Health system design Lessons from Haiti and Rwanda
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1 Health system design Lessons from Haiti and Rwanda Paul Farmer, MD, PhD Harvard Medical School Brigham and Women s Hospital Partners In Health Health Science & Technology S14 MIT, Building 32 May 4,
2 Partners in Health, 2012 Boston Russia Mexico* Guatemala* Haiti Burundi* Rwanda Malawi Lesotho Research, Training, Service Image by MIT OpenCourseWare. 2
3 What is health system strengthening? Community-based Hospital-linked 3 Health-center enriched
4 Countering failures of imagination 10 billion 8.9 billion billion US$ million Resources for AIDS UNGASS World Bank MAP BMGF FOKAL/OSI UNAIDS PEPFAR Global Fund Harvard Consensus Statement HEI UNAIDS & WHO unpublished estimates,
5 Accompaniment A cornerstone of care June year later With accompagnateur 10 years later 5
6 Public-private partnerships Boucan Carré,
7 Public-private partnerships Lascahobas,
8 Public-private partnerships Map of Haiti showing Zanmi Lasante locations removed due to copyright restrictions. 8
9
10 Informatics and care for those who need it most OpenMRS. All rights reserved. This content is excluded from our Creative Commons license. For more information, see 10 Health Affairs. All rights reserved. This content is excluded from our Creative Commons license. For more information, see
11 From Haiti to Rwanda 2005: GoR, with CF support, invites PIH to implement rural health model 11
12 Service 12
13 Strengthening and studying rural health systems Research and professional Evaluate large-scale model delivered development of trained health in public sector workers Build local clinical and research capacity Graph showing increasing number of people treated per month for tuberculosis and HIV has been removed due to copyright restrictions. 13
14 Training 14
15 (Re)building infrastructure Rwinkwavu,
16 (Re)building infrastructure Butaro, 2011 GoR covered 25% construction costs and 48% operating costs 16
17 Horizontal, vertical, diagonal People on ART nationwide People on ART at PIH/IMB sites 0 Year More than 90,000 Rwandans on ART (>80% of PLWA) Source: National AIDS Control Commission. Annual Report for the Fight Against AIDS. Annual Report
18 Horizontal, vertical, diagonal Child mortality Maternal mortality <5 deaths per 1,000 live births 3,500 3,000 2,500 2,000 1,500 1, Deaths per 100,000 live births 18 Source: UNICEF Rwanda Health Statistics Available: WHO World Health Statistics Available:
19 Scaling up in rural Africa UGANDA 1 Democratic Republic of the Congo Virunga MTS. Butaro TANZANIA Ruhengeri Byumba Gisenyi 2 Kibuye LAC Kivu Cyangugu Butare* Rwinkwavu KIGALI Mulindi 2 Gitarama Ruklra Kirehe Nyarubuye Rusuma TANZANIA Rwanda Burundi Malawi 3 BURUNDI km ml 3 Lesotho Image by MIT OpenCourseWare. Various logos removed due to copyright restrictions, including Partners in Health, Khotso Pula Nala, Republic of Rwanda Ministry of Health, Malawi Ministry of Health, Clinton Foundation, and others. 19
20 Global Health Delivery Online Non- Governmental Organization 30% Professional/ Medical Publisher, Media 7% Trade Association 3% Academia 25% For-Profit Organization 6% More than 6,800 members representing more than 2,149 organizations across 158 countries Medical Institution 9% International Agency 6% Government 13% 20
21 Natural disasters & the limitations of health system design: 2010 nursing school collapse 21
22 Cholera in Haiti and the limitations of health system design Cholera confirmed Oct 22 by Haitian Ministry of Health and CDC within 48 hrs of outbreak of acute watery diarrhea in the lower Artibonite Confirmed in PaP by Nov 8 As of Apr 8: > 532,925 cumulative cases > 7,095 deaths Source: MSPP Cholera update, March 1, Available: 22
23 Diagram removed due to copyright restrictions. Please see diagram here: (PDF) 23
24 (Re)building water and sanitation systems? Photos of faucet with clean water and group of villagers waiting with buckets to collect water have been removed due to copyright restrictions. 24
25 What is health system strengthening? Community-based Hospital-linked 25 Health-center enriched
26 Mirebalais Hospital, Nicholas Clark Architects
27 Thank you
28 MIT OpenCourseWare HST.S14 Health Information Systems to Improve Quality of Care in Resource-Poor Settings Spring 2012 For information about citing these materials or our Terms of Use, visit:
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