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Country Health Profile.
Data updated for 2001Haiti Health Situation Analysis and Trends Summary Country Chapter Summary from Health in the Americas, 1998.
HAITIGENERAL SITUATION AND TRENDS Socioeconomic, Political, and Demographic Overview The Republic of Haiti occupies the western third of the Island of Hispaniola, which it shares with the Dominican Republic. The country is divided into nine departments ("départements"), 133 municipalities ("communes"), and 561 districts ("sections communales"). Water supply and basic sanitation services are still very deficient. No city has a public sewerage system, and there only are isolated wastewater treatment units throughout the country. Solid waste management is a serious problem; bad excreta disposal practices are polluting almost all 18 water sources supplying Port-au-Prince. The growing number of motor vehicles and their inadequate maintenance have created a serious air pollution problem in Port-au-Prince. Every year, approximately 20,000 tons of arable land are lost to the sea due to deforestation and erosion. This phenomenon is aggravated by charcoal production throughout the countryside and heavy agricultural pressure on steep slopes. The major trends in the Haitian economy over the past decade indicate a steady decline in the actual gross domestic product and a net rise in unemployment. Economic sanctions that were imposed in 1991 further deteriorated the economy. The gross domestic product in 1994 had decreased back to its pre-1980 level. This was paralleled by a population growth rate of 2.1% and a steep decline in per capita income from 1990 to 1995. The 4.2% growth rate in GDP reported for 1994–1995 could not offset that indicator’s 25% decrease during the embargo (1991–1994), thus maintaining Haiti’s position as the poorest country in the Western Hemisphere. According to World Bank figures, per capita GDP was US$ 220 in 1994, equivalent to US$ 896 adjusted according to purchase power parity (PPP), making it one of the lowest in the world. The inflation rate averaged 25.4% between 1991 and 1994 and rose to 27% in 1995. The unemployment rate is estimated at 70%. Population projections, developed by the Haitian Institute for Statistics and Information Technology in conjunction with the Latin American Demographic Center, estimated the population of Haiti at 7,180,296 inhabitants in 1995. Persons younger than 15 years of age account for 40% of the total population; children under 5 years of age account for 15%. Persons of working age, between the ages of 15 and 64 years, represented 56% of the population. The population aged 65 years old and older accounted for only 4% of the total. Projections for 1995–2000 place the crude birth rate at 34.1 per 1,000 and the crude death rate at 10.72 per 1,000. The fertility rate was estimated at 4.8 children per woman. Based on these estimates and an anticipated population growth rate of 2% per year, it was estimated that the population will reach 8 million by the year 2000. Haiti has one of the highest population densities of all Latin American countries, with 260 inhabitants per km2 as of 1995 and 885 inhabitants per km2 of cultivated land. The percentage of urban population in 1994 was 33%, the lowest in the Hemisphere. However, it has increased in recent years with rapid proliferation of shantytowns in Haitian cities (Le Cap-Haļtien, Gonaļves, Les Cayes). More than one-third of the total population (34.7%) lives in the capital, Port-au-Prince. The rural exodus has overburdened the housing situation, particularly in Port-au-Prince. Haphazard housing construction resulted in the erection of many dwellings in drainage areas, river beds, and protected water resource developments. There were major migratory movements between 1991 and 1994. Internal migration to the countryside occurred after the coup in September 1991, with approximately 200,000 persons fleeing Port-au-Prince to take refuge in rural areas. Since 1995, there has been an increase in internal migration back to Port-au-Prince, accompanied by a decline in illegal migration. The number of Haitians living abroad is estimated at more than 2,000,000, mainly in the USA, Canada, France, and the Dominican Republic. There is no systematic method to collect, process, and disseminate information on mortality. Nearly one-half of all deaths occur within the first 5 years of life. According to a survey on morbidity, mortality, and use of services conducted by the Child Health Institute in 1994–1995 (EMMUS-II), 74 out of each 1,000 live births die before their first birthday, and approximately 131 never reach their fifth birthday. In 1987, an earlier study (EMMUS-I) put infant mortality at 101 deaths per 1,000 live births. There has been a steady improvement in net enrollment ratios at the primary school level over the past decade. Enrollment climbed from 37.2% to 44.1% between 1988 and 1991, and the estimate for 1995 is 51.4%, with similar values for males and females, but this has been accompanied by a shrinkage in the average size of school facilities and the growing numbers of poor-quality schools and overcrowding. School attendance by lower income children is limited by the cost of school fees and curtailed by child labor. French and Creole are the two official languages, but Creole is the everyday language used by all segments of society. The individual perception of illness in Haiti is grounded in a highly complex cultural heritage. There are various types of traditional healers, including spiritual healers. Improper feeding practices have important deleterious effects on health (e.g., administration of purgatives to newborns during the first days after birth and feeding newborns with porridge or solid foods). Forty-two percent of newborns are bottle-fed within the first month; it is estimated that less than 1% of children are completely breast-fed by 6 months of age.
