The Public Health System in Haiti: An Exploratory Study of Hospitals and Health Clinics

Background and Purpose: The earthquake that struck Haiti in January 2010 literally flattened or structurally damaged 90 percent of all commercial, residential, and government buildings in the capital city. The number of confirmed deaths exceeded 250,000, and the number and severity of physical injuries to victims quickly overwhelmed the capacity of organized relief efforts by external entities, including the U.S. military. Additionally, almost 1.5 homeless men, women, and children face a daily emergency for survival and satiation of basic needs. According to the Inter-American Bank (2010), the estimated re-construction cost of $14 billion makes this the most destructive natural disaster in modern times. The purpose of the exploratory study was to assess the following: characteristics of public and not-for-profit health care organizations in rural and urban Haitian cities; patient characteristics, prevalent presenting problems, and services provided; and, funding sources, financial data, and employee information.

Methods: Interpreter-assisted on-site interviews were conducted from a purposive sample (N=8) of hospital and health clinic administrators using the General Orientation Interview (Harrison, 1981), a semi-structured organizational diagnostic instrument. The organization referrals were made by the USAID organization, and were in six different cities. Other organizations were located through snowball sampling. Official government administrative data and agency archive data were also collected during the two-week visit. Data were content and text-analyzed to identify and enumerate salient themes and differential responses. Measures of central tendency and dispersion were used for comparative assessments of empirical data.

Results: Most organizations visited were located in the south and west regions of the country. The administrators were predominantly male (75%) and position titles included medical director, administrator, or director. Most were trained in Europe, none in Haiti. One was an American-born Caucasian female. Respondents had been administrators from 1-13 years, with a mean of 6.5 years. Most hospitals provided a range of curative and preventive services, even though all were severely resource and supply-deficient. The scope of common problems was extensive, and included malnutrition, hydration, tropical diseases, and burns. The number of people served annually ranged from 5,000 to 250,000, with a mean of 65,000. Organization staff sizes ranged from 6 to 400, and annual operating budgets ranged from $20,000 to $7.4 million (U.S.). Haiti has a well-conceived but drastically under-funded public health model.

Conclusion and Implications: Findings contributed to an understanding of Haiti's health care system, the centrality of the Haitian Ministry of Public Health and Population, and the country's dependence upon foreign donors for the minimal health care currently in place. More importantly, the study highlighted the scope and severity of Haiti's health care status as a country. The findings have important implications because (1) there is virtually no scholarship on the public health system in Haiti, and (2) the existing health care network will be a crucial component of Haiti's post-earthquake rebuilding process. It is therefore essential that healthcare delivery strategies and resource-utilization be evidence-based, assessable to all Haitian citizens, and provided as effectively and efficiently as possible. The study data will contribute to that effort.