This Rapid Response Research (RAPID) grant provides funding to conduct a case study centered on the two main hospitals that serve the northern region of Haiti, using semi-structured interviews and an analysis of organizational networks, the research will: 1) examine what local health-related resources were available in the northern region of Haiti, 2) how these were, or were not, made use of in response efforts, and 3) the level of coordination and collaboration among health delivery groups. The northern region of Haiti was relatively unaffected by the 7.0 magnitude earthquake on January 12, 2010, that caused extreme physical damage experienced in the areas in and around Port-au-Prince and the southern region. One might question what the role of an already fragile health system could, or would be, during response and recovery in the face of such an extensive catastrophe. The underdeveloped nature of the health system might support an argument for top-down response from international sources, particularly in the absence of leadership from the Haitian government or Haitian disaster management structures. This research explicitly takes the view, however, that even in a place that is the "poorest in the Western Hemisphere," structures and resources exist through which international assistance and response could work to draw on capacities within the local system.
Through an assessment of what health-related Haitian and NGO resources were operating in this region and an articulation of the level of coordination and cooperation between them, the research will contribute to an understanding of local capacity, particularly in a developing country setting. The study also recognizes that any attempt at sustainable recovery planning and/or disaster mitigation necessitates directly incorporating the Haitian health sector as a building block and so the data collection will establish a baseline for future assessment of the recovery process. The findings can also suggest possibilities for hospital disaster planning beyond Haiti in places with stressed health systems. Most significantly, this research incorporates a partner with a long standing presence in Haiti and a design with a feedback loop so that findings have greater potential for use in capacity building at this location.
The northern region of Haiti was relatively physically unaffected by the 7.0 magnitude earthquake on January 12, 2010, that caused extreme damage in the areas in and around Port-au-Prince. One might question what the role of an already fragile health system could, or would be, during response and recovery in the face of such an extensive catastrophe, especially with most Ministry of Health functions and other resources concentrated in the devastated region. The underdeveloped nature of the health system might support an argument for top-down response from international sources, particularly in the absence of leadership from the Haitian government or Haitian disaster management structures, and yet opportunities likely exist for incorporating bottom-up approaches. Conducting a case study centered on the two main hospitals that serve the northern region of Haiti, using semi-structured interviews and an analysis of organizational networks, the research: 1) examines what local health-related resources were available, 2) how these were, or were not, made use of in response efforts, and 3) the level of coordination and collaboration among health delivery groups with a particular focus on preparedness and recovery. This case study focused on the two main hospitals in the northern region, which provides an interesting comparison, not just because of their location in the periphery of the seismically affected areas, but also since one is a private and the other public institution. Justinian Hospital in Cap-Haitien, the second largest city in Haiti on the north coast, is a public hospital which falls under the Haitian Ministry of Health. It is the largest health care provider in northern Haiti with 250 beds, serving an estimated population of 850,000. Sacre Coeur Hospital, on the other hand, is a private Catholic facility and is located in the town Milot 70 miles south of Cap-Haitien. It is a 73-bed hospital and is the largest private hospital in northern Haiti. Fieldwork was conducted during two, 2-week periods in June and July, 2010. During the first visit, key informant, semi-structured in-depth interviews were completed, at both Justinian and Milot, representing a variety of professional roles, including nurses, doctors, residents, and administrators. Participants were asked a series of questions to record their views of health sector capacity in the Haiti response, and recovery as efforts have shifted. The second fieldwork visit involved administering a survey consisting of a series of questions delivered to health-sector organizations operating in the northern region that captured disaster preparedness and recovery data for organizations using an established survey instrument. Several themes emerged from the surveys and the interviews taken together. In terms of challenges, these included: inadequate hospital capacity, overall poor coordination, although many examples were described where ingenuity and adjustment resulted, the need for a model for integration of international efforts into local structures and organizations, and an urgent need for disaster training. Despite all of the challenges, there were also many positive and encouraging elements of the response. First and foremost, the medical, nursing, and support staff, had an extremely high level of dedication to serving the victims. And, while there were many challenges with international organizations and individuals integrating into the Haitian system for various reasons, there were also several positive examples. Importantly, as the memories of the earthquake recede in the "international consciousness", international health advocates must maintain the focus on the dire state of health care in Haiti. This cannot just be an international effort, however, as the local health authorities and the Haitian Government have the most significant role to play. This research directly informs hospital and public health disaster planning, and so has the potential to influence recommendations that could result in more successful responses in the future, particularly in Haiti and in other resource-poor settings. Importantly, many places in the U.S., though perhaps not quite as extreme as Haiti, also do not have the necessary resources (financial, educational, etc) to carry out effective disaster planning in the health sector, and a lack of integration continues to exist between scales (local to state to national) and among organizations (emergency management, public health, etc).
