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# Social Protection in Haiti: Challenges and Adaptive Perspectives

Vosh Dathus, Evens Emmanuel

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## To cite this version:

Vosh Dathus, Evens Emmanuel. Social Protection in Haiti: Challenges and Adaptive Perspectives. 2025. hal-05082694

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Social Protection in Haiti: Challenges and Adaptive
Perspectives

Vosh Dathus<sup>(a,b,c) (1)</sup> , Evens Emmanuel<sup>a,b</sup>

<sup>a</sup>Pôle Haïti-Antilles, Haiti Sciences et Société (Ha-Sci-So), Port-au-Prince, Haiti

<sup>b</sup>Equipe des Partenaires Scientifiques pour la Communication de la Recherche (E-PSi-CoRe),

<sup>c</sup>Laboratoire dynamique de mondes américains (LADMA), Université d'État d'Haïti.

Summary

Social protection in Haiti, essential to counter poverty and vulnerability, has evolved since
the early 20th century, but still faces major challenges. As early as 1923, initiatives such
as the Caisse d'Assurance Sociale were launched, followed by the creation of OFATMA in
1967 and EPPLS in 1982, aimed at protecting populations against social risks. However,
the housing crisis, exacerbated by the 2010 earthquake which destroyed 208,000 homes,
and recurring climatic disasters (hurricanes, droughts) have made the lives of the most
disadvantaged even more fragile. These populations, often settled on at-risk wastelands,
struggle to access basic needs such as housing, a right recognized by the 1948 Universal
Declaration of Human Rights.

In the face of these challenges, adaptive social protection offers a promising solution by
integrating climate risk reduction and promoting adaptation to climate change, taking it
beyond traditional safety nets. A national adaptive strategy, inspired by models tested in
other contexts marked by financial constraints and vulnerability to natural hazards, would
appear to be relevant for strengthening resilience/resistance and reducing social
inequalities, thus offering hope of stability to a country in crisis.

**Keywords:** Haiti, social protection, vulnerability, housing, resilience/resistance, adaptive social protection.

<footnote n="1">¹ Corresponding author: E-mail :dvosh2000@yahoo.fr / vdathus01@gmail.com</footnote>
**Introduction**

In a country where hurricanes are a regular occurrence, drought suffocates the land and poverty strangles hopes, social protection is emerging as a beacon of hope for millions of Haitians. Far from being limited to one-off assistance, social protection is part of a structural approach to tackling multi-dimensional crises, and represents a lever for the future, enabling the most vulnerable populations to get back on their feet, educate their children and grow old with dignity. As the World Bank states, "social protection systems help poor and vulnerable people cope with crises and shocks, find jobs, invest in their children's health and education, and protect those who are aging" (World Bank, 2023). In Haiti, where every year brings its share of natural disasters and socio-economic upheavals, this mission is vital, but fraught with pitfalls.

Since the Universal Declaration of Human Rights (UN, 1948), which enshrines the right to social security as an inalienable pillar, social protection has become a global imperative. Yet, in Haiti, the application of this right remains a struggle. Nevertheless, pioneering initiatives, such as the creation of the Ministry of Social Affairs and Labor (MAST) in 1967 and the creation of the Office d'Assurance Accident du Travail Maternité et Maladie (OFATMA) in the same year, have laid a fragile foundation, often eroded by political upheavals and natural disasters. Under these conditions, as Holzmann et al (2003) have pointed out, a consensus seemed to be emerging on the need to support individuals, households and communities in managing certain risks. t, demonstrating the urgency of a modern, adaptive approach (Tesliuc et al., 2003). In the same vein, the International Labour Organization (ILO) adds: "well-designed social protection systems can significantly reduce poverty while strengthening social cohesion" (ILO, 2021). Faced with an unprecedented housing crisis, land ravaged by deforestation and populations exposed to increasing climatic risks, Haiti needs to rethink its social protection. This article delves into history to address the challenges of this system, while exploring how an adaptive approach could transform the resilience of the most deprived populations and breathe new life into a country in search of economic and social stability.
# 1- A brief history of social protection in Haiti

