Haiti’s Ministry of Public Health and Population, in collaboration with local and international organizations, has made great strides in reducing the infant mortality rate, leading to a decrease from 80 deaths per thousand live births in 2000 to 59 deaths per thousand.
However, Haiti still has the highest infant mortality rate in the Caribbean.
Fewer than half of all children receive every immunization dose. Around two child deaths in ten are caused by diseases that could be prevented by vaccines. These include diphtheria and pertussis.
The biggest causes of vaccine-preventable death are measles and neonatal tetanus. Measles spreads through the air when an infected person coughs or sneezes and is so contagious that if one person has it, 90% of people close by will also become infected if they are not protected.
Tetanus – caused by a common bacteria in the soil coming into contact with open cuts – can cause a quick and painful death in very young children, and can also claim the lives of mothers.
For Haiti Priorise, Ministry of Planning and External Cooperation (MPCE) economist Magdine Flore Rozier Baldé has researched the benefits of amplifying the MSPP’s current efforts, to lift infant immunization coverage to 90% by 2020.
In Haiti Priorise, researchers examine different ways that additional money could be spent to help Haiti. It aims to provide new data along with answers to the question: what policies and interventions would achieve the most?
Reasons for Haiti’s low immunization coverage include the remoteness and poor quality of health centers, the lack of availability of immunization, and the lack of skilled health personnel.
Of the 644 health institutions providing infant immunization services, an evaluation found that only 264 institutions had personnel that had been trained in the Expanded Program on Immunization, the World Health Organization program that provides national governments with guidelines on immunization coverage.
Therefore, Rozier Baldé suggests focusing on the development of qualified personnel, as well as improving the availability of the basic amenities needed to ensure the quality of immunization. All health institutions in the country that provide immunization services will be strengthened with this investment.
The idea is that this intervention will allow the national immunization coverage rate to rise gradually to 60% in 2017; 70% in 2018; 80% in 2019; and reach 90% by 2020 and 2021.
The cost of vaccination for each child to the government would be around 5,300 gourdes, or USD$78. The total cost of the five-year program would be 2.4 billion gourdes. The bulk of this is the price of immunization and injection equipment, with transportation and training accounting for the rest.
In the first year, an additional 78,624 infants under the age of one would be immunized, and in the second, this would climb to nearly 131,094. Over the course of five years, 864,846 additional children would be immunized, who would otherwise have missed out.
Lives would be saved from the very first year: 975 child deaths would be averted in 2017, and 1,803 in the following year. As the immunization coverage expands, the number would continue to climb until, by the end of the five years, Rozier Baldé finds that 16,506 children would be alive who would otherwise die.
This is a very strong return on a 2.4 billion Gourde investment. Haiti Priorise uses cost-benefit analysis to calculate the benefits to society from different policies. This creates new data that allows different policies to be compared. And this approach means that we can calculate all of the benefits from the investment.
Of course, by saving lives, the intervention will save families a lot of heartbreak. And by avoiding 16,506 children losing almost 70 years of life each, it will have economic benefits. Typically, each year of life that is gained is valued at three-times GDP.
When a child becomes sick, parents understandably miss work. Rozier Baldé estimates that immunization will save parents around 281 million gourdes worth of income that they would otherwise lose.
And it will save the health system nearly 16 million gourdes that would need to be spent on sick children.
Overall, these benefits add up to more than 32.3 billion gourdes. That means that every gourde spent on achieving full immunization for infants will have returns to society worth thirteen gourdes.
By increasing on its recent successes in expanding infant immunization coverage, Haiti has the opportunity to save tens of thousands of lives and achieve thirteen gourdes of benefits for every gourde spent.