Haiti

Health System in Haiti Takes Key Step by Launching National Tuberculosis Tracker

mnathe — Wed, 05 Dec 2018 18:12:43 +0000

Health System in Haiti Takes Key Step by Launching National Tuberculosis Tracker mnathe December 05, 2018

December 17, 2018

Newly digitized data will help the government address the disease, decide where to invest in clinics and staff, and more.

Haiti’s government this year launched a national electronic platform for reporting and tracking tuberculosis (TB), a key step in its efforts to capture, monitor, and report all patient-level data across the country.

Information on cases of TB—a contagious and often deadly disease plaguing the Caribbean nation—is being prepared for aggregation into the System d’Information Sanitaire Nationale Unique, or SISNU, which uses the DHIS2 open-source software platform for reporting, analyzing, and disseminating national health data.

Haiti perpetually suffers the highest incidence of TB in the Americas.

Development of the TB tracker and related work is being led by the Haiti Strategic Health Information System (HIS) Program. Launched in 2017, HIS is funded by the U.S. Agency for International Development (USAID) and implemented by DAI in partnership with Haiti’s Ministry of Health (MSPP). Data on TB cases and treatment regimens is being captured electronically—and soon through a mobile application that will better serves remote locales.

For the three-month TB pilot phase, the HIS team trained health professionals at nine facilities from four of Haiti’s departments—Artibonite, Centre, North, and West. This area includes nearly half of all health facilities in Haiti that provide TB care and covers more than 70% of Haiti’s reported TB cases. Once the pilot was completed in April 2018, the HIS team and its partners deployed the platform to the rest of the country’s 10 departments, their health offices, and select health care facilities.

Our goal was to capture data on 5,000 TB patients—through July 2018, we had captured data on more than 12,000.

Improving TB Management

TB bacteria is typically spread by coughing, and the bacteria can become resistant to most drug cures if patients go untreated or their treatment is mismanaged. Haiti perpetually suffers the highest incidence of TB in the Americas, with an estimated 21,000 cases in 2015.

Solutions to control drug-resistant TB, as prescribed by the World Health Organization, are to cure the TB patient the first time around, provide access to diagnosis, control infection in facilities where patients are treated, and ensure appropriate use of recommended second-line drugs. Implementing these solutions on a national scale requires data.

The tracker can be adapted for other diseases, too, such as HIV, cholera, flu, and noncommunicable diseases.

The TB tracker digitizes previously paperbound patient details registered by health care providers at local facilities. These registries previously had to be manually collected and then transported and entered by hand at the department and national levels. The tracker will eventually include four case-specific modules—for routine cases, outset cases, multi-drug resistant cases, and HIV cases (which can be a precursor to TB).

The TB and future trackers will improve data quality and inform decision making; for instance, helping the government decide where to invest in clinics and staff. The tracker can be adapted to capture and integrate data on other diseases—such as HIV/AIDS, cholera, flu, and non-communicable diseases. It is already capturing patient-level immunization data for migration to SISNU and being used to develop community-based mobile health information apps.

The five-year HIS program ultimately aims to build the capacity of the Ministry of Health to take ownership and optimize the use of SISNU.

Getting Health Systems in Good Order

Haiti’s health reporting platforms need to be shored up to better serve citizens, especially given the country’s history of contagious disease and natural disaster. The January 2010 earthquake demolished 50 health centers, part of Haiti’s primary teaching hospital, and the Ministry of Health. The country still heavily relies on international funding to provide Haitians access to health care services. The government itself could help fund and manage these services if armed with improved aggregated data.

“Haiti and other developing countries can benefit greatly now and well into the future simply by getting their health information systems in good order,” said Bobby Jefferson, Chief Technology Officer for DAI Global Health. “By applying health informatics with discipline, countries such as Haiti will be far better prepared to reap good value from investments in health care planning and delivery.”

The lack of ongoing collection of reliable health data has harmed the Haitian government’s ability to plan for and respond efficiently to public health needs. Launching the TB data platform marks an important step for the country in its goal to become better prepared to respond to both health crises and the daily needs of its 11 million people.

This post originally appeared on DAI Developments.

