Background to the programme
The public health sector in Haiti is based on a system of cost sharing to finance the regular costs (not including wages) of its health organisations. The contribution from the patient during each visit, which is used to guarantee a minimum standard of service, represents a major obstacle to the access to healthcare (the patient lacks resources, and does not have sufficient money for healthcare except for urgent or vital procedures). The neighbourhood Haut Martissant is a very poor area of Port au Prince which has been affected by acts of violence between 2000 and 2009.
Objectives of the programme
From 1993 to 2010,the objective was to improve the lives of people in the community (access to health, education and employment). With regards to health, the development of a solidarity fund enabled very poor families to have access to healthcare network (US$14 per person per year). But following an internal evaluation (2011) the goals became more specific:
- To guarantee access and continuity of care to a very poor population;
- to pay particular attention to young children;
- to enter into a dialogue with government health workers in the country.
- 1993, opening of the Health Centre of Saint-Michel (HCSM) by ATD Quart Monde and the Haitian NGO "Service OEcumeique d'Entraide".
- Following the evaluation (2011): Unique subscription system was established; Clarification of criteria for determining beneficiaries; increased number of health remedies including reduction in price up to the point of being free; Collaboration with other centres for procedures that could not be carried out by HCSM; Planning groups with the beneficiaries, which led to strengthening of material, human and financial means.
Quantitative and qualitative results from the implemented actions
- 2000: 268 families benefited from the subscription, up to 1474 individuals of whom 229 were children under 5 years old.
- 2010: the health protection system affected 1849 people of whom 231 were children under 5 years.
- By the end of 2012, following certain modifications: 707 subscriptions were granted, up to 2932 people of whom 577 children under 5.
- 70% of the families benefiting from the system consulted through the network.
Adjusting to existing realities of the beneficiaries thanks to an internal evaluation, the program has modelled its strategies to guarantee access to healthcare for a very poor population. Thus, in collaboration with the population, some private sources and public partners, a funding system has been created.
Partnership(s) developed in the context of the programme
Parternership between ATD Quart Monde and the NGO "Service Œcuménique d’Entraide" in order to create HCSM.
Difficulties and/or obstacles encountered during the programme’s implementation :
- The price of treatment can still represent an obstacle for some families.
Solutions used to overcome the difficulties and/or obstacles :
- Substantial reduction in the price and a move towards a subscription system: a very small increase in the subscription gives the right to a reduction in the price of treatment and to a secondary care network (complementary examinations not given in the centre, referrals to care specialists associated with state organisations or others already identified as partners with the program).
- 2011: internal evaluation of the system to judge the effectiveness and the efficiency of the program, involving 40 families who had benefited from the subscription (2009-2010) and 41 families (control sample) who were living in the area but were not subscribed to the network.
Suggestions for future improvement :
- Study on the impact of the network on the quality of care and the health status of the population covered.
- To collaborate with other partners and join other initiatives working towards the same goals.
Summary of factors responsible for the programme’s success :
REASONS FOR THE PROGRAMME'S SUCCESS
- This is not an isolated programme, it is part of a bigger programme that aims to improve the conditions of life of the poorest families, and which is based on their participation.
- The network responds to a real need in cases where the cost of health is a destabilising factor for people's budget, when they are already fragile and sometimes indebted and exhausted.
ADVICE FOR EXPANSION OF THE PROGRAMME
This network requires both financial and human resources. It could constitute a step towards the universal health coverage in the country if it is joined by other initiatives working towards the same goals.
De Muylder, R. "Fight against poverty and access to care: an example of Solidarity Funds in Port au Prince"« Lutte contre la pauvreté et accès aux soins : un exemple de Fonds de Solidarité à Port-au-Prince » FACTS REPORTS (2014) special issue number 9.