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The atmosphere is convivial in the maternity waiting room of the community referral hospital in the city of Trou du Nord in northeastern Haiti. Twenty or so women are there for their prenatal checkups. One of them, Choumane Hilaire, who is 20 years old, is four weeks from her due date.

 ¡°When I called my aunt to tell her about my pregnancy, she immediately advised me to come to this hospital for my prenatal care. At first, I wasn¡¯t sure because I was afraid I wouldn¡¯t be able to afford the medical fees. But when I got here, I was surprised to see that the costs were affordable. I also really appreciated the friendliness and the quality of the service,¡± she says.

To improve access to basic health care services, the government of Haiti, supported by the World Bank, decided in 2013 to launch the Improving Maternal and Child Health through Integrated Social Services Project (PASMISSI). This project aims to provide affordable and quality services to pregnant women and to children under 5 years of age in the departments called Nord-Est, Nord-Ouest, Centre and Sud. Thanks to the project, Choumane is now able to benefit from better prenatal care in her city of Trou du Nord.

Even though some health indicators have improved such as life expectancy or infant and maternal mortality rate that were halved between 1990 and 2015, Haiti remains vulnerable to many health challenges. Infant and maternal mortality rate are four or five times higher than those of Latin America and Caribbean region. 

Investing in Health to Build Human Capital

Improving access to quality health care is a way to invest directly in human capital. Haiti ranks 112th globally on the Human Capital Index. This index measures the amount of human capital that a child born today can expect to attain by age 18, given the health and education services available in his or her country. It also measures the gap separating a country from an optimal education and health situation.

In Haiti, difficulty in accessing quality health care and education, partly due to the lack of investment, hinders the development of the country¡¯s human capital. The adult income-earning potential of Haitian children born today is an estimated 45% of what they could earn if they received a complete education and enjoyed good health.

Performance-based Financing

In the community referral hospital of Trou du Nord and the other health facilities funded by the project, the financial support received by the facilities is indexed to the number of people cared for during a given period. ¡°It's a revolution in the health system,¡± says Dr. Jean-Denis Pierre, Director of the Ministry of Public Health for the Nord-Est department. ¡°We have improved the offer and coverage of care especially in rural areas, as well as the quality of health care services in the facilities receiving result-based financing,¡± he continues.

Result-based financing is gradually becoming the preferred national financing policy of Haiti¡¯s public health sector. After it was introduced at the community referral hospital in Trou du Nord, hospital deliveries increased by 22% between 2016 and 2018. The women seen at the hospital receive care from health professionals who are able to diagnose any potential complications that might occur at the time of delivery. Those first results are encouraging. More investments and better spending in primary health care are fundamental to improve access to health care for all the Haitians people.

For Choumane¡¯s child, together with all the other children of his generation, it is critical to invest in the country¡¯s human capital to have a better chance of being healthy adults and a better chance of earning higher incomes than their parents and grandparents.