Haiti didn't wait for the 1948 Universal Declaration of Human Rights (UDHR) to start taking action on social protection. On the contrary, after the publication in France in 1789 of the Declaration of the Rights of Man and of the Citizen (DDHC), Haiti was one of the few countries to have asserted these rights both in its legal texts and even in its social and political life. History allows us to go back to the period between 1843 and 1986 to place protection in the Haitian social context (Aubin, 2025). During this period, there were a number of key moments in the history of the Haitian state's actions in relation to social protection. According to Dr. Ary BORDES, it was in 1923 that the first attempt was made to set up a social protection system, particularly a health system made up of a group of players including the State, contractors and permanent staff. It wasn't until the 1940s that the question was raised again, and a draft law known as the "Social Insurance Fund" came into being (Bordes, 1997 in Colloque international sur la protection sociale en Haïti). Several laws were passed to address the issue of social protection in the country. The decree of December 9, 1938, which was modified by the decree of April 28, established the existence of an assistance fund. This assistance fund, subsequently known as the Caisse d'Assurance Sociale (CAS), which has now become the Direction d'Assistance Sociale (DAS), is responsible for granting benefits to registered destitute people (L'informateur, 2013). In 1949, Haitian social protection underwent a remarkable expansion. The law of October 10, 1949 created the Institut d'Assurance Sociale d'Haïti (IDASH), responsible for administering social insurance. This institute only operated for a few months in 1950. But the law of September 12, 1951 was passed to organize the IDASH. It resurfaced in 1961 with a new mission: to oversee all the country's social risk schemes. In 1967, the creation of the Ministry of Social Affairs and Labor (MAST) established the institutional framework for social protection and action in favor of vulnerable populations. In the same year, the IDASH was replaced by the Office d'Assurance Accident du Travail Maternité et Maladie (OFATMA). Social protection underwent further major extensions during the 2nd half of the twentieth century. The most significant of these were the creation of the Banque Commerciale d'Haïti by decree on November 8, 1965; the creation of the Office National Assurance-Vieillesse; and the establishment of the Entreprise Publique de Promotion des Logements Sociaux (EPPLS) on November 26, 1982. Five years later, the Haitian Constitution of 1987 enshrined the basic principles of Social Protection, taking into account various aspects covering different areas including health, education, living conditions, housing and habitat, childhood and old age, right through to the fight against hunger, the fight against unemployment and the protection of workers (Colloque international sur la protection sociale en Haïti, 2018).
## 2- Climate change: a vector of vulnerability in Haiti

Haiti, which shares the island of Hispaniola with the Dominican Republic, is one of the island states of the Caribbean and the Antilles. Like its Caribbean neighbors, it is exposed to telluric hazards (earthquakes, landslides, etc.), cyclones, hurricanes, tropical storms, floods and climatic risks (Aubin, 2024).

Located in the tropics, Haiti is particularly vulnerable to climatic variations. With a humid tropical climate and distinct seasons, the country is often confronted with major fluctuations, making the management of agriculture, water resources and ecosystems particularly complex (Noncent, 2024).

Over the past few decades, Haiti has seen a decline in rainfall and a rise in temperatures, linked to global climate oscillations such as the Atlantic Multi-decadal Oscillation (AMO), the North Atlantic Oscillation (NAO), the Pacific Decadal Oscillation (PDO), and El Niño (ENSO) (Noncent et al., 2023). Global Climate Models (GCMs) predict a temperature rise of up to 3.3°C by the end of the century and a 6% reduction in precipitation by 2030 (Taylor et al., 2015). These changes exacerbate droughts, floods and deteriorate agriculture and marine ecosystems Haiti, is facing major climatic challenges that are disrupting its environment and economy (Noncent, 2024). Haiti, Raymond (2024) argues, is prey to numerous natural disasters and suffers from the inability of the authorities to put it on the road to development. With each disaster, each political event, the country's vulnerability increases. German Watch (2018) notes in its Global Climate Risk Index (GCRI)<fnref n="2" />, that Haiti is the second most affected small island developing state (SIDS) by climate change and the first of the 20 countries most impacted by meteorological disasters over the last twenty years.