SPECIFIC HEALTH PROBLEMS Analysis by Population Group Health of Children The leading causes of child mortality in Haiti are diarrheal diseases, acute respiratory infections, and malnutrition. Major causes of hospitalization for children 0–14 years old in 1995 were prematurity (23%), pneumonia (16%), malnutrition (8%), meningitis (8%), typhoid (6%), and gastroenteritis (5%). In 1991, the Center for Research on Human Resources conducted a survey in three cities in three different departments. The survey provided an overview of the plight of children (boys and girls under 18 years of age) in especially difficult circumstances, including several groups: children employed as domestics, abandoned children, orphans, incarcerated juvenile offenders, child prostitutes (male and female), abused children, and street children. In 1991, the number of street children in Haiti ranged from 1,500 to 2,000 in Port-au-Prince. Most of them are boys, but the number of girls appears to be increasing, accounting for 18% of the children surveyed. The mean age of these children is about 11 years; 55% of them are aged 12 to 18 years old, and 14% are 5 years old or less. They are particularly vulnerable to tuberculosis, anemia, skin diseases, and sexually transmitted diseases. Many of these children are drug users (53% of the inner-city sample). Health of Adolescents (Age Groups 10–14 and 15–19 Years Old) A study conducted in 1992 in Cité Soleil (the main slum of the capital) by the Research, Culture, Health and Sexuality Team revealed that many young residents were sexually active by 13 years of age. The use of contraceptives is extremely rare within this age group. According to data from EMMUS-II, only 4.4% of those who were sexually active at the time of the survey had used a modern method of contraception, and 8 % of all births were to teenage mothers aged 15 to 19 years of age. Adolescents accounted for 15% of birth-related deaths, and nearly 4% of them had induced abortions with rates higher in the cities than rural areas. Between 1991 and 1992, the Child Health Institute conducted a seroprevalence study of post-partum HIV-1 infected women, which revealed that 7.4 % was seropositive for HIV in metropolitan areas, and 4.1% in rural or semirural areas. Typhoid accounted for some 64% of admissions to the Haitian State University Hospital pediatrics ward of children aged 9–14, and meningococcemia accounted for 28%. Health of Women Women accounted for roughly half of the total population (51%). In the field of education, girls and boys have equal opportunities to attend primary school. At the primary school level the gross number of years of schooling for girls is 0.5–2.1 years lower than for boys. Women also enter the job market at an early age; roughly 10% of young girls aged 5–9 years and 33% of girls aged 10–14 may be considered economically active. Because of food insecurity and short intervals between births, chronic malnutrition, including anemia, was widespread among women of childbearing age. The main indicators include high prevalence of low birthweight (estimated at 15%), of anemia among women (ranging from 35 % to 50%), of body mass index under 18.5 kg/m2 (estimated at 18%), and of high maternal mortality rate (estimated at 456 per 100,000 live births). In 1995, a national study on violence against women was. From a sample of 14 municipalities, out of a total of 133, a total of 1,935 cases of violence were reported: violence was classified as physical (33%); sexual (37%), with rape representing 13% of the total; others (6%); and unspecified (25%). The 81% of all documented cases of violence involved women aged 10–34. According to a study conducted by the Albert Schweitzer Hospital, the cervical cancer is the most common form of cancer. Women are increasingly victims of HIV infection; 53 % of female partners of infected males are HIV carriers. For the 1990–1995 period, life expectancy in Haiti was estimated at 58.3 years for women and 54.9 for men. The general fertility rate is 4.8 children per woman for women aged 15–49 years old. Most women indicated that they wanted to give birth to only three children. Some 71% of the female respondents interviewed during EMMUS-II reported having been attended by a professional or a traditional birth attendant during childbirth. Of the women interviewed, 