Barriers to accessing HIV-prevention services, experienced by African and Caribbean communities in Canada, is an issue warranting sustained research. This study seeks to achieve a better understanding of the nature of HIV-prevention services in Canada, and to explore the dynamics, which underpin barriers to accessing these services confronting African and Caribbean populations in Toronto (Canada). This study also endeavours to assess what is being done to reduce these barriers. Semi-structured qualitative interviews with 7 professionals and community workers who were involved in organizing, researching and delivering HIV-prevention services were conducted for this study. Four themes pertaining to barriers to accessing HIV-prevention services, including, levels of cultural competence and sensitivity among service providers; cultural and social stigma directed at persons living with HIV/AIDS; various social determinants of health, including gender, race and precarious immigration status’; as well as constrained funding resources that are available for service providers; were uncovered in the findings of the study. The paper concludes that several health promotion and health education initiatives exist, which can help reduce these barriers to HIV-prevention service access for these populations. However, in order to ensure their effectiveness there will be much needed involvement from community and other relevant government agencies, which will need to work separately and in conjunction with one another, in order to tackle some of the broader issues that affect these populations.

This report assesses the commendable progress made in maternal and child mortality reductions in Haiti prior to the January 2010 earthquake. Suggested measures that the Haitian government and international donor community can take to maintain these gains are also made. With the Millennium Development Goals (MDGs) deadline of 2015 drawing nearer, the likelihood that Haiti will achieve MDG's 4 and 5 of reducing child and maternal mortality by two-thirds and three-quarters, respectively, by the end of this target year, remain questionable. In particular, the destruction inflicted on the country's health care system and health infrastructure by the 2010 earthquake have already resulted in a slowing of these gains and could potentially threaten an actual reversal of these trends. The country's Soins Obstétricaux Gratuits and Soins Infantiles Gratuits schemes established in 2008 and 2010, which provide free health care to women, newborns and children under 5, represent examples of measures that will need to be sustained and scaled up if the country is to meet its MDG 4 and 5 targets. The Haitian government's endorsement of an increased continuum of care approach to maternal and newborn health will also be vital for future initiatives. Post-quake public health and social service reconstruction efforts will need to incorporate maternal and child health-friendly services into their designs. It also remains critical that international donors continue to meet their pledges to Haiti. The Haitian government should also take more strides to clearly delineate the maternal and child health interventions it implements, both in order to facilitate greater national learning, as well as to improve the likelihood of future replication.

Considerations as to the feasibility with which child survival interventions can be delivered at high levels of population coverage, have been described as a central criterion of interventions intended to reduce child mortality. 1 Accordingly, over two-thirds of child deaths have been demonstrated to be preventable through the delivery of effective and lowcost health interventions, the integrated delivery of which, have also been suggested to be among the most effective strategies for improving child survival. 2 Despite this, and as the countdown to the Millenium Development Goals 2015 has intensified, commensurate admonitions to identify and augment the scale at which highly effective delivery channels for delivering child survival interventions, have remained far less vigorous. This has also been the case despite the fact that at present, the prospects that many countries have of falling short of achieving the fourth millennium development goal, of reducing child mortality by two-thirds -between 1990 and 2015, has become ever more likely. 3 It was within this context that the 2008 Lancet Series on the Rebirth and Revision of Alma Ata, which staunchly advocated for a renewal of interest in the importance and potential of primary health care for improving maternal, newborn, and child health (MNCH), delineated four major factors contributing to the failure of the delivery of effective MNCH interventions at scale. 4 This list identified the lack of a universally agreed upon minimum set of interventions that should be delivered to all women, newborns and children who require them; inadequate attention to demand creation for these interventions at the community level; shortages of well-trained staff and community health workers; and the failure to allocate the necessary resources to ensure the functionality of first level health facilities (including the forging of stronger links between facility-based staff and communitybased workers) -as the main reasons for this drawback. 4 Yet still, despite this acute awareness of the factors impeding the improved delivery of interventions, investments in maternal, newborn, and child health interventions have lost out over the past few decades and have been pitifully low despite the magnitude of the health burden, the availability of cost-effective interventions, and the potential gains for such investments. 5 Such gains include considerable reductions in neonatal and child morbidity and mortality, medium and long-term cost savings by national governments and health systems, and the averting of developmental complications, which may result from the neglect of unameliorated pediatric illnesses. Similarly, within the context of investments in neonatal survival interventions research, Martines et al. asserted that research into intervention delivery strategies was a priority for achieving universal coverage of effective health interventions. 6 These findings, therefore make it unjustified that investments in child health research which focus on new interventions, have far exceeded...