Plan Directeur de Santé 2012-2022

Objectives

Haiti’s 2012–2022 Health Master Plan operationalises the National Health Policy to guarantee the rights to life and health, reduce morbidity and mortality, and build an equitable, universal, efficient and quality health system that provides an adaptable Essential Package of Health Services close to communities.[1][2]Its long-term vision is a health system in which women and men have equitable access to quality care, supported by action on social, environmental, economic and institutional determinants of health.[3][4]

• Achieve universal coverage and equitable access to person-centred, quality services, prioritising vulnerable populations and disadvantaged urban, peri-urban and rural areas.[2][5]
• Strengthen primary care, referral and counter-referral networks, health infrastructure, human resources, essential medicines, diagnostic support, safe blood services and community health-service networks.[2][6][7]
• Address determinants of health through intersectoral action on safe water, sanitation, food security, nutrition, environmental health, housing, violence, accidents and health promotion.[4][8][9]
• Improve reproductive, maternal, neonatal, child, adolescent and young-adult health, including a target to reduce maternal mortality by 50% to 250 deaths per 100,000 live births by 2022.[10][11]
• Prevent, detect and manage communicable diseases, non-communicable diseases, mental-health conditions, disability, substance use, violence, accidents, malnutrition, epidemics and disaster-related health risks.[12][13][14][15]
• Apply the principles of universality, comprehensiveness, equity and quality, ensuring that care responds to the full range of needs regardless of residence or socio-economic status.[16]

Implementation

The Ministry of Public Health and Population leads implementation under government authority through a decentralised, multisectoral and partnership-based model.[1][17]The plan combines a three-level care system, departmental and district-level management, integrated planning, regulation, community participation, performance monitoring and phased three-year operational plans.[18][19][20]

• Organise care across community, primary, secondary and tertiary levels, with community health centres, commune-level health centres, community referral hospitals, departmental hospitals, university hospitals and specialised referral institutions linked through referral and counter-referral arrangements.[18][21]
• Use Health District Units as the operational level for communes, communal sections and provider institutions, with Departmental Health Directorates providing technical support and the central ministry responsible for strategy, regulation, standards, supervision and evaluation.[22][19]
• Define, periodically revise and implement the Essential Package of Health Services and associated technology package for each level of care, including ambulatory care, hospitalisation, laboratory, imaging and safe-blood functions appropriate to institutional complexity.[18][21]
• Coordinate public, private, mixed, philanthropic and traditional providers under ministry standards, accreditation, licensing and quality-assurance mechanisms, while documenting and progressively integrating traditional medicine.[23][24][25]
• Deploy community services through polyvalent community health workers attached to provider institutions, with standardised training, supervision and an intended national norm of approximately one worker per 1,000 inhabitants.[26]
• Align all partners through integrated three-year operational plans that allocate responsibilities and include monitoring and evaluation commitments; use contractual management and performance-based approaches, initially piloted in one health department.[27]
• Engage communities, civil society, local health committees, territorial authorities, professional bodies, training institutions, insurers, technical and financial partners and other ministries in local governance, service-quality assessment, health promotion and action on determinants.[28][29]
• Coordinate international co-operation according to country ownership, alignment, harmonisation, results-based management and mutual accountability, including cross-border communicable-disease action with the Dominican Republic.[30]
• Strengthen financial governance through the Medium-Term Health Expenditure Framework, decentralised expenditure control, internal and financial audits, annual consolidated reporting, a proposed National Health Fund and progressive growth in the health share of the national budget towards 15%.[31][5][32]
• Operate a unified national health information system integrating service, surveillance, resource and performance data, with interoperable databases, automated health maps, routine feedback and regular analytical reports to guide decisions.[33][34]
• Implement systematic surveillance, early warning, outbreak investigation, crisis information management, epidemic evaluation and research governed by ethical and regulatory frameworks.[35][36][37]
• Monitor implementation annually at plan level and quarterly for annual action plans, using harmonised tools and indicators disaggregated by sex where required; submit an annual population health report to the Head of Government and Parliament and disseminate it to partners, civil society and the public.[38]