80% had given birth to their last child at home. Fifty percent of women living in Port-au-Prince generally give birth in a hospital, compared with only 31% of births in other urban areas and 9% of births in rural areas. The leading causes of maternal deaths are: obstructed labor (8.3%), toxemia (16.7%), and hemorrhage (8.3%). The high maternal mortality rate is mainly the result of inadequate prenatal care. According to EMMUS-II, an estimated 68% of pregnant women had at least one prenatal examination by a health care professional and 66% received at least one dose of tetanus vaccine. Among pregnant women, 34% had four or more prenatal examinations, 26% had 2–3 examinations, and 8% had only one examination. The most popular methods of contraception were the birth control pill, female sterilization, injections, and condoms (3% each). Among sexually active women, 13% used a modern method of contraception and 4% relied on traditional methods. Among sexually active men, 17% used a modern method (6% used condoms) and 16% relied on traditional methods.
Analysis by Type of Disease or Health Impairment Communicable Diseases Vector-Borne Diseases. Malaria is considered a public health problem in Haiti, especially in rural areas. Plasmodium falciparum is prevalent throughout the country. The last confirmed indigenous cases of Plasmodium vivax infection occurred in 1983. Most cases of malaria transmission occur in coastal areas at altitudes below 300 m, particularly in the heavily populated rice-growing areas in the south and Artibonite. Estimates made in 1988, as part of an effort to map out a strategy for malaria control, amounted to 250,000 annual malaria cases, with a 1% case fatality rate. Slide positivity indexes for the 1991–1994 period are unusually high, ranging from 31.2% to 42%. Dengue is considered an endemic disease. The Aedes aegypti, is found throughout the country, and extremely high infestation rates have been reported, particularly in urban areas. Data collected 10 years ago by the Department of Public Health put the seroprevalence rate at 3%. In 1994, an outbreak of dengue was reported in Port-au-Prince. Serotype 1 isolates were found in patients suffering from febrile illnesses. Serotypes 1, 2, and 4 are currently found in Haiti, while serotype 3 has never been identified. Lymphatic filariasis, found in scattered urban foci, mainly in the north and Gulf of La Gonāve, is still a serious public health threat in Haiti. Wuchereria bancrofti, transmitted by Culex quinquefasciatus, is becoming meso-hyperendemic in coastal areas. Its effects were most visible in boys and men, who generally develop elephantiasis of the scrotum. Studies conducted by the United States Centers for Disease Control and Prevention indicate that more than 20% of the population of most coastal cities, including Léogāne, Petit-Goāve, Arcahaie, and Limbé, are carriers of the microfilaria. Vaccine-Preventable Diseases. In August 1994, Haiti was declared free of poliomyelitis by the International Certification Commission on Polio Eradication, and since then no cases of flaccid paralysis have been confirmed as poliomyelitis. However, vaccination rates remain very low (30% in 1995). Between 1989 and 1994, the average attack rate for measles was 24 per 100,000 persons. A countrywide measles epidemic broke out in July 1991. Since the national vaccination campaign in 1994–1995, no cases of measles have been confirmed. The routine vaccination rate in infants younger than 1 year old in 1995 was estimated at 75%. Regarding neonatal tetanus, 78 cases were reported in 1995 for the whole country. During the first six months of 1997, 31 cases of neonatal tetanus were reported by 39 sentinel sites from the nine departments. Hepatitis B surface antigen was found in 5.5% of donors tested in 1990. In 1996 serosentinel studies conducted by the Child Health Institute and GHESKIO Centers, at facilities in nine locations (one by department), found hepatitis B surface antigen in 2%–7% of pregnant women. Intestinal Infectious Diseases. There were no reported cases of cholera as of July 1997. The epidemiological surveillance system established for acute diarrhea identified Vibrio furnissii for the first time in the Caribbean and Non-01 Vibrio cholerae isolated from a stool specimen taken from a patient with cholera-like symptoms. From 