Development and use of a master health facility list: Haiti's experience during the 2010 earthquake response

INTRODUCTION

Accurate and regularly updated master health facility lists (MHFLs) are essential for effective planning, coordination, and delivery of health services, particularly in low- and middle- income countries with extensive external donor presence. MHFLs are also important during disasters because the lack of accurate, usable information is a major obstacle to effective disaster response.^1,2 According to the World Health Organization (WHO), an MHFL is a complete list of health facilities in a country (both public and private) with a set of attributes to uniquely identify each facility,³ and it includes basic information about the facility's services and capacities.

With the release in 2012 of draft WHO guidance on the creation and governance of MHFLs, countries may be considering devoting resources to develop such lists.³ However, there are few documented experiences on the construction or use of MHFLs.

The earthquake in Haiti on January 12, 2010, underscored the need for countries to have an MHFL. At the time of the earthquake, the Haitian Ministry of Health (Ministère de la Santé Publique et de la Population [MSPP]) had a list of public-sector health facilities. However, the MSPP list contained little information about privately managed health facilities—a major part of the health delivery system in Haiti—and it lacked critical attributes needed to uniquely identify facilities.

During the earthquake response, the MSPP worked with the Haiti Health Facilities Work Group (Work Group), composed of a multinational group of organizations and governments, to develop a functioning MHFL, which proved useful during not only the earthquake response but also subsequent events such as the cholera outbreak.

This article reviews the development and use of the MHFL and provides a model for other countries interested in developing similar lists, which are increasingly needed to align donor-supported information systems with national health information systems.

THE NEED FOR A COMPLETE HEALTH FACILITY LIST IN HAITI

The epicenter of the 2010 Haiti earthquake was close to the most densely populated areas of Haiti, including the capital, Port-au-Prince. Approximately 250,000 buildings collapsed, including many hospitals.⁴ In the confusion that followed, there was uncertainty about the extent of damage to health facilities⁵ as well as a lack of information about the temporary clinics that were rapidly being set up. First responders were uncertain whether they were referring to the same health facility when communicating about the type, status, and capacity of facilities.

The MSPP is responsible for the health of the population and for the delivery of health-related services.⁶ At the time of the earthquake, the public health care system included more than 500 health institutions (approximately 30% of the country's health facilities), ranging from community health clinics providing basic primary services to university hospitals. In addition, there were more than 250 nongovernmental organizations (NGOs) providing a substantial proportion of the primary health services.^4,7

Prior to the earthquake, multiple, incomplete, and conflicting health facility information systems existed in Haiti; no entity served as a repository for an up-to-date, comprehensive master list. For example, the Haiti Health Information System (Système d'Information Sanitaire d'Haïti [HSIS]) functioned as a health management information system but was incomplete. Similarly, the Electronic Monitoring, Evaluation and Surveillance Interface for HIV-infected patients (MESI) collected data from public, and some private, health facilities in Haiti but primarily from sites receiving support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).

DEVELOPMENT AND USE OF HAITI'S MASTER HEALTH FACILITY LIST

In the immediate aftermath of the earthquake, the U.S. Department of Health and Human Services (HHS) coordinated the formation of the Work Group in support of the MSPP. The first meeting of the Work Group took place via teleconference 5 days after the earthquake (on January 17, 2010) with representatives from U.S. federal agencies; academia; international, local, and Haitian diaspora NGOs; multilateral organizations; foundations; and businesses (Table 1). All Work Group activities were coordinated through conference calls and a shared web space.⁸ Staff of the MSPP's Planning and Evaluation Unit (Unité de Planification et d'Evaluation [UPE]) were responsible for the HSIS; they participated in the Work Group and had final determination regarding edits to the MHFL.

Between January 2010 and August 2011, UPE staff collaborated with the Work Group to develop a single, comprehensive list of all public, private, and mixed (public and private) health facilities. The list was standardized, validated, and up-to-date to guide and coordinate the health response to the earthquake. Senior MSPP leadership provided input and direction during several meetings in 2010.