In its new estimates of global warming, IPCC (2021) states that "at the global level, the average temperature of our planet has increased by about 1.1 °C since the beginning of the 20th century. By the end of the 21st century, an increase of about 1 to 3.5 °C in global average surface temperature is expected compared to 1990 years, based on current projections of increases in atmospheric concentrations of greenhouse gases and sulfates" (IPCC, 2021). In Haiti, research has shown evidence of change in Haiti's climatic parameters over recent decades, i.e. an upward trend in temperature and changes in precipitation patterns and water balances (Singh and Cohen, 2014; Noncent et al., 2023). According to the IPCC (2021), Haiti is one of the island states most vulnerable to extreme climatic events. Aubin (2024) notes that during the months of June to August 2024, the country's population experienced a truly overwhelming heat wave. Several cases of dehydration were reported. Among the negative effects of climate change on human health, Hales et al. (2014) note: heat-wave-related mortality in the over-65s, mortality associated with coastal flooding, diarrheal diseases in the under-15s, malaria, dengue

<footnote n="2">² The IRC (Global Climate Risk Index) by Germanwatch is an analysis based on one of the most reliable data sets on the impact of extreme weather conditions and the associated socio-economic data. The IRC 2018 by Germanwatch is the 13th edition of this annual analysis. Its aim is to contextualize current climate policy debates - in particular international climate negotiations - by showing concrete impacts over the previous year and the last two decades (German Watch, 2018).</footnote>
fever and malnutrition. Apply et al (2021) argue that Haiti is also likely to see an increase
in the prevalence of endemic infectious diseases, including vector-borne diseases.

Between 1990 and 2008, Haiti was the Caribbean country most affected by natural
disasters (3 droughts, 1 epidemic, 22 floods, 23 storms and hurricanes). The US$53 billion
in damage incurred by the country during this period represents 39% of the damage
suffered by the entire Caribbean (Weissenberger, 2018). Hurricanes Ivan and Jeanne
devastated the country in 2004, respectively in the Southern Peninsula, the West Coast
and Gonaïves, causing loss of life and significant material damage. In 2005, hurricanes
Denis and Wilma hit the South and West coasts, and in 2007, the departments of Grand
'Anse, Sud-Est, Ouest, Nord, Nord-Ouest and Nord-Est were all shaken by hurricanes. In
2012, hurricanes Isaac and Sandy affected the country. In 2015, a severe drought
ravaged the country as a consequence of the El Niño phenomenon. In February 2016,
the city of Cap-Haitien was blocked for several days by flooding, and in October of the
same year, Hurricane Matthew devastated the departments of Sud and Grand 'Anse; in
2017, Hurricane Imma hit the department of Nord-Est; in 2018, a magnitude 5.9
earthquake struck the country. The magnitude 7.2 earthquake of August 14, 2021,
followed by tropical depression Grace on the night of August 16 to 17, 2 days later, left
over 2,000 people dead, more than 12,000 injured and 340 missing. Towns, farms, entire
fields and buildings were destroyed, leaving communities in disarray (Raymond, 2024).

Moreover, these disasters are a major constraint on the food supply issue. They reduce
the volume of food available, making access to a diversified diet more difficult and
increasing rates of acute malnutrition, especially among children and pregnant women.
Poor households, often dependent on subsistence farming, lose their means of
subsistence, leading them to adopt negative survival strategies (reduced mealtimes,
consumption of less nutritious foods, etc.).

