March 2002
BRIEFING PAPER ON HAITI'S DETERIORATING HEALTH CONDITIONS IN WAKE OF US-LED FINANCIAL EMBARGO
THE UNITED STATES RESISTS HUMANITARIAN CALLS TO RELEASE AID AND LOANS PROMISED FOR HAITI'S HEALTH SERVICES AND SOCIAL CONDITIONS
"There are too many needs in Haiti going unaddressed and we should not be holding up any funds. We are putting politics and process above the needs of the Haitian people." Andrew Cuomo, February 20, 2002 on a recent visit to Haiti where he toured the maternity ward of the ailing State General Hospital
Background:
At the urging of the United States, funds to the government of Haiti are being withheld by the United States, the European Union, the International Monetary Fund (IMF), and the Inter-American Development Bank (IDB). In early 2001, the government of Haiti met all the conditions for the approval of the IDB loans, which are for health and accompanying development, including satisfying all arrears owed to the IDB. The IDB subsequently approved the loans to Haiti and were ready to disperse the funds when the US caused them to be halted ( i ). Although the IDB acknowledges that this situation is unprecedented, the government of Haiti is being penalized with a charge of $79,000 per month in credit commissions to the IDB on loans, which have yet to be disbursed.
The first phase of the IDB loans is to address quality and access to healthcare through targeted tasks such as construction of low-cost community health centers, training of personnel, purchase of basic materials, providing of healthcare services to 2 million Haitians (25% of population), including pre-natal, post-natal care, primary dental care, treatment of contagious diseases. The ultimate objective is to reduce the high infant mortality rate, reduce the high juvenile death rate, and reduce the birth rate ( ii ).
Current Status of Healthcare in Haiti:
With the current financial sanctions taking a toll on Haitians and the delivery of healthcare, the original statistics cited in 1998 with the signing of the loan agreements between the IDB and the government of Haiti pale when compared with today's realities as follows ( iii ):
· Child mortality rose from 74 deaths per 1,000 to 80;
· Juvenile death rose from 131 deaths per 1,000 to 149 in the rural countryside;
· The birth rate rose from 4.6 to 4.7 and as high as 7.6 in one of the poorest sanitary departments.
Leading Healthcare Providers in the NGO Community of Haiti Call for Immediate Release of the IDB Health Loans:
Dr. Bill Pape, co-founder of Centre GHESKIO, the oldest AIDS treatment and research institution, wrote to the IDB president urging that the health loan be released because, "a battle against AIDS is directly linked to the reorganization of the health system."
Dr. Paul Farmer, medical director of a private health facility in Haiti's Central Plateau that treats patients infected with HIV/AID, tuberculosis and other diseases, reports that "the aid embargo has in effect rendered the Ministry of Health incapable of reviving the national network of clinics and hospitals." Dr. Farmer's facility, which normally receives no more than 25,000 visits per year, will this year see an estimated 60,000 patients. He attributes this rise to, "dramatically diminished ability of the public-health system to respond to the needs of the Haitian people. The Ministry of Health, the only institution with a mandate to serve the entire population, has been strapped by financial constraints."
Assistance through the NGO sector is simply not enough and is no substitute for a comprehensive public health policy. In its 2001 newsletter, the Haitian Health Foundation, a non-profit organization working in Haiti wrote, "the number of villages that we serve has grown from 15 to 92 with a population that now stands at more than 200,000. Despite this dramatic increase, USAID has failed to keep pace."
According to Dr. Farmer, although the Haitian HIV/AIDS epidemic has been contained more effectively than in many African countries, it is the gravest in this hemisphere. World Bank assistance for HIV prevention has continued to flow to other less gravely affected countries in the region but not to Haiti. A one million dollar pledge of funds by the IDB for Haiti, made 5 months ago, even when it was criticized for its disproportionate allocation of funds to administrative costs versus the actual treatment of AIDS, has yet to make it to Haiti.
In a recent visit to Haiti, Congresswoman Carrie Meek, citing worsening health indicators, said, "It is morally correct to release the aid," and Congressman John Conyers said that resources, materials, food and assistance "should be coming into Haiti unabated!"
