From: Secretary of Health, Haiti

Matthew George

Child Health in Haiti

From: Secretary of Health, Haiti

To: Minister of Finance, Haiti

Introduction:

Haiti is facing widespread problems in child health. The under-5 mortality rate is 72 per 1000 live births and the infant mortality rate is 54.36 per 1000, with death attributed mostly to neonatal disorders, diarrhea, and pneumonia.[i] Children in rural, poor areas with food insecurity, a lack of infrastructure, poor sanitation, and mothers with poor nutrition and health practices are most at-risk for these problems. It is important that we address child health problems by focusing on at-risk groups, creating better access to food and sanitation, improving training of health workers, and enhancing nutritional, birthing, and hygienic practices.

Nature/Magnitude:

The health status of our country’s children is a severe problem. The under-5 mortality rate is 72 per 1000 live births and the infant mortality rate is 54.36 per 1000, meaning most children who die do so in their first year.[ii] The causes of death are heavily due to neonatal disorders (29%), along with diarrhea (20%) and pneumonia (20%).[iii] Undernourishment is also staggering, with 18.9% of under-5 children being underweight, 29.7% stunting (low height for age), and 10.3% wasting (low weight for age).[iv] A quarter of all children are born with low birthweight, making them vulnerable to undernourishment at the onset of life.[v] Many are also lacking essential micronutrients: 32% of preschool-age children are vitamin A deficient.[vi] Even in children ages 5-14 years, infectious and parasitic diseases accounted for 24% of the registered deaths.[vii]

Affected Populations:

Children most at-risk for problems are in poor, rural areas and are most susceptible in their first year of life. The under-5 mortality rate is 114 for rural children compared to 78 for urban, and 125 for the poorest 20% compared to 55 for the wealthiest 20%.[viii] Only 15% of rural and 6% of the poor have births attended by a skilled professional, compared to 47% of urban and 68% of the wealthiest.[ix] Only 12% of rural areas utilize improved sanitation facilities, compared to 29% of urban areas.[x] Food insecurity is rampant, with 25% of rural individuals consuming less than 1600 Kcal per day.[xi] The worst-off region is the North-West, with food insecurity affecting 42% of households.[xii] These are major problems since 53% of our population lives in rural areas.[xiii]

Risk Factors:

There are four main risk factors for poor child health in Haiti: poverty, a lack of infrastructure, poor sanitation, and the nutrition and health practices of pregnant women and mothers. About 54% of the population lives on less than $1 a day.[xiv] Food expenditure represents 59% of household spending.[xv] Families, especially in the North-West, do not have enough money to access health services or buy food for children. The lack of general infrastructure also leaves children at risk, with only 4 health care workers per 10,000 people.[xvi] Improved sanitation coverage in rural areas is a mere 12%, and access to improved drinking water is only 51%.[xvii] The nutrition of mothers is directly connected to their children. Undernourished women may be smaller and more likely to give birth to smaller babies, with 25% of births resulting in low birthweight.[xviii] About 50.3% of pregnant women are anemic, significantly increasing the risk of premature birth. In terms of practices, only 40.6% of children under 6 months get exclusive breastfeeding.[xix]

Economic and social consequences:

With many of our children are at risk for significant health problems, we face startling and widespread consequences. Undernourishment and food insecurity leads to compromised immune systems in our children, leaving them exposed to deadly communicable diseases. High rates of stunting have led to impaired cognitive function and poor motor development.[xx] Children with compromised immune systems also get sick more often, meaning they are less likely to go to school and become productive members of society. If women are malnourished their children may have low birthweight, lack essential micronutrients, and be at higher risk for diarrhea and pneumonia.[xxi] They are also at risk for premature birth, comprising 11% of all under-5 deaths.[xxii] Poor sanitation facilities and a lack of access to safe water put children at high risk for waterborne diseases, keeping them out of school and killing many. With less money to spend on health services, children are not getting the care they need, hurting their chances at surviving past their first year of life. On top of this, with a shortage of health care workers that have limited training in birthing procedures and treating diseases, children who can access care are still vulnerable to dying from neonatal disorders and communicable diseases. If our children cannot develop properly or go to school due to nutritional problems and vulnerability to communicable diseases, we cannot lift our people out of poverty and develop our society to its full potential.

