Healthcare Assessment Study in Les Cayes, Haiti: Towards a Framework for Rural Capacity Development and Analysis1

By Guilbaud, Patrick; Preston, Mary | Journal of Haitian Studies, Fall 2006 | Go to article overview

Healthcare Assessment Study in Les Cayes, Haiti: Towards a Framework for Rural Capacity Development and Analysis1


Guilbaud, Patrick, Preston, Mary, Journal of Haitian Studies


Introduction

A healthy population may require a relatively prosperous and stable economy, but this need not imply the levels of income and resource consumption common in developed countries. Many communities with a relatively low level of income have made substantial improvements in health. Improved health can be separated from ever-increasing consumption if development programs stress the promotion of health both in the narrow sense of curing or preventing disease and in the broad sense of promoting well-being and informed participation. (WHO, 1992)

The above quote from the World Health Organization epitomizes the contradictory aspects involved in the notion of sustainable health care. Nevertheless, and it is often mentioned, many people who work in the field of healthcare are somewhat frustrated with the lack of progress seen in places such as Haiti. Despite the frustration for those working in the field, the WHO quote serves as a reminder that healthcare is not only simply a concern for the physical body, since education, prevention, and awareness or a holistic orientation towards healthcare can have a significant impact on quality of life outcomes.

The critical challenges and service inequalities in the healthcare sector of Haiti are described in a 2006 country profile report by the U.S. State Department. They are stated, as follows: "Considerable barriers remain in Haiti in the provision of quality prevention, treatment, and care services that include: a low level of public health services; a lack of clinical capacity to deliver ART [Antiretroviral Treatment]; and an unreliable commodities logistics system, which cannot be relied upon to ensure timely drug supplies."

It is also generally agreed that the atmosphere of poor socio-economic conditions that currently prevails in Haiti (Berggren, et al. 1981; Farmer, 1991 & 2003; Dupuy, 1989; Fatton 2002) plays a crucial role in the country's inability to carry out and maintain successful healthcare development programs. Wide differences in access to adequate healthcare service exist throughout Haiti. Gaps in service offerings are even more pronounced in the rural areas of the country.

Governmental organizations such as CIA (Central Intelligence Agency), PAHO (Pan American Health Organization), UNDP (United Nations Development Program) and WHO (World Health Organization) report that the poor state of human development in areas such as post-secondary education, basic municipal infrastructures, economic activity, and vocational training found in Haiti are major contributors to the country's healthcare problems. As a result, the country faces a host of economic and human development challenges.

State of Healthcare in Rural Haiti

A major deficiency in the healthcare system in Haiti that is often noted is the unevenness in the geographical distribution of its healthcare facilities and in the allocation of hospital beds (PAHO, 2001). On a per capita basis, there are approximately 30% of the doctors, nurses, and health specialists in the rural areas of the country. However, since Haiti has a 65/35 rural/ urban split, there is greater polarization in the level of infections and care treatment provided to debilitating infections and illnesses such as HIV-AIDS, tuberculosis, syphilis and malaria in the rural areas of the country (PAHO, 2001; Farmer et al, 2001; Fitzgerald et al, 2003).

As seen in the works of Berman (1995), Londono (1997), and Bronzino (1991), there is a clear acceptance and understanding that economic oriented policies and measures tend to have an excessive impact on healthcare issues in poor countries. However, efforts to increase healthcare and build health capacity in Haiti are often short-term in scope or single-disease focused (Farmer, 2003). Worse yet, at times it appears that under-emphasis is placed on individualized projects or uncoordinated efforts, which often do very little to lift the country out of its present state of inadequate and unsustainable health care. …

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