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PAHO Basic Health Indicator Data Base This is a multidimensional query tool that offers a collection of 108 indicators from 1995 to 2005. The system presents data and indicators on:
- demography
- socioeconomic
- mortality by cause indicators
- morbidity and risk factors
- access, resources and health services coverage.
Selected indicators are disaggregated into age groups, sex and/or urban/rural region. Generated tables can be exported and printed.
The data presented is updated annually with the latest country information.
GENERAL SITUATION AND TRENDS Haiti occupies the western third of Hispaniola , the
second largest island in the Caribbean . Its nine departments occupy a land
area of 27,700 km2. The first country to declare its independence
in the Americas , Haiti 's recent past has been marked by political and social
violence. After several years of political conflicts, elections were held in
2000 for municipal officials, new deputies, senators, and finally, the presidency.
Demography:The
population in 2000, based on the census of 1982, was estimated at 7,958,964
for a density of 282 inhabitants per km2. The estimated annual population
growth rate during 1995-2000 was 2.1%. Sixty-four percent of the people live
in the countryside, 21 % in the metropolitan area of Port-au-Prince , and 15%
in other urban areas. Forty percent of the Haitian population is under 15 years
old, and only 5% is over 65. The population dynamic has been characterized by
a progressive urbanization, emigration to countries abroad and a shifting population
toward the neighboring Dominican Republic . A sizable percentage of professionals
and qualified technicians contribute to the Haitian diaspora , especially the
United States ( Florida and New York ), Canada and neighboring islands. The
monthly remittances sent to families in Haiti account for 8.3% of household
income. The crude birth rate was 33 per 1,000 population , and the general fertility
rate was 4.4 children per woman. Life expectancy at birth was 54.4 years for
the general population (52.8 for men, 56 for women).
Economy:
The 1990s saw a worsening of poverty for the Haitian population. In 1999-2000,
the growth in the GDP was 1.2%, a decrease compared to the previous period that
is mainly explained by the decline in the contribution of the agricultural sector
(-1.3%). Inflation was estimated at 15% in 1999-2000 and during the same period
the price of food increased 10.4%. A survey conducted in 1999-2000 found that
67% of the population was living in poverty, that 31.4% of the households had
more than seven members and that 46% of families had only one room to sleep
in. The official languages are Haitian Creole and French, the latter being used
to a large extent in the cities. Mortality:
Since 1997, the Ministry of Public Health and Population (MSPP) and PAHO have
been promoting the certification of deaths. In 1999, a total of 7,997 death
certificates were issued, believed to represent 10 % of all deaths. Although
almost half the certificates show ill-defined causes of death, the information
gained allowed a mortality profile to be defined. Communicable diseases headed
the list, representing 37.5% of deaths presenting a defined diagnosis. The second
most important group was diseases of the circulatory system. External causes
ranked third (4.3%) and neoplasms were in fourth place (2.7%). In terms of specific
causes of death, AIDS ranked first, with 5.2% of the total deaths, followed
by diarrhea and infectious gastroenteritis (5%) and cerebrovascular accidents
(3.5%). Of the 10 leading causes of death in women, the first three coincide
with the general pattern, but maternal causes come fourth, with 157 deaths.
SPECIFIC HEALTH PROBLEMS Analysis by population group Children (0-4 years): Infant
mortality increased from 73.8 per 1,000 live births in 1996 to 80.3 in 2000.
The rise is associated with increased poverty, deficiencies in the health system,
and the impact of the AIDS epidemic. Acute diarrheal disease is the number-one
health problem in children. The leading causes of death in 1999 were intestinal
infectious diseases (12.1%), infections of the perinatal period (10.2%), malnutrition
(9.1%) and acute respiratory infections (6.9%).
Schoolchildren (5-9 years):
An estimated 20% of the group under 15 years old are in a state of vulnerability,
i.e. living in poverty, undernourished, with limited access to education, residing
in foster homes where they do domestic work (a situation referred to as restavek
), or else in the street. In the age group 5-14 years, infectious and parasitic
diseases accounted for 24% of the registered deaths. External causes represented
10 % of all causes of death.
Adolescents (10-14 and 15-19 years): According
to death certificates for 1999, adolescents and youth accounted for 8% of the
deaths in the country. HIV/AIDS was the leading cause of death in this age group
(5.8% of all certified deaths). Among the 10 leading specific causes of death
on this population group were assault and homicide, tuberculosis, typhoid, and
causes related to maternity (35 maternal deaths in the age group 10-24 years
in 1999). The fertility rate in girls aged 15-19 years was 80 per 1,000 in 2000.
