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

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 “ Workforce Indicators of Staffing Need.” 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.