RESUMO
Following the massive 7.0-magnitude earthquake that devastated much of the Haitian capital city of Port-au-Prince on January 12, 2010, the Haitian health system and its medical education programs were fragmented, fragile, and facing a significant, overwhelming demand for clinical care. In response, the authors of this paper and the institutions they represent supported the development of a teaching hospital that could fill the void in academic training capacity while prioritizing the health of Haiti's rural poor-goals aligned with the Haitian Ministry of Health (MOH) strategy. This bold initiative aimed to address both the immediate and long-term health care needs within post-disaster Haiti through a strategic investment in graduate medical education (GME). Here, the authors describe their approach, which included building consensus, aspiring to international standards, and investing in shared governance structures under Haitian leadership. The Haitian MOH strategy and priorities guided the development, implementation, and expansion of solutions to the ongoing crisis in human resources for health within the acute context. Local leadership of this initiative ensured a sustained and transformative model of GME that has carried Haiti beyond acute relief and toward a more reliable health system. The enduring success can be measured through sustained governance systems, graduates who have remained in Haiti, standardized curricula, a culture of continuous improvement, and the historic achievement of international accreditation. While ongoing challenges persist, Haiti has demonstrated that the strategy of investing in GME in response to acute disasters should be considered in other global settings to support the revitalization of tenuous health systems.
Assuntos
Atenção à Saúde/estatística & dados numéricos , Terremotos/história , Educação de Pós-Graduação em Medicina/economia , Currículo/normas , Desastres , Terremotos/estatística & dados numéricos , Educação de Pós-Graduação em Medicina/métodos , Haiti/epidemiologia , Implementação de Plano de Saúde/métodos , História do Século XXI , Humanos , Ensino/organização & administraçãoRESUMO
OBJECTIVE: To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. METHODS: Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. FINDINGS: Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. CONCLUSION: Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.
Assuntos
Centros Comunitários de Saúde/economia , Atenção à Saúde/economia , Recursos em Saúde , Orçamentos , Criança , Custos e Análise de Custo , Feminino , Haiti , Humanos , GravidezRESUMO
Shortages of trained health care workers plague low- and middle-income countries around the world. When resources are scarce, the ability to support medical education is severely constrained. While there are many important "building blocks" of health systems that need to be bolstered in low- and middle-income countries, the authors propose that U.S. academic medicine can make unique contributions in the realm of human resource development-specifically, increasing the supply of physicians who directly provide health care to the populations they serve and who often manage and lead these health systems. Strengthening medical education in low- and middle-income countries is critical to improving the quantity and quality of physicians to staff and lead these health systems. The authors provide specific examples of how U.S. institutions are pursuing this global endeavor, including the Academic Partnership Providing Access to Healthcare in Kenya, the Medical Education Partnership Initiative throughout Africa, partnerships between U.S. medical schools and with institutions in Qatar and Singapore, and postgraduate medical education efforts in Vietnam and Haiti. They urge that the U.S. academic medicine community embrace this challenge as part of its mission to ensure that all those who, wherever they may live, have the ability, the dedication, and the compassion to pursue a career in medicine be given the opportunity to do so.