To save lives, Haiti should focus
PORT-AU-PRINCE
When Canada unveiled a new hospital in Haiti’s Artibonite Valley nearly three years ago, its ambassador described the $30 million facility as “Canada`s commitment to improving access to quality maternal, neonatal and child health care.”
But La Providence Hospital in Gonaïves would almost immediately begin to flounder. A little more than a year after its ribbon was cut, the beds lay empty first because gangs made retaining hospital staff members difficult and then due to a countrywide hospital strike.
Today, La Providence is open. But a new World Bank study released Tuesday is questioning the effectiveness and goals of that hospital and a slew of others in Haiti, where the priority, the lead author says, should be on primary and preventive healthcare and not hospitals. The study calls for Haiti’s government and donors to better coordinate health financing. It says the country, which currently devotes less than 5 percent of its budget to health, has to spend more and run a more efficient health system.
“We have a lot of hospitals that do not necessarily provide care at the level they are supposed to,” said the study’s lead author, Eleonora Cavagnero, a health economist for Haiti at the World Bank, who also advocates for a moratorium on new hospital construction. “A lot of the things that Haitians suffer from could be treated at the primary health care levels in a more cost-effective way.”
While the study found that Haiti has significantly more hospitals than many countries including Burundi and Tanzania, it spends less on healthcare per capita than its closest neighbors. The Dominican Republic spends $180, Cuba $781 and the Latin American and Caribbean region, $336 dollars. Haiti spends just $13.
What that means is that the poorest Haitian mothers are still far less likely to deliver in a health facility, and maternal and infant mortality rates are still four or five times higher many countries in Latin America and the Caribbean. Despite these and other pressing health care needs, Haiti has seen a sharp drop in government health expenditures in the last two decades with a consequent increase in donor-dependency, the report says.
“Donor financing is itself decreasing and thus, the government urgently needs to plan for increasing domestic funding for health to avoid a spike in out-of-pocket expenditures,” the report says. It urges the country to remain focused on the poorest people, who frequently bypass the public health system due to lack of trust and cost, relying instead on consultations from traditional healers or medication from unregulated providers.
"While Haitians can now expect to live longer, access to basic health services is still lacking," the report says.
Video: http://www.miamiherald.com/news/nation-world/world/americas/haiti/article158264744.html
A healthcare crisis in Haiti festers as doctors, medical workers strike
A perfect storm of striking medical residents, missing doctors and a lack of money has virtually paralyzed an already weak healthcare system in Haiti, and no one seems to be in a hurry to fix it, critics say. Jacqueline Charles, C.M. Guerrero
Since 2004, public spending on health in Haiti has fallen from 16.6 percent of the country's approximately $2 billion budget to 4.4 percent of the latest $1.8 billion budget submitted by Haitian Prime Minister Jack Guy Lafontant, a physician, and approved this month by Haiti’s Parliament. Most of the healthcare money pays for administrative costs, rather than medical facilities.
Only 32 percent of health facilities in Haiti provide essential medicines, and only 31 percent possess basic medical equipment, the report notes. The best run facilities are not government owned, but those operated by non-governmental or charitable organizations, the study found.
“For example, 87 percent of the operational budget at the University Hospital of the State of Haiti is allocated towards staff payroll, which is high based on international benchmarks,” the report says. “In public facilities, administrative staff represent nearly half of the workforce, which is also high in comparison to other low-income countries.”
Shortly after taking officer earlier this year, Haiti President Jovenel Moïse toured several hospitals in the Port-au-Prince metropolitan area. Moïse reached some of the same conclusions as the World Bank report.
"Most of these hospitals attest to a serious human resource problem," Moïse said. Even if equipment is available, it often doesn't have technicians to operate it, and some hospitals "have been completed, but political instability has prevented them from functioning normally."
And while he’s promised to tackle the problems, another promise he made — creating a specialty hospital just for police officers — could exacerbate the situation unless the hospital is part of a network, Cavagnero said.
The Haitian government and its development partners like Canada and the United States, she says, “should spend more on primary healthcare by shifting resources away from hospitals.”
Haiti’s succession of natural disasters and political instability also have not helped. After last year’s Hurricane Matthew, the post-catastrophe response took the form of construction or rehabilitation of hospitals. This was done, the report says, “without planning for how running costs will be borne after the initial emergency has passed.”
It was the same in the aftermath of the country’s 2010 earthquake, when France and the United States agreed to finance an $84.2 million University Hospital of the State of Haiti. The construction of the 534-bed facility is now 18 months behind, projected to be completed in June 2018.