By Atwood Raphael

Deputy chief of party, USAID/Haiti Strategic Health Information System Program

Tuberculosis Haiti

Haiti health information systems field officer Pouchy Dacière trains Northeastern Health Directorate representatives to insert data on SISNU. Photo courtesy of DAI.

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The ‘Fatal Flow’ of Health Worker Migration

Anonymous — Tue, 27 Sep 2016 13:44:41 +0000

The ‘Fatal Flow’ of Health Worker Migration Anonymous (not verified) September 27, 2016

March 17, 2011

March 17, 2011 is Match Day, when tens of thousands of medical graduates learn their odds in a professional lottery that determines the rest of their careers—the day new physicians are matched with the residency programs that will train them as specialists. Every year, thousands of foreign-trained doctors who want to practice in the United States apply for and fill up to 20 percent of first-year residency positions, because US medical schools don't produce enough graduates to fill training programs at hospitals nationwide. Kate Tulenko is a physician herself and an expert on health workforce migration. She shares some of the implications and ethics of recruiting foreign physicians—starting with the country that has the highest attrition of doctors in the world…

This blog entry was also featured on InterAction's AID Buzz blog.

More than a year after its devastating earthquake, Haiti is still struggling to recover and rebuild its health system. Yet one of the major barriers to providing even the most basic health services is the migration of health personnel out of the country. Over the past 20 years, most of Haiti’s physicians and a full 94% of its nurses have migrated out of the country to work—a rate higher than any country in the world.

But the migration of health workers is not just a problem in unstable countries like Haiti. Countries like Malawi, which has never seen a war or major disaster, have more than half their physicians working outside the country while jobs sit empty and ten out of 100 children die before their fifth birthday. India, the second most populous country in the world, has a shortage of more than 450,000 health workers, while their physicians make up the largest group of foreign trained physicians in wealthy countries. In fact, 20 to 25% of health workers in wealthy countries are foreign-born and -trained.

Traditionally, we have viewed migration as a positive. Unskilled people left lives of unemployment and poverty to take jobs in wealthy countries that no one wanted. This is not the case with health workers. Most developing countries have large numbers of health worker vacancies, and health workers’ salaries, though small compared to those in developed countries, easily put them in the top 20% of wage earners in their country. Meanwhile in wealthy countries, many more qualified young people apply to nursing and medical school than there are seats.

The loss of these workers impairs the ability of their countries to fight against life- and economy-destroying diseases such as HIV/AIDS, malaria, and TB, and even common scourges such as diarrhea, pneumonia, and vaccine preventable diseases. Since the number of health workers per capita is directly related to the population’s health, migration has been branded as “Fatal Flows.” A recent study revealed that the number one cause of loss of professors from African medical schools was migration. So not only does migration cause the loss of labor, but it impairs countries’ ability to train more health workers. Since most health workers are trained using public funds, their importation to wealthy countries also represents a subsidy of developed country health systems.

Luckily, recent progress has been made. Last year the World Health Assembly, made up of ministers of health from around the world, approved the Global Code of Practice on the International Recruitment of Health Personnel. Although not binding, the code encourages wealthy countries to invest in their own young people and train enough health workers to meet their own needs. It also encourages wealthy countries to assist developing countries to train workers to replace those lost to migration and to help them improve their health systems so that there are fewer of the frustration factors that cause physicians and nurses to leave: poor management, lack of equipment and medications, and lack of access to career development.

The World Health Organization and the Global Health Workforce Alliance are taking further steps to address the issue. In January they convened the world’s experts on the global health worker shortage in Bangkok, Thailand at the Second Global Forum on Human Resources for Health and recommended several key changes and commitments that must be made to eventually ensure that everyone, everywhere, has access to a health worker and a robust health system. Readers can make a difference by encouraging their local nursing and medical schools to expand enrollment so that their community can be self-sufficient in the production of health workers and not need to import health workers from countries like Haiti, which can ill afford to lose them.

By Kate Tulenko

Former Vice President of Health Systems Innovation

Health Workforce & Systems Migration Haiti

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Midwives Matter for Haiti's Moms

Anonymous — Tue, 27 Sep 2016 13:43:30 +0000

Midwives Matter for Haiti's Moms Anonymous (not verified) September 27, 2016

May 04, 2015

This week I am traveling around Haiti reporting on global health issues that affect women and children.

