Plan directeur santé 2021-2031

Objectives

Haiti’s Health Master Plan 2021–2031 establishes a ten-year framework for universal health coverage, guided by universality, comprehensiveness, equity, quality, the rights to life and health, solidarity, citizen participation and efficiency. Its overarching aim is to continuously improve population health by strengthening the health system, reducing morbidity and mortality, contributing to socio-economic development, and ensuring equitable access to quality essential health care and services according to need.[1][2][3]

• Strengthen coherent leadership, stewardship, regulation, decentralisation, partnerships, citizen participation and accountability across the health system.[3][4][5]
• Provide quality, integrated and people-centred services, particularly for vulnerable groups, through primary health care supported by integrated hospital services, referral systems, emergency capacity and quality improvement.[3][6][7]
• Ensure a motivated, competent, equitably distributed and high-performing health workforce, with particular attention to family doctors, midwives and polyvalent community health workers at primary level.[3][8][9]
• Strengthen production, analysis, integration and use of health information for decision-making, management and epidemiological surveillance.[3][10][11]
• Ensure the availability and appropriate use of safe, effective and quality medical products and technologies through stronger regulation, integrated procurement and distribution, quality assurance, rational use and risk management.[3][12][13]
• Optimise mobilisation and use of health financing, expand solidarity, prepayment and risk-pooling arrangements, reduce direct household payments, and strengthen strategic purchasing and financial protection.[3][14][15]

The plan is structured around six World Health Organization health-system pillars: leadership and governance, service delivery, human resources for health, health information systems, essential medical products and technologies, and health financing.[16][17][18]It shifts from earlier disease-priority planning towards a system-strengthening approach, while retaining priority action on maternal, newborn and child health, nutrition, communicable diseases, chronic diseases, emergencies and health-security threats.[19][6][20]

Its strategic choices comprise primary health care, intersectoral action, participation and policy dialogue, strengthened primary-level services, and hospitals operating as integrated components of the care system.[20]Nine high-level priorities include reorganising and strengthening the Ministry of Public Health and Population, decentralising management, aligning donors and technical partners, strengthening essential health services, integrating supply chains, managing the workforce strategically, consolidating strategic information, and promoting solidarity-based health financing.[20]

The plan sets ten-year outcome targets, including reducing neonatal mortality from 25.3 to 12 per 1,000 live births, under-five mortality from 65 to 25 per 1,000 live births, and maternal mortality from 529 to 350 per 100,000 live births.[6]It also seeks to increase vaccination coverage among children under one from 36% to 95%, skilled birth attendance from 42% to 60%, and key health-worker density from 0.7 to 1.5 per 1,000 population.[6]

Implementation

Implementation uses a coordinated whole-system model led by the Ministry of Public Health and Population, combining national strategic direction, decentralised departmental delivery, operational planning, partner coordination and performance monitoring.[15][21][22]The plan is translated into three-year and annual operational plans, with three national triennial plans for 2021–2024, 2024–2027 and 2027–2030, followed by an interim plan for 2031.[18][22]

• Direct implementation through the Ministry’s senior leadership, comprising the Minister and Directorate-General, with national coordination led by the Directorate-General and supported by the Studies and Programming Unit.[15][21]
• Coordinate stakeholders through a high-level donor coordination table, a Health Sector Table and departmental health tables involving Ministry entities, technical and financial partners, territorial authorities, private-sector organisations and civil society.[23][21]
• Strengthen departmental leadership, health-budget allocations, emergency preparedness, local health-management arrangements and hospital-management autonomy as part of decentralisation.[24][25]
• Establish joint programmes, interministerial action, partnership standards and citizen-participation mechanisms, including engagement with civil society, women’s organisations, health-worker groups, universities and human-rights institutions.[4][24][26]
• Update and apply legal, regulatory and technical standards covering service delivery, health workforce management, health financing, contracting, strategic purchasing, emergency response, quality, traditional medicine, medical products, patient protection and mandatory reporting.[26][5]