3- Housing: a fundamental element of social protection in Haiti

A dwelling is a living space, the basic building block of a house or building where one
usually lives (Yché, 2011). And Article 25 of the Universal Declaration of Human Rights
stipulates that everyone should have an adequate standard of living to ensure his or her
health, well-being and family security, particularly in relation to food, clothing and
housing. In other words, the right to housing is regarded as fundamental, conferring on
every person the possibility of having adequate, healthy, safe and accessible housing in
accordance with his or her needs. Today, Haiti is facing an unprecedented housing crisis,
reflected in the inability of its leaders to provide housing adapted to the needs of the
population (Dathus, 2023), particularly the poorest populations. The latter, still struggling
with housing shortages, are periodically hit by recurring natural phenomena that only
worsen their situation. For example, the 2010 earthquake that destroyed more than
208,000 homes (Kawas, 2014) only exacerbated the housing crisis and made the poorest
even more vulnerable. This segment of the population has resorted to various strategies
to cope with the need for housing, such as building with salvaged materials. These
dwellings are generally erected on high-risk sites, such as those that flood easily along
rivers and gullies, and those with steep mountain slopes. Another factor that exposes this
segment of the population to insecurity is that they occupy land where land tenure is
uncertain, or even contentious. As a key element of social protection, housing is one of
the fundamental needs identified in Abraham Maslow's pyramid, and an integral part of
the text of the Universal Declaration of Human Rights (UN, 1948). This means that the
most vulnerable people in need of housing must be supported by the public and private
authorities and institutions in charge of social protection.

4- Lack of health infrastructure: a handicap to "ageing well" in Haiti

The Haitian healthcare system is faced with a series of major challenges that prevent it from being effective in providing care to the population. The deficiency and small number of health infrastructures and the inadequacy of medical staff are among the system's weaknesses. According to the Ministry of Public Health and Population, relaying data from the Institut Haïtien de Statistique et de l'Informatique, the Haitian population is approximately 12,033,670 (MSPP, 2022, p. 4). For this entire population, there are only 1,007 health facilities (hospitals, health centers, dispensaries, etc.). Geographically, the majority of these health facilities are concentrated in the Ouest department (36.4%) and 63.6% in the other nine departments. The country has just 7,597 beds for hospitalization purposes, equivalent to 6.4 beds per 10,000 inhabitants. The shortage of medical staff is particularly acute. In fact, this staff is essentially made up of doctors, nurses and midwives. The proportion of doctors in Haiti, at 7.3 per 10,000 inhabitants, is well below that recommended by the World Health Organization (25 per 10,000 inhabitants). This health workforce is not exclusively employed by the public sector: a significant proportion of this health workforce is employed by the private sector, i.e. 43% (MSPP, 2022).

One alarming fact about Haitian medical personnel remains undeniably the exodus of doctors. According to information published in the columns of Le Nouvelliste, 40% of doctors graduate from the Faculty of Medicine and Pharmacy (Nouvelliste, 2017). The same source points out that 13% of black doctors practicing in the United States are Haitians trained at great expense in Haiti. In fact, several reasons are put forward to explain this state of affairs: young doctors find it very difficult to specialize, the salary on offer in Haiti is derisory, and the skyrocketing insecurity, particularly in Port-au-Prince. The emigration of Haitian doctors exacerbates the inadequacy of the country's medical system.

According to the Economic Commission for Latin America and the Caribbean (ECLAC), reported by Vant Bèt Enfo (2023), Haiti and the Dominican Republic are among the countries with the lowest levels of long-term ageing. The organization predicts that by 2023, the elderly will represent less than 10% and 15% of their population respectively. Nevertheless, the slow ageing of the Haitian population should not lead us to believe that the elderly have easy access to healthcare. On the contrary, it should be noted that aging in Haiti in such a context of health care shortage raises crucial humanitarian, social, economic and political issues for the elderly. This segment of the population, made up mainly of widows and widowers, often with reduced mobility and generally affected by
old-age diseases such as blindness and osteoarthritis, is among the most vulnerable in Haiti. The lack of health care exposes these people to high health risks.

**5. Adaptive social protection: an option for reducing vulnerability in Haiti**

Adaptive social protection is an integrated and dynamic approach aimed at strengthening the resilience of vulnerable populations in the face of crises and economic, social and environmental shocks, while adapting to contemporary challenges such as climate change and natural disasters. Unlike traditional social protection systems, which focus primarily on safety nets such as allowances or food aid, the adaptive approach takes a more holistic view, integrating several key dimensions.

