[CCIH-Haiti] CCIH Affiliate, MSH, urges two-pronged approach to Haiti development

[MartinRS at aol.com]

Earlier today CCIH-Haiti circulated an article indicating that the U.S.  
Government is expected to emphasize a long-term development strategy in Haiti  
that will give priority to strengthening the government, implying that past 
 approaches focusing more on NGOs will receive less priority.  Here, a CCIH 
 Affiliate, Management Sciences for Health, _www.msh.org_ 
(http://www.msh.org) , calls for a two-pronged approach that  emphasizes both the capacity of 
government ministries and working in partnership  with NGOs.
 
For more information on MSH's work in Haiti, which involves collaboration  
with faith-based organizations, go to 
_http://www.msh.org/msh-helping-haiti-to-rebuild/index.cfm_ 
(http://www.msh.org/msh-helping-haiti-to-rebuild/index.cfm) .  The President and CEO of MSH, Dr. Jonathan Quick, will be speaking 
at the June  11-13 CCIH annual conference.
 
 
International Donors' Conference Towards a New  Future for Haiti

MSH Calls for Two-Pronged Approach to Development  in Haiti: Restore 
Leadership Capacity of Government Ministries and Work in  Partnerships with NGOs

On the eve of the International Donors' Conference Towards a New Future  in 
Haiti to be held in New York on March 31, Management Sciences for Health  
(MSH), urged donors to consider a successful two-pronged development approach 
 that has led to improved health in Haiti. 

"The two-pronged  approach is grounded in the principle that the Haitian 
government must  ultimately lead the process but also work together in 
partnership with NGOs and  the private sector," said Dr. Jonathan D. Quick, MD, 
MPH, President and Chief  Executive Officer of MSH. MSH has worked in Haiti for 
over 30 years with the  Ministry of Health and a network of dozens of 
Haitian NGOs to achieve health  impact.

In Haiti, success in the health sector resulted from the  approach 
developed by a four-way partnership between the Government of Haiti,  the United 
States government, a network of Haitian and international NGOs (Sante  Pour le 
Developpment et la Stabilite d'Haiti (SDSH), and MSH.  

Applied to post-earthquake recovery, the two-pronged approach  would 
include two key strategies:
(1) Strengthening the leadership capacity  of the Ministry of Health to 
carry out policymaking, standard-setting, and  coordination roles that uniquely 
belong to government. Begin at the national  level, but quickly move to 
include departmental ('county') and local  government.

(2) At the same time, preserve, respect, and build on  existing local human 
resources, physical infrastructure, and health system  elements already in 
place. Work with all existing service providers-public, NGO,  and private 
sector- to support and build their capacity to provide responsive,  quality, 
community-based and facility-based preventative and curative  care.

Five Critical Actions for Success:
Over the last decade,  this approach has been implemented through five 
critical  actions:

1. Building leadership, governance, managerial capacity of  the Ministry of 
Health at the national and departmental level. Decentralization  through 
integrated department planning-moving from many plans and many actors in  each 
department to one plan with committed partners.

2. Forming  collaborative relationships between the Ministry of Health and 
Haitian community  groups and NGOs working on health. A framework for 
coordination was established  with groups organized into clusters by service area, 
but integrated into one  national health strategy. 

"This framework managed by MSH worked  well in Haiti in 2005 for 
implementing PEPFAR funds from the US government and  should be utilized again after 
the donors' conference," said Dr.  Quick.

3. Establishing a standard national package of basic health  services with 
necessary training and capacity building of local groups to manage  
implementation.
 
4. Utilizing performance based financing for operating budgets. Giving NGO  
and public sector providers a modest incentive for achievement of targets  
improved quality and outcome of care, increased efficiency, and rewarded  
innovation for meeting service targets.

5. Developing  public-private partnerships is crucial to success. In the 
past two years, more  than $10 million was secured in leveraged contributions 
to the health system  from multiple partners in Haiti's commercial sector. 
Cost-shared interventions  on the ground should help to optimize resources 
and ensure  sustainability.

"Haiti's Ministry of Health and Haitian health  workers and community 
leaders can take pride in what they accomplished in the  health sector, in 
partnership with the US Government, USAID, MSH and other  partners," said Dr. 
Quick. "Donors should build on those successes. We do not  have to start over."

In 2008-2009, over 4 million Haitians in all  10 departments (47% of the 
population) had access to primary health care  services by 26 health NGOs, 147 
MOH facilities and 4,000 community health agents  and more than 4,000 
traditional birth attendants.

The SDSH network  made an impact on maternal health by training and 
supporting over 4,000  traditional birth attendants. Community-based prenatal care 
is reaching 8 times  the number of women who deliver in a health facility 
and 83,889 women worked  with a care provider to make a birth plan. 45% of 
pregnant mothers had three  prenatal visits, and 40% received a home visit 
within three days after giving  birth. 

SDSH also tested 49,196 pregnant women for HIV, and saw  over half of those 
who tested HIV positive through the entire course of  treatment to reduce 
the risk of HIV transmission to their babies. The network  also achieved 
significant improvements in child vaccination, increasing its  coverage of DPT3 
vaccines for infants by 26%. Vitamin A therapy was provided to  over 250,000 
children to combat malnutrition. By training and equipping 1.035  community 
health agents to promote family planning, the network contributed to a  24% 
increase in the use of modern contraceptive methods. And by the end of 
2009,  the SDSH network had scaled up antiretroviral treatment for AIDS to 2,077 
 patients and provided palliative care to over 11,000 people living with 
HIV  & AIDS. 

"The SDSH network has also contributed to Haiti's  economic development by 
creating jobs," said Dr. Florence Guillaume, Deputy  Chief of 
Party/Technical Director of MSH/SDSH.  "Almost 4,000 community  health agents were 
employed by public and private sector partners and the  services of another 4,000 
trained traditional birth attendants were supported.  Additionally, salaries 
were paid for over 1,150 facility based health providers.  In Haiti, the 
health system is not primarily about buildings or technical skills  but it's 
about health worker motivation and support." 

"Our  partnership with the Haitian Ministry of Health has proven that it is 
possible  to build on the complementary strengths of governments, civil 
society, and the  private sector and achieve significant health impact," said 
Dr.  Quick.

MSH encourages expansion of the health section of the Action  Plan for 
Reconstruction and National Development of Haiti to include more  comprehensive 
planning for primary care that includes maternal health, family  planning 
and people living with HIV & AIDS and people infected with TB. MSH  also 
encourages involvement of all stakeholders, including NGOs and service  
providers, in the discussions on health going  forward.
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