Global Health Action - Haiti


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Global Health Action - Haiti

To contribute to the reduction of maternal and infant mortality in the Petit Goave Region of Haiti.

Mia Forman, MCHIP

CORE Group Spring Meeting, April 29, 2010

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  • Under Behavior Change Communication: *Community Members: community groups that will share important BCC messages, use of media and radio spots and public events to promote improved health seeking behaviors and practices. *Health providers: BCC messages and strategies to target improvements in service delivery at all levels. Health providers disseminate important health messages to communities.
  • Under Behavior Change Communication: BCC messages on safe delivery, HH/C-IMCI, ANC, and PNC, malaria, nutrition, control of diarrheal diseases, hygiene, danger signs for delivery, immunizations, breastfeeding, emergency transport plans, referrals services Under Improving Quality of Services: * In service training: MAMAN, recognition of danger signs, timely/effective referrals
  • Under Establish and Strengthen Community Based Workers, Health Committees, and Social Support Groups: Train VHWs and TBAS in: healthcare system orientation, technical interventions, health education strategies and data collection/reporting MAISHA: Men Active in Sustaining Health Action: pilot strategy for engaging professional drivers to communicate health information to their own families and to passengers and passing community members. –disseminate messages, post health messages on their vehicle and distribute materials. * Survive and Thrive Groups: community support groups to promote health pregnancies, healthy deliveries, and health children. Under Behavior Change Communication: * AFYA 1-2-3: project’s key community-based health communications strategy. Based on overwhelming success of the A-B-C campaign for HIV/AIDS prevention. Communications messages focused on health that are clear and easy to remember.
  • Under Behavior Change Communication: Council Health Management Team: Primary provider of health services in the district under the auspices of the MoHSW, Regional Health Office and Karatu District Council.
  • Under Increase Access to Basic Package of Health Services: Mobile health care teams use evidence based interventions to treat specific health conditions, provide health education, and BCC messages. CHVs: provide BCC messages, make referrals, respond to emergencies, and coordinate with primary health care teams and local health facilities * Care Groups: make routine home visits with health messages, encourage and model proper behaviors, and perform community health surveillance of disease and vital events. TBAs: trained to do clean, safe birth and neonatal resuscitation, to quickly recognize and refer obstetric emergencies, provide ANC and PPPC, and provide health education Under Ensure Quality CBIO= Census-based, Impact Oriented Methodology:
  • Global Health Action - Haiti

    1. 1. Haiti
    2. 2. Background <ul><li>Petit Goave, 65 KM from Port Au Prince </li></ul><ul><ul><li>Population: 125,789 </li></ul></ul><ul><ul><li>25% (31,447) WRA </li></ul></ul><ul><ul><li>11% (13,836) under 5 </li></ul></ul><ul><ul><li>Project Goal:   To contribute to the reduction of maternal and infant mortality in the Petit Goave Region of Haiti. </li></ul></ul><ul><li> improve the availability and quality of key child survival and maternal and newborn health services; and </li></ul><ul><li> increase the demand for and utilization of those same key services </li></ul><ul><ul><li>LOE: </li></ul></ul><ul><li> MNC: 55% </li></ul><ul><li> Promotion of BF: 25% </li></ul><ul><li> Immunization of pregnant women and WRA: 20% </li></ul>
