208350 How well is Haiti performing on its commitment to ensure a basic package of care for all?

Tuesday, November 10, 2009: 3:06 PM

Marie Agathe Jn Baptiste, MD, MPH , Health Alliance International, University of Washington, Seattle, WA
Amy Hagopian, PhD , School of Public Health, Dept of Global Health, University of Washington, Seattle, WA
Stephen Gloyd, MD, MPH , Health Alliance International, University of Washington, Seattle, WA
Raoul RaphaŽl, MD , Departement sanitaire du Centre, Central Plateau Health directorate, Hinche, Haiti
Purpose: About 13 years ago, Haiti's Ministry of Health made a commitment to health as a human right. To implement this concept, the Ministry adopted a "Minimum Package of Care" to which the population would be entitled, including reproductive health, integrated management of childhood illnesses, treatment and prevention of communicable diseases among others. The purpose of this paper is to report on the gap between the Ministry of Health's promises and the current state of the delivery system, both in terms of capacity and scope and services, with a focus on workforce shortage.

Data & Methods: A Haitian physician surveyed facilities in the Central Plateau Region of Haiti using a method developed for the World Health Organization, the ď Workforce Indicators of Staffing Need.Ē For both private and public facilities, we calculated the full-time equivalent (FTE) staff required in each health worker category (nurses, physicians, lab technicians, and others), and the shortfalls or surpluses at each site and overall.

Results: Simply to provide the basic package of care, not even including inpatient care, we calculated a shortfall of 105 FTEs overall, with a shortage of 16 physicians, 14 nurses and 75 nurse midwives in the region. In all categories of care, the volume of services expected to be delivered would require more health personnel than are currently delivering the selected services at the facilities.

Conclusion and recommendations: Haiti's capacity to meet its commitment to deliver a minimum package of care is severely compromised by limited resources. Further, coordination between public and private sector facilities isn't optimal, perhaps contributing to inefficiencies in deploying the personnel available.

Learning Objectives:
1. Explain how the Workforce Indicator of Staffing Need model can be applied to project demand for patient care visits from a population, based on World Health Organization methodology and country-level standards of care; 2. Use an established and tested model and simple spreadsheet technology to project numbers of health workers needed to implement a minimum package of health care services. 3. Formulate strategies to implement a minimum package of care and assess the nature of the barriers to successfully implementing those strategies.

Keywords: Health Service, Workforce

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Faculty at the University of Washington and conduct research on international health workforce issues
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.