In fact, I am writing this post in the back of an SUV with my fixer and translator headed south of Port-au-Prince to visit Social Good Moms’ partner, Midwives for Haiti.

In the poorest country in the Western Hemisphere there are still many challenges that persist in both maternal and child health in Haiti.

Midwives are critical to the lives of expectant mothers.

While malaria cases are relatively in check across the nation, there were 15 confirmed cases of Dengue fever in Deschappelles over the past two weeks—all children!Women still continue to overwhelmingly have their babies at home, which can cause problems with their health as well as with their newborns. There were two cases of fistula at Hôpital Albert Schweitzer, whom I worked with yesterday.

While the hospital has reportedly increased OB-GYN clients, mothers still desire to deliver at home.That is why midwives are so critical to the lives of expectant mothers, as are matrones, or birth attendants, as they are called here.

Being in Haiti also serves as an advance trip for an upcoming global health reporting trip with a Social Good Mom to also report from the ground about our partners’ work. Other members have already traveled to India, South Africa, Nicaragua, Indonesia, and the Philippines. I have always maintained that one of the cornerstones of Social Good Moms is to provide as many opportunities as possible for members to go, do, see, travel, and write!Follow @socialgoodmoms for more updates during the week from Haiti.

This post originally appeared on Mom Bloggers for Social Good, titled Reporting from Haiti this Week.

By Jennifer James

Founder of Mom Bloggers for Social Good

Child Health Midwives Haiti

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Maternity Ward Observations: Midwifery Care in a Haitian Hospital

Anonymous — Tue, 27 Sep 2016 13:43:30 +0000

Maternity Ward Observations: Midwifery Care in a Haitian Hospital Anonymous (not verified) September 27, 2016

May 08, 2015

The sunny, steaming hot morning when I visited L’Hôpital Sainte-Thérèse in Hinche, Haiti, the maternity unit was overflowing with busy midwives checking charts and administering care, nurses-in-training in white and yellow uniforms obtaining requisite clinical hours, as well as a few obstetricians checking on patients.

Of course, there were expectant mothers, mothers who had just given birth, and those who were being prepped to deliver their babies. Husbands and other family members milled about slowly, but deliberately, bringing food and water to their loved ones, or just sat on benches and waited.

Midwives were attending to their care—calmly and respectfully.

In each of the maternity units—antenatal, postpartum, and labor and delivery—there was a bed for every woman. No expectant mother laid on the ground waiting for space. In fact, I even saw some empty beds.That is not always the case, I was told. Some times of the month are busier than others, but each mother can be accommodated.

Some expectant mothers—many with swollen feet and ankles—walked around slowly outdoors in the sunlight angling for some type of momentary relief from the constant wave of contractions. Others laid in bed with worried eyes anticipating the incumbent pain they faced.When I visited labor and delivery, one mother’s screams were piercing and she wasn’t even pushing yet. Another woman was calm, smiled, and gave me a quick wave as I walked by, despite her contractions. Midwives were attending to their care—calmly and respectfully.

The mothers in postpartum care sat with their babies who were asleep and breastfed those who were awake. Husbands, aunts, mothers, or sisters sat at their besides intent to help.

Each of the mothers had a look of subtle relief knowing their babies had arrived healthy and alive and that they were, too.

Some mothers weren’t as lucky, however.

In Haiti, 85% of women still opt to give birth at home.

A few certified nurse midwives from Arizona who were volunteering with Midwives for Haiti said two premature babies around twenty weeks didn’t make it in the early morning hours. The mothers rested in postpartum care where three midwives check on women to ensure there is no hemorrhaging or other delivery complications.

Midwives for Haiti has brought a new level of respectful, quality maternal health care to Haiti’s Central Plateau, an area that is quite difficult to reach through the mountains for locals and primarily serves a rural population.

Through training and staffing, Midwives for Haiti has saved the lives of countless women who choose institutional births at L’Hôpital Sainte-Thérèse. They only lose between one and four mothers per month. Most of the women who do not make it are transferred from outside clinics and are pronounced dead at the hospital.