    3. 3. Maternal and Child Health Strategies <ul><li>Behavior Change Communication: </li></ul><ul><ul><ul><li>Use of media, radio spots, and public events to promote improved health seeking behaviors and practices </li></ul></ul></ul><ul><li>Quality Improvement: </li></ul><ul><ul><ul><li>Reintroduction of MOH protocol and guidelines to improve quality of services via in-service training for service providers including management of stock </li></ul></ul></ul><ul><li>Increasing Access to Services: </li></ul><ul><ul><ul><li>Establish a referral system </li></ul></ul></ul><ul><ul><ul><li>Strengthen and expand network of Community Health Workers (CHWs) and Traditional Birth Attendants (TBAs) </li></ul></ul></ul><ul><ul><ul><li>Train health providers in essential drug and laboratory services </li></ul></ul></ul><ul><ul><ul><li>Strengthen mobile clinic services in the region </li></ul></ul></ul>
    4. 4. Birth Spacing/Family Planning Strategies <ul><li>Behavior Change Communication: </li></ul><ul><ul><li>Story-telling activities disseminated during festivals </li></ul></ul><ul><ul><li>Mobile services, including FP, are available during festivals </li></ul></ul><ul><li>Quality Improvement: </li></ul><ul><ul><li>Capacity building trainings with clinics and hospitals around FP logistics management </li></ul></ul><ul><li>Increasing Access to Services: </li></ul><ul><ul><li>Family Planning is part of CHW and TBA training </li></ul></ul><ul><ul><li>FP counseling for women who wish to space births </li></ul></ul><ul><ul><li>Pills and Condoms provided by CHW and TBA </li></ul></ul><ul><ul><li>Referral made to nearby facility for other FP methods </li></ul></ul><ul><ul><li>Mobile services provided which include FP services (promoted by CHW/TBA) </li></ul></ul>
    5. 5. Niger
    6. 6. Background <ul><li>Konni Health District in Tahoua Region,Niger, 417 KM East of Niamey </li></ul><ul><ul><li>Population: 400,000 </li></ul></ul><ul><ul><li>22.8% (91,297) WRA </li></ul></ul><ul><ul><li>20.7% (83,124) under 5 </li></ul></ul><ul><li>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. </li></ul><ul><li> Increase practice of selected behaviors for MCH </li></ul><ul><li> Ensure sustainable MOH and community support for community health workers </li></ul><ul><li> Strengthen capacity of communities and local/district health teams </li></ul><ul><li>LOE: </li></ul><ul><ul><ul><li>MCH: 30% </li></ul></ul></ul><ul><ul><ul><li>Nutrition : 30% </li></ul></ul></ul><ul><ul><ul><li>Malaria : 20% </li></ul></ul></ul><ul><ul><ul><li>Control of Diarrheal Diseases : 20% </li></ul></ul></ul>
    7. 7. Maternal and Child Health Strategies <ul><li>Behavior Change Communication : </li></ul><ul><ul><li>Community groups and health workers disseminating messages </li></ul></ul><ul><li>Improving quality of services: </li></ul><ul><ul><li>In service training for CHWs in safe delivery </li></ul></ul><ul><ul><li>Strengthen the HIS from district to community level </li></ul></ul><ul><li>Increasing Access to services: </li></ul><ul><ul><li>Link communities to services </li></ul></ul><ul><ul><li>Immunization Campaign </li></ul></ul><ul><ul><li>ITN Distribution and Net-Retreatment </li></ul></ul><ul><li>Policy and Advocacy: </li></ul><ul><ul><li>National policy changes: Zinc, Vitamin A distribution, ANC kits, and matrons training </li></ul></ul>
    8. 8. Birth Spacing/Family Planning Strategies <ul><li>Behavior Change Communication : </li></ul><ul><ul><li>Birth Spacing messages are part of the CHW training and disseminated during visits </li></ul></ul><ul><ul><li>Women and CARE groups conduct health education sessions which include birth spacing information </li></ul></ul><ul><li>Increasing Access to services: </li></ul><ul><ul><li>CHWs refer women to pharmacies and health posts for contraceptive methods </li></ul></ul>
    9. 9. Tanzania