Service delivery is intended to intensify the proximity-based integrated model, organised around three tiers of primary care and supported by an updated health map, referral and counter-referral mechanisms, emergency and intensive-care networks, ambulance services, emergency medical teams and departmental epidemic-response networks.[7][27][28]The approach includes harmonised guidance for maternal, neonatal and child health, nutrition and communicable diseases, alongside expanded responses to tuberculosis, HIV, diabetes, hypertension, cardiovascular disease and cancer.[27][29]

Workforce measures include a multisectoral steering committee for the Strategic Human Resources for Health Development Plan, an operational workforce-planning unit, strengthened departmental capacity, integrated workforce information, redistribution of staff towards primary and remote facilities, and a special support fund for recruitment, deployment and incentives.[9][30]Training, accreditation, continuing professional development, licensing, performance management, remuneration and career planning are intended to support sustainable workforce development and retention.[30][31]

For health information, the plan proposes integration of routine, community, workforce, logistics, financial and material-resource information, computerisation of hospital medical records, strengthened data quality control, wider surveillance coverage and public-health laboratory capacity.[32][10][11]For essential medical products and technologies, it proposes a single national procurement and distribution system, a harmonised logistics information system, clearer institutional responsibilities, provider training, inspections, rational-use programmes, quality-promotion arrangements and pharmacovigilance.[12][33][13]

Health-financing implementation centres on innovative resource mobilisation, a National Health Fund, stronger financial management, a national financial-protection system, prepayment and risk pooling, national service pricing, contracting, strategic purchasing and potential expansion of performance-based financing.[34][35][15]The financing framework targets health expenditure equivalent to 15% of the national budget, National Health Fund resources equal to 25% of the Ministry budget, and direct expenditure reduced to 50% of health expenditure within ten years.[15]

Monitoring and evaluation are led by the PDS monitoring and evaluation unit within the Studies and Programming Unit, implemented by central monitoring officers and departmental statisticians, supported by partners and validated by entity directors or managers.[36]Activities include semi-annual monitoring meetings, annual reviews, field visits, surveys, internal three-year reviews, a mid-term external evaluation and a final external evaluation.[37]The framework identifies 200 indicators to be refined through operational planning, with regular routine, synthesis, review, survey and evaluation reports intended to inform decision-making.[37]

Monitoring & Evaluation

The Health Master Plan 2021–2031 establishes a system-wide monitoring and evaluation architecture intended to track implementation, assess results and impact, document resource use and performance, and provide reliable information for decision-making.[22][36]It combines routine health information, epidemiological surveillance, policy and programme review, performance assessment, field monitoring, surveys and external evaluations.[6][10][37]

