Haiti

Women and child in Tambura, South Sudan. {Photo credit: MSH.}Photo credit: MSH.

Nearly 50 countries, including Afghanistan, Democratic Republic of the Congo, Haiti, Liberia and South Sudan, are considered a fragile or conflict-affected state -- a state that is in conflict, recovering from conflict or crisis, or a state that has collapsed or has a strong and repressive government. Over nearly 40 years of working in fragile states, Management Sciences for Health (MSH) has identified best practices, lessons learned, and appropriate interventions for a myriad of situations in fragile states.

MSH takes an integrated approach to building high-impact sustainable public health programs that address critical challenges in leadership, health systems management, health service delivery, human resources, and medicines. Wherever our partnerships succeed, the positive impact of good health has a ripple effect, contributing to the building of healthy nations.

MSH works collaboratively with health care policymakers, managers, providers, and the private sector to increase the efficacy, efficiency, and sustainability of health services by improving management systems, promoting access to services, and influencing public policy.

Women, men and children stand in line at the St. Joseph's Health Center in Abricots, Haiti. {Photo credit: Gumy Dorvilmar/MSH.}Photo credit: Gumy Dorvilmar/MSH.

It was 11 o’clock one February morning when the Santé pour le Développement et la Stabilité d’Haiti (SDSH) project technical team arrived on site at St. Joseph Health Center.

The center’s activities were well underway. Dozens of people sat on benches or stood in line, waiting for their turn. One person comes to care for her child who has had a high fever. Another comes for contraception. Another just gave birth to a healthy infant.

St. Joseph Health Center is located in Abricots, a remote community in the department of Grande’Anse, Haiti, far from Port-au-Prince. Abricots is nearly inaccessible because of rough terrain and hazardous mountain trails.

Since 2007, with support from the USAID-funded SDSH project, led by Management Sciences for Health (MSH), St. Joseph Health Center has provided a basic package of health services: pediatrics, maternal health, reproductive health, detection and treatment of sexually-transmitted infections, HIV/AIDS, tuberculosis (TB) and family planning.

This free clinic is the only health institution in this hard-to-reach area, serving an estimated 32,000 people.

Yvonise is a good-natured 40-year-old woman with an easy smile. She is mother to four children: two boys and two girls. Her youngest, a little girl, is six years old.

Today, Yvonise sits patiently at the pharmacy of Hôpital Immaculée Conception de Port-de-Paix (HIC Port-de-Paix) in Haiti, waiting for Miss Sevrine, her caregiver, to provide her with a month’s supply of life-saving medicine.

Yvonise is one of 2,200 patients enrolled in the HIV/AIDS program at HIC Port-de-Paix. She was infected years ago with the AIDS virus, but her family does not know. Keeping her secret is a constant burden.

“I tell my kids that I have an infection for which I am being treated,” she said. This is how she justifies her monthly trips to the hospital.

Yvonise knows first hand how important it is for her to keep her appointments. “Since I’ve been coming to the clinic and taking my medication, I’ve been feeling more energetic,” she said, grinning from ear to ear.

The theme of this year’s Global Health Council annual conference was Securing a Healthier Future in a Changing World. As populations are shifting, so are their health priorities. Increasing urbanization has led to more people living in and around cities, creating a series of problems that are new to public health professionals. Nutritional challenges, the need for improved water and sanitation infrastructure, and addressing the issue of unregulated health care providers are all problems facing governments, ministries, NGOs, donors, and populations. In addition, non-communicable diseases (NCDs), including cancer, diabetes, cardiovascular conditions, and mental illness, are adding a new strain to many already resource constrained health systems. Of course, immunization, malaria, pneumonia, diarrhea, and maternal death are all still very serious challenges in many of these systems and remain key priorities.

As Haitians continue to struggle against many obstacles in improving and developing their country, cholera and sanitation remain challenges to many development efforts.

Since the cholera epidemic started in October, there have been a total of 252,640 confirmed cases. MSH integrated its response, where appropriate, with the national response that was coordinated by the Ministry of Health. Following the earthquake, MSH’s USAID-funded Santé pour le Développement et la Stabilité d’Haíïti (SDSH) Project found that provision of basic health care through mobile kiosks in the settlement camp tents were an effective way to provide services and messages. Educational messages and oral rehydration solution (ORS) therapy are now being delivered via these kiosks. In addition, SDSH distributed cots, buckets, bleach, bottled water, and ORS to combat the disease.

I recently visited Haiti and had the opportunity to meet with some local Haitian non-governmental organizations supported by MSH’s Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project, as well as the central Ministry of Health, and departmental Ministry of Health offices. I was searching for information in an effort to learn more about how Performance-Based Financing (PBF) has affected service delivery in Haiti. The SDSH-supported facilities produce monthly service utilization reports that capture the important information, but I’ve been working to obtain comparable information on other facilities. My first thought was the Health Information System (HIS) Unit at the Ministry of Health (MoH).

Ryan Cherlin, USAID, wrote this blog after a recent visit to Haiti. This blog post was originally posted on USAID's IMPACT Blog.

A woman holds one of the USAID hygiene kits at a Cholera Treatment Center on Thursday, Oct. 28, in Verrettes in the Artibonite department of Haiti. The center, run by USAID partner International Medical Corps, opened earlier this week.

 

When a Haitian says, Dí¨yí¨  mí²n gen  mí²n, they mean to say, as you solve one problem there is always another that must also be solved.

Driving through the densely populated city of Port-au-Prince I wondered how many times this old proverb was the subject of conversation this past year.

In the months following the earthquake in early January 2010, Haitians endured the devastating effects of hurricane Tomas, political instability and violence stemming from a presidential election, and a cholera epidemic.

Dr. Florence Guillaume, Deputy Chief of Party for MSH's Santé pour le Développement et la Stabilité d'Haíïti (SDSH) Project reflects on the year since the Haiti earthquake last January 12 in this video.

SDSH is a USAID-funded health project in Haiti supporting decentralization, strengthening public-sector capacity in service delivery, and supporting local nongovernmental organization service delivery.

Prior to January 12, 2010, Management Sciences for Health’s Leadership, Management and Sustainability Program was working with Haiti’s Ministry of Public Health and Population to build capacity in several areas:  family planning and reproductive health; commodity management and security; coordinating HIV & AIDS awareness and community mobilization activities; and leadership development.

But after the terrible earthquake of one year ago, we who normally promote leadership in the health sector were faced with our own leadership challenges:  how to continue to lead and manage our program effectively during an ongoing crisis, and most importantly, how to ensure continued help to those who rely on LMS support. Our immediate priority:  dealing with the collapse and destruction of our office.  For months, we worked out of large tent constructed next to the LMS warehouse, a reminder everyday that many of those we were serving had been forced to move into temporary shelters.  

Haiti, One Year On: Realizing Country Ownership in a Fragile State

Tuesday, January 11, 2011, 3:00-5:00 p.m., B-340, Rayburn House Office Building, Capitol Hill
This Washington DC event will be webcast live. You can tune in and join the discussion, below, starting at 3:00 p.m.

Dr. Florence Duperval Guillaume, MSH’s Deputy Chief of Party and Technical Director, Santé pour le Développement et la Stabilité d’Haíïti, will be discussant at this Oxfam America-hosted policy discussion to examine aid effectiveness in Haiti within the context of country ownership. Other speakers will include:

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