    10. 10. Background <ul><li>Karatu District in Arusha Region in northern Tanzania </li></ul><ul><ul><li>Population: 218,654 </li></ul></ul><ul><ul><li>Target group is WRA and children under 5 </li></ul></ul><ul><li>Project Goal:   to improve the health of infants and children under the age of five and women of reproductive age in Karatu District, Tanzania </li></ul><ul><li> strengthening government mandated cadres (VHWs) and institutions (VHCs)  mainstreaming traditional providers (TBAs, drug vendors) </li></ul><ul><li> developing new community groups for high-need populations (single mothers, transport drivers) </li></ul><ul><li>LOE: </li></ul><ul><ul><ul><li>MCH: 35% </li></ul></ul></ul><ul><ul><ul><li>Malaria : 20% </li></ul></ul></ul><ul><ul><ul><li>Control of Diarrheal Diseases : 15% </li></ul></ul></ul><ul><ul><ul><li>Pneumonia : 15% </li></ul></ul></ul><ul><ul><ul><li>Birth Spacing: 15% </li></ul></ul></ul>
    11. 11. Maternal and Child Health Strategies <ul><li>Establish and strengthen community based workers, health committees, and social support groups </li></ul><ul><ul><li>Reinvigorate Village Health Committees (VHCs) </li></ul></ul><ul><ul><li>Train existing and new Village Health Workers (VHWs) and TBAs </li></ul></ul><ul><ul><li>Promote Male involvement (Men Active in Sustaining Health Action) </li></ul></ul><ul><ul><li>Establish and Support Survive and Thrive Groups (STGs) </li></ul></ul><ul><li>Behavior Change Communication </li></ul><ul><ul><li>Individual level: AFYA 1-2-3 campaign </li></ul></ul><ul><ul><li>Community level: Communication campaign to change behaviors (posters, dramas, etc.); MAISHA and STGs </li></ul></ul>
    12. 12. Birth Spacing/Family Planning Strategies <ul><li>Behavior Change Communication: </li></ul><ul><ul><li>Facility and community based health workers convey messages on: delaying first pregnancy, child spacing, efficacy/safety of modern FP methods </li></ul></ul><ul><ul><li>Council Health Management Team recruits FP users to speak to STG and Women’s Groups </li></ul></ul><ul><ul><li>MAISHA peer educators promote child spacing to men </li></ul></ul><ul><li>Increase Access </li></ul><ul><ul><li>Community health workers refer clients to health facilities for FP methods (CBD not available) </li></ul></ul><ul><li>Quality Improvement: </li></ul><ul><ul><li>In service training and regular supervision of all FP service providers to update knowledge and skills </li></ul></ul>
    13. 13. Liberia
    14. 14. Background <ul><li>North-central Liberia; Northwest Nimba County in six sub-districts </li></ul><ul><ul><li>Population: 149,322 </li></ul></ul><ul><ul><li>23%(34,344 ) WRA </li></ul></ul><ul><ul><li>17% (25,385) under 5 </li></ul></ul><ul><li>Project Goal:   60% reduction in the U5 mortality rate over baseline by EOP </li></ul><ul><li> to increase access to the Basic Package of Health Services </li></ul><ul><li> to increase equity </li></ul><ul><li> increase demand for health services </li></ul><ul><li>  ensure quality </li></ul><ul><li>  ensure sustainability </li></ul><ul><li>LOE: </li></ul><ul><ul><ul><li>MNC: 30% </li></ul></ul></ul><ul><ul><ul><li>Malaria : 20% </li></ul></ul></ul><ul><ul><ul><li>HIV: 15% </li></ul></ul></ul><ul><ul><ul><li>Control of Diarrheal Diseases : 15% </li></ul></ul></ul><ul><ul><ul><li>Pneumonia : 10% </li></ul></ul></ul><ul><ul><ul><li>Immunization: 10% </li></ul></ul></ul>
