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Valerie Percival and Frederick Burkle Jr.

A vision for Haitian health care Add to ...

Next week in Montreal, Canada will play host to a ministerial meeting to develop a long-term vision for Haiti's reconstruction. Ministers should agree to key principles for the Haiti operation, including the primacy of United Nations co-ordination mechanisms, civilian leadership over the military's aid efforts, the need to build and support local capacity and ownership, and the rapid development of realistic sector-specific plans.

What should those plans look like in the health sector?

Even before the earthquake, Haiti's situation reflected its abject poverty: infant, child and maternal mortality. Widespread malnutrition, chronic tuberculosis, a 2-per-cent HIV prevalence rate and endemic malaria. Shortages of health workers, weak government regulatory and oversight capacity. Private, non-profit and public providers.

The full extent of the damage is undetermined, but it's clear many clinics have been destroyed, many health workers have been killed or injured, and even basic government capacity has been crippled. Rebuilding will require careful strategic planning and leadership, beginning with building a solid infrastructure and a system that ensures physical and social protections.

Donors need to ensure that the Pan American Health Organization (the regional arm of the WHO) can assume the leadership role outlined in the humanitarian cluster approach. While the United Nations bureaucracy deservedly has critics, it is the best option to co-ordinate donors, militaries and hundreds of NGOs. The UN also has the most experience building the capacity of government and civil-society groups - crucial for Haitians' ability to exercise some control over reconstruction. To support the UN and build national leadership, donors should consider seconding experts to PAHO and the Haitian Health Ministry.

With this enhanced capacity, PAHO can work with government and civil society to develop a health strategy. This strategy would facilitate co-ordination, guide donor involvement and ensure broad-based support. It must be developed through an assessment of population health priorities. Epidemiologists are gathering this data now.

The planning process should also be guided by a mapping exercise that is under way to assess damage to health infrastructure. This can help determine what infrastructure should be rebuilt and provide NGO and donor guidelines.

But the strategy must go beyond a reconstruction plan. It should build on a vision articulated prior to the earthquake - the development of a Haitian health system capable of delivering universal access to a basic package of health services. Health systems are complex beasts, but with realistic objectives and a practical, cost-effective plan, Haiti can move toward this vision.

To do this, the strategy needs to outline how primary, secondary and tertiary levels of care will ensure public health protections; to estimate human-resources needs and identify training priorities; to articulate a financing approach that ensures a functioning and sustainable system; and to prioritize health and management information systems. It must also address how the system will integrate and regulate private and non-profit clinics.

Even simple interventions can become quickly embroiled in politics, corruption and the complexities of the international response. Without long-term strategies, Haiti risks continuing its cycle of missed opportunities and wasted resources. This time, we can, and must, do better.

Valerie Percival is assistant professor at Carleton University's Norman Paterson School of International Affairs.

Frederick Burkle Jr. is professor and senior fellow with the Harvard Humanitarian Initiative and senior public policy scholar at the Woodrow Wilson Center in Washington.

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