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USAID/Haiti Maternal and Child Health and Family Planning Portfolio Review and Assessment

A limitation to the study was the use of key informants who were thought to be the most knowledgeable in their country but who might have come from differing perspectives. For a few countries multiple responses were obtained. In these cases, the information provided was reviewed and the most internally consistent response was incorporated into the survey database. Concern with the low response rate was discussed with WHO’s network of experts in this area and others involved in this type of studies. WHO was advised that it is particularly dif- fi cult to obtain responses in the area of child and. | USAID Haiti Maternal and Child Health and Family Planning Portfolio Review and Assessment August 2008 Assessment Team Agma Prins Adama Kone Nancy Nolan Nandita Thatte Printed September 2008 USAID FROM THE AMERICAN PEOPLE MSH Management Sciences or Health This report was made possible through support provided by the US Agency for International Development under the terms of the Leadership Management and Sustainability LMS Program Cooperative Agreement Number GPO-A-00-05-00024-00. The opinions expressed herein are those of the author s and do not necessarily reflect the views of the US Agency for International Development. Management Sciences for Health 784 Memorial Drive Cambridge MA 02139-4613 Tel. 617-250-9500 Fax 617-250-9090 Website www.msh.org CONTENTS I. ACRONYMS AND ABBREVIATIONS.3 II. ACKNOWLEDGMENTS.5 III. EXECUTIVE SUMMARY.6 IV. INTRODUCTION.10 V. BASIC DETERMINANTS OF POOR MATERNAL AND CHILD HEALTH IN HAITI. 11 a. Demography.12 b. Poverty.12 c. Governance.14 d. Role of Donors.15 e. Societal Dysfunction.17 Overall Instability.17 Violence.17 Family Instability.21 f Infrastructure and Services.19 Transportation.19 Water and Sanitation.20 g. Health Care.20 Health Facilities. 20 Health Personnel . 22 VI. ISSUES IN MATERNAL AND CHILD HEALTH AND FAMILY PLANNING.24 a. Hunger. 24 b. Maternal and Neonatal Health.25 Maternal Mortality. 25 Prenatal Care.27 Obstetrical Care.29 Postnatal and Neonatal Care.31 Abortion and Postabortion Care.33 c. Family Planning.36 Role of Family Planning in Maternal and Child Health.34 Fertility Patterns.35 Use of Contraceptives . 35 Knowledge of Contraceptives.36 Unmet Need and Demand.36 Postpartum Family Planning.38 Apparent Contradiction between Stagnating CPR and Decreasing Fertility.38 Role of Social Marketing.39 d. Child Health.39 Overview . 39 Integrated Management of Childhood Illness. 41 e. Immunization . 42 VII. HEALTH SECTOR LOGISTICS MANAGEMENT SYSTEM.44 VIII. INDICATORS AND USE OF DATA. 47 IX. DONOR PROGRAMS.49 USAID HAITI