    15. 15. Maternal and Child Health Strategies <ul><li>Increase Access to Basic Package of Health Services </li></ul><ul><ul><li>4 Mobile Primary Health Care Teams: </li></ul></ul><ul><ul><li>Community Health Volunteers (CHVs) </li></ul></ul><ul><ul><li>Care Groups of female community volunteers </li></ul></ul><ul><ul><li>Traditional Birth Attendants (TBAs) </li></ul></ul><ul><li>Ensure Quality </li></ul><ul><ul><li>Community Health Volunteers (CHVs) trained in the CBIO Methodology to monitor community health </li></ul></ul><ul><ul><li>Intervention Teams (Intervention Supervisor): </li></ul></ul><ul><ul><ul><li>Maternal/Newborn Care Team (Maternal/Newborn Care) </li></ul></ul></ul><ul><ul><ul><li>IMCI Team (Pneumonia, Malaria, Diarrhea) </li></ul></ul></ul><ul><ul><ul><li>WatSan Team (Diarrhea) </li></ul></ul></ul><ul><ul><ul><li>HIV Team (HIV/PMTCT) </li></ul></ul></ul><ul><ul><ul><li>EPI Team (Immunization) </li></ul></ul></ul><ul><ul><ul><li>Community Support Team (cross-cutting) </li></ul></ul></ul>
    16. 16. <ul><li>Behavior Change Communication </li></ul><ul><ul><li>Child spacing messages disseminated by CHVs and TBAs during home visits. </li></ul></ul><ul><ul><li>Facility based health workers disseminate child spacing messages during immunization, antenatal care, and mobile outreach services </li></ul></ul><ul><li>Increase Access to Basic Package of Health Services which includes Post Abortion Care (PAC) </li></ul><ul><ul><li>TBAs trained in basic health life skills which includes post-abortion care. </li></ul></ul><ul><ul><li>Service providers trained in PAC and receive referrals from nurses and TBAs </li></ul></ul>Birth Spacing/Family Planning Strategies
    17. 18. Indicators measuring birth spacing/family planning activities <ul><li>% 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 </li></ul><ul><li>Percentage of mothers of children age 0-23 months who are using a modern contraceptive method- WellShare Tanzania & Curamericas Liberia </li></ul><ul><li>No birth spacing/FP indicator collected by RI Niger </li></ul>
    18. 19. Challenges with integrating birth spacing/family planning activities <ul><li>Without additional funding, unable to scale up successful model of CHW curriculum/training ( GHA Haiti ) </li></ul><ul><li>Weak supply chain system (stockouts of commodities) ( All interviewees ) </li></ul><ul><li>Difficult to add another health intervention when the health system is already so weak ( RI Niger ) </li></ul><ul><li>Cultural barriers ( Curamericas Liberia ) </li></ul><ul><li>CBD of FP methods not approved by MOH ( WellShare Tanzania ) </li></ul><ul><li>KPC survey is already long and time consuming so adding more FP indicators might be burdensome for some and also costs money ( WellShare Tanzania ) </li></ul>
    19. 20. Recommendations to improve integration of birth spacing/family planning activities <ul><li>Share best practices or lessons learned on community based integration of child spacing/child survival programs </li></ul><ul><li>Technical assistance to work with the MOH to improve the supply chain system (get commodities to rural areas) </li></ul><ul><li>USAID approved protocol manual related to FP messages for all health programs </li></ul><ul><li>Exchange visits between programs that have successful CBFP programs </li></ul><ul><li>Pilot project to do CBD in remote areas (Tanzania) </li></ul><ul><li>Funding to expand birth spacing/family planning activities to youth </li></ul><ul><li>Additional education material on birth spacing to share with WRA </li></ul><ul><li>Create community depots throughout project areas for access to FP methods while building demand </li></ul><ul><li>Train existing CHWs in CBD of injectables, pills, FAM, etc </li></ul><ul><li>Use community groups such as CARE groups as points of access for FP methods and services </li></ul><ul><li>Train local health partners in FP service provision for sustainability purposes </li></ul>
    20. 21. Recommendations to improve integration of birth spacing/family planning activities <ul><li>Share case studies that highlight the synergies between education, job opportunities, and family planning </li></ul><ul><li>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 </li></ul><ul><li>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 </li></ul>