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Haiti: The general structure of the health system, including the existence of a doctor registry, the appearance of prescriptions, the process for obtaining medical reports, and the medico-legal certificate

General structure of the health system

A report published in 2007 by the Pan American Health Organization (PAHO) provides the following information on the general structure of Haiti's health system:

[PAHO English version]

Haiti's health system is made up of the public sector, the private for-profit sector, the mixed nonprofit sector, and the traditional sector. The public sector consists of the Ministry of Public Health and Population and the Ministry of Social Affairs. The private for-profit sector includes all health professionals in private practice, working on their own or in clinics. The mixed nonprofit sector consists of Ministry of Public Health and Population staff who work in facilities run by the private sector, by nongovernmental organizations, or by religious organizations.

...

All health system facilities are overseen and coordinated by the Ministry of Public Health and Population as part of the Ministry's regulatory role. The Ministry has not been able to fully assume this role, however. International cooperation resources have been directed more to the nonprofit private sector and, therefore, some private facilities have acquired greater capacity than the public sector....

The private, for-profit sector is concentrated in the metropolitan area, where most professionals work....

The public sector encompasses about 35.7% of the health infrastructure; the mixed private sector, 31.8%; and the private sector, 32.5%.... An estimated 40% of the population lacks access to health services. Around 80% of the general population has access to traditional medicine.... (PAHO 2007, 13-14)

Essentially, the Haitian health system is based [translation] "on the principle of cost recovery from users, or 'fee-for-service' for consultation and medication prescribed during the medical visit" (Médecins du monde Apr. 2008, 1).

Doctor registry

In 9 January 2009 correspondence, the Director of the International Health Unit (Unité de santé internationale) of the Université de Montréal department of medicine stated that Haiti [translation] "has no professional body or official registry, although a census of medical staff was conducted across Haiti." However, the creation of an order of doctors, which the Haitian Medical Association (Association médicale haïtienne) established in November 2006 as its primary objective (Le Nouvelliste 20 Nov. 2006), was proposed in a bill that will be examined during the 2009 parliamentary session (ibid. 12 Jan. 2009).

Prescriptions

The Director of the International Health Unit stated that there is no standard format for prescriptions and that they generally contain the same information as in Canada: the practitioner's name and address, the name of the medication, the dosage, and instructions for use (9 Jan. 2009). Further information on the appearance of prescriptions in Haiti could not be found among the sources consulted by the Research Directorate.

Process for obtaining medical reports

According to the Director of the International Health Unit, there is no standard procedure for obtaining a medical report and the procedure varies from doctor to doctor (9 Jan. 2009). Moreover, there are usually fees for obtaining medical reports, even in the officially-free public sector, and the practitioner sets the cost (Director 9 Jan. 2009). The Director also stated that [translation] "medical archives are not always well maintained or accessible, according to the institutions and practitioners" (ibid.). Further information on obtaining medical reports in Haiti could not be found among the sources consulted by the Research Directorate.

Medico-legal certificate

According to the Director of the International Health Unit, the medico-legal certificate is [translation] "issued by a doctor (or a medical institution) and is submitted to a judge or other legal authority in the event of a complaint (such as rape) or a criminal charge" (9 Jan. 2009). In November 2006, the Ministry for the Status of Women and Women's Rights (ministère à la Condition féminine et aux Droits des femmes, MCFDF), the Ministry of Public Health and Population (ministère de la Santé publique et de la Population, MSPP) and the Ministry of Justice and Public Safety (ministère de la Justice et de la Sécurité publique, MJSP) signed a [UN English version] "draft agreement on the provision of a free medical certificate" (UN 2 Feb. 2007, para. 55; Haiti 30 Mar. 2007, 25; AlterPresse 28 Nov. 2007). A report from the United Nations (UN) Human Rights Council indicates that, according to the agreement, [UN English version] "'a medical certificate may be issued to any person, including women victims of any kind of assault, be it physical, sexual or otherwise, by a licensed, officially recognized physician'" (2 Feb. 2007, para. 56). The three ministries reportedly signed a new agreement on the certificates in January 2007 (AlterPresse 28 Nov. 2007; see also Le Nouvelliste 14 May 2007 and Haiti June 2007, 31). An article in Le Nouvelliste indicates that victims of violence can obtain a medico-legal certificate free of charge (14 May 2007), but an article published by AlterPresse reports that what victims of violence receive is a [translation] "medical certificate concerning sexual and/or domestic assault" (28 Nov. 2007), which, according to the MCFDF, is issued to women victims of violence (Haiti June 2007, 31). Victims previously had to pay for this certificate (Haiti 30 Mar. 2007, 25; Le Nouvelliste 24 Nov. 2006), which was valid if it was issued by the Haiti State University Hospital (Hôpital de l'Université d'État d'Haïti, HUEH) or another public health institution (SOFA Jan. 2007; URAMEL 2004b). The certificate can now be obtained from hospitals, health centres and clinics (Alterpresse 28 Nov. 2007). However, according to Solidarite Fanm Ayisyèn (SOFA), the medico-legal certificate is not yet available in every region of the country (ibid. 25 Nov. 2008), and some doctors are reluctant to issue one or they charge for one nevertheless (Le Nouvelliste 14 May 2007).