1987 to 1994, the National Health Surveys detected a sharp decline in the incidence of diarrhea in children under 5 years old (from 43% to 27.6% for the two-week period preceding the surveys); however, values remain very high, reaching 47.7% in the age group 6–11 months old. Diarrheal diseases are the leading cause of illness and death in children under 5 years of age, often associated with acute respiratory infections and malnutrition. Typhoid is endemic in Haiti. In 1991, a major typhoid epidemic was confirmed in several low-income neighborhoods of Port-au-Prince. Several epidemic foci were reported in 1992–1993, predominantly in the south. From July to December 1995, typhoid was responsible for 6% of admissions at the Haitian State University Hospital pediatrics ward. It ranked as the fifth leading cause of hospitalization. Chronic Communicable Diseases. Between 1981 and 1990, more than 6,000 new cases of tuberculosis were notified each year to WHO; 10,237 cases or 154.7 per 100,000 were reported in 1991, date of the last notification. The incidence of tuberculosis in Haiti is estimated at 180 per 100,000 inhabitants. The high mortality rate is the result of the country’s generalized poverty, and HIV/AIDS epidemic. In a study conducted in 1992–1993, an HIV seroprevalence of 19% was found in a group of 240 tuberculosis patients. Data from 1991 show that 50% of all patients with AIDS suffered from tuberculosis. Seroprevalence studies among children, conducted in 1996, confirmed the close correlation between tuberculosis and HIV infection. Between 1977 and 1996, the country’s two referral facilities, Providence Hospital in Gonaļves (Artibonite) and the Fame Pereo Institute in Port-au-Prince, saw 1,998 registered patients, 80.5% them being paucibacillary cases and 19.5% multibacillary cases. A breakdown of leprosy patients by age group reveals that 21% were children under 15 years of age of whom 12.6% were multibacillary cases. Of 521 leprosy cases diagnosed between 1993 and 1996, 22 cases of disabilities grade 2 and over were notified. Acute Respiratory Infections. Data produced by EMMUS-II for 1994 showed that 20% of children under 5 years of age suffered from acute respiratory infections (ARIs) during the two weeks preceding the survey. In 1994, ARIs accounted for 25% of deaths among children under 5 years of age, and pneumonia was the number one cause of death among ARI patients. In 1994–1995, ARIs were the leading cause of patient visits to 42 sentinel facilities in Haiti. Rabies and Other Zoonoses. Two to four cases of human rabies were reported each year between 1990 and 1995. Only one of the cases in 1993 was confirmed by the Connecticut State Laboratory in the United States. Seven cases were reported in 1996. Leptospirosis appeared to be on the rise. In 1995, 64 cases of the disease were identified and 32 cases were reported during the first four months of 1996. The male-to-female ratio is 2:1, with 35% of the cases involving males between the ages of 20 and 39. The disease proved fatal in 33% of the cases. AIDS and Other Sexually Transmitted Diseases. A cumulative total of 4,967 AIDS cases (46% of whom were female) were reported between 1982 and 1992. Official reports and notification of AIDS cases were suspended by 1992. As of 1996, the percentage of the sexually active population infected with HIV was estimated at 3%–5% in rural areas and 7%–10% in urban areas. Preliminary projections, based on different mathematical models, conclude that the number of HIV-positive individuals will reach more than 380,760 by the year 2000 and the annual number of deaths could climb as high as 27,000, including 6,000 children. HIV transmission is predominantly heterosexual (male/female ratio 1.2:1). Emerging and Re-emerging Diseases. In late April 1994, a meningococcemia epidemic was reported in Ouanaminthe, in the Northeast Department. By the end of November, approximately 100 cases and nine deaths had been reported. Group C Neisseria meningitidis was identified. In 1995, in the Port-au-Prince area, over 75% of the cases involved children between 5 and 14 years of age. The rest of the country also reported cases, with the largest number of cases seen in rural areas in the Artibonite. In all of 1995, 158 cases were reported, of which 55 died, yielding a case-fatality rate of 35%.