• Operate the monitoring and evaluation system under Ministry of Public Health and Population leadership, through the Plan Directeur Santé monitoring and evaluation unit in the Studies and Programming Unit, central monitoring and evaluation officers, departmental statisticians, partner support and validation by entity managers.[36]
• Implement semi-annual monitoring meetings, coordination meetings, at least annual field visits, annual indicator reviews, internally produced three-year reviews, a mid-term external evaluation and a final external evaluation.[37]
• Refine the framework of 200 monitoring and evaluation indicators after preparation of three-year operational plans and the monitoring and evaluation plan, selecting key indicators for closer tracking and producing routine, synthesis, review, survey and evaluation reports.[37]
• Track ten-year health outcomes and service targets, including reductions in neonatal, under-five and maternal mortality; improvements in immunisation, assisted births and health-worker density; HIV and tuberculosis outcomes; malnutrition; emergency obstetric and newborn care; and antiretroviral treatment and viral suppression.[6]
• Monitor governance through policy analysis and evaluation reports, cyclical health-situation analyses, a health-system performance-assessment framework, a strategic monitoring committee, partnership-agreement monitoring and public tracking of major health-sector interventions through the Ministry website.[4][24][26]
• Strengthen accountability through national and departmental health-sector forums, partnership agreements, results-based management, transparency measures, participatory management, civil-society engagement and user-satisfaction monitoring.[26][25]
• Measure service delivery through coverage, facility readiness, emergency capacity, referral systems, quality programmes, skilled attendance at birth, tuberculosis and HIV service availability, chronic-disease care and community-health-worker deployment.[28][29][8]
• Publish annual quality-of-care reports and use quality indicators covering departmental programmes, secondary hospitals, quality situation reports, treatment protocols, rational prescribing, product losses and pharmacovigilance.[38][8][33][13]
• Conduct regular workforce-planning follow-up and performance assessment through an integrated workforce information system, regular implementation reports and a framework with procedures and indicators for assessing health-worker performance.[9][31]
• Strengthen the health information system through annual reports, triennial evaluations, routine supervision, data-quality controls, situation rooms, indicator review, hospital medical records, financial and material-resource information, and expanded institutional and community disease surveillance.[39][10][40][11]
• Use information-system targets covering DHIS2 availability, indicator coverage, facility reporting, hospital-record use, municipal community-surveillance coverage, laboratory coverage and national and departmental intervention teams.[11]
• Produce annual health-financing working-group reports, triennial assessments of financing-information needs, validated studies and research, and regular reports monitoring financing policies and strategies.[15][23]

Important shortcomings remain: earlier sections identify incomplete, unreliable and delayed data; uneven resource statistics; weak information use in decision-making; fragmented systems; limited systematic strategic follow-up; and insufficiently regular assessment and accountability for human-resources performance.[41][42][43][44][45]Several operational indicators require baselines to be established, and the supplied extracts do not fully specify reporting responsibilities, enforcement arrangements or sanctions for underperformance across all pillars.[28][29][8]

Costing & Financing

The plan seeks to optimise mobilisation and use of financial resources, expand solidarity-based financing, reduce direct household payments and dependence on external aid, and improve strategic purchasing, pooling and financial protection.[1][34][35][15]Although it sets percentage-based financing targets and calls for budgets and financing plans for selected programmes, the supplied extracts do not provide a consolidated monetary budget, costed implementation plan, currency-denominated funding gap or economic assumptions for the full Health Master Plan.[9][30][33][15]

• Mobilise additional domestic and external resources, establish a National Health Fund, strengthen financial-management systems and coordinate a national health-financing strategy.[34][15]
• Develop prepayment, risk-pooling and solidarity mechanisms to reduce out-of-pocket and catastrophic expenditure, including financial protection for illness, maternity-related risks and disability.[34][35]
• Improve purchasing through national service-pricing policy, contracting, revised funding priorities, appropriate provider incentives and potential expansion of performance-based financing.[35][15]
• Increase the health budget from a five-year target of 10% to 15% of the national budget within ten years, and increase National Health Fund resources from 10% to 25% of the total Ministry budget.[15]
• Reduce direct expenditure to 50% of total health expenditure within ten years and expand performance-based financing to 60% of health institutions.[15]
• Increase departmental health-budget allocations by 20% after five years and 50% after ten years relative to a baseline yet to be established.[25]
• Finance human-resources development through a budgeted development plan, special support fund for recruitment, deployment and incentives, and costed training and professional-development plans.[9][30][46][32]
• Update the transition plan for a single national procurement and distribution system with a corresponding budget and financing plan.[33]

Financial constraints are substantial: health-sector resources are insufficient relative to expenditure and identified needs; household payments remain substantial; financing is fragmented and weakly pooled; donor funding strongly influences priorities; and health-system pillars including human resources, information and medical products depend heavily on external support.[47][48][49][1]Only around 5–7% of the population benefits from prepayment and risk-sharing insurance arrangements.[1]The wider economic context includes negative gross domestic product growth, rising public debt, inflation and widespread poverty, which may constrain public resource mobilisation.[50]