The MHFL's initial purpose was to address the urgent need for a common list of health facilities in Haiti to ensure all emergency response personnel knew they were communicating about the same facility. The Work Group adapted guidelines on a minimum set of data elements necessary to uniquely identify a health facility, known as a signature domain,⁹ to inform the core set of information contained in the MHFL (Box). These elements included:

• A unique identifying code for each facility

• The facility name, address, and type

• The entity that manages/owns the facility

• Each facility's geographic coordinates

A codebook for the signature domain fields was created building on codes created by the Institut Haïtien de Statistique et d'Informatique (Supplementary Appendix).

The first iteration of the MHFL that contained only the signature domain fields was created on January 29, 2010, by blending the MSPP's existing HSIS health facility list with partial lists, volunteered geographic information, and local knowledge on the post-earthquake status of health facilities in order to produce a more comprehensive list (Table 2). To improve functionality, the Work Group included standardized names of each facility in English, French, and Haitian Creole. The Work Group verified information by soliciting feedback on a publicly posted version of the MHFL coupled with direct outreach to health facilities by phone or in-person when possible.

In keeping with United Nations recommendations on the coordination of information during humanitarian emergencies, the Pan American Health Organization's Emergency Operations Center (PAHO EOC) took a lead role in managing the MHFL.^10,11 The PAHO EOC published the first iteration of the MHFL and codebook to a public Google Site.¹² Posting the list to an open website increased the likelihood that the MHFL and its codes would be used and that those involved in the response would provide feedback to note missing facilities and to correct errors. Contributors through the site included NGOs, members of the Crisis Mappers Network,¹³ and health facility staff. Between January 29 and March 18, 2010, WHO/PAHO released 6 updated versions of the Master List. Each version of the MHFL included new health facilities, fewer duplicates, and corrected variable values (Table 2).

The MHFL was used widely in the initial earthquake response. In addition to the Google Site, a link to the list was posted to many of the information portals that proliferated following the earthquake. The MHFL was also used as the reference data set for health facilities in the OpenStreetMap (OSM) platform.^14,15 OSM updated its health facility layer with each of the 7 versions of the list.¹⁶

As the initial effort transitioned from emergency response to reconstruction, stewardship of the MHFL was transferred to Shoreland, Inc., during April 2010.¹⁷ Following the cholera outbreak in Haiti in October 2010, fields for cholera treatment centers (CTCs) and cholera treatment units (CTUs) were added. The MSPP used the MHFL to determine which communities lacked health facilities so CTCs and CTUs could be installed to provide care to the affected population.¹⁸

In September 2011, the MSPP incorporated data from the MHFL into its routine health information system, which collects information on key services provided and human resources present at each facility. The MHFL formed the basis of the Liste des Institutions Sanitaires, the MSPP's listing of health facilities in the country,¹⁹ which is an updated and more robust version of the HSIS. It was also integrated into the Carte Sanitaire, the MSPP's service delivery and infrastructure status database.^20,21 MEASURE Evaluation and the MSPP's UPE continue to work collaboratively to update and validate the Liste des Institutions Sanitaires in coordination with the directors of statistics and epidemiology within each of the 10 departments. Health facilities and field hospitals can now be uniquely identified. However, some duplicates and data quality issues remain.

GOVERNANCE OF A NATIONAL MHFL: OPPORTUNITIES AND CHALLENGES

In routine health system planning, lists of health facilities, generally maintained by ministries of health, help organize information about health systems and are instrumental to answering basic questions such as how health services are distributed in a country and how resources may be allocated to address gaps in health service coverage.^22,23 These lists facilitate reporting on the condition of health infrastructure and capacity to deliver services, which are key information requirements during a response to a humanitarian crisis, such as a natural disaster.²⁴ Such lists are also essential for routine health information systems because they allow information about specific health facilities to flow within distributed networks in support of health decision-making.^25,26

CONCLUSION

Having an accurate, regularly updated, and freely accessible national MHFL is important for effective routine planning and the delivery of health care services. During the 2010 Haiti earthquake response, the creation of a functioning MHFL proved useful for coordination and reconstruction efforts including subsequent events such as the cholera outbreak. A pre-populated data set that was comprehensive, accurate, and relatively up-to-date would have greatly facilitated initial relief efforts. Recognizing that disasters can occur anywhere and that accurate data are critical for effective response, countries without lists should develop and maintain an MHFL. Modest efforts in this area could greatly enhance the ability to mount a rapid, coordinated, and effective response.