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The story of Nelta is not uncommon in present-day Haiti. A few months ago, she gave birth to her second child, Jasmine, at her modest home, in the town of Jacmel, 30 miles south of Port-au-Prince.
Unexpectedly, she went into labor when she was 7 months pregnant, but lived too far from the health center to be able to get there in time for delivery. Jasmine was born prematurely and with a low birth weight.
Fortunately, both mother and baby are healthy now and one can see how happy she is to see her daughter’s little smiling face. Yet, making sure that her baby gets regular health care and grows adequately is a daily struggle: nutritious foods are often scarce at home and Nelta needs to walk for about an hour, climbing steep dirt roads, to reach the nearest health center (one in three of the poorest Haitians travel more than 3 miles to reach a health center).
To make matters worse, the earthquake stripped Jacmel of critical health infrastructure, such as hospitals and clinics, and killed many healthcare workers.
Like Nelta, 70 percent of Haitian women give birth at home, contributing to one of the highest maternal and child mortality rates in the Western Hemisphere – child mortality is three times the region’s average.
In Haiti, a child’s ability to survive, develop, succeed in school and become an adult earning a decent living is undermined by chronic malnutrition as well as vitamin and mineral deficiencies.
A large proportion of Haitian children are afflicted by iodine and vitamin A deficiency, affecting brain development and weakening the immune system. The very young ones are particularly susceptible to anemia and growth retardation, which irreversibly impair cognitive abilities and prevent the body from developing optimally.
A silver lining
Most of these nutrition problems could be avoided if families had regular access to good quality health care.
The earthquake was a terrible tragedy. Yet, at the same time it represents an opportunity to build back better Haiti’s health system and ensure improved services, especially outside the capital.
Prior to the earthquake, the Ministry of Public Health and Population (MSPP) faced great difficulties in regulating the sector and providing essential health services. The lack of financial and competent human resources combined with poor accountability and coordination prevented it from fully exercising its leadership role.
Two years on, the Haitian government is back in the driver’s seat. President Michel Martelly is spearheading Aba Grangou (End Hunger) to address malnutrition and food insecurity problems among the poorest. This program, in its initial stages, aims to ensure access to adequate nutritious food though increased food production, job creation and social protection mechanisms.
In addition, the Manman ak Timoun an Sante (Healthy Mom and Baby) program has already been underway for some time with support by the Pan-American Health Organization (PAHO) and Canada. The initiative finances essential health and nutrition services for pregnant women and children under five, using results-based financing –an incentive mechanism to improve targeting and coverage of beneficiaries. The World Bank actively supports the development of these health and social programs and, at the government's request, is involved in the country's healthcare reform.
Participating health providers are reimbursed based on the delivery and quality of health services per beneficiary. These include prenatal care, deliveries in health centers, care to the new mom and her infant, wellness checkups, as well as care for diarrhea and respiratory infections.
Channeling health funds through the Ministry of Health to private and public providers based on the achievement of clear performance indicators makes sense in the Haitian context. In other countries struck by civil or financial turmoil, results-based financing is a proven strategy to achieve both rapid expansion of essential health and nutrition services and longer-term development of health system capacity.
This model allows governments to focus on setting standards and improving quality of services rather than on day-to-day management of inputs, fostering better oversight of both public and private health service providers. In a key aspect of this approach, contracted healthcare providers, whether public or private, are encouraged to improve productivity and quality of services through performance incentives. Thanks to this initiative disadvantaged mothers and children, such as Nelta and Jasmine, can expect high-quality essential health and nutrition services, free-of-charge and closer to their homes.
The earthquake shattered Nelta’s home and part of the health system. But with programs such as Manman ak Timoun an Sante and Aba Grangou, there is hope of a healthier future and for both of them to move out of poverty.
Little Jasmine may be able to receive free health care and eat the nutritious foods she needs to grow strong, learn better in school and become a successful professional.