The US Fights Back Against Humanitarian Calls for Release of Health Monies:Despite the alarming impact of the sanctions on Haiti which have caused an increase in preventable and treatable diseases and a higher
mortality rate, U.S. Secretary of State Colin Powell, stating that, "we have questions about providing that kind of assistance [to the government of Haiti]," stood firm recently against the recommendations made by the 15-nation CARICOM block who have called for the lifting of the sanctions.
Despite Obstacles, the Government of Haiti Continues to Address Health Needs Despite tremendous obstacles and decreasing resources, the government of Haiti (GOH) has made some important strides in the health sector:
In October 2001, the GOH completely renovated and reopened the School of Midwifery;
Haiti is part of an important 3-country HIV/AIDS trial vaccination program;
New healthcare centers were opened in three municipalities, St. Louis du Sud, Thomazeau, and Raboteau;
New healthcare centers were opened in three municipalities, St. Louis du Sud, Thomazeau, and Raboteau;
Renovations of existing health centers and/or hospitals have been completed or are underway:
· St. Catherine in Cite Soleil;
· The operating room at the Port Salut health center;
· A modern operating room was added to the hospital in Jean Rabel;
· The Miragoane public hospital;
· The Cap Haitian public hospital;
· The pediatric ward of the St. Marc public hospital;
· The public hospital in Gonaives;
The morgue at the State University Hospital was fully renovated, and doctors were trained in forensic medicine;
The GOH's cooperation with Cuba has lead to the expansion of the number of physicians in areas of the country with no doctors;
The GOH initiated a salt iodination project to combat iodine deficiencies reported to affect 10% of the population;
The government initiated an aggressive campaign to vaccinate children against measles, rubella, polio, and other childhood diseases.
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1 On July 21, 1998, the Government of Haiti (GOH) and the Inter-American Development Bank (IDB) signed a 22.5 million dollar loan for Phase I of a project to decentralize and re-organize the national healthcare system. The GOH was required to contribute 2.5 million dollars to this project. In October 1998 the GOH's Ministry of Health presented the IDB loan agreement to the 46th Legislature for ratification; the Haitian parliament was, at the time, dominated by the political party OPL, now leading spokesparty for Convergence Democratique, a platform of opposition parties that continues to oppose the release of this and other humanitarian assistance to the GOH. The legislature's term expired in January 1999 without ratification of the IDB contract.
In October 2000, after the installation of the 47th Legislature the new parliament immediately ratified the IDB health project along with 3 other vital IDB loan agreements for education, potable water and secondary roads.
The GOH and IDB collaborated immediately to update and revise the health project. On March 2, 2001 when the new government was installed, the Minister of Health notified the IDB that the conditions required of the GOH under the loan agreements had been fulfilled. Later that month, with the verbal assurance from the IDB that the health loans and 3 accompanying development loans would indeed be funded, the GOH satisfied all arrears owed to the IDB.
In April 2001 at the Summit of the Americas in Quebec, the IDB informed the GOH that there was nothing precluding the release of funds to Haiti, except for authorization by the U.S. On May 15, 2001, notwithstanding the fact that still not one penny of the 22.5 million dollar health loan or the other 3 loans had been funded, the IDB advised the GOH that it was being charged and would be required to pay a "credit commission" of 0.5% of the entire balance of undispersed funds effective 12 months after the date of approval of the loans. Based on calculations provided by the IDB, every month that political "crisis" is allowed to endure and approved loans from the IDB are not dispersed, the GOH would be required to pay $79,000 a month in credit commissions alone.
