Lessons from Haiti and Rwanda

Transcription

1 Health system design and natural disasters Lessons from Haiti and Rwanda Paul Farmer, MD, PhD Harvard Medical School Brigham and Women s Hospital Partners In Health The Current Situation of Health in China Harvard Center Shanghai May 8, 2012

2 Health system design in the 21 st century Community-based Hospital-linked Health center-enriched

3 China s Cooperative Medical System Barefoot doctors Primary health care, including control of vaccine-preventable and vector-borne diseases Sanitation Life expectancy: 35 years in years in s economic reforms affect coverage? 1979: 80-90% covered by CMS 1984: 40-45% Sidel VW. The barefoot doctors of the People's Republic of China. New England Journal of Medicine1972;286: ; David Blumenthal and William Hsiao, Privatization and Its Discontents The Evolving Chinese Health Care System New England Journal of Medicine 353, no.11, (2005): 1165.;

4 Accompaniment A cornerstone of care June year later With accompagnateur 10 years later

5 Public-private partnerships Boucan Carré, 2003

6 Public-private partnershipsp

7 Building platforms for control of complex, chronic diseases 10 billion billion billion US$ millio on Resources for AIDS PEPFAR UNGASS World Bank MAP BMGF Global Fund FOKAL/OSI 1623 UNAIDS Harvard Consensus Statement HEI UNAIDS & WHO unpublished estimates,

8 From Haiti to Rwanda

9 (Re)building infrastructure Rwinkwavu, 2005

10 (Re)building infrastructure Bt Butaro, 2011 GoR covered 25% construction costs and 48% operating costs

11 Horizontal, vertical, diagonal People on ART nationwide People on ART at PIH/IMB sites 0 Year More than 90, Rwandans on ART (>80% of PLWA) Source: National AIDS Control Commission. Annual Report for the Fight Against AIDS. Annual Report Available:

12 Horizontal, vertical, diagonal Child mortality <5 deaths per 1,000 live births Maternal mortality 3,500 3,000 2,500 2,000 Deaths per 1, ,000 1, live births 0 Source: UNICEF Rwanda Health Statistics Available: WHO World Health Statistics Available:

13 Platforms for control of complex, chronic diseases PACT: community-based care in the US U.S. Enrollment 35% savings

14 Global Health Delivery Professional/ Medical Publisher, Media 7% Trade Association 3% Academia 25% Non Governmental Organization 30% For Profit Organization 6% Medical Institution 9% International Agency 6% Government 13% More than 6,800 members representing more than 2,149 organizations across 158 countries

15 Partners In Health, 2012 Research, Training, Service

16 Natural disasters and the limitations of health system design

17 Natural disasters and the limitations of health system design General Hospital nursing school collapse

18 Haiti s earthquake in context People killed per million inhabitants Damages (US Millions, 2009) Haiti 2010 Nicaragua 1972 Guatemala 1976 Myanmar 2008 Honduras 1974 Honduras 1998 Sri Lanka 2004 Venezuela 1999 Bangladesh Earthquake Earthquake Earthquake Cyclone Cyclone Cyclone Tsunami Flood 1991 Cyclone Solomon Is. Indonesia Tsunami Tsunami Cavallo E., A. Powell, and O. Becerra, Estimating the Direct Economic Damage of the Earthquake in Haiti, Inter-American Development Bank Working Paper Series #IDB-WP-163, 2010.

19 Haiti earthquake: acute response Source: US Comfort image from Grant Traverse Herald Archives: archives.gtherald.com.

20 Diagnosis: acute-on-chronic Over 3 million people affected by earthquake At peak, 1.3 million in resettlement camps April, 2012: ~450,000 still in camps Source: OCHA. Humanitarian Bulletin: Haiti, November 17; USAID. Haiti Earthquake. Fact Sheet #10, Fiscal Year (FY) February 4, 2011; OCHA. Haiti: One Year Later. Available at: USAID. Fact Sheet #7 Haiti Earthquake and cholera. June 13, Available:

21 Tangshan, 1976

22 Sichuan, 2008

23 Disasters natural and unnatural Sichuan, 2008 >150 aircraft mobilized: largest non-military airlift in Chinese history Total damages estimated ~$20 billion; overall economic costs ~$75 billion GDP per capita: $4,046 (2011, 24 th out of 31 Provinces)

24 Building back better Mirebalais Hospital, 2012