Haiti and the health marketplace: the role of the private, informal market in filling the gaps left by the state

Durham, J., Michael, Marcos, Hill, P. S. and Paviignani, E. (2015) Haiti and the health marketplace: the role of the private, informal market in filling the gaps left by the state. BMC Health Services Research, 15 424: . doi:10.1186/s12913-015-1088-5

Author Durham, J.
Michael, Marcos
Hill, P. S.
Paviignani, E.
Title Haiti and the health marketplace: the role of the private, informal market in filling the gaps left by the state
Journal name BMC Health Services Research   Check publisher's open access policy
ISSN 1472-6963
Publication date 2015-09-28
Year available 2015
Sub-type Article (original research)
DOI 10.1186/s12913-015-1088-5
Open Access Status DOI
Volume 15
Issue 424
Total pages 10
Place of publication London, United Kingdom
Publisher BioMed Central
Collection year 2016
Language eng
Formatted abstract
In most societies the health marketplace is pluralistic in character, with a mix of formal and informal providers. In high-income countries, state regulation of the market helps ensure quality and access and mitigate market failures. In the present study, using Haiti as a case study, we explore what happens to the functioning of the pluralistic health marketplace in severely disrupted environments where the informal sector is able to flourish.

The overall research design was qualitative. Research methods included an extensive documentary and policy analysis, based on peer-reviewed articles, books and “grey” literature--government policy and program reports, unpublished research and evaluations, reviews and reviews from key multilateral and bilateral donors, and non-government organisations, combined with field site visits and in-depth key informant interviews (N = 45).

The findings show that state fragility has resulted in a privatised, commoditised and largely unregulated and informal health market. While different market segments can be identified, in reality the boundaries between international/domestic, public/private, for profit/not-for-profit, legal/illegal are hazy and shifting.

The lack of state capacity to provide an enabling environment, establish, and enforce its regulatory framework has resulted in a highly segmented, heterogeneous and informal health market. The result is deplorable health indices which are far below regional averages and many other low-income countries.

Working in fragile states with limited capacity to undertake the core function of securing the health of its population requires new and innovative ways of working. This needs longer time-frames, combining incremental top-down and bottom-up strategies which recognize and work with state and civil society, public and private actors, formal and informal institutions, and progressively facilitate changes in the different market functions of supply, demand, regulation and supporting functions.
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2016 Collection
School of Public Health Publications
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Created: Mon, 28 Sep 2015, 18:11:54 EST by Jo Durham on behalf of School of Public Health