CRICOS Provider No 00025B Haïti and the Health Marketplace: The Results are Perishable Jo Durham,...
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Transcript of CRICOS Provider No 00025B Haïti and the Health Marketplace: The Results are Perishable Jo Durham,...
CRICOS Provider No 00025B
Haïti and the Health Marketplace: The Results are Perishable
Jo Durham, PhD International HealthSchool of Population Health University of Queensland
CRICOS Provider No 00025B
Haïti and the Health Marketplace: The Results are Perishable
One of six country case studies examining the provision of health services in severely disrupted environments
The state is so weak (some questioned if the state even existed), it is unable to meet its core obligations of provision of accessible and functional health services and its governance function of regulation making the marketplace unplanned, informal, pluralistic, emergent and inequitable with health reconfigured as a commodity
CRICOS Provider No 00025B
In Haiti we found . .
Secondly
Interventions have focussed primarily on supply at the expense of demand and the supporting function of governance, further contributing to market failure
CRICOS Provider No 00025B
Outline
Brief overview of Haïti
Methods
Results & discussion
Conclusion and further research
CRICOS Provider No 00025B
Haïti
Disasters and disease outbreaks, violence, social divisions and political instability, have created a succession of “routinized ruptures”
Reflected in HDI (0.454, 158/179) and health and social indicators
Total population 10,174,000
Gross national income per capita (PPP international $)
1,180
Life expectancy at birth m/f (years) 61/64
Probability of dying under five (per 1 000 live births)
70
Probability of dying between 15 and 60 years m/f (per 1 000 population)
258/223
Total expenditure on health per capita (Intl $, 2011)
94
Total expenditure on health as % of GDP (2011)
7.9
WHO, http://www.who.int/countries/hti/en/
Methods
Partly funded by the Danish Ministry of Foreign Affairs, coordinated through the Australian Centre for International and Tropical Health (ACITH)
Case study approach:Extensive documentary and policy analysis - peer-reviewed articles, books and “grey” literature
In-depth interviews using thematic guide (January and February 2011, N = 45)
Thematic analysis and subsequently analysed using a market perspective
CRICOS Provider No 00025B
Health system
Public, private, traditional
Public & private not-for-profit provides coverage to around two thirds of the population
Private sector serves around 10%
Traditional “available to everyone”
CRICOS Provider No 00025B
CRICOS Provider No 00025B
Discussion
Emphasis in Haïti has been on the supply side of health care with the gap in state provision filled by the private sector
Limited attention has been paid to the demand side or institutional capacity building
The presence of internationally subsidised services has reduced demand for public services
The inability of the state to regulate the market has led to market failure, and ineffective, inefficient and unequal allocation of resources and ultimately ruinous health outcomesCRICOS Provider No 00025B
Discussion
Emphasis on supply side has undermined capacity of state to fulfil its obligations
Has allowed health care to expanded in an unplanned, uncoordinated and unregulated manner & commoditised health
Relative over supply of curative services, over-prescription of pharmaceuticals and asymmetrical knowledge between providers and patients
Raises questions of transparency and accountability – who are private providers accountable to? Governance dispersed and global
Conclusion
Reversing fragility and building resilience & adaptive capacity into the health system needs interventions at multiple levels
Need to recognise and harness the wide range of players which provide healthcare with analysis including analysis of broader social and political environment
Find ways of building demand side capacity to influence the behaviour of consumers
Conclusion
Further research is needed to better understand how to build demand, e.g. how can community networks be leveraged to shape health systems where the state is weak
While not without risks need long-term engagement with state
Find ways of influencing providers to understand what incentives would motivate the private sector to self regulate
Recognise that program design is likely to be emergent and require new ways of monitoring and evaluation – what works in what contexts for who?
CRICOS Provider No 00025B
Full report
http://www.sph.uq.edu.au/docs/Haiti_Final_8May12.pdf
CRICOS Provider No 00025B
Acknowledgements
Dr Peter Hill
Dr Enrico Pavignani
Dr Markus Michael
Mark E Beesley, RN
Images from global image
CRICOS Provider No 00025B
Selected References Bloom, G., & Standing, H. (2008). Future health systems: Why future? Why now? Social Science & Medicine, 66, 2067-2075. Bloom, G., Standing, H., & Lloyd, R. (2008). Markets, information asymmetry and health care: Towards new social contracts. Social Science & Medicine, 66, 2076-2087. Bloom, G., Standing, H., Lucas, H., Bhuiya, A., Oladepo, O., & Peters, D. H. (2011). Making health markets work better for poor people: The case of informal providers. Health Policy and Planning 26, i45–i52. Cammack, D., McLeod, D., Menocal, A. R., & Christiansen, K. (2006). Donors and the ‘Fragile States’ agenda: A survey of current thinking and practice. Report submitted to JICA. London: ODI.Caple James, E. (2010). Ruptures, rights, and repair: The political economy of trauma in Haïti. Social Science & Medicine, 1, 106–113. Timmermans, S., & Almeling, R. (2009). Objectification, standardization, and commodification in health care: A conceptual readjustment. Social Science & Medicine, 69, 21–27. Tschumi, P., & Hagan, H. (2008). A synthesis of the making markets work for the poor (M4P) approach: UK Department for International Development (DFID) and Swiss Agency for Development and Cooperation (SDC).Zanotti, L. (2010). Cacophonies of aid, failed state building and NGOs in Haïti: Setting the stage for disaster, envisioning the future. Third World Quarterly, 31(5), 755-771.
CRICOS Provider No 00025B