The aid operation in quake-devastated Haiti has undermined the national health system as medical staff quit to take up better-paid jobs with international agencies, medical charity Merlin says.
A report released this week – one year after the Jan 12 quake - says the availability of free medical care and drugs has also severely affected many local health services which relied to some extent on patient fees.
Pharmacies have been forced to close and local doctors have lost their patients, according to a separate Reuters report.
Hundreds of foreign medical teams swept into Haiti’s shattered capital Port-au-Prince after the quake which killed some 250,000 people and injured more than 300,000 others.
But Merlin strongly criticises international agencies for failing to work with local medical staff, health services and aid groups. There was little attempt to find out what was already available or make use of local expertise, the agency says.
It cites the example of one Haitian surgeon who went to the General Hospital to offer her services only to be told that the international team there had brought enough foreign staff with them.
By mid February between 400 and 600 international health agencies had arrived in the country.
However, Merlin says many teams lacked plastic surgeons who are needed for dealing with the sorts of crush injuries common in quakes. The report also highlights claims that the inexperience of some clinicians led to unnecessary amputations and post-surgery complications.
In addition, many clinicians did not speak French which created problems for local staff and for patients, who often did not know what was happening to them.
“Haitians would lie down not knowing whether they would lose a leg or have an injection,” said a member of one non-governmental organisation (NGO).
Despite its stark criticism, Merlin says no one would dispute that the aid agencies have saved thousands of lives and brought huge benefits.
“Health care in Port-au-Prince is now more available and considered of higher quality than before the quake. While suspension of user fees has meant that more people can access health care than ever before…," the report says.
But it adds: “Worryingly, more national health workers have been streaming out of the public and private sector towards better paid and resourced INGO (international NGO) jobs. The longer-term impact of this brain drain is not known.”
It says Haiti’s government has been trying to cap salaries paid by international organisations to stop the exodus of staff from the national health system.
Merlin’s report Is Haiti’s health system any better? calls for a more co-ordinated approach in responding to disasters. It says international agencies must assess what skills and facilities are already available and must collaborate with local medical staff, health services and NGOs.
It also calls for greater efforts to strengthen the ability of governments to anticipate and respond to major humanitarian crises.
In Haiti, Merlin says that reports from the ground suggest national staff did not appear to have any sort of emergency plan for responding to a crisis. For the first few days, they did not know where to send the injured or how to deal with the mounting piles of corpses.
“Building up strong and robust health systems must now become one of the key pillars of all disaster risk reduction,” the agency adds.