Le Nouvelliste describes the medico-legal certificate as being quite substantial and reports that it contains the following information:

[translation]

the name of the signing doctor, the name of the victim, the date and time of the examination, the victim's exact statements, the findings of the clinical exam, the psychological effects noted, the duration of the complete inability or permanent partial inability to work, and the nature of any prescribed treatments. (Le Nouvelliste 14 May 2007)

The information on the contents of the medico-legal certificate provided by Le Nouvelliste can be found in the template of the medical certificate relating to sexual assault developed by the Medico-Legal Research and Action Unit (Unité de recherche et d'action médico-légale, URAMEL) (URAMEL 2004a), an association of medical examiners, doctors, lawyers and judges (URAMEL n.d.). URAMEL has asked the Ministry of Health (ministère de la Santé) to approve its medico-legal certificate template (ibid.).

This Response was prepared after researching publicly accessible information currently available to the Research Directorate within time constraints. This Response is not, and does not purport to be, conclusive as to the merit of any particular claim for refugee protection. Please find below the list of sources consulted in researching this Information Request.

References

AlterPresse. 25 November 2008. "Haïti : les femmes plus enclines à dénoncer la violence qu'elles subissent." <://www.alterpresse.org/spip.php?article7908> [Accessed 8 Jan. 2009]
_____. 28 November 2007. "Haïti-Genre : campagne institutionnelle contre les stéréotypes et l'exploitation du corps des femmes." <http://www.alterpresse.org/imprimer.php3?id_article=6701> [Accessed 28 Jan. 2009]
_____. 24 March 2006. "Haïti-Droits humains : mettre fin à l'impunité des violeurs et autres aggresseurs de femmes." <http://www.medialternatif.org/alterpresse/imprimer.php3?id_article=4366> [Accessed 16 Feb. 2009]

Director of the Unité de santé internationale of the Université de Montréal department of medicine. 9 January 2009. Correspondence to the Research Directorate.

Haiti. June 2007. Ministère à la Condition féminine et aux Droits de la femme (MCFDF). Bilan janvier-juin 2007. <http://www.mcfdf.gouv.ht/pub/mcfdf-bilan2006-2007.pdf> [Accessed 16 Feb. 2009]
_____. 30 March 2007. Ministère à la Condition féminine et aux Droits de la femme (MCFDF). "Une réponse à la violence faite aux femmes en Haïti." <http://www.mcfdf.gouv.ht/pdf/violence.pdf> [Accessed 22 Jan. 2009]

Médecins du monde. April 2008. L'accès gratuit aux soins de santé primaire : une stratégie payante. Appel au G8. <http://www.medecinsdumonde.org/fr/publications/les_rapports/l_ acces_gratuit_aux_soins_de_sante_primaire_une_strategie_payante_ appel_au_g8> [Accessed 9 Jan. 2009]

Le Nouvelliste. 12 January 2009. Samuel Baucicaut. "Un menu très copieux pour la première session." <http://www.lenouvelliste.com/article.php?PubID=1&ArticleID=66050> [Accessed 27 Jan. 2009]
_____. 14 May 2007. "Une médecine légale embryonnaire au service des victimes en Haïti." <http://www.lenouvelliste.com/article.php?PubID=1&ArticleID=43356> [Accessed 22 Jan. 2009]
_____. 24 November 2006. Jean Max St Fleur. "Un certificat médical gratuit aux victimes d'agressions sexuelles." <http://www.lenouvelliste.com/article.php?PubID=&ArticleID=36904> [Accessed 22 Jan. 2009]
_____. 20 November 2006. Alain Gaillard. "Vers la création d'un Ordre des médecins en Haïti." <http://www.lenouvelliste.com/articleforprint.php?PubID=1&ArticleID=36637> [Accessed 27 Jan. 2009]

Pan American Health Organization (PAHO). 2007. "Haïti." Health in the Americas 2007. <http://www.paho.org/hia/archivosvol2/paisesfra/haiti%20frances.pdf> [Accessed 15 Jan. 2009]

Solidarité Fanm Ayisyen (SOFA). January 2007. Rapport : bilan IV sur les cas de violence accueillis et accompagnés dans les centres Douvanjou de la SOFA de juillet à décembre 2006. <http://www.collectif-haiti.fr/data/File/rapport_bilan_4.doc> [Accessed 9 Jan. 2007]

Unité de recherche et d'action médico-légale (URAMEL). 2004a. "Certificat médical pour agression sexuelle." lt;http://haitimedical.com/uramel/documentation.asp> [Accessed 3 Feb. 2009]
_____. 2004b. "Le certificat médical : une preuve incontournable dans les cas de violence faites aux femmes." <http://haitimedical.com/uramel/formulaires/violence_femmes.pdf> [Accessed 16 Feb. 2009]
_____. N.d. "Documentation." <http://haitimedical.com/uramel/documentation.asp> [Accessed 3 Feb. 2009]

United Nations (UN). 2 February 2007. Human Rights Council. Application de la résolution 60/251 de l'Assemblée générale du 15 mars 2006, intitulée "Conseil des droits de l'homme." Situation des droits de l'homme en Haïti; rapport établi par l'Expert indépendant Louis Joinet. (A/HRC/4/3) <http://ap.ohchr.org/documents/dpage_f.aspx?c=78&su=86>

Additional Sources Consulted

Oral sources: The United Nations Children's Fund (UNICEF), the Groupe haïtien d'étude du sarcome de kaposi et des infections opportunistes (GHESKIO), the Pan American Health Organization (PANO), the ministère de la Santé publique et de la Population (MSPP), and the Unité de recherche et d'action médico-légale (URAMEL) [Port-au-Prince] did not answer requests for information from the Research Directorate within time constraints.

Internet sites, including: Factiva, Haiti – Ministère de la Santé publique et de la Population (MSPP), Haiti Press Network, The Miami Herald, United Nations Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW).

Topics: Health care,