The Health in the Americas+ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.
Environmental and social determinants of health
Although great strides have been made over the past two decades in terms of life expectancy at birth, the country's social and health situation continues to present high levels of precariousness, aggravated by the outbreak of the COVID-19 pandemic, political instability, and natural disasters such as earthquakes and droughts in the context of climate change.
In 2000, the total population of Haiti was 8 360 225 inhabitants; by 2021 this figure had risen to 11 447 569, representing a 36,9% increase. Regarding the country's demographic profile, in 2021 people over 65 years of age accounted for 4,5% of the total population, an increase of 0,8 percentage points compared to the year 2000. In 2021, there were 101,8 women per 100 men and 13,9 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country's population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 63,2% of the total population of the country in 2021 (7 229 380 people). When these figures are added to the potentially passive population (3 704 218 under 15 years of age and 513 971 over 65 years of age), the result is a dependency ratio of 58,3 potentially passive people per 100 potentially active people. This ratio was 78,8 in 2000.
Life expectancy at birth was 63,2 years in 2021—lower than the average for the Region of the Americas and 4.8 years higher than in 2000.
Figure 1. Population pyramids of Haiti, years 2000 and 2021
The unemployment rate in 2021 was 15,7% for the total population. Disaggregated by sex, the rate was 19% for women and 12,7% for men. The literacy rate was for was 61,7% in 2016 (65,3% for men and 58,3% for women). In addition, 58,5% of the population was below the national poverty line in 2012, and when defined as the percentage of the population with an income of less than US$ 1.90 per day, it was 24,5%; this is above the regional average of 3%.
During the period 2000–2021, the country improved its score on the Human Development Index, with an increase of 13,8% from a score of 0.470 to a score of 0.535; during the same period, the index rose 15% internationally and 11% in Latin America (Figure 2).
Figure 2. Human Development Index in the Region of the Americas, 2021
In 2019, public expenditure on health accounted for 0,5 % of gross domestic product (GDP) (Figure 3) and 5,4% of total public expenditure, while out-of-pocket spending on health accounted for 43,3% of total health expenditure.
Figure 3. Public expenditure on health as a percentage of gross domestic product in the Region of the Americas, 2018
The development of access to connectivity will continue to progress, and while coverage currently reaches only about a third of the population, recent progress has been significant.
In 2020, 34,5% of Haitians had an Internet connection, representing a considerable increase from 2000, when 0,2% of the population had an Internet connection.
Maternal and child health
In the area of children's health, health indicators should gradually improve. Despite this, the relative burden of mortality from acute diarrheal diseases and acute respiratory infections in children under 5 years of age remains disproportionate. Poor living conditions and malnutrition play a major role, and structural problems of sanitation and drinking water supply will need to be addressed in order to reduce these factors as causes of mortality. Strengthening strategies to optimize immunization coverage of the child population will also have great benefits for children's health. Between 2000 and 2017, infant mortality in Haiti decreased from 80,3 to 59 per 1000 live births, a decrease of 26,5%. The percentage of low-weight births (less than 2500 g) decreased from 9.6% to 9.1% between 2012 and 2013, while exclusive breastfeeding in the child population up to 6 months of age was 23.7% in 2000, and rose to 39.9% in 2017 (latest data available).
Regarding the immunization strategy, measles vaccination coverage was 73% in 2021, a reduction of 7 percentage points over 2000.
The maternal mortality ratio for 2017 was estimated at 480 per 100 000 live births, an increase of 9,8% over the estimated value for 2000. The maternal mortality ratio, at very high levels and with an upward trend, is a dramatic health reality, and the occurrence of preventable deaths should be placed at the highest priority for government management. The importance of accelerating the local production of blood products, necessary for emergency obstetric care, is equally critical.
In relation to fertility, in 2022 was estimated that women have an average of 2,8 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 31,9% decrease, from 76,2 live births per 1000 women aged 15 to 19 years in 2000 to 51,8 in 2022. Between 2000 and 2020, the births attended by skilled birth personnel went from 24,2% to 67,8%.
Figure 4. Infant mortality per 1000 live births, 1995–2019
Figure 5. Maternal mortality per 100 000 live births, 2000–2017
With regard to communicable diseases, Haiti has one of the highest incidences of tuberculosis in the region, the transmission of which continues to be facilitated by housing conditions and overcrowding. Health services based on primary health care, with a supply of essential medicines available to the population and active community outreach, will play a central role in the fight against tuberculosis and other common problems such as HIV, malaria, and dengue fever.
In 2020, there were 99 new cases of tuberculosis per 100 000 population in Haiti. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 9.2 (7.9 for women and 10.5 for men).
