Vienna AIDS Conference: MSH, PIH, GHESKIO Call for "Whole of Society" Systems Approach to Addressing HIV in Haiti

VIENNA, Austria — The physician-leaders of three of the largest non-governmental organizations (NGOs) working on health in Haiti called on the international community to direct its support to a "whole of society" integrated approach to strengthening health systems as the best way to sustain HIV/AIDS prevention, care and treatment over the long term, in comments today at an event at the XVIII International AIDS Conference here.

This approach would draw on the diverse insights and experiences of all participants in the Haitian health sector, incorporating the public, private and NGO sectors and involving the government as well as communities. It supports integration of HIV services with other health services, such as tuberculosis, malaria, family planning/reproductive health and maternal, newborn and child health.

The three physicians — representing GHESKIO, Partners In Health (PIH) and Management Sciences for Health (MSH) — said it is the most efficient and sustainable way to address HIV and other health issues in Haiti and other resource-poor countries, and that it was only because the health system had been strengthened prior to the earthquake that delivery of antiretroviral therapy (ART), condoms and other family planning commodities was able to be resumed immediately after the earthquake.

The earthquake that struck on Jan. 12 rendered 1.2 million people homeless. To address this situation, GHESKIO, the 2010 recipient of the Gates Award for Global Health, seeks to build a pilot model village that will eventually be scaled up to address the environmental, health, educational and vocational challenges facing the 1.2 million displaced people.

The Global Health Village will have such components as housing, nutrition, education (primary, vocational and adult literacy) and integrated health services. Major donors have already been secured for education and nutrition, but GHESKIO seeks additional funding of $7 million for the other components.

"The most urgent need is to move 1.2 million people to a site where essential services in addition to health care can be provided," said Dr. Jean William Pape, a founder and director of GHESKIO. "Our main objective is to create a model village where global health is offered — sanitation, potable water, latrines, mosquito control, job creation, microcredit, vocational school, kindergarten and primary school for children. Once done, others will be encouraged to use the same model to support displaced populations."

Paul Farmer, MD, PhD, founding director of Partners In Health and the deputy United Nations special envoy for Haiti, also called for a more integrated approach to development in Haiti when he called on donors to increase funding for the Ministry of Health and the public sector.

"The government needs resources to do its job," said Dr. Farmer. "Even those of us from NGOs and the private sector, such as universities, cannot continue to fail to help the public sector rebuild. Public health and public education were both extremely weak prior to the earthquake, which further aggravated the disability and death seen since January 12. Rebuilding these services will require more resources moved into the public sector — moving Haiti from a republic of NGOs to one in which the Haitian people enjoy basic social and economic rights."

Jonathan D. Quick, MD, MPH, president and chief executive officer of MSH said: "The fact is that more than 6 million Haitians (60%) had access to primary health care before the earthquake because the government, civil society, donors, and businesses worked together. This system — based on developing local leadership and organizational capacity, and ensuring accountability for results — enabled most participating health facilities and community providers to quickly resume services post-earthquake. A mobile program that brings the prevention of mother-to-child transmission to pregnant women in their communities, condom distribution, HIV testing and enrollment of new antiretroviral patients all continued or expanded post-earthquake. We must build on what has been achieved to create a health system that serves all Haitians from their household to the hospital."

The three groups also called on the donor community to support the Haitian Ministry of Health's plea for training of more health workers and increasing the salaries of existing workers so that critical care health centers can remain functional.  

The speakers made clear that Haiti now needs to move beyond the emergency phase and begin to put into place the building blocks of a long-term and sustainable approach to rebuilding and improving the pre-earthquake health system.

"The challenge for Haiti is to move beyond the outpouring of humanitarian assistance since the earthquake to find sustainable solutions to create an effective and resilient health system," said Council President and CEO Jeffrey L. Sturchio, who moderated the event. "As the work of GHESKIO, Partners In Health and MSH demonstrates, that sustainable future will require a holistic approach that builds on the complementary skills and resources of a broad range of public and private partners working in coordination with the people of Haiti."