Image result for world Bank

A new World Bank report reveals that the health sector needs a higher level of public investment and a better allocation of resources to improve access to health for all Haitians.

The report, entitled "Better spending, better attention: a look at health financing in Haiti," underscores that public expenditure per capita on health is US $ 13 per year, below the US $ 15 average in low Income Countries and much less than the average among its neighbors, such as the Dominican Republic (US $ 180) and Cuba (US $ 781). In addition, although there has been a significant increase in funding from NGOs and the international community since the earthquake, this financing is steadily declining, placing doubts on the sustainability of investments in the sector.

Taking into account the recurrent emergencies that hit the country, more than half of total health spending is directed to curative rather than preventive care. In fact, 38 per cent of total health spending goes to the hospital sector, mostly due to the high number of hospitals, a figure well above countries like Burundi (23 per cent) or Tanzania (26 per cent). Hospitals often lack the equipment to provide the necessary care, and the current level of expenditure has not led to increased provision of services. The cost of inpatient care is much higher than in primary health care facilities. The ratio of clinics per inhabitant nationwide is 0.3 per 10,000, well below the standard established by the Ministry of Public Health and Population of Haiti.

"The decline in international aid means that unless primary health care is given priority through greater access to essential treatments for those most in need, universal health coverage will not be possible," said Eleonora Cavagnero, Health Economist for Haiti, and lead author of the report.

Life expectancy increased, and maternal and child mortality was halved between 1990 and 2015. However, Haiti remains vulnerable to a number of health challenges: the maternal and infant mortality rate is four to five times higher than in the rest of Latin America and the Caribbean. Only 68 percent of children younger than 24 months received the three vaccines that prevent diphtheria, tetanus, and whooping cough, compared to 80 percent in similar-income countries.

The World Bank's special envoy for Haiti, Mary A. Barton-Dock, notes that "no investments have been made in areas that require them. Under the current framework of significant budgetary constraints, what is needed is a results-oriented financing mechanism to make the health system more efficient and equitable. "

The report proposes options for achieving better health care by improving spending, as well as health coverage among the poorest:

Increasing public spending on health : Despite the country's health needs, the public health budget has declined significantly in the last twelve years, falling from 16.6 percent of the national budget in 2004 (above average for Latin America and the Caribbean) to 4.4 percent of the current budget. Due to the sharp reduction in donor funding that has taken place in recent years, the government must project an immediate increase in public spending on health and improve the coordination of international aid. The creation of excise taxes - on tobacco and alcohol, for example - could help raise funds for the health sector.

Prioritize primary and preventive health care : this involves redirecting funds to primary care, prioritizing and calculating the cost within the current Master Health Plan. Underpinning the provision of primary and preventive health care services would be of great help in reducing the main causes of mortality in Haiti. Development partners should finance the technical assistance necessary for hospitals to achieve financial viability, strengthen existing infrastructure, and implement a licensing policy. This shift in investments to the health sector should be empirically based.

Improve equitable access to quality health care : this will be achieved by mapping health facilities, reclassifying them to improve their operational capacity and establishing a functional referral network. This reclassification will help improve the distribution of medical equipment and drugs. A policy should be pursued to promote more equitable geographical access to primary health services. Among those households that did not consult a health professional, 49 percent said they did not do it for financial reasons. This policy also promises to improve the efficiency and profitability of the delivery of primary health services by linking the financing of personnel and health institutions with the results.