The estimated cost to run the hospital — between $12 million and $15 million a year — is far more than Haiti spends in operational costs, minus salaries, on its entire system. That amount, Cavagnero says, is $8 million.
Dr. Ronald LaRoche, who operates a network of private hospitals around the country and is a primary care advocate, said Haiti’s healthcare crisis is going to get “worse when considering the shrinking of international assistance, the lack of income coming from the government side, the inflation rate, the increase of the population and the emergence of new hazards like cholera and Zika, and the reappearance of old ones like tuberculosis.”
The solution, he said, is universal health coverage where those who can pay received an insurance card, and those who cannot are covered by the government or donors.
“This system will prevent the financing of inefficient healthcare facilities like the general hospital, which is always on strike and lacks the most basic items to save lives although everybody receives a salary every month,” LaRoche said.
But the study isn’t optimistic that even a change in the healthcare system such as that could improve health in Haiti where more than half of the population lives on less than $1.90 a day and the unemployment rate is more than 30 percent.
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AMONG THE STUDY’S FINDINGS AND RECOMMENDATIONS:
▪ Haiti’s Ministry of Public Health and Population allocates 90 percent of its operating budget to personnel costs, leaving little room for other operational costs. At the strike-prone University Hospital of the State of Haiti, 87 percent of the operational budget is allocated for staff payroll.
▪ After Haiti’s 2010 earthquake, aid increased significantly. But it remains volatile and government spending dropped significantly.
▪ The country should set up a licensing policy for hospitals to help determine whether hospitals can be built or expanded.
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▪ In public facilities, administrative staff represent nearly half of the workforce, which is also high in comparison to other low-income countries. Decentralization of human resources would make health facilities more accountable, limit absenteeism and raise productivity.
▪ Hospitals managed by non-government organizations (NGOs) are more efficient than public hospitals. Private, for-profit hospitals are the lowest-performing, and they also spend more than facilities managed by the health ministry and NGOs.
▪ Haiti doesn’t tax cigarettes but should consider imposing one, along with raising taxes on alcohol. to raise funding for health.
SOURCE: WORLD BANK
Haiti’s Sunrise Airways Adds Airbus
Haiti-based Sunrise Airways has added a major new addition to its expanding fleet: a new Airbus A320.
The 150-seat aircraft features 12 seats in first class and 138 in economy.
“The type of expansion we are pursuing throughout the Caribbean and into North and South America demands that we continually invest in modern jet aircraft offering the very best in comfort and reliability,” said Philippe Bayard, President of Sunrise Airways. “Our new A320, with seating in both first class and economy, continues our mission to elevate Caribbean aviation to new heights, while also paving the way for us to serve new and existing international markets at a high level.”
Sunrise Airways’ newest Airbus A320 currently operates from the carrier’s hub in Port-au-Prince to three destinations in Cuba – Havana, Camaguey, and Santiago de Cuba – with additional expansion throughout the Caribbean, as well as North and South America, planned for 2017 pending government approval.
Haitians will not be able to enter Chile without a visa!
On Wednesday, June 28th, 2017, in a letter sent to the Chilean Chamber of Deputies, the Minister of Foreign Affairs, Heraldo Benjamín Muñoz Valenzuela, informed that the government has decided to now require an entry visa from any Haitian who wants to visit Chile as a tourist.
This measure, which was suggested by Members of Parliament, would aim at containing the stream of Haitians who are settling down in Chile without documents. This situation is beginning to create hostilities in certain communities and is making these migrants vulnerable since they do not have access to all the advantages and benefits reserved for the legal residents and citizens.
According to the Secretary, this move is to protect the rights of migrants and to manage and bring order to the settling of foreigners while establishing a regulated migration.
The Secretary also revealed that Haitian authorities have been kept abreast of the discussions on this matter, and they have asserted that they understand the Chilean government’s initiative and intend to cooperate and to establish similar measures from their end.
Both parties are working on the possibility of setting up a Bilateral Commission on migratory and consular issues, in order to reach an agreement on the trafficking of human beings and the illicit traffic of migrants. (rezonodwes.com)
Caribbean migrants risk danger and discrimination for a new life in Chile
Santiago - Many Haitians and Dominicans are moving south for jobs and opportunities – and some are receiving a less than sympathetic welcome after a 3,000km trek.
More than 50,000 Haitians and 15,000 Dominicans are part of an economic story quickly moving up the political agenda.
Piotr Kozak in Santiago
Last modified on Friday 30 June 2017
Digna Batista was promised she would be heading to paradise when she paid people smugglers to take her from the Dominican Republic to Chile. Instead, she found herself walking across a desert minefield to encounter a less than sympathetic welcome in a society that is struggling to accommodate a growing number of migrants from the Caribbean.
