Reducing under-five mortality through Hopital Albert Schweitzer's integrated system in Haiti

Perry, Henry B.; Cayemittes, Michel; Philippe, François; Dowell, Duane; Dortonne, Jean Richard; Menager, Henri; Bottex, Erve; Berggren, Warren L.; Berggren, G

doi:10.1093/heapol/czl005

Cited by 15 publications

(14 citation statements)

References 23 publications

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“…The hospital always served as the Ministry of Health’s district hospital for the health district in which it is located, with 258 000 people in its catchment area during most of the period covered by the impact assessment. The population served by HAS’s primary health care project fluctuated over the years, from 18 820 in 1958 to 180 000 in 1996 and to 350 000 in 2016 [3,20]. …”

Section: Resultsmentioning

confidence: 99%

“…HAS thus became a comprehensive integrated health and development system with strong CBPHC services together with facility–based primary health care, hospital referral care and community development activities [3]. …”

Section: Resultsmentioning

confidence: 99%

“…In the late 1990s, 1500 volunteer community health workers ( Animatrices ), one for every 15 households, were recruited to provide peer–to–peer health education to other women, to assist with the Rally Posts and Mobile Clinics, to promote community involvement, and to assist with referral of patients to higher levels of care [3]. In addition, eight Monitors ( Monitrices ) provide liaison with and training of lay midwives, along with supervising and training the Animatrices.…”

Section: Resultsmentioning

confidence: 99%

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Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Perry

Rassekh

Gupta³

et al. 2017

Journal of Global Health

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BackgroundThere is limited evidence about the long–term effectiveness of integrated community–based primary health care (CBPHC) in improving maternal, neonatal and child health. However, the interventions implemented and the approaches used by projects with such evidence can provide guidance for ending preventable child and maternal deaths by the year 2030.MethodsA database of 700 assessments of the effectiveness of CBPHC in improving maternal, neonatal and child health has been assembled, as described elsewhere in this series. A search was undertaken of these assessments of research studies, field project and programs (hereafter referred to as projects) with more than a single intervention that had evidence of mortality impact for a period of at least 10 years. Four projects qualified for this analysis: the Matlab Maternal Child Health and Family Planning (MCH–FP) P in Bangladesh; the Hôpital Albert Schweitzer in Deschapelles, Haiti; the Comprehensive Rural Health Project (CRHP) in Jamkhed, India; and the Society for Education, Action and Research in Community Health (SEARCH) in Gadchiroli, India.ResultsThese four projects have all been operating for more than 30 years, and they all have demonstrated reductions in infant mortality, 1– to 4–year mortality, or under–5 mortality for at least 10 years. They share a number of characteristics. Among the most notable of these are: they provide comprehensive maternal, child health and family planning services, they have strong community–based programs that utilize community health workers who maintain regular contact with all households, they have develop strong collaborations with the communities they serve, and they all have strong referral capabilities and provide first–level hospital care.ConclusionsThe shared features of these projects provide guidance for how health systems around the world might improve their effectiveness in improving maternal, neonatal and child health. Strengthening these features will contribute to achieving the goal of ending preventable child and maternal deaths by the year 2030.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Perry

Rassekh

Gupta³

et al. 2017

Journal of Global Health

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“…There are a number of variations of home visitation strategies using community–level workers, from weekly home visits for providing micronutrients to children [39] to regular monthly visitation of all homes in a program population as part of a more comprehensive approach to delivering basic services to the entire population [40]. …”

Section: Methodsmentioning

confidence: 99%

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

Perry¹,

Sacks²,

Schleiff³

et al. 2017

Journal of Global Health

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BackgroundAs part of our review of the evidence of the effectiveness of community–based primary health care (CBPHC) in improving maternal, neonatal and child health (MNCH), we summarize here the common delivery strategies of projects, programs and field research studies (collectively referred to as projects) that have demonstrated effectiveness in improving child mortality. Other articles in this series address specifically the effects of CBPHC on improving MNCH, while this paper explores the specific strategies used.MethodsWe screened 12 166 published reports in PubMed of community–based approaches to improving maternal, neonatal and child health in high–mortality, resource–constrained settings from 1950–2015. A total of 700 assessments, including 148 reports from other publicly available sources (mostly unpublished evaluation reports and books) met the criteria for inclusion and were reviewed using a data extraction form. Here we identify and categorize key strategies used in project implementation.ResultsSix categories of strategies for program implementation were identified, all of which required working in partnership with communities and health systems: (a) program design and evaluation, (b) community collaboration, (c) education for community–level staff, volunteers, beneficiaries and community members, (d) health systems strengthening, (e) use of community–level workers, and (f) intervention delivery. Four specific strategies for intervention delivery were identified: (a) recognition, referral, and (when possible) treatment of serious childhood illness by mothers and/or trained community agents, (b) routine systematic visitation of all homes, (c) facilitator–led participatory women’s groups, and (d) health service provision at outreach sites by mobile health teams.ConclusionsThe strategies identified here provide useful starting points for program design in strengthening the effectiveness of CBPHC for improving MNCH.

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“…The coverage of key child survival services was considerably higher for the HAS service population than for the rest of Haiti, and under-five mortality had been at least half that compared to the rest of Haiti for the three previous decades [32,33]. The leadership of the institution and its staff were aware of the geographic and socioeconomic disadvantages which burdened the people living in the mountains, were concerned about the possibilities of health and health care inequities and assisted in the design of the study.…”

Section: Introductionmentioning

confidence: 99%

Health equity issues at the local level: Socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti

Perry

King-Schultz

Aftab

et al. 2007

Int J Equity Health

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BackgroundAlthough health equity issues at regional, national and international levels are receiving increasing attention, health equity issues at the local level have been virtually overlooked. Here, we describe here a comprehensive equity assessment carried out by the Hôpital Albert Schweitzer-Haiti (HAS) in 2003. HAS has been operating health and development programs in the Artibonite Valley of Haiti for 50 years.MethodsWe reviewed all available information arising from a comprehensive evaluation of the programs of HAS carried out in 1999 and 2000. As part of this evaluation, two demographic and health surveys were carried out. We carried out exit interviews with clients receiving primary health care, observations within health facilities, interviews with households related to quality of care, and focus group discussions with community-based health workers. A special study was carried out in 2003 to assess factors determining the use of prenatal care services. Finally, selected findings were obtained from the HAS information system.ResultsWe found markedly reduced access to health services in the peripheral mountainous areas compared to the central plains. The quality of services was more deficient and the coverage of key services was lower in the mountains. Finally, health status, as measured by under-five mortality rates and levels of childhood malnutrition, was also worse in the mountains.ConclusionThese findings indicate that local health programs need to give attention to monitoring the health status as well as the quality and coverage of basic services among marginalized groups within the program service area. Health inequities will not be overcome until such monitoring occurs and leaders of health programs ensure that inequities identified are addressed in the local programming of activities. It is quite likely that, within relatively small geographic areas in resource-poor settings around the world, similar, if not even greater, levels of health inequities exist. These inequities need to be measured and addressed in order for health programs to achieve equity and maximum improvement in health status within the population.

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Reducing under-five mortality through Hopital Albert Schweitzer's integrated system in Haiti

Cited by 15 publications

References 23 publications

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 7. shared characteristics of projects with evidence of long–term mortality impact

Comprehensive review of the evidence regarding the effectiveness of community–based primary health care in improving maternal, neonatal and child health: 6. strategies used by effective projects

Health equity issues at the local level: Socio-geography, access, and health outcomes in the service area of the Hôpital Albert Schweitzer-Haiti

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