The prevalence of sexually transmitted infections in adolescent males 15-19
years old was 9.9%. In one survey, 18% of the females and 33% of males stated
that they had used a condom in their last sexual encounter. Violence and sexual
abuse are very frequent in this population group (70% of adolescent girls and
women have been exposed to violence of some sort).
Adults (20-59 years): The
fertility rate is in decline, estimated at 4.7 children per woman in 2000. Of
all women with a regular partner in 2000, 22% were using a modern method of
contraception and 5.8% a traditional method. AIDS is the leading cause of death
for the population 15-49 years of age (21.6% of deaths with specifically defined
diagnosis). Intestinal infections come second and maternal causes rank third.
The maternal mortality rate in 2000 was 523 per 100,000 live births, a 15% increase
relative to 1995. Maternal causes of death included problems related to arterial
hypertension and eclampsia , as well as complications of labor. Seventy-eight
percent of pregnant women had prenatal checkups with a health professional in
2000.
The elderly (60 years and older):There
is no definite social security policy for this population group, nor specific
health programs for older adults despite efforts by the State. In 1999 the causes
of death were mainly noncommunicable diseases. Diseases of the circulatory system
accounted for 39% of the deaths with a valid diagnosis. Malignant neoplasms
of the digestive organs, along with tuberculosis and HIV/AIDS, were among the
10 leading specific causes of death.
Family health: Constant
displacement and migration abroad are causing the family structure to break
down in urban and rural areas. There are no programs geared to family health.
Workers' health: The
informal sector (mainly women) and the agricultural sector make up 96% of the
working class. No services are provided for this informal sector. Government
workers have a poorly organized insurance system, while the health of employees
in the private sector comes under the responsibility of the Office of Medical
Insurance and Maternity. In 1999-2000, the indemnity for temporary incapacity
or permanent disability was paid to 559 persons, 90% of them men.
The disabled: It
was estimated in 1998 that 7 % of the Haitian population had some form of disability,
half of them occurring in children under 15 years of age. Blindness was the
most frequent disability (1% of the population).
Border population:
A socioeconomic survey conducted in communities of sugar cane workers in the
Dominican Republic showed that 27.5 % of the mothers stated that they were of
Haitian or Dominican-Haitian origin. The survey found that 20 % of children
under 5 years with Haitian mothers were suffering from moderate or severe malnutrition.
Analysis by type of health problem Natural disasters: Haiti
is susceptible to hurricanes because of its geographic location. Because of
the severe deforestation throughout the island, even normal rains can cause
floods in urban areas. It is also at risk for earthquakes because of its location
on eight tectonic faults. In September 1998, Hurricane Georges claimed 230 lives,
caused damage or injury to 344,000 persons and battered 13,000 homes. In November
2000, torrential rains caused major damage in the Department of the North.
Vector-borne diseases: Plasmodium
falciparum malaria is endemic, causing 59 deaths in 1999 (with 90% underregistration
and data from only 4 departments) and a total of 973 cases reported to the MSPP.
Epidemiological data are insufficient to estimate the magnitude of the dengue
problem in Haiti , but in 2000, 59 clinical cases of dengue were reported. The
Aedes aegypti vector is present throughout the country. Lymphatic filariasis
is widespread in urban areas, especially in the Department of the North. In
some cities of the North and of the Center, the rate of microfilaria carriers
exceeds 30%.
Diseases preventable by immunization: As
a result of the discontinuation of vaccination efforts during 1995-1999, an
epidemic of measles occurred in the city of Gonaďves in March 2000 (990 confirmed
cases, most of them in the area of Port-au-Prince , during that year). Despite
immediate vaccination efforts, cases were confirmed in various municipalities.
By the end of 2000, measles vaccination coverage had reached 75% in the country.
Unsatisfactory vaccination coverage resulted in a case of acute flaccid paralysis
reported in 2000 in a 2-year-old girl. Virologic studies identified a poliovirus
derived from the Sabin type 1 vaccine. Seven more cases occurred in 2001, the
last one in July. Vaccination coverage after the epidemic was 100%. Eight cases
of diphtheria were reported in 1999, and 60 cases of neonatal tetanus in 2000.
However, the true number of cases is thought to be greater.
Intestinal infectious diseases: Diarrhea
and gastroenteritis are the second leading cause of death in the general population,
especially in children. Typhoid accounted for 67 registered deaths in 1999,
although it is not subject to surveillance.
Chronic communicable diseases: In
1999, the estimated prevalence of tuberculosis - the sixth most important cause
of death in the country - was 114 per 100,000 population . The network of health
services observing the WHO DOTS strategy is incipient. The AIDS epidemic has
aggravated the tuberculosis situation. It can be said that leprosy is still
endemic in Haiti , although its true prevalence is not known.
Acute respiratory infections: According
to the 1999 death certificates, there were 209 deaths attributable to acute
respiratory infections, 97 of them in children under 5 years of age.