Midwives for Haiti also provides training and clean birth kits to traditional birth attendants who deliver the vast majority of babies across all of Haiti.

In Haiti, 85% of women still opt to give birth at home with traditional birth attendants, or matrons as they are called. Most women who decide to give birth at L’Hôpital Sainte-Thérèse come because there are complications with their pregnancies or they live nearby and have easy access to the hospital for delivery with trained midwives. Some women even stay multiple months at the hospital on bedrest.

Compassionate Care

One of the tenets of Midwives for Haiti is training upcoming midwives to practice compassionate care, which is lacking in many low- and middle-income countries.

“We’re definitely a balance between what is culturally appropriate and what is being taught in America,” said Emily Davis, Midwives for Haiti program coordinator who is based in Hinche. “They are being taught to be kind to women and give women the best possible care.”I saw that compassionate care when I spent more time in the maternity ward later that day.

“I can’t anymore,” she screamed in Creole. “I can’t anymore! Oh, my God!”

A 20-year-old, slender, frail woman had come to the hospital at only eight weeks pregnant, but also had what the midwives and nurse volunteers suspected were kidney stones. The woman wailed in pain constantly and flailed around on her bed even though she was hooked to an IV. She nearly ripped it out several times.

The pain was so excruciating that she didn’t cry. I saw no tears. I just heard constant wailing.

“I can’t anymore,” she screamed in Creole repeatedly. “I can’t anymore! Oh, my God!”The midwives and nurse volunteers worked to figure out ways to alleviate her pain. Her husband finally joined her and stood by her bedside. He left to clean her bucket where she constantly vomited during the day. He poured what little water he had left from his water bottle in it.

The woman, still in unbearable pain, hopped out of bed and backed into the wall. She slid down almost to the floor before she fell back into bed again.

The midwife, Miss Val, asked the husband if he could afford to buy pain medications. Equally young as his wife, he looked bewildered, wondering if he had enough money to purchase the medications. It was also getting late in the afternoon and the pharmacy would close soon.

He left and returned sooner than I expected with two doses of tramadol, a pain medication that would be injected every six to eight hours to provide his wife relief. The cost was about $5 US, a fortune for a very poor Haitian.

Miss Val went to the supply closet and prepped a syringe. She walked over to the woman and calmly told her that she needed to turn on her side and that she was going to pull down her skirt to give her the shot of medication.

After nearly fifteen minutes the woman’s wails minimized substantially. The throngs of pain subsided. Her flailing stopped. I could tell she could finally feel the slight breeze from the four fans on the walls that she couldn’t appreciate when she was experiencing excruciating pain.

When I left L’Hôpital Sainte-Thérèse, I hoped her husband could afford more medication. Realistically, I knew he probably couldn’t.

Walking away I couldn’t get the woman out of my mind, but I was relieved to see that she, as well as all of the other women I met, were afforded quality, compassionate maternal health care by Midwives for Haiti.

Update 5/5/2015: One of the great things about meeting stellar health workers and living with them for just a few days is you make bonds you’d never think you’d make.

I left Haiti on a Thursday morning and the aforementioned certified nurse midwives from Arizona who volunteered with Midwives for Haiti stayed until Saturday. They just let me know that the woman who was in such great pain was “induced on Friday night and passed her baby easily. She was suffering from a pregnancy complication of the liver.”

When the CNMs left Hinche for Port-au-Prince on Saturday, they stopped to check on her on their way to the airport. They said, “She was out of pain, and was resting and recovering. As soon as she further recovers she will be referred to another hospital for treatment of her kidney stones. She will survive, get treatment, and hopefully not have this complication in future pregnancies.

”This post originally appeared on Mom Bloggers for Social Good.

By Jennifer James

Founder of Mom Bloggers for Social Good

Maternal and Newborn Health Midwives Nurses Haiti

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Haiti’s Need for Mental Health Services, Before and After the Quake

Anonymous — Tue, 27 Sep 2016 13:43:17 +0000

Haiti’s Need for Mental Health Services, Before and After the Quake Anonymous (not verified) September 27, 2016

July 30, 2015

Mental illness affects 1 in 10 people, yet only 1% of the global health workforce is dedicated to mental health. Haiti feels the effects.

