Carrying the Elephant: Continuing Haiti’s Health Policy Agenda during a Lame Duck Period

Haiti is often characterized as the poorest nation in the Western hemisphere with the lowest health indicators.  While one cannot deny where Haiti falls in terms of ranking as compared to other nations in the region,  these rankings fail to speak about progress made and being made at the ground level that are increasing access to and the quality of the health services Haitians receive through the public health system. 

Over the past 16 years, this progress has resulted in improvements to public health, such as:

  • Life expectancy at birth for both sexes increased by 6years over the period of 2000-2012 and continues to slowly rise. [1]
  • Reduction in infant mortality from a rate of 72 per 1000 live births in 2010 to a rate of 53 in 2015. [2]
  • The Maternal Mortality ratio is nearly half its established 1990 baseline ratio of 670 per 100,000 live births. 1
  • Close to 1000 new Haitian doctors, 40 biomedical technicians and 500 multi-skilled community health agents have been trained.[3]
  • An increase in the number of new hospitals and Community health centers across the nation

The agenda and strategic actions that have driven these changes have been struggling to remain afloat amidst the political impasses in Haiti over the past two years.

A 2014 budget stalemate meant that the budget needed to bring on board the 2014 and 2015 health care graduates was not passed as planned.  When the budget stalemate was finally resolved at the end of 2014, there was a reduction in the number of new personnel that the Ministry of Public Health and Population (MSPP) was able to employ.  Still unanswered is how many new graduates, unable to wait for a year to be paid, simply abandoned their new degrees or have left Haiti to work elsewhere?

In January 2015 the parliament was dissolved when the terms of most of its members expired following failed electoral negotiations over term elections.[4] For a year, critical new laws, budgets, proposals and more simply sat.  As budget funds dried up, health workers were not paid but were expected to continue working.  Development projects were halted.  Finally in October, parliamentary elections were held and this past January the new National Assembly was sworn in.  How quickly the new parliamentary body will work on the accumulating health bills on the docket remains to be seen.

And as the presidential elector process drags on now to April 2016, international collaboration partners stand on the fence looking in, trying to decide whether or not to move forward with new health projects not sure if there will be continued government commitment to any agreements enacted now.  All of this amidst an international funding scenario where grants and loans to Haiti are expected to fall by 20% in the coming year. [5]

Haiti’s current health policy, developed in 1996, established that “Every Haitian citizen, without distinction, is entitled to preventive and curative quality health care.” This is a fundamental right guaranteed by the state in recognition that it needs citizens trained, educated and healthy in order to secure sustainable development.  The Ministry of Public Health and Population (MSPP) cannot achieve this in isolation.   

Governance is a key part of a public health system and the impact the electoral process has on governance should not be overlooked.  In the U.S. we are going through our own electoral process, not sure what impact the electoral results will have on the recently enacted Affordable Care Act.  In Haiti, the uncertainty is what impact the electoral process will have on the health gains of the past 16 years. Observing the MSPP carry on its mission during the past 2010 and current electoral process has been like watching someone carry an elephant on its head.  The question is for how long can it continue to do this?

 Understanding Haitian Elections

Timeline of Events -

State of the Deputy Chamber -

State of the Senate -

Presidential Elections – In progress

Helpful Resources -

Understanding Haitian Public Health:

The Ministry of Public Health and Population (MSPP) is the second largest national employer. Of the total staff, approximately 55% are physicians and medical personnel and 45% are support staff and administrative personnel.

World Health Organization Resources:


HEALTH SYSTEM FINANCING COUNTRY PROFILE: Haiti, 2012:  Visit this page and select Haiti -

MSPP Resources:

Haiti’s MSPP Current Challenges and Strategic Plan to increase Universal Health Coverage:


[1] WHO Country Health Profile

[2] Child Mortality Estimates, UN Inter-Agency Group on Child Mortality Estimation

[3] Proyecto Tripartito Brazil, Cuba y Haiti.

[4] On January 14, 2015, Haiti's parliament was dissolved after the failure of last-minute negotiations over a new electoral law.  Haiti had not held legislative or municipal elections for three years prior. Therefore the majority of the parliamentary terms expired leaving the National Assembly without caucus.


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