Health in Haiti

Deficient sanitation systems, poor nutrition, and inadequate health services have pushed Haiti to the bottom of the World Bank's rankings of health indicators. The World Bank reports that Haiti's infant and maternal mortality rates remain among the highest in the region, with declining preventive care coverage, particularly affecting the poorest households. Also, according to the United Nations World Food Programme, 80 percent of Haiti's population lives below the poverty line. In fact, 75% of the Haitian population lives off of $2.50 per day. Consequently, malnutrition is a significant problem. Half the population can be categorized as "food insecure," and nearly one in four children in Haiti suffer from chronic malnutrition, known as stunting, which has long-lasting physical consequences. According to the Global Nutrition Report, 21.9% of Haitian children under five years old are affected by stunting, indicating chronic malnutrition. Less than half the population has access to clean drinking water, a rate that compares poorly even with other less-developed nations. Haiti's healthy life expectancy at birth is 63 years. The World Health Organization (WHO) estimates that only 43 percent of the target population receives the recommended immunizations. This article will examine Haiti's healthcare infrastructure, prevalent public health challenges, and international initiatives aimed at enhancing health outcomes in the nation.

In 2013, there were approximately 800 primary care facilities in Haiti, with only 43% of these facilities being classified as good for accessible care. Only 8% of people living in rural areas have access to one of these facilities.

In terms of health care spending, Haiti ranks last in the western hemisphere. Economic instability has limited any growth in this area. Per capita, Haiti spends about US$83 annually on health care. There are 25 physicians and 11 nurses per 100,000 population. Only one-fourth of births are attended by a skilled health professional. Most rural areas have no access to health care, making residents susceptible to otherwise treatable diseases. In 2003, for example, the WHO confirmed an outbreak of typhoid fever in Haiti that, because of a lack of access to doctors and safe water, led to dozens of deaths.

Haiti has the highest incidence of human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) outside of Africa. Sex tourism and lack of health education led to the beginning of the epidemic in the early 1980s. Estimates vary, but the United Nations projects the national prevalence rate to be 1.5 percent of the population. Other estimates place the rate as high as 5 percent in the urban population and 3 percent in rural regions. Annually, 5,000 Haitian babies are born infected with the AIDS virus. The disease causes a fifth of all infant deaths and has orphaned 200,000 children. Haiti also continues to face challenges with communicable diseases, including vector-borne illnesses such as dengue and malaria.

The Human Rights Measurement Initiative finds that Haiti is fulfilling 72.9% of what it should be fulfilling for the right to health based on its level of income. When looking at the right to health with respect to children, Haiti achieves 87.0% of what is expected based on its current income. In regards to the right to health amongst the adult population, the country achieves only 83.2% of what is expected based on the nation's level of income. Haiti falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 48.3% of what the nation is expected to achieve based on the resources (income) it has available.

Structural violence, as defined by medical anthropologist Dr. Paul Farmer, is a source that is negatively affecting Haiti's healthcare system and the health of the Haitian people. Structural violence is the way by which social arrangements are constructed that put specific members or groups of a population in harm's way. Such groups include females and those belonging to lower socioeconomic classes Being one of the world's poorest countries, Haiti illustrates how prevailing societal frameworks perpetuate the suffering of certain individuals and communities. Due to social factors such as pollution, poor housing, poverty, and varying forms of social disparity, structural violence prevents the citizens of Haiti, particularly those living in rural areas or coming from lower social classes from receiving proper clinical treatment and medicine. Studies have suggested by addressing unfavorable biosocial phenomena, such as poverty and social inequality, the negative impacts of structural violence on health can be reduced and that improvements to both healthcare access and health outcomes in Haiti can be attained.

Natural disasters such as the earthquake in 2010 are the main causes of trauma and loss in Haiti; these events can have a severe impact on mental health. With only 10 psychiatrists and 9 psychiatric nurses serving Haiti's public sector as of 2003, the prevalence of mental illnesses is unknown. However, the distribution of diagnoses seen at one psychiatric hospital in 2010 was as follows: 50% schizophrenia, 30% bipolar disorder with mania, 15% other psychoses and 5% epilepsy.

Most healthcare facilities are located in urban areas, and of those only 30% are public; 70% of those in rural areas are private and provide mainly primary health care. Structural barriers such as cost, distance and location prevent most people in Haiti from utilizing professional biomedical services. Instead, many people rely on a health care system composed of Roman Catholic, Protestant or Vodou (which combines West African traditions and Catholicism) practices. Health professionals in Haiti often use religious leaders as allies to serve as consultants, as they gain the patients' trust more readily.