Independent Global Health Consultant (Former Advisor of Japan International Cooperation Agency for the Ministry of Health in Haiti), Kakogawa, Japan.
Direction Générale, Ministère de la Santé Publique et de la Population, Port-au-Prince, Haiti.
Health Syst Reform. 2020;6(1):e1719339. doi: 10.1080/23288604.2020.1719339.
Haiti announced in 2018 its aim to achieve universal health coverage. In this paper, we discuss what this objective means for the country and what next steps should be taken. To contextualize the notion, we framed Haiti en route to the 2030 goal and analyzed qualitatively the status quo in terms of geographic, financial, and service access. For each dimension, we focused on the context, the government's policies and political agendas, their implementation progress, and key influential factors. Our analysis found little progress and numerous challenges. Geographic access was limited due principally to the insufficient number of facilities, difficulties in reaching health facilities, and local customs. Financial coverage was low because of the government's insufficient budgets, inefficient budget allocation, and ineffective management. Service access also had room for significant improvement for a lack of basic infrastructure and resources, gaps between the essential service package guidelines, health professionals' skills, and the needs, as well as deficiencies in people-centered care. These factors affected not only health service coverage but also its quality. We found that the root causes of these issues were composed of unstable financing mechanisms, opportunistic resource allocation, and ineffective management control systems. We suggest that to overcome these issues and achieve universal health coverage with decent service quality, Haiti's health system needs to be reformed by implementing strategic financing, decentralized management systems, and community engagement in primary health care.
海地于 2018 年宣布其实现全民健康覆盖的目标。在本文中，我们讨论了这一目标对该国的意义，以及应该采取哪些下一步措施。为了使这一概念具体化，我们将海地置于 2030 年目标的背景下，并从地理、财务和服务获取三个方面对现状进行了定性分析。对于每个维度，我们都重点关注背景、政府的政策和政治议程、它们的实施进展以及关键的影响因素。我们的分析发现进展甚微，挑战重重。地理上的可及性受到限制，主要是因为设施数量不足、难以到达卫生设施以及当地习俗。财务覆盖范围较低，原因是政府预算不足、预算分配效率低下以及管理不善。服务获取也存在很大的改进空间，原因是基础设施和资源匮乏、基本服务包指南之间存在差距、卫生专业人员的技能与需求之间存在差距以及缺乏以患者为中心的护理。这些因素不仅影响了卫生服务的覆盖范围，还影响了其质量。我们发现，这些问题的根源是不稳定的融资机制、机会主义的资源分配以及无效的管理控制系统。我们建议，为了克服这些问题并实现具有良好服务质量的全民健康覆盖，海地的卫生系统需要通过实施战略性融资、权力下放的管理制度以及社区参与初级卫生保健来进行改革。
