CORE Global Health Practitioner Conference, Fall 2014

1. Community health systems strengthening in Petit-Goave, Haiti
Girija Sankar
Associate Director
Global Health Action Atlanta GA, USA & Port-au-Prince, Haiti

2. 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.

3. Presentation outline:
Background
Framework for a functioning health system
Working with Institutions
Working with community health providers
Critical considerations

4. 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

5. Basic Indicators for Haiti
Country Data
Population
10M
Birth Rate
26
NMR
25.5
Facility Birth
36%
Skilled Birth Attendants
37%
Source: UNICEF, WHO

6. Program Area: Petit-Goave commune
•Total population of 157,296
• 68 km west of Port-au-Prince.
•25% of women of reproductive age

7. 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.

8. 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

9. Positive Outcomes(highlights)
•Trained network of community health providers
•Community health services complimented by facility-based services
•Community mobilization

10. 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

11. 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)

12. What’s different now? 2014-

13. 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

14. Working with community providers
Traditional Birth Attendants:
•TBAs supported by community
•Open to training and skill building
•Challenge: not recognized by health system

15. 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

16. 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

17. Funding & Implementing Partners

18. Thank You!
Girija Sankar
gsankar@globalhealthaction.org
Photo credits: GHA staff