March 6, 2015 Page 1

Development of a Health Financing Strategy for Haiti

Background:

Haiti is addressing the dual challenge of how to mobilize sufficient funds for health care and how to

efficiently manage and allocate those resources to provide quality care to the Haitian people.

Currently, the health budget is developed on an annual basis; the vision for the health sector beyond

the one-year horizon is limited and not backed by an implementable plan with the necessary

resources.

Haiti has an approved national health policy which addresses “what” is to be done but does not yet

have a national health financing strategy that outlines “where” resources will come from and “how”

they will be used to achieve the country’s health objectives.

Activity:

HFG is working with the Ministry of Health through a health financing ‘task force’—including the

ministries of finance and social welfare—to develop a health financing strategy for the sector.

Planning for a large health financing conference in April 2015 is underway. The conference will

include stakeholders from the government, private sector, and multilateral and bilateral donors.

Participants from Ethiopia and Ghana will share their experiences with health financing reform.

HFG produced a situational analysis of Haiti’s current health financing situation with the following

findings:

o There are many actors in the health sector.

o A large portion of financial resources pass in the form of direct payments from the population to

private, for-profit contractors and NGOs.

o Funds are also passed directly to public facilities by means of co-payments, which are often set

arbitrarily without calculation of the actual costs.

o Foreign aid often falls outside the control of the Ministry of Health. Technical and financial

partners offer and negotiate projects and funds with the ministry, but the latter is not in a

position to refuse or realign these proposals or funds.

o Donor assistance is fragmented, and the Ministry of Health is not systematically informed of

foreign aid contributed.

o More than 70 percent of resources are focused on vertical programs targeting HIV and cholera,

even though the proportion of these patients to national morbidity figures is relatively low.

o Personnel salaries account for more than 90 percent of the government’s operating budget.

Proposed deliverable:

Haiti needs a health financing strategy and implementation plan that gives the Ministry of Health the

capacity to negotiate tangible increases in health financing using a specified mechanism to collect and

pool resources and purchase health services in a way that is technically sound and efficient.

March 6, 2015 Page 2

Health Governance Dimensions

Key Questions

Decision-making Structures

Are each governing entity’s formal roles and responsibilities clearly defined and legally binding?

Do governing entities have informal roles, and do they negatively impact formal decision-making structures?

Are mechanisms in place to resolve conflicts of responsibility between governing entities and build consensus?

Has the level of decentralization been accounted for in these decision-making structures?

Institutional Capacity Do roles and responsibilities correspond with decision-making power?

Do governing entities have the resources and institutional capacity to effectively fulfill their roles and responsibilities?

Monitoring & Evaluation

Do feedback channels exist to ensure that reliable, clear, and timely information is received and acted upon by governing entities?

Are tools/data/instruments available to monitor and evaluate the link between health policies, governance responsibilities, and health system performance?

Transparency & Accountability

Are health policies publically available, easily understandable, and legally binding?

To whom are governing entities held accountable?

Are official and actual consequences of non-performance by governing entities the same?

Are consequences of non-performance clearly defined and implemented?

Is autonomy and accountability strong yet balanced for each governing entity?

Stakeholder Voice

Do all health system actors play a clear role in policy decision-making?

Are procedures in place for stakeholders to voice grievances?

Is stakeholder participation equitable?

Do governing entities effectively balance communicating with stakeholders yet avoid capture?

Regulation & Enforcement

Are tools/instruments in place to ensure that health policies are effectively enforced?

Are rules on compliance and sanctions for health system actors clearly defined and enforced?

Stability Have fundamental governance roles, health system characteristics, and

performance objectives remained stable over time?