The American Journal of Public Health [June 2011:101(6)] published the editorial by Louise Ivers*: “Strengthening the Health System While Investing in Haiti.” In this editorial, Dr. Ivers describes “how health programs that were successful before the [January 2010 earthquake] disaster provided both a platform from which to respond and a lesson on how to strengthen the country’s health system.”
Although there was a weak public health infrastructure before the earthquake, nevertheless the “national HIV program had made great strides” with support from the Global Fund for AIDS, Tuberculosis and Malaria and the President’s Emergency Relief Plan for AIDS Relief. She notes, “The program is considered a success story for scale-up of HIV prevention, diagnosis, and treatment in a resource-poor setting, with more than 19,000 individuals on HIV treatment at the end of 2009.” Because this program was in place, Dr. Ivers reports, Partners In Health and the other major participating organization were able to account for 95% of their patients on antiretroviral (ARV) treatment within two weeks of the earthquake. Among the earliest public health messages broadcast after the earthquake informed HIV patients that ARVs were available and where to obtain them. Dr. Ivers writes, “Although significant challenges lie ahead, particularly for displaced people living with HIV, the lesson is simple: a program with sufficient human resources, a functional medical records system (with electronic back-up), and a working coordination mechanism pre-earthquake was able to recuperate rapidly and to work on implementing a plan for its own needs going forward.”
Dr. Ivers explains that the national HIV program was actually strengthening the health system more broadly by “increasing physical space, laboratory capacity, and human resources for non-HIV health activities.” She reports that “funds initially targeted for increasing access to HIV diagnosis and treatment were successful in increasing attendance at primary care clinics for children and pregnant women, testing for syphilis, and providing vaccinations for children.” She concludes, “ . . . the lesson is that investments in health care programs can and should be made with the system as a whole in mind, carefully constructed within the context of national plans and avoiding the errors of vertical projects. In this way, a program created to respond to one crisis (HIV) has the breadth and flexibility and substance with which to respond to a totally different kind of crisis (mass casualties). She calls for relative newcomers assisting post-earthquake Haiti “to take stock of the previously successful programs . . . that invested in the health system, aligned with a national plan, and developed Haiti’s own human resources” and she invites all “to put our shoulders together to create a health system that is greater than the sum of its potentially disparate parts.”
Those who subscribe to AJPH can see the full article at: AJPH web site.
*Dr. Ivers is Assistant Professor of Medicine and Global Health and Social Medicine at Harvard Medical School. In April, the University College Dublin (Ireland) named her the 2011 Distinguished Graduate for making an extraordinary contribution to medicine in her field.