At project outset, health indicators in Honduras were among the worst in the region: between 1990 and 1997, the maternal mortality ratio declined by 38 percent, but remained high at 108 deaths per 100,000 live births; and infant mortality was 36 per 1,000 births. A fragmented health care system, inequity in coverage across regions, weak regulation, centralized resource allocation preventing results accountability, and a health care system oriented to curative vs. preventive care (preventive care made up just 5 percent of public health spending) were some of the causes behind those poor indicators. Only 15 percent of the population had health insurance.
The project seeks to extend health care coverage and raise its quality, especially among poor people, by supporting system-wide reform. Particular attention is being given to topics such as maternal-child health services, HIV/AIDS prevention and care, and problems concentrated in the poorest segments of the population. Although the project is still ongoing, initial studies suggest that the use of decentralized clinics and performance-based contracts has improved both the coverage and quality of health services to poor people in Honduras.
Access to services increased, especially for women and children, the most vulnerable groups.
Highlights:
- A 35 percent increase in the number of births attended by skilled medical personnel, due to the use of decentralized clinics and performance-based contracts with local providers. More pregnant women have been seeking antenatal care earlier; for example, 66 percent of pregnant women sought antenatal care during the first 20 weeks of their pregnancy in the municipality of Taulabe.
- A 46 percent increase in the number of people covered by health insurance provided by the Honduran Social Security Institute (IHSS) (from 376,000 to 600,000 direct insured); beneficiary surveys indicate a wide recognition that the quality of IHSS services has improved.
- Rehabilitation works completed for 6 clinics: Santa Maria (El Paraiso), Reitoca (Francisco Morazan), Lepaterique (Francisco Morazan), Trascerros (Santa Barbara), and Marcala (La Paz).
- Fourteen mother-child clinics received life saving equipment.
- Total project cost is US$31 million of which IDA provided US$27 million and the government of Honduras US$4 million.
- Introduction of the decentralized clinic model in Honduras was a major achievement that was facilitated by IDA's experience with this type of service delivery mechanism in other countries. - A family health status census was conducted in all of the seven project communities and risk maps were prepared based on the results, identifying households at risk. This data allowed health teams to visit vulnerable households, following-up on their health status, providing them with health education, and, if needed, referring them to health care units.
- Catalyzed by the project, a network of volunteers and primary health care teams has been established and is functioning in all the communities. Health fairs organized in the communities promote healthy behaviors and environments.
The main challenge facing decentralized delivery models is sustainability. As an initial main step, the government will start to fund these models directly from the Ministry of Health budget. Other steps which would benefit from IDA support include: (i) involving the Social Security Institute (IHSS) in these contracts; (ii) scaling up the number of decentralized clinics; and, (iii) developing a health insurance system for poor people.
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