評估海地的健康照護系統對抗潛在大流行之功能與準備狀況:以COVID-19為例

Abstract

Emerging Infectious Diseases (EID) are considered to be a major public health problem because of their potential to be used as biological warfare agents, their unpredictable nature, and their potential to become pandemic. During an epidemic or pandemic scenario if the health system is not well prepared it could be overwhelmed, and the outcomes could be worse than predicted. Therefore, prior preparedness plans, response protocols are needed. This dangerous new member of the coronavirus family was first identified in Wuhan, China in December 2019. Since then the WHO-named COVID-19 has spread to more than 200 countries and territories worldwide. In March 2020, the government announced two first confirmed cases of COVID-19 in Haiti becoming one of the latest countries to be affected by the virus. The cholera epidemic in Haiti recently proved that the country is not sufficiently prepared to face a pandemic of this magnitude. Haiti’s health system is ill-prepared for the looming catastrophe. Objectives: This study aimed to assess the capacity, quality, and preparedness of the Haitian health system against pandemics looking at how they manage to combat the current COVID-19 pandemic. And also, to suggest some strategies and recommendations to strengthen their preparedness protocols using the Taiwan health system as a model. Methods: We used the Donabedian approach to analyze the resources and their effectiveness, and the Global Health Security index (GHS index) to evaluate the capacity and preparedness of the Haitian Health system to cope with this ongoing pandemic, finding what is missing and what could be changed. A qualitative approach was used, and the main method of data collection was the documentation analysis. Result: The result showed as of September 30, 2020, 8792 confirmed cases, and 229 deaths from COVID-19 were registered in the country. Only 37 COVID-19 treatment centers were operational in Haiti for 1011 beds. Borders control is well organized but still has illegal entries. The country doesn’t possess a health emergency plan, and biosafety and biosecurity regulations, 9 laboratories have the capacity to test for COVID-19 across the country and are partly understaff and centralize. Lack of human resources and personal protective equipment (PPE) led to a decrease in primary care (vaccination, institutional birth, and chronic disease). Which can also be explained by the lack of communication, rumors, fake news that are circulated, stigmatization caused distrust and decreased the number of people seeking health care. Only 5.9 million of 11.8 million inhabitants received awareness messages about COVID-19. Conclusion: The study revealed that the Haitian healthcare system is still not prepared to combat this pandemic. Nevertheless, compared to the neighboring country the Dominican Republic which scored higher in the GHS index than Haiti and Cuba, has much worse COVID-19 outcomes than those countries (Haiti, Cuba). However, Taiwan with an almost perfect GHS index score has even better outcomes. Additional models should be coupled with the GHS index to evaluate health systems capacities and health outcomes. We suggested the development of a national public health emergency response plan that includes EID by the Haitian government.