Thank you very much for your invitation. It is an honor to address the Association of Haitian Physicians Abroad, particularly on this important occasion. This year marks the 40th anniversary of the founding of the AMHE, the beginning of decades of engagement for a better Haiti. Later today, which is World AIDS Day, your organization will pay tribute to seven individuals with long and distinguished records in the fight against that disease. It is a privilege to be part of this event, and I thank you for that.
I would like to give a brief overview of the efforts of the U.S. government, in partnership with Haitians, to implement health and development programs in Haiti, and to underscore the valuable contribution you in the Diaspora make toward a healthier Haiti. I will try to leave time for a few questions following my remarks.
Just two days ago, speaking in recognition of Worlds AIDS Day, Secretary of State Clinton noted that “We will promote a global effort to achieve an AIDS-free generation, because this must be a shared responsibility.” Donor nations, country partners, multilateral organizations, the private sector, civil society – including faith-based organizations – all have a role to play in the HIV/AIDS response. Launched in 2003, the President’s Emergency Plan for AIDS Relief, or PEPFAR, is the largest effort by any nation to combat a single disease. PEPFAR progress is measured by lives improved and saved around the world – including in Haiti.
As the members of the AMHE well know, Haiti continues to present unique challenges to the successful implementation of health and other development programs in the face of the 2010 earthquake, the cholera outbreak, and the limited, though growing, capacity of Haitian institutions.
Statistics bear this out. Haiti has an HIV prevalence rate of 1.9 percent and a population of 10 million. Although low in comparison to many PEPFAR countries, this prevalence rate is the highest in the Americas, where the average is less than 1 percent. Haiti’s HIV/AIDS epidemic is generalized, with higher prevalence rates in major cities and driven by most at risk populations – such as commercial sex workers and men having sex with men – and the social conditions of women and youth. Of Haiti’s estimated 135,000 HIV infected individuals, the Ministry of Health estimates that 56 percent of individuals with immediate need for antiretroviral, or ARV, therapy receive it; 20 percent of the general population has access to counseling and testing; and 61 percent of pregnant women get tested for HIV. There is a high level of stigmatization towards HIV positive individuals in the country, especially at the community level.
Nevertheless, through our efforts, we can also point to more positive numbers in Haiti:
In Haiti, the United States is committed to making significant but smart investments in the national HIV response. PEPFAR remains one of our Embassy’s largest programs and the foundation of our Health Strategy. We are proud that PEPFAR’s technical and financial support is building capacity in the country’s health system to make it possible for every Haitian to have access to quality HIV prevention, care and treatment.
Despite the devastating impact of the earthquake on Haiti, the United States has been able to keep providing health services at pre-earthquake levels and in many cases at better levels (immunization, Lymphatic Filariasis, HIV testing of pregnant women, new initiations of clients onto antiretroviral treatment). We funded a massive response to the cholera outbreak in October 2010, and we moved quickly to address the new health needs caused by the earthquake, including for disability care. We are also making progress on rebuilding key health infrastructure that was destroyed.
This year U.S. government continued to support 251 sites that provide primary care and 52 that provide secondary care nationwide. Through these sites our partners provided a range of services, including HIV, TB, family planning, and nutrition. We increased the number of eligible patients on ARV from 60% of those in need nationally in March 2012 to 69% in September 2012. We are working with the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria to reach universal coverage of ARVs for all eligible patients by June 2015.
We have built on our PEPFAR platform to address new health needs, like cholera. We expanded what was a PEPFAR agreement with the Ministry of Health to include cholera funding, so that health facilities that provide HIV services can also provide cholera services. When cholera first broke out, the U.S. Agency for International Development’s Office of U.S. Disaster Assistance funded international NGOs who set up cholera treatment facilities in tents away from health centers. Within six months the U.S. was phasing out funding of international NGOs and increasing funding of local NGOs and the Ministry of Health to integrate cholera services into regular health centers. In the last six months, the cholera response has been well and truly “nationalized”, which the U.S. government views as a tremendous success.
Over the past year, the PEPFAR team has worked to achieve a strategic shift in the management of the PEPFAR program in Haiti. A focus on accountability and performance has been intensified, with measures implemented to improve efficiencies and impact in PEPFAR-supported programming. PEPFAR-supported partners have received a clear mandate to achieve ambitious goals related to key technical priorities that will continue throughout FY13, including rapidly scaling up the provision of prevention of mother to child transmission services and fast-tracking initiation of currently eligible clients for antiretroviral therapy.
PEPFAR is active in developing country ownership of the HIV response in Haiti in the context of transitioning the broader U.S. government health investments to the government of Haiti. In June 2012, the governments of Haiti and the United States signed a Partnership Framework on Health that lays out a mutually-accountable, joint strategic agenda to accelerate the development of Haiti’s public health services to reach the Millennium Development Goals. The Partnership Framework builds upon the foundations laid by the government of Haiti, civil society, the private sector, non-governmental organizations and bilateral and multilateral partners, including existing coordination mechanisms such as the Global Fund Country Coordinating Mechanism.
By 2017 it is expected that results in maternal and child health, reproductive health, care for disabilities, nutrition, and the fight against HIV/AIDS and other infectious diseases in Haiti will have made significant improvements. The overarching goal advanced in the Partnership Framework is to strengthen the government of Haiti’s ability to plan, manage and, ultimately, finance a sustained response to Haiti’s public health needs well beyond the lifespan of U.S. government assistance.
Diaspora organizations such as the AMHE can play, and are playing, a valuable role in helping Haiti meet those needs. As I noted at the World Haitian Diaspora Congress in Washington in October, few countries in the world suffer more from the effects of brain drain than Haiti. Many in this room know from personal experience how much of Haiti’s talent lies beyond its borders. As members of the Diaspora, you have much to offer to building a better Haiti. With your skills, your language, your contacts, your resources, your knowledge of the culture, you can be a bridge between Haiti as it is today and a thriving, prosperous, flourishing Haiti in the future.
Indeed, the AMHE is demonstrating this commitment in practice. The AMHE Foundation, in collaboration with the Haitian Physicians Association and the Haitian Red Cross, has pledged to provide the Haitian population with a continuous supply of personal and family filters, aimed at preventing water-borne diseases in time of disaster. The AMHE Foundation sponsors regular visits by groups of Haitian-American physicians to Haiti and the Dominican Republic to provide free care to the poor, to lecture and conduct technical workshops for physicians and students at the Medical School of the University of Haiti. And the AMHE Foundation helped in the construction of the Student Center at the State University of Haiti and, over the years, contributed continuously to its day-to-day functioning. The activities of the AMHE are an example to others.
The ties that link the United States and Haiti are broad and deeply rooted. The U.S. Government is committed to helping Haitians build a better future, and that commitment is long term. You, members of the Diaspora, share that commitment. I know that the Haitian Diaspora has the talent, the energy and the dedication to play an even greater role in helping build a better future for the people of Haiti.