Haiti has the highest infant and maternal
mortality rate in the Americas. This is not
surprising considering that health service
coverage is very low. A woman is likely to
travel long distances to a government health
post and wait all day to see a health worker
with limited medical training. Medicines and
supplies at these facilities
are non-existent.
AMURT health
agents and volunteers cover every single household in
AMURT’s target areas. During home visits health agents and
volunteers teach family members what they can do to improve
their health and give lots of support and encouragement.
They also offer preventative interventions, home-based care
for selected illnesses, and make referrals to the local
clinics.
AMURT offers
high-quality primary health care at three clinics in
northwest Haiti. Each clinic has a medical team that
includes a nurse, a clinic aide, and an
accountant/administrator supervised by a physician. AMURT is
currently building/renovating these clinics and equipping
them with furniture, medicines, materials, selected
laboratory equipment, and other diagnostic tools.
Each year, AMURT organizes medical missions to provide
consultations, medicines, and eyeglasses to people in
the northwest. During these missions, AMURT pairs
foreign health care professionals with local health care
practitioners so that they can share their knowledge and
experience. Groups cover their own expenses
(transportation, room and board) and bring medicines and
materials to use during the mission. |
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Introduction
The escalating socio-political crisis in Haiti has
continued to have a negative impact on the health of the
Haitian population. Haiti has the highest general
mortality rate, the highest infant and maternal
mortality rate, the highest rate of chronic and acute
malnutrition, and the highest prevalence of HIV/AIDS in
the Americas. Health service coverage is very low: 40%
of the population has no access to basic health care,
76% of births are not assisted by trained personnel,
only 50% have access to medicines, and less than 50% of
all children have been vaccinated (www.paho.org).
These problems are experienced even more acutely in
northwest Haiti, where AMURT is focusing many of its
interventions. The NW is the most isolated,
impoverished, and neglected region in the country.
Almost no health services are available to the largely
rural population. A single community health worker with
limited medical training typically staffs the rare
government health post. Medicines and supplies at these
facilities are non-existent. When faced with a medical
emergency, people are forced to travel long distances
often by foot or by expensive and infrequent public
transportation. As a result, many people do not seek
help or they do not seek help early enough to avoid
dangerous sequelae. The consequence is needless
suffering and death, especially among women and young
children.
Since 2004, AMURT has been working on relief and
development projects in the northwest, but without
improvements in health true progress in this region is
impossible. Working in solidarity with the Haitian
Ministry of Public Health and Populations and local
community groups AMURT is reducing the needless
suffering and death caused by inadequate primary health
care.
Objectives and Approach
The goal of AMURT’s health program is to improve health
outcomes in northwest Haiti. Partial funding for our
program is provided through the Canadian International
Development Agency with an even greater dependency on
individual donations.
In the first phase of this project, AMURT is focusing on
decreasing morbidity and mortality in three communities.
This project targets children under five and women of
reproductive age; deaths in these age groups make up the
largest contribution to morbidity and mortality in rural
Haiti. AMURT’s approach is to provide high-quality
clinical care integrated with targeted community
education and prevention. For example, a child with an
acute respiratory infection detected by a community
health worker during a home visit is referred to the
clinic for treatment with antibiotics or a child
presenting with diarrhea in the clinic is followed up at
home within two days by a community health worker. AMURT
hopes to be able to expand this project in the future,
implementing our model in other communities in the
northwest. Ideally, this project will serve as a model
for health service provision in rural Haiti.
Community Census and Baseline Assessment
An essential part of this project is conducting a census
and baseline assessment in our three targeted
communities, using the methodology of the
Community-Based Impact Oriented (CBIO) approach to
primary health care developed by CURAMERICAS and the
CORE group. This method is helping to ensure that our
limited resources and services are targeted towards the
most common causes of preventable sickness and death;
that health services are equitable, reaching out to
those of greatest need in our communities; and that the
impact and outcomes of our project are accurately
measured. Organizations working in other parts of Haiti
have been successful using this approach including the
Foundation of Compassionate American Samaritans and the
Haitian Health Foundation.
Census:
The community census enables us to: 1) divide the
population into the sex/age categories targeted by this
project, i.e. children under five and women of
reproductive age; 2) create detailed maps of each
community so that all families with children under five
and women of reproductive age can be identified and
visited regularly by clinic staff and community health
workers; and 3) establish dossiers for each family in
the clinic that are linked to household information.
Baseline Assessment:
The baseline assessment helps us to identify the most
common causes of morbidity and mortality in the
communities. This allows us to offer education,
preventative care, and treatment that target the most
frequent, serious, and preventable health problem in
each community. It also provides us with specific data
we can use to design future interventions that we can
propose to donors or other organizations.
Clinics
This project is building and/or renovating three clinics
in the communities of Lagon, Sources Chaudes, and
Coridon. These villages are ideal sites for community
health centers; both Lagon and Sources Chaudes draw
large crowds from the surrounding villages to their
open markets and Coridon is situated along the major
route of travel. AMURT is equipping each clinic with
furniture, medicines, materials, selected laboratory
equipment, and other diagnostic tools. Each clinic has a
medical team that includes a nurse, clinic aide, and
accountant/administrator supervised by an AMURT
physician. Our physician rotates between the three
clinics, offering medical consultations and training
medical staff at each facility.
Community Management
A very unique aspect of AMURT’s health project is its
community management structure. AMURT works closely with
9-member community health committees in each village,
and is preparing them to independently manage the
clinics. The health committees’ sense of ownership and
responsibility for the clinics helps to assure their
long-term viability. By the end of the first year of the
project, community committees will assume all
administrative responsibilities including finances,
staff, and clinic maintenance. The committees are also
involved in follow-up and evaluation activities
including the census and baseline assessment. As the
capacity of the committees strengthens they will become
increasingly involved in program planning, exercising
broad authority in program decision-making.
Health Outreach and Education
AMURT is training six full-time health agents along with
60 volunteers to offer health education and prevention
activities in the communities. Health Agents assisted by
volunteers conduct home visits and rally posts where
they offer education along with other preventative interventions
such as vaccination, de-worming, vitamin and iron
distribution, and nutritional evaluation. They also
provide care for select illnesses and refer people to
the clinics. It is an objective of our program to
achieve complete coverage within our target areas,
reaching every single woman of reproductive age and
child under five. Health agents and
volunteers keep careful records for all women of
reproductive age (15-49) and children under five that
document the health of each client and the specific
interventions that they receive in the program. The
health agents also keep a vital events registry that
tracks births and deaths for the entire community
enabling us to compute general mortality in the
villages. Health volunteers, in addition to assisting
the health agents, organize groups of 10-15 women in their
neighborhood. The volunteer meets with the group monthly to
discuss health issues affecting women and children in the
community. |