Firstly, it focuses on risk reduction. This component anticipates climatic, economic or social threats by developing preventive mechanisms. For example, insurance against natural disasters or vocational training programs to improve employability help limit the impact of shocks. According to Hallegatte et al. (2017), "adaptive social protection systems must integrate risk management tools to protect populations before crises occur."

Secondly, the approach integrates adaptation to climate change. Faced with the growing impacts of global warming, such as droughts, floods and rising sea levels, adaptive social protection offers sustainable solutions. This includes the construction of resilient infrastructures, such as dykes or adapted housing, as well as targeted financial aid for affected populations. For example, in Ethiopia, the Productive Safety Net Programme (PSNP) combines cash transfers with public works to strengthen the resilience of rural communities to droughts (Devereux & Sabates-Wheeler, 2015).

What's more, adaptive social protection stands out for its ability to offer a rapid response to crises. During sudden shocks, such as earthquakes or hurricanes, it effectively mobilizes resources to meet immediate needs while preparing for long-term reconstruction. For example, after Cyclone Idai in Mozambique in 2019, emergency cash transfers were distributed to support the stricken population, while funding sustainable reconstruction projects (UNDP, 2020).

Finally, this approach places particular emphasis on the inclusion of vulnerable populations. It targets the most fragile groups, such as the poor, the elderly, children or women, by addressing their specific needs, including access to housing, health or education. Dathus (2025) points out that this approach is particularly relevant to Haiti, where populations are exposed to multiple risks (droughts, hurricanes, earthquakes) and where chronic poverty exacerbates vulnerability.

The disasters caused by the aforementioned hazards, coupled with the disastrous effects of the January 12, 2010 earthquake, have left millions homeless across the country. And they are only increasing the vulnerability of populations whose standard of living was already abysmal. In the face of this glaring fragility, what role can social protection play in finding sustainable solutions? What approach to social protection could best remedy the situation?
In Haiti, one of the approaches that could help alleviate this situation may well be adaptive social protection. This refers to a comprehensive, integrated approach to social protection that goes beyond traditional safety nets by incorporating elements of disaster risk reduction and climate change adaptation (CEPAL and UNDP, 2024).

In practice, adaptive social protection could include relocation programs to less disaster-
prone areas, or conditional cash transfers to encourage investment in education or health.
For example, in Bangladesh, cash transfer programs linked to children's school enrolment
have reduced poverty while building household resilience to seasonal flooding (Ahmed et
al., 2019).

Adaptive social protection represents a major evolution in social protection systems. By integrating prevention, adaptation, rapid response and inclusion, it offers a comprehensive response to the multidimensional challenges faced by vulnerable populations, particularly in contexts of recurring crises such as Haiti.

Conclusion

The global problems facing the Haitian population - climate change, inefficient health infrastructures and the housing crisis - are making the poorest sections of the population increasingly vulnerable. Pregnant women and children are malnourished following the loss of crops caused by the floods; the elderly have great difficulty accessing healthcare due to the inefficiency of the medical system, and the housing problem remains unresolved. This is compounded by the fact that the pension system for former salaried employees and former civil servants does not allow them to meet their needs in the normal way. Community strategies such as meal reduction and the consumption of non-nutritious foods, among others, are showing their limits.

This brings us to the point that the reorganization of Haiti's pension system should be included in the next public policy agenda in Haiti. In addition, the Haitian medical system needs to be restructured and strengthened. Secondly, in order to address the housing shortage, the relevant bodies and authorities should set up social housing in areas where land tenure is reliable. And finally, climate change education for young Haitians, to help them understand how to deal with this phenomenon.

Subsequently, it is essential that Haitian institutions in charge of social protection adopt
the adaptive approach in order to develop and implement strategies calling for viable
actions capable of addressing global social, environmental and health challenges, and to
equip themselves with the appropriate means to considerably reduce the vulnerability of
the poorest populations to these risks, thereby reducing social inequality.

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