Determinants of Health Productivity in Haiti
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Washington, DC: World Bank
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Understanding the key factors that
underlie the efficiency of specific health programs is key
to improve population health. This is especially true for
Haiti, where utilization of health services (in the formal
sector) on average is very low, even when compared to other
low-income countries, and despite a relatively high density
of health facilities per unit area (meaning that distance is
not the main barrier to access). There is a particular need
to evaluate policies that may enhance primary health care
utilization and outcomes, since primary care has proven to
be an effective platform for strengthening health systems in
several countries. Potential interventions to be evaluated
include community health workers as possible key
determinants of health care utilization in Haiti. Limited
healthcare resources in low, and middle-income countries
(LMICs) have led policymakers to improve healthcare
productivity. A simple indicator of efficiency, such as
productivity of health facilities, measured using routine
health facility data and demographic health surveys, as well
as other data sources such as health facility surveys, is an
approach that can be replicated and compared across
different contexts; more specifically, productivity is
defined as the ratio of the output to the inputs of any
system. Therefore, a productive system is one which achieves
higher levels of performance (outcomes, outputs) relative to
the inputs (e.g., resources, time) consumed; and for this
study, we measure outcomes or outputs as total provision of
services, either outpatient visits or vaccine provision,
while the number of clinical health workers is the input
measure for this study. The latter is a viable measure since
health care workers account for the largest share of the
total cost of functioning of health facility. Hence the
productivity measure used is the number of patient visits,
or the number of pentavalent vaccines provided, per clinical
health care worker at a health facility.