Zoonotic diseases such as rabies are common in the country. In 2021, 2 cases of human rabies were reported in Haiti. Timely supply of human rabies vaccines in adequate quantity and capacity for early detection and case management need to be improved.
Noncommunicable diseases and risk factors
The communicable diseases described above coexist with other chronic health conditions, such as hypertension, obesity, and diabetes, whose upward trends are already representing an additional challenge for a health system with limited resources and high demand for service delivery.
In Haiti, the prevalence of tobacco use among people aged 15 and older was 8.3% in 2019. In the same age group, the prevalence of overweight and obesity was 54.9% in 2016.
In 2015, the reported prevalence of arterial hypertension (high blood pressure) was 24.5% a decrease of 1.6 percentage points compared to 2000 (26.1%). The prevalence of diabetes mellitus, which stood at 5.7% in 2000, increased to 8.7% in 2014.
In 2019, the adjusted rate of potentially avoidable premature mortality in Haiti was 606,5 deaths per 100 000 population, a decrease of 30,9% from a rate of 877,8 in 2000. This meant that, in 2019, the rate in the country was 167.5% higher than the average rate reported for the Region of the Americas as a whole. Among potentially avoidable premature mortality, the rate for preventable causes was 314,2 per 100 000 population in 2019, which is 129.2% higher than the regional average rate; and the rate for treatable causes was 292,3 per 100 000 population, above the regional average of 89,6.
The overall age-adjusted mortality rate was 11,5 per 1000 population in 2019, a decrease of 23,7% compared to 2000 (15,1 deaths per 1000 population).
When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 218,1 per 100 000 population (221,9 per 100 000 in men and 214,7 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 838,7 per 100 000 population (829 per 100 000 in men and 848,5 per 100 000 in women). The rate of age-adjusted mortality from external causes was 97,7 per 100 000 population (141,8 per 100 000 in men and 56,8 per 100 000 in women), including road traffic accidents (19,9 per 100 000 population), homicides (20 per 100 000 population) and suicides (11,2 per 100 000 population). In 2000, the percentage distribution of causes was 46,7% for noncommunicable diseases, 44,1% for communicable diseases, and 9,3% for external causes; in 2019, the percentages were 64,7%, 24,7%, and 10,6%, respectively (Figure 4).
Figure 6. Proportional mortality in Haiti, 2000 and 2019
Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 49,1 per 100 000 men; lung cancer, 6,5 per 100 000; and colorectal cancer, 8,8 per 100 000. In women, these values were 16,9 deaths per 100 000 for breast cancer, 7,2 per 100 000 for lung cancer, and 10,1 per 100 000 for colorectal cancer.
The health situation and the COVID-19 pandemic
In Haiti in 2020, there were a total of 10 015 cases of COVID-19, representing 874,9per million population. In 2021, there were 16 198 identified cases, equivalent to 1 415,1 per million population. In 2020, there were 236 deaths directly caused by COVID-19 in people diagnosed with the disease, 20,6 per million population; in 2021, 537 deaths were reported, or 46,9 per million. In 2020, Haiti ranked 45th in the Americas in terms of the number of deaths from COVID-19, and 50th in 2021 (Figure 5).
According to estimates by the World Health Organization, there was a total of 2 865 excess deaths in 2020, or 25 per 100 000 population; a total of 6 744 deaths were estimated excess mortality of 58 per 100 000.
As of 31 December 2021, at least one dose of COVID-19 vaccine had been given to 1.6% of the country's population. As of 2 July 2022 (latest available data), 1,4% of the population had completed the vaccination schedule.
Figure 7. Cumulative COVID-19 deaths in the Region of the Americas, to 31 December 2021
In the response to the COVID-19 pandemic, efforts will focus on access to vaccines, improving epidemiological surveillance circuits, optimizing risk communication strategies, and improving laboratory network resources.
Measures to achieve universal health coverage
Challenges continue for Haitian healthcare reform. The healthcare system remains fragmented, with considerable dependence on out-of-pocket payment at the point of service as well as external aid that is mostly disease-specific or program-specific, and often short-term. Recruiting and retaining health professionals is a particular concern. Healthcare accessibility for rural communities is a recognized inequity. There is an urgent need to strengthen health literacy and community participation in health, while renewing the regulatory and governance framework of the health sector. The responses to these challenges are contained within the 25-year National Health Policy and the 10-year Master Plan for Health.