In a letter dated June 4, 2001, the IDB acknowledged that, "the position of certain members of the IDB Administrative Council regarding the situation in Haiti is temporarily preventing the institution from strictly conforming to the norms and procedures agreed to with respect to the management of the project [with Haiti.]" And that in this "unprecedented situation", it was awaiting the green light from either the Organization of American States (OAS) or "major partners" of the IDB's Administrative Council, to go forward with the loans. The IDB further acknowledged that, "the Minister of Health extended considerable efforts to elaborate the necessary support documentation and has satisfied the pre-conditions." The letter goes on to reaffirm the inability of the IDB to "honor its commitment" and requests that the GOH advance monies to the ministries of health, education, and public works, "since the preconditions have been satisfied", with the assurance that
this advance would be reimbursed by the IDB once the loan was funded.
To date, the loans, totaling 145.9 million dollars, have not been funded.
The "authority" sought from the OAS or the IDB's "major partners" has not been given, even as the GOH has made substantial progress towards the resolution of the political crisis with the resignation of all contested senators and a term reduction agreed to by all members of parliament elected
May 2000 -- the pre-conditions under the OAS resolution for the "normalization of relations between Haiti and the international financial institutions."
11 During Phase I, the project targeted four of Haiti's ten sanitary departments, the goals were to:
Improve the quality and access to public and private health services;
Increase the efficiency of services at a national level; and
Develop innovative models for healthcare services able to be reproduced at the national level.
Over the 3-year period of Phase I, the following was to be accomplished:
Technical assistance in the 4 sanitary departments;
The training of Haitian human resources;
Purchase of basic equipment and material;
Construction of low-cost community health clinics;
And the provision of the below listed primary healthcare services to 2 million Haitians, 25% of the population:
· Complete health care services for all children;
· Pre-natal and post-natal care;
· Reproductive healthcare;
· Treatment of contagious disease;
· Surgical emergencies;
· Essential medicines;
· Health education; and
· Primary dental care.
The project's goal was to:
Reduce infant mortality rate from 74 deaths per 1,000 births to 50 deaths per 1,000 births;
Reduce juvenile death rates from 131 deaths per 1,000 births to 110 deaths per 1,000 births;
Reduce the birth rate from 4.6 to 4.
These statistics were recorded in 1998 at the signing of the loan agreements.
Since then, there has been an increase in the infant and juvenile death rate and an increase in the overall birth rate:
· Child mortality rose from 74 deaths per 1,000 to 80;
· Juvenile death rose from 131 deaths per 1,000 to 149 in the rural countryside;
· The birth rate rose from 4.6 to 4.7 and as high as 7.6 in one of the poorest sanitary departments.
111 Alarming Health Indicators and HIV/AIDS
Other recent health indicators in Haiti are alarming:
62% of all births are not followed by any post natal care; in the rural countryside, that figure jumps to 71%;
23% of all births take place outside a health facility;
24% of all births are not accompanied by any healthcare professionals;
Only 34% of infants between the ages of 12 and 23 months are fully vaccinated;
39% of children under 5 have, or have had, acute respiratory disease;
The maternal mortality rate is 523 deaths per 100,000 deliveries;
On the HIV/AIDS front, the infection rate is nearly 5%, with 30,000 new cases annually.
Only 4% of woman questioned for a 2001 health survey and 6% of the men admit to ever having been tested for HIV/AIDS.
Although the World Bank acknowledges and claims "concern" for a worsening poverty in Haiti, it issued a statement on February 8, 2002, that it would not extend any new credits for Haiti because of the "political crisis."
Distances Traveled by Haitians for Access to Health Care Reinforces Need for Decentralized Approach Adopted in the Blocked IDB Health Project
According to the most recent survey here are estimates of distances that must be traveled by urban and rural residents to reach 3 categories of health facilities in Haiti:
Health Facility Distance % of Rural Population %Urban Population
____________________
Hospitals Less than 5 kms 8.2% 65%
5 to 14 kms 27%
26.6%
15 kms or more 59.2%
8.4%
None available 5.6%
-
Health Clinics Less than 5 kms 34.9% 83%
5 to 14 kms 31.2%
13.1%
15 kms or more 34.0%
3.4%
None available - -
Dispensaries Less than 5 kms 53.7% 89.8%
5 to 14 kms 24.6%
7.9%
15 kms or more 16.2%
2.3%
None available 5.6%
-
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