Noncommunicable Diseases and Other Health-Related Problems Nutritional Diseases and Diseases of Metabolism. In 1994–1995, EMMUS-II revealed a significant increase in the prevalence of wasting since 1990, mainly affecting children under 3 years of age. More than one-third of all children who survived their first birthday showed signs of severe growth retardation. By age 5 years, 41% of all children were severely stunted. High rates of malnutrition and infectious diseases suggest that many preschool children are suffering from the effects of vitamin A deficiency and/or nutritional anemia. Mangoes are an important dietary source of vitamin A, and following their abundant availability, a seasonal variation has been observed in the dietary intake and deficiency of vitamin A. A 1991 survey conducted in the Central Plateau showed a prevalence rate of 10% for all types of goiter (Grades 1 + 2) and 2.5% for visible forms of goiter. Similarly, urinary iodine in the general population was 10.3 µg/dl. Iodine deficiency problems are typically confined to the isolated inland mountainous areas. There were three types of diabetes registered in Haiti: type 1, or insulin-dependent diabetes (10% of total); type 2, or non-insulin-dependent diabetes; and type 3, or malnutrition-related diabetes ("tropical" diabetes). The prevalence ranges from 2%–8% for different parts of the country. Half of all amputations performed in the State University Hospital in 1987 concerned patients with diabetes. Cardiovascular Diseases. These diseases accounted for 40% of patient admissions at the State University Hospital in 1996, mainly cerebrovascular accidents and ischemic heart disease. Two surveys suggest a 13%–15% prevalence of high blood pressure in the adult population 18 years and older. Malignant Tumors. The National Cancer Institute statistics showed that the most frequent type of cancer treated was cervical cancer, representing 60% of the total for the period 1988–1990 and 40% for the period 1991–94. Breast cancer ranked second with 15% and 30 % respectively. Nasopharynx occupied the third position with 10%–15% of the cases. The total cases of cancers treated by the institution averaged 250 per year from 1988 to 1994. Several health care facilities are partially involved in the detection, diagnosis, treatment, and care of patients suffering from cervical cancer/dysplasia. Accidents and Violence. Data reported by the Haitian State University Hospital for 1995 showed that a higher incidence of traffic accidents occurred in December, as compared with the rest of that year. The total annual number of dead and injured was 2,393; males were more affected than females (1.7:1). Frequent domestic accidents resulted in serious burns mainly affecting children. In addition, Haiti is regularly the scene of fires and shipping accidents, such as the Neptune tragedy in February 1993, which caused 1,500 deaths. Natural Disasters. Tropical storm Gordon struck Haiti in November 1994, claiming 1,122 lives. It destroyed 3,550 homes, seriously damaged several water supply systems, killed thousands of livestock, and damaged vast acres of food crops. The storm affected the health services through increased demand for and redistribution of limited resources. Widespread flooding, both in rural (the south in November 1995, and the south and northwest in February 1996), as well as urban areas (beachfront areas of Port-au-Prince) caused extensive damage. Drought regularly affects the country’s northwest.
