Community health systems strengthening in Petit-Goave, Haiti

Girija Sankar

Associate Director

Global Health Action Atlanta GA, USA & Port-au-Prince, Haiti

Objectives of Panel :

• Objective 1: By the end of this session, participants will have greater appreciation for the need to engage Ministries of Health, local NGOs, and Faith-based institutions in identifying innovative ways of expanding community volunteers as links to the formal health services

• Objective 2: By the end of this session, participants will have learned about efforts to repurpose existing cadres such as Traditional Birth Attendants to achieve greater community acceptance and use of health services.

• Objective 3: By the end of this session, participants will compiled a set of critical considerations for external organizations to draw upon when developing community based health volunteers.

Presentation outline:

Background

Framework for a functioning health system

Working with Institutions

Working with community health providers

Critical considerations

Background

2004-2010, USAID-funded maternal and child health project in partnership with faith-based organization and Ministry of Health.

Petit-Goâve commune

HAITI

Source: Google Maps

Basic Indicators for Haiti Country Data

Population 10M

Birth Rate 26

NMR 25.5

Facility Birth 36%

Skilled Birth Attendants 37%

Source: UNICEF, WHO

Program Area: Petit-Goave commune

• Total population of 157,296

• 68 km west of Port-au-Prince.

• 25% of women of reproductive age

Child Survival Project, 2004-2010

MAIN OBJECTIVES:

• Improve the quality of pre- and post-natal/infant services.

• Improve access to pre- and post-natal/infant services.

• Establish a local network of referral services that provide quality maternal and neonatal care.

GOAL: Contribute to reduction of maternal and infant mortality in Petit-Goâve commune.

Interventions • Health promotion by Community Health Workers (CHWs)

• Birth attendance by trained Traditional Birth Attendants (TBAs)

• Facility-based care (HIV testing & counseling; STI counseling)

• Mobile health services

Positive Outcomes(highlights) • Trained network of community health providers

• Community health services complimented by facility-based services

• Community mobilization

Challenges

• Resource-poor institutional mechanisms

• Vertical program not sustainable without strong foundations of a community health system

• CHWs integrated into project from past MOH initiatives

Functioning Community Health System: A Framework

• Partnership between health facilities and the communities they serve

• Appropriate and accessible health care and information from community based providers

• Collaboration between state, facility, community-based providers and the communities through community associations

Ref: CORE group (http://coregroup.org)

What’s different now? 2014-

Working with Institutions

• Administration and infrastructure support for MOH

• Proactively seeking MOH input and feedback for program activities

• Working with village/community health committees

• Helping faith-based partner set up a health board to oversee and coordinate health activities

Working with community providers

Traditional Birth Attendants:

• TBAs supported by community

• Open to training and skill building

• Challenge: not recognized by health system

Working with community providers (cont.)

Community Health Workers:

• In many instances CHWs are not necessarily “chosen” by community

• Tend to be elected or nominated officials; representatives of municipal government; faith-based leaders; spiritual healers

Critical considerations for developing community based health systems & providers:

• Long term support for health systems

• Innovative ways to support CHWs

• Greater engagement with/of TBAs

• Getting the community back in community-based

• Network at all levels of MOH

Funding & Implementing Partners

Thank You! Girija Sankar

gsankar@globalhealthaction.org

Photo credits: GHA staff