Discrimination, labour abuse and outdated immigration policies have made adjustment difficult for many among the more than 50,000 Haitians and 15,000 Dominicans who are part of an economic migration story that is quickly moving up the political agenda before a presidential election later this year.
Batista borrowed more than $2,500 to pay coyotes (the people smugglers) for the journey across the Andes and the Atacama desert in the hope of finding a better life.
Leaving her three-year-old son behind, she first flew to Ecuador, where she continued by bus – at one point crushed with 17 others in the luggage hold – on the 3,000km overland route through Peru to the Chilean border. Once there, she and the others were told to head towards a distant light.
“We walked all night. Finally, in the morning, we got to a road, stopped a passing taxi and asked the driver to take us to the nearest hostel. He told us we’d just walked through a minefield,” she recalled.
The dangers are all too real. More than 90,000 mines were laid by the Chilean military in the 1970s – a time of dictatorship and paranoia about Peru. Although the army subsequently promised to decommission them all by 2012, progress has been slow and about 40,000 are still in place. Warning signs are either inadequate, misplaced or ignored by desperate migrants. Last year, a 24-year-old Dominican, Daniel Sosa, lost his left foot when he stepped on a mine trying to enter the country illicitly to find work after being denied a visa.
A string of such incidents – some of them fatal – have caused growing diplomatic concern that Chile’s border policies are driving people to risk illegal crossings. The Dominican Republic consul in Arica, Nina Consuegra, said Chile’s PDI border police are now stopping and denying entry to anyone who is either black or Venezuelan if they fail to show pre-paid hotel vouchers and return tickets.
But even those who arrive legally face prejudice.
Until the 1990s, Chile had only a small black population, so the recent arrival of a black migrants has caused a stir.
History suggests this ought not to be the case. A 2014 genetic study found that one in two Chileans had ancestors among the thousands of African slaves brought to the country between the 16th and 19th centuries. But Chile’s elite have long preferred to emphasise their country’s European roots and the newcomers are now the subject of a growing debate.
“[The migrants] are often very badly discriminated against,” says sociologist María Emilia Tijoux. “Some are really suffering. And it’s not just a legal problem, it’s because there’s a part of Chilean society that’s so damned racist.”
Batista says she has experienced kindness and hostility.
She now works as a maid in uptown Santiago while trying to legalise her residency so that one day she can bring her son Brayan to live with her.
Many Haitians find low-paid niches in the labour market where Chileans are reluctant to work, particularly construction, domestic service and agriculture.
Lacking full legal rights, some are exploited, said Haitian community leader Widner Darcelin, who said migrants sometimes work for months without being paid.
Earlier this month, a homeless Haitian migrant named Joseph Polycart died of hypothermia after he was twice turned away from a local hospital on a freezing night.
But there are also positive stories. N’kulama Saint Louis arrived in Santiago with his wife Patricia and two-year-old son N’kulahi in 2010, following Haiti’s devastating earthquake. Today N’kulama works as a street-sweeper, and studies sociology at the Catholic University by night. “We got a lot of support from our Chilean friends,” he said, “but the government doesn’t have a comprehensive immigration policy and that’s a huge problem.”
The current system is widely criticised as outdated. One notorious immigration law – a holdover of the Pinochet dictatorship – intrinsically views all migrants as potential subversives, said Jean Claude Pierre-Paul, a Haitian social worker.
And the situation could get worse. The centre-right candidate in the election, former president and billionaire businessman Sebastian Piñera, is following the example of Trump in the United States and Argentina’s Mauricio Macri by proposing tighter border controls and the expulsion of all irregular migrants – an estimated 150,000 people.
Given Chile’s enormous 5,000km frontier, there is no suggestion of a border wall, but tighter regulations alone could drive more migrants to attempt risky illegal crossings of mountains, deserts and minefields.
“Visas don’t control migration – migrants will just turn to people smugglers to enter the country,” said Rodrigo Sandoval, head of the ministry of the interior’s immigration department.
Sandoval said Chile needs a new immigration law that helps to attract more outsiders to offset the country’s aging population and labour shortages.
His proposals have prompted a rightwing backlash on social media, where xenophobes describe him as a traitor who is allowing Chile to be “invaded.”
Cooler heads urge self-reflection. In the Independencia neighbourhood, social worker Patricia Loredo, who helps run the Sin Fronteras migrants rights collective, believes Chileans need to be much better informed and educated about their heritage.
“Most Chileans don’t have a clear idea of their cultural identity,” she said, “but this is clearly a mixed-race society.”