Integrating HIV, TB, and Malaria in Haiti

THE PROBLEM

Haiti is a low-income country with the highest prevalence of HIV infection in the Latin American and Caribbean (LAC) region; is the only nation in the Caribbean where malaria is still endemic; and has the highest TB burden in the Western Hemisphere. The Haitian Ministry of Public Health and Population (MSPP) has developed a vertical response to each of these three diseases. However, international experience suggests that there are a number of issues that cut across the different programs that could be better addressed jointly, such as procurement and supply chains, disease surveillance and laboratories services, program planning and supervision, and delivery of HIV, TB, and malaria screening and treatment. Responding to the three diseases in Haiti through siloed vertical programs results in duplication of efforts, competition for resources, disparate emphasis on certain interventions at the expense of others, and piecemeal (and often unsustainable) initiatives.

THE PHAROS SOLUTION

At the request of the Global Fund and Haiti’s MSPP, a Pharos team composed of international and local health systems, infectious disease, and financing experts is working with local stakeholders to develop recommendations to better integrate the HIV, TB, and malaria responses in Haiti.

Preparation/Diagnostic Phase (September-December 2019) The Pharos team kicked off the project with a series of telephone meetings with the MSPP, Global Fund, and other NGOs and technical agencies working on HIV, TB, and Malaria. Using interview findings and an analysis of documents, the team analyzed a wide range of issues such as HIV/TB/Malaria epidemiology, governance, institutions, and human rights, as well as areas where integration might be expanded – such as supply chains, information systems, laboratories, prevention services for key populations, and program financing. Despite ongoing political unrest in Haiti, the Pharos team visited the country in December and drafted a preliminary list of priority areas for integration.

Assessment Phase (March-April 2020) In early March a larger Pharos team traveled to Haiti to conduct field visits and interview a broad cross-section of stakeholders. At the end of the mission the team presented its preliminary findings to the MSPP, comprising more than a dozen priority actions for integration. These findings and recommendations were incorporated in a draft report to the government and the Global Fund, which was used in preparing Haiti’s $119.4 million grant request to the Global Fund for 2021-23.

Validation Phase (May-July 2020) Depending on a series of factors beyond Pharos’ control – especially political volatility in Haiti and the global coronavirus situation – Pharos will validate its integration findings and recommendations with stakeholders in Haiti and finalize its report, including a roadmap for implementing key recommended actions.

LOOKING AHEAD

Pharos will disseminate the methods and findings from the Haiti HIV/TB/Malaria integration study, both to help shape the country’s response to the three diseases and its overall primary health care system. The Haiti project can also feed into the larger debate on health services integration and global efforts to improve the effectiveness of disease control programs.

Status: Ongoing, March 2020 – October 2020

Team Members Involved: Robert Hecht, Diana Bowser, Sunil Parikh, Diana Gonzalez, Charles-Patrick Almazor, Walter Gabriel, Emily Briskin, Moises Escobar

For more information, contact Diana Gonzalez at diana@pharosglobalhealth.com.

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