RESPONSE OF THE HEALTH SYSTEM National Health Plans and Policies In March 1996, the Ministry of Health introduced a health policy that recognizes a fundamental right to health and the State’s obligation to guarantee access to health care for all. Health sector reform was designed as part of the State’s decentralization effort to ensure equal access to a minimum package of services. Health Sector Reform The Ministry of Health defined the following priorities: • Strengthening the Ministry of Health at central and departmental levels, including developing human resources and managerial capacity; using new health financing modalities, undertaking hospital reforms, updating health legislation, reviewing the policy on essential drugs, developing the health information system, pursuing intersectorial coordination, and implementing community health units based on decentralization and community participation. • Developing primary health care aimed at delivering a minimum package of health services to the population, including comprehensive child care that targets acute respiratory infections; comprehensive health care for women with emphasis on pregnancies and reduction of maternal mortality; vaccination; access to essential drugs; prevention and control of communicable diseases; targeting emerging and re-emerging diseases such as tuberculosis, STDs, and AIDS; controlling meningococcal infections and vector-borne diseases; eradicating measles, neonatal tetanus, and leprosy; and improving medico-surgical emergencies and dental care. • Strengthening health promotion activities to encourage the population to assume responsibility for its health and adopt a healthy lifestyle—programs included health information dissemination, health education, and social mobilization, particularly in the prevention of communicable diseases, violence and accidents, school health, and pathologies linked to poor nutritional habits. • Improving environmental health, including access to potable water, food hygiene, control and disposal of excreta and atmospheric pollution as well as the prevention and mitigation of disasters. Organization of the Health Sector Institutional Organization Haiti’s health system includes the public sector, the semi-public sector, and the private sector. The public sector was seriously affected by the country’s political crisis, which led all foreign aid to be channeled through nongovernmental organizations (NGOs). The Ministry of Health is structured into central, departmental, and community levels. Through its central directorates and units, it sets standards. Planning, monitoring, and supervision are the responsibility of the heads of the nine sanitary departments. One-third of the country’s 663 health institutions belong to the public sector. The semi-public or mixed sector encompasses nonprofit institutions that are supported mainly by NGOs. Staff is paid in whole or in part by the public sector, but is managed by the private sector. In 1994 there were 49 hospitals and 61 other inpatient facilities, with an estimated 90 beds per 100,000 population. Of the country’s total health care facilities, 32% are operated by NGOs. The private, profit-making sector is comprised of physicians, dentists, and other private practice specialists who mostly work in Port-au-Prince and in private health care facilities. Public and private establishments function completely independent of one another with very little networking. Differences in access to adequate health care are further magnified by the uneven geographical distribution of centers and hospital beds. Social security benefits are limited to formally employed people. In 1995, the Insurance Agency for Occupational Accidents, Illness, and Maternity (OFATMA), an autonomous body under the umbrella of the Ministry of Social Affairs, provided insurance coverage to 2,500 public and private firms. In 1996 it covered 60,000 workers, an increase from 40,000 covered in 1994. The estimated per capita expenditure in health for 1995 was G15.7 (US$ 2.0); it represented a decrease compared with that of 1990, which was G24.8 (US$ 3.4). Total per capita expenditure on health reached US$ 9, representing 3.5% of GDP in 1995. According to these estimates, in 1996 the government budget represented about 16% of the total expenditure; external donor agencies, which are mostly channeled through the Ministry of Health and NGOs, 28%; NGOs, 20%; and private expenditures, 36% in 1996. Organization of Health Regulatory Activities Health legislation originally enacted in 1981 remains in effect, but a new legal administrative framework is being drafted. The Ministry of Health established criteria for the operation of medical and paramedical education facilities. Two private nursing schools and 10 training facilities for auxiliary nurses obtained operating licenses. The Ministry’s pharmacy service issues a certificate to pharmacy students after completion of a four-year training program with a one-year internship. The pharmacy service regulates all matters related to pharmaceuticals, which mainly involves the inspection of private pharmacies. Haiti has no drug registration, control of drug imports, or inspections of drug manufacturers. Drugs that normally required prescriptions are easily accessible and commonly sold by street vendors. Between November 1995 and June 1996, an outbreak of acute renal failure affected 100 children, and the majority died. A multiagency investigation revealed that the condition was due do the ingestion of a locally produced acetaminophen syrup contaminated with imported diethylen glycol. To address the situation, the Ministry of Health endeavored to improve quality control monitoring through regular inspection of manufacturers, importers, suppliers, and pharmacies. Because there was no national quality control laboratory, all samples had to be sent abroad for analysis. In November 1995, the Ministry of the Environment elaborated the National Action Plan of Environment, designed to deal with various environmental threats to freshwater, seawater, air, and soil.