Zoonoses:During
1995-2000 there were 22 reported cases of human rabies and 44 cases of laboratory-confirmed
canine rabies, most of them in the Port-au-Prince metropolitan area. Prevention
measures such as canine vaccination have been stepped up. Anthrax is endemic
in the departments of the North, Southeast, and the Artibonite , but no data
is available.
HIV /AIDS and sexually transmitted infections:
HIV/AIDS infection affects 4.5% of the Haitian
population. It is estimated that every year there are some 13,000 pregnant women
who are HIV-positive, and that 30 % of their children will be born with the
infection. In 2000, a study showed prevalence rates in pregnant women of 5.6%
for syphilis and 3.8% for hepatitis B. In 1999-2000, the screening of prospective
blood donors showed that 1.4% were positive for HIV, 3.6% for hepatitis B, 0.1%
for hepatitis C, and 0.8% for syphilis.
Nutritional and metabolic diseases: According
to a survey, overall malnutrition in 1995 was 67.3%. Malnutrition ranks eighth
among the causes of general mortality, 76% of cases being in children under
5. Prevalence of anemia is believed to be high. A 1997 study of household and
maternal determinants of vitamin A and iron status showed severe stunting in
31% of the sample, and wasting in 4%. Ninety-two percent had vitamin A deficiency.
Numerous foci of iodine deficiency have been found and cases of cretinism reported.
In 2000, the prevalence of exclusive breast-feeding for 0-5 months was 49% and
non-exclusive breast-feeding 99%.
Diseases of the circulatory system: Cerebrovascular
diseases are the third leading specific cause of death; other cardiopathies
are in fifth place and arterial hypertension in eleventh place. There are more
registered deaths among females than males.
Malignant neoplasms: They
correspond to 2.5% of registered deaths with a certified diagnosis. In 1999,
there were 196 cases of malignant neoplasms (111 in females and 85 in males),
the malignant tumors of the digestive tract heading the list (66 cases), followed
by those of the male genital organs (33). This information is not conclusive
because of sizable underregistration .
Accidents and violence:They
contribute significantly to morbidity and mortality in Haiti , especially in
the economically active population and among adolescents and youth. In 1999,
there were 98 deaths due to transport accidents (12 th place among
all causes of mortality) and 70 deaths due to assault with a firearm (16 th
place).
Oral health: Surveys
in small localities have found a 37% prevalence of caries in 12-year-olds in
the city of Jérémie . It revealed that in 1996, 50 % to 79% of the adults had
at least one missing tooth and only 1% of the 17-59 years of age had teeth with
fillings.
Emerging and re-emerging diseases: In
1999, there were 56 cases of meningococcal meningitis with a case-fatality rate
ranging between 20 and 30%.
RESPONSE OF THE HEALTH SYSTEM National health policies and plans:
In 1998, the MSPP published its national health policy, which calls for the
strengthening of the Ministry's steering role in the planning, execution and
evaluation of health programs, while recognizing the difficulties it had to
face with inadequate human and financial resources to serve a nation immersed
in poverty and with great health needs. The Municipal Health Units ( UCSs )
are decentralized administrative units responsible for carrying out a series
of health activities with the participation of the community. Although traditional
medicine is recognized and widely practiced, it does not receive direct support
from the health sector.
Health sector reform strategies and programs:The primary health care strategy serves as the basis
for national health programs. Although not yet institutionalized in the health
services, it is provided in the form of a minimum package of services that includes
health care for children, adolescents and women; emergency medical and surgical
care; communicable disease control; public health education; environmental health;
water supply; and the supply of essential drugs. The second strategy is the
reorganization of the health system, which includes the still incipient functional
decentralization of the Ministry based on the UCSs .
The health system: It
includes: a) the public sector (Ministry of Public Health and Population and
Ministry of Social Affairs); b) the private for-profit sector (all health professionals
in private practice); c) the mixed nonprofit sector (Ministry of Health personnel
working in private institutions (NGOs) or religious organizations; d) the private
nonprofit sector (NGOs, foundations, associations); and e) the traditional health
system. A number of central bureaus execute the health programs (except AIDS
and tuberculosis, directly under the Office of the Director General). There
are also 10 directorates (one for each department and for the Nippes Coordination),
under which come the UCSs . Due to the country's political problems, there has
been no recent progress in health legislation. All health system institutions
are coordinated by the Ministry of Health, however it has been unable to assume
its leadership role in the recent past, as the economic embargo directed resources
toward the nonprofit sector. The health services reach 60% of the population.
There are 371 health posts, 217 health centers and 49 hospitals. It is estimated
that 40 % of the population relies on traditional medicine, mostly in rural
areas.
