  1.  More health workers. Haiti needs the appropriate level of health care providers – from the Diaspora, thru community health training.
  2. Accountability for results through performance-based contracts and program management.
  3.  Strong leadership & governance – in government, in youth, and in all health partners.

Today, I presented these remarks at a press conference with Paul Farmer of Partners in Health, and Bill Pape of GHESKIO at the International AIDS Conference in Vienna.