When people find out that I experienced the 7.0 magnitude earthquake that struck Haiti in 2010, they are understandably curious.

But when I tell the story, even five years later, my heart rate rises. I get goosebumps. My palms sweat. I feel short of breath, and often tears well up in my eyes.

As each aftershock came and went, people erupted in song and prayer.

I was half asleep in the backseat of a car in sweltering Port-au-Prince when we felt the vehicle rock back and forth as if riding a huge wave. Buildings and houses began to fall, creating clouds of dust, and from those clouds people were running, barely escaping as the buildings collapsed.

We grabbed each other and ran, and every way we turned we saw destruction, despair, and death.

We made our way to my family’s home down the middle of a wide street with thousands of other people, quickening our pace as the aftershocks followed, some feeling as powerful as the initial quake. We slept outside on the ground that night as the earth continued to tremble. As each aftershock came and went, people erupted in song and prayer.

As I write this now, the memories—rubble piled high, screams and cries, having to step carefully to avoid the dead bodies lining the street, putting rubbing alcohol under my nose to avoid the smells—flood my mind.

When I first got back I had trouble in social interactions. I felt guilty, alone, and on edge. I woke up in cold sweats, and could feel the ground shaking even when it wasn’t.

These were all symptoms of the post-traumatic stress disorder (PTSD) I was suffering. With the help of therapy and treatment, many of my symptoms have faded. But I was lucky to have access to mental health care after the earthquake. Most Haitians did not.

What happens to a population’s health and well-being under that type of widespread, long-lasting stress? Especially when there are no trained health or social service workers there to help address the effects?

The psychological toll of the quake has been extraordinary for the people of Haiti.

The earthquake in Haiti killed approximately 200,000 people. More than 300,000 were injured, more than 1 million displaced. Research in 2013 found that 90.5% of survey respondents had at least one relative or close friend who was injured or killed. And 93% saw dead bodies.

The psychological toll has been extraordinary for the people of Haiti, a country that already faced the many stressors of disease and chronic poverty: almost a quarter of the population experienced PTSD in the aftermath, and even more experienced a major depressive disorder. Haiti’s health workforce was woefully underprepared to provide the physical care the population needed then, much less the psychosocial and mental health services. Since the quake, there have been some mental health capacity-building projects there. But mental health care is still a neglected need in Haiti—and around the world.

On July 14, the World Health Organization released the 2014 Mental Health Atlas, which provides a comprehensive overview of global mental health. This fourth edition includes data from 171 countries and shows dramatic differences in resources for mental health and access to care among high-, low-, and middle-income countries.

Mental illness affects about 1 in 10 people around the globe, yet only 1% of the global health workforce is dedicated to mental health.

Our discussions of noncommunicable diseases often ignore mental health.

Training for mental health workers is essential if we are to improve the capacity of the health workforce around the globe. And it could have far-reaching effects, as poor mental health is often the root cause of other health conditions, and it can inhibit people from participating in social and economic development.

The World Health Organization outlines three ways to make the mental health workforce a priority:

The disparity in financial expenditures per person in global mental health in high-, low-, and middle-income countries must be bridged. Expenditures should be around $50 a day per person (as they are in high-income countries) instead of $2 a day.
A greater percentage of the health workforce must be allocated to global mental health. But because there is a global shortage of health workers, the workforce must also increase overall so more health professionals can be trained to enter the field of mental health.
Policies, plans, and procedures must be put in place to create resilient health systems that can provide mental health resources before and after emergencies, such as the quake in Haiti.

Despite the fact that noncommunicable diseases (NCDs) have become the leading cause of death across the globe, we have yet to make them a clear global health priority. And our discussions of NCDs often ignore mental health.

We must begin to consider the impact the quake had on mental health in Haiti, and make mental health care a priority there and around the world.

By Yanica Faustin

2015 UNC-IntraHealth Summer Fellow

Mental Health IntraHealth-UNC Summer Fellows Social Service Workers Haiti

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