Global Health Action - Haiti

Background
Petit Goave, 65 KM from Port Au Prince
Population: 125,789
25% (31,447) WRA
11% (13,836) under 5
Project Goal: To contribute to the reduction of maternal and infant mortality in the Petit Goave Region of Haiti.
 improve the availability and quality of key child survival and maternal and newborn health services; and
 increase the demand for and utilization of those same key services
LOE:
 MNC: 55%
 Promotion of BF: 25%
 Immunization of pregnant women and WRA: 20%

Maternal and Child Health Strategies
Behavior Change Communication:
Use of media, radio spots, and public events to promote improved health seeking behaviors and practices
Quality Improvement:
Reintroduction of MOH protocol and guidelines to improve quality of services via in-service training for service providers including management of stock
Increasing Access to Services:
Establish a referral system
Strengthen and expand network of Community Health Workers (CHWs) and Traditional Birth Attendants (TBAs)
Train health providers in essential drug and laboratory services
Strengthen mobile clinic services in the region

Birth Spacing/Family Planning Strategies
Story-telling activities disseminated during festivals
Mobile services, including FP, are available during festivals
Capacity building trainings with clinics and hospitals around FP logistics management
Increasing Access to Services:
Family Planning is part of CHW and TBA training
FP counseling for women who wish to space births
Pills and Condoms provided by CHW and TBA
Referral made to nearby facility for other FP methods
Mobile services provided which include FP services (promoted by CHW/TBA)

Background
Konni Health District in Tahoua Region,Niger, 417 KM East of Niamey
Population: 400,000
22.8% (91,297) WRA
20.7% (83,124) under 5
Project Goal: Healthy Start’s goal is to reduce morbidity and mortality rates of mothers and children less than five years of age in the district of Konni.
 Increase practice of selected behaviors for MCH
 Ensure sustainable MOH and community support for community health workers
 Strengthen capacity of communities and local/district health teams
LOE:
MCH: 30%
Nutrition : 30%
Malaria : 20%
Control of Diarrheal Diseases : 20%

Behavior Change Communication :
Community groups and health workers disseminating messages
Improving quality of services:
In service training for CHWs in safe delivery
Strengthen the HIS from district to community level
Increasing Access to services:
Link communities to services
Immunization Campaign
ITN Distribution and Net-Retreatment
Policy and Advocacy:
National policy changes: Zinc, Vitamin A distribution, ANC kits, and matrons training

Behavior Change Communication :
Birth Spacing messages are part of the CHW training and disseminated during visits
Women and CARE groups conduct health education sessions which include birth spacing information
Increasing Access to services:
CHWs refer women to pharmacies and health posts for contraceptive methods

Tanzania

Background
Karatu District in Arusha Region in northern Tanzania
Population: 218,654
Target group is WRA and children under 5
Project Goal: to improve the health of infants and children under the age of five and women of reproductive age in Karatu District, Tanzania
 strengthening government mandated cadres (VHWs) and institutions (VHCs)  mainstreaming traditional providers (TBAs, drug vendors)
 developing new community groups for high-need populations (single mothers, transport drivers)
LOE:
MCH: 35%
Malaria : 20%
Pneumonia : 15%
Birth Spacing: 15%

Establish and strengthen community based workers, health committees, and social support groups
Reinvigorate Village Health Committees (VHCs)
Train existing and new Village Health Workers (VHWs) and TBAs
Promote Male involvement (Men Active in Sustaining Health Action)
Establish and Support Survive and Thrive Groups (STGs)
Behavior Change Communication
Individual level: AFYA 1-2-3 campaign
Community level: Communication campaign to change behaviors (posters, dramas, etc.); MAISHA and STGs

Facility and community based health workers convey messages on: delaying first pregnancy, child spacing, efficacy/safety of modern FP methods
Council Health Management Team recruits FP users to speak to STG and Women’s Groups
MAISHA peer educators promote child spacing to men
Increase Access
Community health workers refer clients to health facilities for FP methods (CBD not available)
In service training and regular supervision of all FP service providers to update knowledge and skills

Liberia

Background
North-central Liberia; Northwest Nimba County in six sub-districts
Population: 149,322
23%(34,344 ) WRA
17% (25,385) under 5
Project Goal: 60% reduction in the U5 mortality rate over baseline by EOP
 to increase access to the Basic Package of Health Services
 to increase equity
 increase demand for health services
 ensure quality
 ensure sustainability
LOE:
MNC: 30%
Malaria : 20%
HIV: 15%
Pneumonia : 10%
Immunization: 10%

Increase Access to Basic Package of Health Services
4 Mobile Primary Health Care Teams:
Community Health Volunteers (CHVs)
Care Groups of female community volunteers
Traditional Birth Attendants (TBAs)
Ensure Quality
Community Health Volunteers (CHVs) trained in the CBIO Methodology to monitor community health
Intervention Teams (Intervention Supervisor):
Maternal/Newborn Care Team (Maternal/Newborn Care)
IMCI Team (Pneumonia, Malaria, Diarrhea)
WatSan Team (Diarrhea)
HIV Team (HIV/PMTCT)
EPI Team (Immunization)
Community Support Team (cross-cutting)

Behavior Change Communication
Child spacing messages disseminated by CHVs and TBAs during home visits.
Facility based health workers disseminate child spacing messages during immunization, antenatal care, and mobile outreach services
Increase Access to Basic Package of Health Services which includes Post Abortion Care (PAC)
TBAs trained in basic health life skills which includes post-abortion care.
Service providers trained in PAC and receive referrals from nurses and TBAs

Indicators measuring birth spacing/family planning activities
% non-pregnant mothers who desire no more children in next two years (or are not sure) who are using a modern method of child spacing – GHA Haiti
Percentage of mothers of children age 0-23 months who are using a modern contraceptive method- WellShare Tanzania & Curamericas Liberia
No birth spacing/FP indicator collected by RI Niger

Challenges with integrating birth spacing/family planning activities
Without additional funding, unable to scale up successful model of CHW curriculum/training ( GHA Haiti )
Weak supply chain system (stockouts of commodities) ( All interviewees )
Difficult to add another health intervention when the health system is already so weak ( RI Niger )
Cultural barriers ( Curamericas Liberia )
CBD of FP methods not approved by MOH ( WellShare Tanzania )
KPC survey is already long and time consuming so adding more FP indicators might be burdensome for some and also costs money ( WellShare Tanzania )

Recommendations to improve integration of birth spacing/family planning activities
Share best practices or lessons learned on community based integration of child spacing/child survival programs
Technical assistance to work with the MOH to improve the supply chain system (get commodities to rural areas)
USAID approved protocol manual related to FP messages for all health programs
Exchange visits between programs that have successful CBFP programs
Pilot project to do CBD in remote areas (Tanzania)
Funding to expand birth spacing/family planning activities to youth
Additional education material on birth spacing to share with WRA
Create community depots throughout project areas for access to FP methods while building demand
Train existing CHWs in CBD of injectables, pills, FAM, etc
Use community groups such as CARE groups as points of access for FP methods and services
Train local health partners in FP service provision for sustainability purposes

Recommendations to improve integration of birth spacing/family planning activities
Share case studies that highlight the synergies between education, job opportunities, and family planning
Have child spacing/FP be mandatory in any RFA that is released that include immunization, MCH, or HIV health interventions as these are opportunities for integration
Include an indicator in KPC which states preferred FP method for women so we can focus our energies on increasing access to that method and what the beneficiaries want

Global Health Action - Haiti

by jehill3 on May 04, 2010

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Global Health Action - Haiti — Presentation Transcript