The Government of Haiti, through the Ministry of Public Health and Population, developed a National Health Policy in 2012 to guide health care for the next 25 years. From this policy, a 10-year Master Plan for Health (Plan Directeur Santé 2021-2031) details a strategic framework in six broad areas: health system governance, healthcare delivery, human resources for health, health information systems, essential medical technologies, and health financing. The plan embraces the concept of universal healthcare accessibility – an adoption of the global move toward universal health coverage. Specific universal health coverage strategies include a focus on health through the life course with planned expansion of primary healthcare services working within integrated health service delivery networks, expansion of emergency care, a focus on maternal and child health, and a recognition of the role of traditional medicine in community well-being. Early efforts are beginning to integrate prevention and continuous care for noncommunicable diseases and mental health into primary care. Plans for improved health system governance and performance monitoring will strengthen health system quality control.
Challenges related to population health
Haiti has the youngest age profile in the Caribbean, but is aging and the pace of this aging is predicted to increase. In 1980, the proportion of Haiti’s population aged 65 and older was 4.1%. This proportion changed little in the intervening 40 years, nudging up to an estimated 5.2% by 2020, but is predicted to more than double to 12.9% by 2060. This future increase of 7.8 percentage points is well below the regional averages for the Caribbean of 10.7 percentage points and for the Americas of 13.7 percentage points. Cardiovascular disease, cancers, and diabetes in 2019 collectively accounted for one-quarter of all healthy life lost. Neonatal disorders, respiratory infections, diarrheal disease, and HIV/AIDS accounted for another quarter, reflecting Haiti’s continuing double burden of noncommunicable diseases and communicable diseases. Nonetheless, the disease burden is shifting toward noncommunicable disease, with the burden of many communicable diseases now decreasing (notably for malaria, HIV/AIDS, and intestinal infections). Solutions for reducing many of these challenges require multisectoral cooperation.
Response to COVID-19 and natural disasters
Haiti remains highly vulnerable to natural hazards, mainly hurricanes, floods, droughts, and earthquakes. A 7.0 earthquake near Port au Prince in 2010 killed 220 000 Haitians and displaced 1.5 million more, with massive health care implications. Basic reconstruction costs surpassed the country’s annual gross domestic product. Between 2015 and 2017, drought led to crop losses of 70%, and in 2016 the Category 4 Hurricane Matthew heavily damaged the country’s housing, livestock, and infrastructure. Haiti was then struck by back-to-back disasters in August 2021, when a magnitude 7.2 earthquake rocked the southern peninsula, destroying 30 percent of local homes, killing over 2000 people, and displacing tens of thousands more. Days later, Tropical Storm Grace exacerbated the situation, dumping heavy rains and triggering flash flooding and landslides. A National Disaster Risk Reduction plan has been recently approved and a National Climate Change Adaptation Plan is being finalized. Broader societal challenges contribute to healthcare underdevelopment, including decreasing public financing of the health sector over the past decade, and ongoing sociopolitical instability.
The financial crisis of 2009 and the COVID-19 pandemic in 2020–2021 have adversely affected the economic stability across the Small Island Developing States of the Caribbean. The Haitian response to COVID-19 has included strengthening of surveillance capacity, including genomic surveillance of variants, strengthening infection prevention and control measures, risk communication and community engagement, and limiting COVID-19 mortality through improved case management and access to life-saving medicines, oxygen, and medical devices. Major efforts are under way to scale up COVID-19 vaccination in the country to achieve 40% coverage by the end of 2022.
Measures to reduce inequalities in health
The National Policy for Social Protection and Promotion aims, by 2040, to reduce poverty, inequalities, and economic, social and structural inequities in Haiti. Included in this policy is a focus on health, specifically among older adults and people living with disabilities. This represents direct action on health inequalities, and feeds into the goal for universal health coverage. There is also a particular emphasis on financial protection through the elimination of user fees for essential health services at the point of care.
Additional indicators provided by Haiti
|Indicator||Year||Value||Source||Data provided by|
|Confirmed malaria cases||2021||8,038||Statistical report 2021||Ministry of Public Health and Population|
|HIV Prevalence||2015||1.7||National program to fight AIDS||Ministry of Public Health and Population|
|HIV Incidence 15-49 years||2015||0.02||National program to fight AIDS||Ministry of Public Health and Population|
|Probable diphtery cases||2021||198||DELR National Network for Epidemiological Surveillance||Ministry of Public Health and Population|
|Cases of sexually transmitted infections||2019||74,678||Statistical report 2019||Ministry of Public Health and Population|
|Cases of diabetes mellitus||2019||24,171||Statistical report 2019||Ministry of Public Health and Population|
|Cases of high blood pressure||2019||115,419||Statistical report 2019||Ministry of Public Health and Population|