Monitoring & Evaluation

The Health Master Plan establishes an integrated monitoring, evaluation and operational-research system to assess health-system strengthening, intervention effectiveness and efficiency through input, process, output, outcome and impact indicators.[20]The Ministry of Public Health and Population leads coordination, while central, departmental and Health District Unit structures share implementation responsibilities.[38]

• Develop a monitoring and evaluation plan at the start of the first three-year period, supported by an integrated annual monitoring plan prepared centrally in consultation with departmental and district levels.[20][38]
• Use a unified National Health Information System for policy monitoring, epidemiological surveillance, service delivery, institutional and individual performance, and financial, human and material resource management.[33]The system is to integrate databases, interoperable interfaces, analytical platforms, health maps and regular automated reports.[34]
• Strengthen integrated surveillance, early warning, outbreak investigation, epidemic control and crisis information management in line with the International Health Regulations.[35][39]
• Apply supervision, regulatory inspection, accreditation, certification and audit mechanisms to assess compliance with standards, infrastructure capacity, provider performance, pharmaceutical quality and service quality.[40][41][7]
• Track phased targets for health infrastructure, including an increase in operational departmental hospitals from 5 of 10 to 8 of 10, health reference centres from 30 of 41 to 41 of 41, health centres from 70 of 144 to 144 of 144, and community health centres from 400 of 570 to 570 of 570 by 2019–2022.[42]
• Monitor major health outcomes and service coverage through detailed programme indicators, including maternal mortality, skilled birth attendance, immunisation, HIV, tuberculosis, nutrition, water and sanitation, non-communicable diseases, emergency preparedness and health-facility compliance.[43][11][44][45]
• Report overall plan performance annually through a population health report submitted to the Head of Government and Parliament, presented to partners, political parties and civil society, and published on the Ministry website.[38]
• Report annual action-plan implementation quarterly to inform health-sector meetings, alongside quarterly, six-monthly and annual monitoring sessions.[38]
• Strengthen accountability through decentralised expenditure control, internal and financial audits, compliance with budget-execution procedures, annual consolidated financial reporting and contractual performance management.[31][46][5]

Costing & Financing

The financing framework seeks to expand equitable and sustainable health financing, reduce direct out-of-pocket payments, align resources with national priorities and progressively increase the health-sector allocation within the national budget.[2][47][48]Resource availability is recognised as limited, requiring prioritisation and phased implementation over three successive three-year periods.[20]

• Increase the health-sector share of the national budget from a reported 9.82% in 2012 to 10% in 2013–2016 and 15% in both 2016–2019 and 2019–2022.[32]
• Target health expenditure per person of 60 United States dollars in 2013–2016, 100 United States dollars in 2016–2019 and 150 United States dollars in 2019–2022.[32]
• Establish a common National Health Fund and a national solidarity fund, decentralise health-budget management, apply a Medium-Term Health Expenditure Framework, and use contractual and results-based financing.[31][49][5]
• Mobilise resources through the Public Treasury, insurance and prepayment arrangements, community and corporate insurance, household contributions, international partners and specified ecological, harmful-product, sanitation and postage-stamp levies.[50][46]
• Budget the Health Master Plan and establish costing tools during the first three-year tranche; the 2013–2016 operational plan is budgeted, with more detailed budgeting for fiscal year 2013–2014.[46]
• Allocate resources by programme, expenditure type, level of care and commune, with preferential allocation for vulnerable groups and disadvantaged areas.[5]
• Use the Investment Budget to establish the planned health-service network.[51]
• Address historical affordability constraints: health expenditure represented 5.7% of gross domestic product in fiscal year 2005–06, health-sector budget expenditure was 75 million United States dollars in fiscal year 2009–10, and approximately 80% of that budget was allocated to staff salaries.[52]
• Recognise that no comprehensive programme cost, quantified funding gap, detailed donor commitments or full economic assumptions are provided in the supplied extracts.[32][53][20]