From the Ground Up

By Nellie Bristol

Haiti's new health system will guarantee access to quality services for all through a performance-based funding system and large investments in human resources, according to rebuilding plans laid out by the Haitian government. The effort will require an investment of $1.5 billion according to a Post Disaster Needs Assessment (PDNA) developed by the Haitian government and international groups. The estimate of funding "needs" in the document takes into account recovery, reconstruction and re-establishment of the Haitian government.

Stakeholders already have begun meeting to develop specific objectives and goals for the system's development, said Judith Timyan, health program coordinator for USAID's Haiti Reconstruction Task Team. Overall reconstruction initially will be overseen by a Haitian interim commission for recovery led by former U.S. President Bill Clinton in his role as UN special envoy to Haiti and by Haitian Prime Minister Jean-Max Bellerive.

Donor funding will be pooled in trust fund overseen by the World Bank. Auguste Kouame, World Bank Sector Leader for Poverty Reduction and Economic Management and Lead Economist for the Caribbean, said the Bank will serve as a fiduciary agent for the fund. The trust fund will receive and distribute money largely from major international donors, keeping with the priorities of the Haitian government. Kouame said the fund is modeled on a similar structure used to distribute international donations related to the 2004 tsunami and included strict oversight to ensure the quality of the work funded through the program. "It worked beautifully," Kouame said. "If we could replicate and adapt the Aceh model in Haiti it would be great."

The PDNA indicates that 30 out of 49 hospitals have been damaged or destroyed. On the plus side, it says, 90 percent of health centers are intact or suffered only minor damage, providing a platform to launch a community based health strategy. Priorities for a new system include services in maternal and reproductive health and to combat the spread of HIV/AIDS.