The U.S. Agency for International Development (USAID) submits this report, pursuant to Section 7019(e) of Division K of P.L. 117-328, the Department of State, Foreign Operations, and Related Programs Appropriations Act, 2023, which incorporates by reference the requirements of House Report 117-401, on access to certain health care in Haiti:
“The Committee is concerned about the availability of quality prenatal, neonatal, and maternal care in Haiti and the resulting impact of Haitians seeking such care in neighboring countries. Not later than 45 days after the enactment of this Act, the USAID Administrator shall submit to the Committees on Appropriations a report on proposed resources and programs to improve access to needed services for women, as well as assistance for impacted communities.”
CONTEXT AND CHALLENGES
Access to voluntary family planning, reproductive health, prenatal, neonatal, and maternity care remains a pressing concern in Haiti, as the country continues to exhibit the highest rates of maternal and infant mortality in the Western Hemisphere amid the reemergence of cholera in 2022. USAID's close collaboration with the Ministry of Health (MOH) has helped ensure access to a package of essential primary health care services at approximately 170 health facilities across the country’s 10 departments. In 2021, USAID-supported facilities demonstrated better health and wellness outcomes than those without USAID support. Building on long-standing health assistance, USAID ensures that approximately 40 percent of the population has access to basic health services which address the key drivers of mortality and morbidity.
Despite progress in recent years, access to quality healthcare for women and children in Haiti is hindered by limited access to facilities, particularly in rural areas, inadequate provision of healthcare services, and a perceived lack of demand for local healthcare services by Haitians due to ongoing insecurity and unrest and mistrust of the healthcare system. Data from the World Health Organization (WHO) indicates that in 2016, only 39 percent of births in Haiti take place in healthcare facilities which reflects issues of access, quality, and demand as well as low rates of postpartum newborn care. This has resulted in Haiti having the highest rate of maternal mortality in Latin America and the Caribbean and poor health outcomes for women and children, with 44 percent of children under 5 being stunted and. The COVID-19 pandemic and the outbreak of cholera in Haiti, with over 25,000 registered suspected cases as of January 2023, 20 percent of which are among children under five years of age, further exacerbate the dangers to women and children and overwhelm the fragile healthcare system.
The Government of Haiti (GOH) and the Ministry of Public Health and Population (MSPP) have taken steps to improve healthcare conditions through the establishment of a Package of Essential Services, a commitment to community health, and the implementation of a National Plan for the Reduction of Maternal and Neonatal Mortality. However, structural instability and operational inefficiencies have limited progress, and the intervention of international donors has been necessary to prevent significant backsliding in Haiti’s public health conditions. The last two years have also seen an increase in Haitian migration to the Dominican Republic (DR) including to seek medical care. While the exact number of Haitians crossing the border to seek medical care is unknown, Dominican authorities have taken measures to limit the healthcare services that undocumented Haitians can access and to stem the tide of general migration into the DR, particularly in the wake of increased violence, instability, and the reemergence of cholera in Haiti.
The U.S. government, through USAID, is committed to improving access to quality healthcare for Haitians, meeting the immediate needs of a population in crisis, and working with the GOH to build long-term solutions to both chronic and emergent health challenges affecting the country. Through its 5-year, $90 million project, Integrated Health Service Delivery (IHSD) USAID works to increase access to integrated health care with a strong emphasis on high-quality and patient-centered primary health services. In collaboration with the Ministry of Public Health and Population (MSPP), USAID resources target improved quality of and accessibility to the Package of Essential Services, focusing on voluntary family planning, maternal, newborn, child, and adolescent health as well as nutrition to ensure a continuum of care and efficient use of resources. USAID supports healthcare service delivery through a community-based, decentralized approach in all ten of Haiti’s departments.
USAID, in coordination with other U.S. government efforts and other partners and stakeholders, also works at the national level to support the GOH to prioritize universal health coverage, strengthen the capacity of the health system to respond to emerging infectious diseases such as COVID-19, emergencies and disasters, and achieve epidemic control of HIV/AIDS through accountability, transparency, participation, and inclusion.
