Equitable realization of the right to health in Haiti: how household data inform health seeking behavior and financial risk protection

Abstract

Background Though the right to health is included in Haiti’s constitution, little progress has been made to expand universal health coverage nationwide, a strategy to ensure access to health services for all, while preventing financial hardship among the poor. Realizing universal health coverage will require a better understanding of inequities in health care utilization and out-of-pocket payments for health. This study measures inequality in health services utilization and the determinants of health seeking behavior in Haiti. It also examines the determinants of catastrophic health expenditures, defined by the Sustainable Development Goal Framework (Indicator 3.8.2) as expenditures that exceed 10% of overall household expenditures. Methodology Three types of analysis were conducted using the 2012 and 2013 Household Surveys (Enquête sur les Conditions de Vie des Ménages Après Séisme (ECVMAS I (2012) and ECVMAS II (2013)) to measure: 1) outpatient services as a measure of inequalities using the 2013 Concentration Index; 2) drivers of health seeking behavior using a logistic regression model for 2013; and 3) determinants of catastrophic health expenditures using Seemingly Unrelated Regressions for both 2012 and 2013. Results The rate of catastrophic health expenditures increased nationwide from 9.43% in 2012 to 11.54% in 2013. This increase was most notable among the poorest wealth quintile (from 11.62% in 2012 to 18.20% in 2013), yet declined among the richest wealth quintile (from 9.49% to 4.46% during the same period). The increase in the rate of catastrophic health expenditures among the poorest coincides with a sharp decrease in external donor funding for the health sector. Regression analysis indicated that the rich wealth quintiles were less likely than poor wealth quintiles to incur catastrophic health expenditures. Interestingly, households were less likely to incur catastrophic health expenditures when they accessed care from Community Health Workers than when they received care from other types of providers, including public and private health care facilities. This study also shows that Community Health Worker-provided services have a negative concentration index (− 0.22) and are therefore most utilized by poor quintiles. In contrast, both public and private outpatient services had positive concentration indexes (0.05 and 0.12 respectively) and are most utilized by the rich wealth quintiles. Seeking care from traditional healers was found to be pro-poor in Haiti (concentration index of − 0.18) yet was also associated with higher catastrophic health expenditures albeit the coefficient was not significant. Conclusion The expansion of universal health coverage in Haiti is evolving in a ‘pro-rich’ manner. Realizing Haiti’s right to health will require a course-correction supported by national policies that protect the poor wealth quintiles from catastrophic health expenditures. Such policies may include C...

Main Health Issue In Haiti: A Brief Review

“…deteriorating significantly among the economically most disadvantaged quintile from 11.6% to 18.2% over the same period, while reducing the richest quintile from 9.5% to 4.5%. 10 This finding also highlights the problems of low efficiency in Haiti's health sector. The mechanism for wage payments is another problem, as widespread corruption hinders the proper use of financial resources.…”

Realizing the right to health in Latin America, equitably

“…A summary of 13 papers included in this special issue is presented here to highlight the results of the ongoing challenges in the Latin America and the Caribbean Region to ensure the equitable realization of the right to health enshrined in their constitutions. There are four types of studies: First, those presenting inequalities in the performance outcomes of health systems in relation to efforts to ensure the right to health for vulnerable populations [ 4 , 5 , 17 ]. Second, studies highlighting efforts to ensure the right to health for specific disease conditions [ 10 , 12 , 20 , 24 ].…”

“…Articles in this series begin by presenting inequalities in the basic principles of universal health coverage and the right to health. The authors, [ 5 ] explore available data from Haiti to assess inequalities in health service utilization, catastrophic health expenditures and the determinants of health seeking behavior in the years 2012 and 2013 after the devastating 2010 earthquake. The authors find increases in catastrophic health expenditures between the 2 years, mostly driven by increases in these expenditures among the poor and at a time of a decrease in external donor funding, when compared to those observed in the period immediately after the earthquake.…”

“…The authors find increases in catastrophic health expenditures between the 2 years, mostly driven by increases in these expenditures among the poor and at a time of a decrease in external donor funding, when compared to those observed in the period immediately after the earthquake. The findings also show greater catastrophic household expenditures among the poor as compared with those of the wealthier households, although the results also suggest persons who sought care from community health workers were less likely to incur in catastrophic health expenditures as compared to those receiving care from other types of providers [ 5 ]. These results suggest that models of care could be playing a role in out-of-pocket health care expenditures in Haiti.…”

Opportunities to catalyze improved healthcare access in pluralistic systems: a cross-sectional study in Haiti

“…The under five year mortality rate is 67/1,000 live births compared to 41/1,000 live births globally 38 . Healthcare seeking behavior in Haiti has been evaluated for mental health 39 , prenatal care 40 , childbirth location 41 and cost 42 43 . Our objective was to address actionable knowledge gaps, having generalizable impact beyond Haiti, on care seeking behavior and provider selection from conventional and non-conventional providers, and their associated networks.…”