Organization of Services for Care of the Population Health Promotion and Social Communication in Health. Several large-scale, public awareness campaigns involving various sectors were launched, some of which are highlighled below. A social marketing campaign for condoms, managed by PSI with AIDSCAP funding since September 1992, resulted in the sale of 14 million condoms. The "baby friendly hospitals" initiative that UNICEF and PAHO jointly launched in 1994 to promote breast-feeding resulted in the certification of two hospitals as baby friendly in 1996. The national campaign for the eradication of measles, which was implemented in 1994–1995, achieved a 98% vaccination coverage. The national campaign for the promotion of breast-feeding that was launched in August 1995 reached the majority of the population. The observance of "Tuberculosis Day," "International Women’s Day," "Safe Water, the Environment, and Health Day," "World No-Tobacco Day," "Mental Health Day," and "AIDS Day" receives media coverage. School Health. The Ministries of Public Health and of Education, with external financial and technical assistance, are working together to develop school health policies appropriate for Haiti, including early detection of hearing and vision problems; promotion of oral health and detection of dental caries; nutritional surveillance; detection of iron deficiency and diseases caused by intestinal parasites; early detection of poor posture; health education and promotion, including sex education; and the prevention of STDs. Workers’ Health. Haiti has no national health program for workers, but workers who receive coverage from the Agency for Occupational Accidents, Illness, and Maternity were given annual examinations to detect tuberculosis and syphilis. The Agency has a 30-bed hospital in Port-au-Prince that granted appointments to an average of 30 outpatients a day. Programs for Disease Prevention and Control. In 1992, NGOs throughout the country allocated funds for the planning and implementation of vaccination programs in which regular staff members from public health facilities participated. A vaccination campaign against measles was carried out between November 1994 and June 1995, resulting in the vaccination of 2.8 million children, which represents 98% of the target population of children between 9 months and 14 years of age. A countrywide network of four to five storage and distribution units for vaccines and supplies for immunization in each department was established. This process will be completed with the establishment of an active distribution system with motorized couriers. In 1996, 200 clinics provided diagnosis, treatment, and follow-up of tuberculosis patients. The cure rate varied considerably from one department to another, ranging from 40 % to 78%. Improvements in cure rates are most likely the result of the increasingly widespread use of the short-course therapy. Training activities conducted from 1993 to 1995 targeted 828 health care workers. In 1995, the emergence of several cases of drug-resistant tuberculosis made it necessary to use costly second-line drugs. This significantly raised the cost of treatment for a drug resistant patient from US$ 45 to US$ 3,000. Regarding malaria, the country pursues a primary health care strategy that involves the elimination of deaths and the reduction of morbidity rates by emphasizing early detection and timely treatment. The vector control component includes provisions for community participation. The Ministry of Health undertook the task of training all health care personnel in the prevention and control of malaria. Upon completion in 1997, a total of 3,500 health workers will have been trained. Since 1991, AIDS control efforts have been supported technically and financially by four organizations, including: PAHO, USAID, WHO (GPA) and the French Cooperation, and UNFPA. This support has bolstered activities implemented by roughly 20 NGOs in the areas of serosentinel surveillance for HIV infection, IEC campaigns, production of IEC materials, training of health workers and community leaders to care for AIDS and STD patients, clinical and psychological care of patients suffering from STDs/AIDS in a reference center in Port-au-Prince and in three hospitals based in both urban and rural areas, financial aid and nutritional assistance for AIDS patients and their families in Port-au-Prince, distribution of condoms, and supply of drugs and materials for the prevention and control of STDs. |
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