Strengthening Health Service Delivery in Haiti: the Package of Essential Services

 {Photo credit: MSH}Attendees pose for a group photo at the launch ceremony for the updated Package of Essential Services.Photo credit: MSH

Even before the 2010 earthquake, Haiti’s public health system struggled to meet the growing demand for services by low-income families, and when disaster struck on January 12, 2010, the already-struggling health services around the country sustained extensive damage. Since then, the Ministry of Public Health and Population (MSPP), with support from a range of donors and partners, has been rebuilding to meet its obligation to provide a timely, adequate, and efficient response to the population’s need for health services.

One important strand of this recovery effort has involved the development of an updated Package of Essential Services (PES) which defines a set of core health services to be provided for all Haitians. The USAID-funded Leadership, Management, and Governance (LMG) Project, led by MSH, has provided ongoing technical support to the MSPP’s Direction of Health Service Organization (DOSS) as they create the PES. Based on health policy directives and guidelines laid down by the government in 2012, the PES will address conditions and emerging diseases relevant to post-earthquake Haiti and it will enable the MSPP to tailor health services to the needs of the population, ensuring that services are always available and accessible.

Defining a New Paradigm

To develop the new PES, its accompanying implementation plan, and the MSPP’s capacity to implement the PES nationwide; the LMG Project facilitated a participatory workshop with senior staff members from various directorates and other national stakeholders. The PES implementation manual sets out a new paradigm for health care delivery by redesigning the architecture of the primary and secondary levels of Haiti’s health system.

This new paradigm encompasses a continuum of care leading from community health centers to health centers to community reference hospitals to district hospitals The PES manual establishes standards, norms, and procedures for providing tailored health care at the primary and secondary levels; defines key providers who deliver essential services; and creates guidance on facility construction.

After the official launch of the updated PES and manual, the LMG Project supported the MSPP to implement it in three health departments (Artibonite, Grande Anse, and Sud). This effort began in late February 2017, with a three-day participatory workshop in Port-au-Prince, for 38 senior MSPP staff from the central directorates and all ten of the country’s departments. Dr. Gabriel Thimothé, the MSPP’s General Director, symbolically presented each departmental health director with a copy of the PES manual, advising them to read it carefully, to make it their own, and to contribute fully to its implementation in their departments.

“This manual,” Dr. Thimothé said, “lays out the appropriate policies, approaches, and procedures that will enable our Ministry to provide the population with high-quality health care. It is up to us to effectively, progressively implement them, based on the reality on the ground and using the resources that we have available.”

“The government,” he continued, “must make the necessary investments to firmly ground the PES in concrete, sustainable action. The issue of public health funding must be addressed to ensure that the system functions smoothly.”

[Breakdown of the three levels of the Haitian health system, as defined by the PES.] {Graphic: MSH}Breakdown of the three levels of the Haitian health system, as defined by the PES.Graphic: MSH

Anna Van Rooyen, LMG/Haiti Project Director, added, “It is a great honor and privilege for the LMG Project to have the opportunity to work jointly with the DOSS to develop this very important tool, thanks to USAID’s funding. I hope that you all will make good use of it, to strengthen the national health system and to improve the population’s health and well-being.”

At the end of a lively, constructive workshop, more than 1,200 copies of the manual were distributed for use by the ten departmental health directorates in each health facility. Three districts (Port-Salut, Dessalines, and Anse-d’Ainault) from the South, Artibonite, and Grand-Anse departments were selected by MSPP to carry out a pilot implementation using a similarly participatory approaches as was used at the national level, in preparation for full nationwide scale up.

In his closing remarks to the workshop, Dr. Julio Desormeaux, Technical Advisor to the MSPP Director General, noted that “LMG [Project] is among MSPP’s key partners, and the PES clearly illustrates the success of this partnership.” The Ministry is strongly committed, he concluded, to reinforcing this mutually-respectful partnership “to face together current and future challenges to the benefit of the health system.”