Organization of health regulatory actions: The
inadequate legal framework hampers the formulation of strategies and the execution
of activities to guarantee minimum services. The nation's laws governing the
safety and efficacy of drugs were enacted in 1948 and 1955. The new law, drafted
in 1997, has still not been approved because of political problems.
Environmental quality:As
71% of the energy consumed in the country comes from wood and charcoal, only
3% of the land area is covered by natural forests, causing soil erosion and
clogging urban sewers with mud. In dwellings, coal smoke causes many respiratory
problems, especially in children. Inadequate management of excreta and household
refuse causes contamination of surface waters and overexploitation of the phreatic
layer.
Organization of public health care services:
Health Promotion services: Communication activities
are integrated into various MSPP programs, which collaborate with the health
media. The healthy municipalities initiative got underway at the end of 1998.
Disease prevention and control programs:
High priority is given to AIDS and tuberculosis control, through networks with
NGOs, public and private institutions. A program for feeding schoolchildren
and the control of parasitoses was initiated in 2000.
Health analysis, epidemiological surveillance,
public health laboratory systems: The health
sector has no established health information system that would generate a culture
of use and analysis of information. A strategic plan for the development of
epidemiology was designed in November 2000, with 6 lines of action to remedy
this deficiency.
Potable water and excreta disposal services:
Access to water for human consumption is a
major problem in Haiti . The Metropolitan Autonomous Station for Potable Water
is the State enterprise responsible for the distribution of potable water. In
1999, the potable water supply system reached 47% of the population in the Port-au-Prince
area, 46% in secondary cities, and 48% in rural areas. In 1999, coverage with
excreta disposal systems was 44% in urban areas and 18% in rural areas. There
is no control of hospital waste.
Food safety:The
Ministry of Agriculture has a food control laboratory, but only for monitoring
purposes. It is impossible to exercise any control over the sale of prepared
food sold in the street.
Food aid programs: It
is estimated that 159,000 tons of food aid was received by Haiti in 1994 (68%
from the US ) and programs are carried out mainly by NGOs.
Organization of Individual Health Services:
Although mental health is not considered a national priority, there are two
government institutions that provide mental health care in the Port-au-Prince
area. The Haitian Red Cross has 6 transfusion centers in the department capitals
and there are also centers in private institutions, although blood safety cannot
be guaranteed in the latter.
Health supplies: There
are three pharmaceutical laboratories that have been officially designated to
produce drugs for national use and they cover 30 to 40% of the Haitian market.
Drugs are dispensed at numerous sites (some unauthorized). The public sector
has an essential drug program with a decentralized logistic system. Eighty percent
of the country's expenditure on drugs is made by the private sector. With the
problems involved in regulating the sector, it is impossible to know the precise
volume of pharmaceutical products available on the market.
Human resources: In
1998, there were 2.4 physicians per 10,000 population and in 1996 there was
1 nurse per 10,000 and 3.1 auxiliaries per 10,000. There are sizable differences
by departments. Human resources are insufficient but lack of funds has prevented
the MSPP from creating new positions and many professionals go into private
practice or emigrate. In 1999, a bilateral cooperation agreement was signed
with Cuba , under which 500 Cuban health professionals have been working in
62% of the municipalities, for 5 years until the return of 120 young Haitians
now studying medicine in Cuba . There are public and private schools (of the
four private schools of medicine, only one is recognized by the State). In 1998,
there were nine recognized nursing schools. In 2000, a school for nurse-midwives
opened. Oversight of training of health personnel and of professional practice
is ineffective. Since 1998, a dozen public sector hospital administrators and
directors are trained every year.
Health Research and Technology: The
Epidemiology and Research Service under the MSPP is responsible for planning
and carrying out research contributing to policies and programs in disease prevention
and control. There are financial limitations and lack of trained personnel.
Several other institutions conducting research are not approved or overseen
by the MSPP.
Health sector expenditure and financing: Public
funds spent on health represent only 0.8% to 1% of the GDP. Most of the MSPP's
allocation (US$ 57 million in 1999, unchanged since 1996) is spent on salaries.
Execution of the investment budget, which depends largely on foreign aid, was
49% in 1999. Activities are thus slowed down or halted and morale is low. To
remedy this, operational spending was decentralized in 1998 in all departments
except the Department of the West.
External Technical Cooperation and Financing:
Nine specialized UN agencies have offices in
Haiti , six of them working in health. There is also cooperation with the IDB
and the European Union and bilaterally with USAID, CIDA and the governments
of France , the Netherlands and Japan . When Haiti joined CARICOM, regional
integration was strengthened. However, there are still not many collaborative
activities with the Dominican Republic except joint meetings and visits by technicians
to both countries, as well as a project on prevention and control of rabies.
