international agendas and changing national leadership: what has been the effect on health status in...
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International Agendas and Changing National Leadership: What Has Been the Effect on Health Status in Haiti?
Presentation’s Context
We will concentrate on the effect of both a changing national leadership and international agendas on the health sector in Haiti
Historical Summary
Year Economic
1969 Sweatshops
1982 Competition
1994 SAP: Devaluation
Privatization, Liberalization
1995 Unit of Democratization of Public Enterprises
Child Mortality over time
050
100150200250300
Period
num
ber o
f dea
th p
er
1000
U5MR
DerivedIMR
Historical Summary
Year Economic Health
1969 Sweatshops U5MR:250
1982 Competition
1994 SAP: Devaluation
Privatization, Liberalization
1995 Unit of Democratization of Public Enterprises
U5MR: 131
IMR by socio-economic class
020406080
100
Socio-economic classes
Deat
hs u
nder
age
12
mon
ths
per
thou
sand
birt
hsIMR
Children stunted by Socio-economic class
01020304050
Socio-economic classes
perc
enta
ge o
f ch
ildre
n un
der 5
ye
ars
belo
w -2
sd
z-sc
ore,
wei
ght f
or a
geChildren stunted
Total fertility rate by Socio-economic class
02468
Socio-economic classes
birt
hs p
er w
oman
age
15-4
9
Total fertility rate
Health Sector Influences
Leadership changes International Agendas
Health Sector Realities
Historical Summary
Year Economic Political Health1960s Sweatshops U5MR:250
1980s Competition End of dictatorship
1991-1994 SAP: Devaluation
Privatization, Liberalization
1st Democratic election, Coup,
Multinatn’l force intervention
1995 Unit of Democratization of Public Enterprises
U5MR: 131
2001 15 different leaders since 1986
Leadership changes
Int’l agenda
Policy consequences
Health sector consequences
End of dictatorship
Attentive
Market liberalization
Centralized health sector
President Aristide 1st time
Unclear Privatization???
Corruption crack down;
Increase in Minimum wage
Decentralization starts
Leadership changes
Int’l agenda
Policy consequences
Health sector consequences
Coup d’Etat Embargo
Powerful PAHO/
WHO influence
Breakdown of the economy;
No food production
Thousands of deaths;
Halt in medical service provision;
Health workers demoralized
Poorer nutritional status;
Sexual Violence;
Medication cost skyrocketed;
Decrease in household
Purchasing power
Leadership changes
Int’l agenda
Policy consequences
Health sector consequences
President Aristide 2nd time
(In the beginning)
Paris document;
110% support
Process to sell state-owned plants;
Open-investment policy;
Social services proposed for newly privatized industry;
Decentralization process started
President Aristide 2nd time
(Later)
WB, IMF held back 300 million committed funds
Privatization stalled (Prime Minister resigned)
Decentralization stalled
Investment in health facilities, drugs and equipments blocked
Leadership changes
Int’l agenda
Policy consequences
Health sector consequences
President Preval
Agreement made with IDB to fund Health system reorganization
IDB disbursement stalled due:
1st to Prime resignation
2nd to Parliament not renewed;
Reduction of the number of state employees
Conflicting policies:Pro-state/Privatizat.
Health system reorganization (decentralization) still stalled
Less public health workers
Leadership changes
Int’l agenda
Policy consequences
Health sector consequences
Aristide
3rd time
Non-recognition, non-support of gov’t due to contested elections
Increase currency devaluation;
National budget deficit
Health system reorganization (decentralization) still stalled
Purchasing power decreasing evermore;
Low access;
Poor coverage;
Decrease in nutritional intake
Though leadership changes and international agendas are uncontrolled influences that have an effect on the health sector, we can not conclude that they are the ONLY direct or indirect influences.
Other possible influences:
Governance Degree of macro-policy implementationCapacity of public sector responseHistorical and social conditions - particularly
for the poorDeforestationDecline in agricultural outputDecline in agricultural exportsErosion
Other Considerations
We can not conclude that the current health status is only influenced by the realities of the health sector,
however, the health sector’s realties does influence the health status trend
Roads to Explore
Actions of the national leaders to favor equity by re-distribution of wealth will provide more health outcomes
Actions targeting the poor in all sectors in order to fill the gap between the richest and the poorest.
Other Roads to Explore
Public health activities targeted the poor like:– Preventing malnutrition– Promoting vaccination– Providing potable water– Low cost medical services
Find a way to avoid instability of resources in the health sector.
Be aware of foreign assistance that can worsen Haiti’s situation rather than alleviating it.
Other roads to Explore
New kind of leaders with leadership skills to deal simultaneously with international institutions and the challenging aspects inside the country for more health outcomes.