Priority Steps:

There are cost-effective measures we can implement to address the major issues of child health, including better access to food and sanitation, improved training, and enhanced nutritional, birthing, and hygienic practices. In the short-term, we must create therapeutic feeding centers that focus on children under 2 and pregnant women, with many in rural sectors. They will distribute foods high in micronutrients like Plumpy’nut and supplements of vitamin A and iron to ensure proper development and fewer premature births. At these centers we can also focus on educating mothers on proper nutritional practices like the importance of breastfeeding and hygiene to avoid diarrheal diseases. We can also distribute oral rehydration therapies and teach mothers how to use them to combat diarrheal diseases. To address rural areas with food insecurity, we can work with the World Food Programme’s “Food for Assets” program. Through this we can train individuals how to properly grow their own food, irrigate land, and use improved seeds, using food rations as the incentive.[xxiii] This will redirect the population toward better income generating activities while allowing them to grow their own food. Our government must also directly address our health infrastructure problems. We must create incentives to train more basic health care workers, especially skilled birth attendants in rural areas. With neonatal disorders accounting for most under-5 deaths, attendants must be trained in hygienic practices to prevent easily fixable problems of infection and asphyxiation.[xxiv] Once we have a larger trained workforce, we can use conditional cash transfers to incentivize pregnant women to give birth in the presence of a skilled attendant, limiting these complications. We must also increase access to improved water sources and sanitation. We can collaborate with NGOs and communities on how to train people to build and maintain low-cost pit latrines to limit water-borne diseases. Installing low-cost community standpipes will help better distribute water in areas with limited water resources.[xxv] We can also negotiate private-public partnerships between decentralized water districts in rural areas and private operators to help communities maintain standpipes, a method working in countries like Rwanda and Tajikistan.[xxvi] However, this will only be effective if we reinforce hygienic habits. Hygienic practices must be taught by local feeding centers and trained community hygiene promoters, who can work with local leaders to ensure communities engage in simple food and hand washing. This simple intervention has been shown to reduce diarrhea by 33%, as well as respiratory infections.[xxvii] Such programs can ensure healthier habits, better access to food, and improve infrastructure to ensure growth and better health for our children.

Endnotes

[i] http://www.unicef.org/infobycountry/haiti_statistics.html

[ii] http://www.unicef.org/infobycountry/haiti_statistics.html

[iii] http://www.who.int/gho/countries/hti.pdf

[iv] http://apps.who.int/nutrition/landscape/report.aspx?iso=HTI&rid=161&template=nutrition&goButton=Go

[v] Ibid

[vi] http://apps.who.int/nutrition/landscape/report.aspx?iso=HTI&rid=161&template=nutrition&goButton=Go

[vii] http://www.paho.org/english/dd/ais/cp_332.htm

[viii] http://www.who.int/gho/countries/hti.pdf

[ix] http://www.who.int/gho/countries/hti.pdf

[x] http://ochaonline.un.org/humanitarianappeal/webpage.asp?Page=1843

[xi] http://home.wfp.org/stellent/groups/public/documents/ena/wfp197128.pdf

[xii] http://home.wfp.org/stellent/groups/public/documents/ena/wfp197128.pdf

[xiii] http://www.who.int/gho/countries/hti.pdf

[xiv] http://apps.who.int/nutrition/landscape/report.aspx?iso=HTI&rid=161&template=nutrition&goButton=Go

[xv] http://home.wfp.org/stellent/groups/public/documents/ena/wfp197128.pdf

[xvi] http://ochaonline.un.org/humanitarianappeal/webpage.asp?Page=1843

[xvii] http://ochaonline.un.org/humanitarianappeal/webpage.asp?Page=1843

[xviii] http://apps.who.int/nutrition/landscape/report.aspx?iso=HTI&rid=161&template=nutrition&goButton=Go

[xix] http://apps.who.int/nutrition/landscape/report.aspx?iso=HTI&rid=161&template=nutrition&goButton=Go

[xx] “Progress for Children: A World Fit for Children Statistical Review.” UNICEF. 2010. 29 October 2010. http://www.unicef.org/progressforchildren/2007n6/index_41505.htm

[xxi] Skolnik, 174

[xxii] http://www.who.int/gho/countries/hti.pdf

[xxiii] “Food for Assets.” United Nations World Food Programme. 2010. 29 October 2010. http://www.wfp.org/food-assets

[xxiv] Skolnik, 179

[xxv] http://web.mit.edu/urbanupgrading/waterandsanitation/levels/provide-water-supp.html#community-standpost

[xxvi] http://web.worldbank.org/WBSITE/EXTERNAL/EXTABOUTUS/IDA/0,,contentMDK:22510883~pagePK:51236175~piPK:437394~theSitePK:73154,00.html

[xxvii] Skolnik, 122