System Strengthening Key to a Healthy Haiti, Experts Agree

Whenever Jean Max Leilo Joseph is feeling discouraged in his work in Haiti, he takes a trip to the field.

“When I come back, I’m happy,” he told the audience at the Jan. 29 event “Five years after the earthquake: Moving forward for a healthy Haiti” held on Capitol Hill in Washington, DC.

Ti Max, as he’s known to his colleagues and friends, is the Technical Director of Services de Santé de Qualité pour Haiti project led by Pathfinder. The three-year, USAID-funded project expands health services, improves the quality and equity of those services, and strengthens Haiti’s capacity to deliver and sustain services after the project is complete.

A Haitian himself, Ti Max knows that no matter how discouraged he may feel, the work of SSQH is making a difference in the lives of fellow Haitians.

“I see those people there, telling us thank you, because we—not we as a project but the system—brought them services in their home, right there in their household,” he said.

Ti Max was joined by Michele Russell of USAID/Haiti; Karine Duverger with Health Through Walls; and Tisna Veldhuijzen van Zanten from the University Research Company (URC) on a panel discussing the state of health in Haiti.

Purnima Mane, President & CEO of Pathfinder, moderated the session.

“Whenever we reflect on the earthquake,” Mane said, “there is a sense of feeling a bit that everything is very challenging. We know that of course lasting change takes time, it takes hard work, it takes patience.”

Recognizing this, however, should not be a reason to stop working toward the goal of a healthy Haiti, she said.

“We do see the progress that has been and the commitment that exists,” notes Mane.


To all the panelists, improvements in Haiti’s health systems are the ultimate sign of success.

“It’s not the sexiest area like Susanna Baker said earlier,” said Russell. “But when it doesn’t work, we all know it doesn’t work. And it comes under a lot of scrutiny.”

For USAID, health system strengthening is focused in a few areas: supporting the Ministry of Health, strengthening supply chains, and improving health information systems.

They do that through projects like SSQH.

Through integration and strong partnerships, the project is addressing the many complexities around Haiti’s health system.

“The first week I was on board I met with our country representative,” Ti Max told the audience, “and the first thing he said was ‘no parallel systems.’”

The project has stayed true to those words, working within Ministry of Health systems, doing activities with the Ministry and through the Ministry.

“It’s a big challenge, but it’s worth it,” said Ti Max, “to work with the system that the Ministry of Health has put in place and make it more efficient.”

The SSQH project also works toward complete integration. Recognizing a paradigm shift is needed, Ti Max and his colleagues are using innovative approaches like Pathfinder’s Pathways to Change game to gather information about community needs and desires.

“We think that it’s very important to integrate community itself,” he said. “We cannot work for the community if they’re not part of the whole process.”


In direct response to the 2010 earthquake, USAID invested funds in providing health services for Haiti’s disabled. Not only were there more people with disabilities following the earthquake, many local disabled persons organizations were severely impacted.

Five years later, that funding is almost up.

“Disability funding ends at the end of this year,” Russell told the audience. “So now we need to integrate our disability work within existing programs. How are we going to implement a more integrated approach as disability money runs out?”

For Karine Duverger and Health Through Walls, funding shortages are a continual issue, especially with major overcrowding in the country’s prison system.

“In the main prison, there are 4,300 prisoners in a building built for 800,” said Duverger. “With overcrowding comes serious problems for health.”

And it’s not just the health of the prisoners: it affects the parents and family members who come to visit and the Health Through Walls employees.

The organization has worked in Haiti since 2011 providing meaningful health services such as medical screening, treatment, and discharge planning leading to continuity of care upon release. Today they are in six of the country’s 16 prisons.


USAID and URC have teamed up to focus on improving the quality of health care in Haiti. A lack of resources is a typical culprit for poor quality of care, so URC—through their project in the Northern region of Haiti—is introducing the idea of results-based financing.

“Payments are now going to be tied to measurable results,” explained Veldhuijzen van Zanten of URC.

Facilities are using URC’s Collaborative Quality Improvement approach to take the issue of quality into their own hands and identify ways to bring high quality services to their community.

“The Ministry of Health has a quality checklist…that the Ministry expects to be provided to its population,” she explained. But how facilities apply that checklist is not easy.

“Knowing what you’re supposed to do and making it a reality, there’s often a big gap,” she said.

So URC partners with regional health departments and the health facility providers to introduce ways to analyze process of care, and measure their progress.

“We bring to them simple tools—through medical records and small quick measurements—so they can see where their bottlenecks are and then bring together teams of health worker and say ‘how are we going to fix this?’” Veldhuijzen van Zanten explained.

And it’s working.

“When they actually notice that prenatal care is following a checklist, and that before, maybe half the time that a woman showed up they were doing everything they were supposed to do, now it’s 60-70%,” she said.

It’s moments like these when people like Veldhuijzen van Zanten and Pathfinder’s Ti Max know that they are making a real difference in the lives of Haitians—and ensuring a healthier future.