USAID/Haiti: Population and Health

USAID/Haiti's health program aims to improve the health and well- being of Haiti 's most vulnerable population groups, particularly women and children. USAID's primary goal in these sectors is sought by addressing Haiti 's most pressing health concerns: malnutrition, child mortality, reproductive health, and HIV/AIDS. As with all development problems facing Haiti , health and related services are rendered more difficult by a high population growth rate and a fragile political and economic environment.

USAID works to achieve objectives in the areas of child survival, reproductive health, HIV/AIDS, and tuberculosis (TB). Through a USAID-funded network of health service providers, 2.6 million Haitians have access to basic health care. The increased access to health care has resulted in increased contraceptive use, reduction of chronic child malnutrition, improved child and maternal health, and increased immunization rates. Through a new departmental strategy, USAID is working in collaboration with both the public and private sectors to extend the outreach of these comprehensive health services nationwide.

USAID works with public and private health providers to improve service delivery to the Haitian population in the following areas:

Child health: Treatment and prevention of major causes of infant and child mortality such as diarrhea, fever, respiratory infections, measles and malnutrition.

Reproductive health: Improved access to family planning education and services, pre-natal and post-natal care, and improved management of complications during pregnancy through training of medical professionals.

Infectious diseases: HIV/AIDS prevention, care and treatment for people living with AIDS; detection and treatment of TB and sexually transmitted infections (STI). Prevention of mother to child transmission of HIV/AIDS. Haiti is a focus country in the President's Emergency Plan for AIDS Relief.

• Immunization rates of 90% in USAID-funded areas averaged almost twice the national immunization rate of 34%.

• USAID's health program provided vitamin-fortified rations of supplementary food for nearly 37,000 malnourished children and 52,000 pregnant and lactating women. Community health workers and mobile “rally” posts provided nutrition surveillance to more than 110,000 children last year.

• Family planning use in USAID target areas was 29.4%, well above the national average of 15%.

• 47% of pregnant women received three or more pre-natal consultations in USAID-funded areas.

• Haiti 's National TB Program was expanded last year, adding 19 new TB/DOTS (Directly Observed Treatment Shortcourse) service providers throughout the country, with the treatment success rate reaching 75%.

US Government Support for the Fight Against HIV/AIDS

The United States Government, through the US Agency for International Development (USAID) and the Centers for Disease Control and Prevention (CDC) is the largest bilateral donor for HIV/AIDS activities in Haiti . Together, they have committed over $21 million for fiscal years 2003 and 2004 to support the National Strategy to Fight HIV/AIDS. As a Presidential Initiative focus country, this support to Haiti will be reinforced over the next four years, under the President's Emergency Plan for AIDS Relief (PEPFAR), probably with $40 million for FY 2005. USAID's current HIV/AIDS program in Haiti includes a comprehensive set of prevention, care and treatment activities, designed to attain specific five-year targets in line with the 2-7-10 overall Plan goals. USAID also supports community-based programs for care and support for Persons Living with HIV/AIDS (PLWHA), and under PEPFAR, will increasingly be moving into antiretroviral (ARV) treatment. Most of USAID's program is implemented through public/private partnerships, which include the Ministry of Health and a broad spectrum of NGOs, both faith-based and community-based.

In supporting the Haitian National HIV/AIDS Strategic Plan, the U.S. Government started with Voluntary Testing and Counseling (VCT) for HIV, primarily targeted at pregnant women seeking pre-natal services at public and NGO clinics. This grew under President Bush's Prevention of Mother to Child Transmission (PMTCT) Initiative to include ARV treatment for sero-positive pregnant mothers and their newborns. This initiative has grown rapidly to 36 of an initially planned 27 sites, where women and men receive pre- and post-test counseling and if tested positive, will then receive some kind of treatment and further counseling. Ultimately, some 80 sites will be ready to provide PMTCT and ARV treatment to pregnant women, their families, and other target groups. Training is also provided to Traditional Birth Attendants who assist about 80% of births in Haiti . VCT has also been extended to include the Haitian National Police, commercial sex workers, and youth of both sexes.

USAID has launched a variety of behavior change campaigns with many partners and the Ministry of Public Health that seek to reach different populations at risk of HIV/AIDS infection, to help them to adopt safer behaviors. Wherever possible, USAID programs emphasize the fight against stigma and discrimination, one of the key variables in the spread of HIV/AIDS.

In its campaigns oriented toward youth in particular, USAID and its partners stress abstinence, being faithful and if necessary, the correct and consistent use of condoms (“A,B,C”). This approach is beginning to show positive results, given recent study findings. The Agency also supports a successful condom and other contraceptive social marketing program in Haiti . More than 6.5 million Pante condoms were sold in 2004, despite the difficulties linked to the political crisis.

Under the new PEPFAR program, USAID and CDC are providing, ARV treatment to approximately 3,500 as of the end of CY 2004, through their major NGO and public sector partners. In FY 2005, treatment will be extended to approximately 5,500 additional PLWHA, through a network of departmental and private sector hospitals covering all health departments. Treatment will be coordinated with prevention, counseling and with community care and support. Nutritional supplementation and other life-extending treatment and therapy will be included through basic care packages.

USAID and CDC are working at the community level to strengthen the capacity and reach of local faith-based and community-based organizations to provide a network of support to people infected with or affected by HIV/AIDS, including programs for orphans and vulnerable children and PLWHA. These networks support care programs using an integrated family and community approach, seeking to reduce stigma and discrimination against this already hard hit population. CDC is supporting the development of a network of PLWHA and USAID has provided funding to expand this approach in all nine departments of Haiti.

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