Blog

Danielle Brown is the Program Coordinator of the Leadership, Management and Sustainability (LMS) project in Haiti. She worked with our teams in Haiti from October 24 – November 14.

River Crossers at Rivií¨re des Barres

 

Last year, the mHealth Alliance and the National Institute of Health (NIH) sponsored their first mobile health (mHealth) “Summit,” at the Ronald Reagan building in Washington, DC. The location was telling: it is the home of the US Agency for International Development (USAID). This year’s mHealth Summit has nearly doubled in size, moved its location to the Convention Center, and is being keynoted by Bill Gates and Ted Turner. It is safe to say that mHealth is certainly a topic de jour. The problem is that the big names---the global mobile phone network providers, manufacturers, pharma companies, and global consulting firms---are all jumping on the bandwagon, but they are late to the game. And the conversations in the plenary sessions highlight the fact that there’s a huge disconnect between the global companies and the on-the-ground implementers.

Blog post also appeared on Global Health Magazine.

PEPFAR Fellow in the field

As the country with the second highest maternal mortality rate in the world, outranked only by India, Nigeria loses one in every 18 women during child-birth. The country also has one of the highest infant mortality rates in the world, one of the lowest life expectancy rates---estimated at 47 years---and the second largest population of people living with HIV & AIDS, with only 30% of people eligible for anti-retroviral treatment able to access these life-saving drugs.

With Hurricane Tomas approaching and the cholera outbreak not yet contained, the Santé pour le Développement et la Stabilité d’Haíïti (SDSH) project, led by MSH and funded by USAID, is working to simultaneously provide health facilities with necessary supplies for the cholera response and also work with local and international partners to prepare for the storm.

Over 100 more deaths from cholera have been reported in the past week, raising the total to 442 deaths and 6,742 hospitalizations. Potential flooding caused by Tomas could exacerbate the outbreak. In the coming weeks, SDSH will train 300 auxiliary nurses, 2,500 traditional birth attendants, and 2,000 community health workers across 147 sites in community-based prevention of cholera.

International and local agencies are working together to secure water, sanitation, and hygiene commodities and shelter, and create communication centers to prepare for the hurricane response.

The SCMS team in Port-au-Prince unload medicines from the SCMS delivery last week.

In late October 2010, the USAID Supply Chain Management System project (SCMS) distributed close to 50,000 lbs of essential products including oral rehydration salts, antibiotics, lab supplies, water treatment and ringer lactate to support Haiti's response to the cholera epidemic. The commodities came from existing stock in the SCMS warehouse as well as products available on the local market. SCMS also provided international procurements of 60,000 IV solution units and 20,000 IV sets.

Antoine Fadoul is the Supply Chain Management System Country Director in Haiti.

A team of experts from WHO, UNICEF, UNFPA, and World Bank recently published a report on maternal mortality entitled “Trends in Maternal Mortality: 1990 to 2008" (PDF).

The document reports some fantastic news about a public health indicator that has until recently refused to budge. That indicator is the maternal mortality ratio, the number of maternal deaths per 100,000 live births. The improvement between 1990 and 2008 is significant and promising.

The part of the report that received much less coverage relates to HIV and its strong, adverse effect on maternal mortality. The authors estimate that in 2008 there were 42,000 deaths due to HIV & AIDS among pregnant women and approximately half of those were maternal deaths. In absence of HIV we would have had 337,000 maternal deaths in 2008 instead of 358,000.

Reeling from Shock

Estama Murat, Director of the Drouin Methodist School, cautiously hopes to reopen: “This obviously will not come easy," he says, "because we have many children still sick and other pupils have fled the village.”

Drouin is in Grande Saline, where the cholera virus was first discovered in the Artibonite department last week. The population of 17,000 is still in shock. Many of them left for the chief town of Gonaives, Mr. Murat explains, or toward Saint-Marc in the Lower Artibonite region.

The Santé pour le Développement et la Stabilité d’Haíïti (SDSH), led by MSH, funded by USAID, has been supporting the Drouin health center for the past three years, to deliver a package of primary health services in maternal and child health and family planning. Through the USAID-funded project, MSH also supports a network of community health workers and traditional birth attendants for community outreach activities, ensuring that the services reach the people in need.

A volunteer nun tending to a chld at the Drouin health centerOn Tuesday and Wednesday, Dr. Serge Conille, the HIV/AIDS technical Advisor of the USAID-funded SDSH project led by Management Sciences for Health, and designated lead of the project's emergency cholera task force, and I visited project-supported health facilities in the epicenter of the epidemic in the lower Artibonite Department (Province).

We drove into the cholera zone over a dirt track through a flat plain of fields, green, but neglected. The road ran parallel to what appeared to be a wide canal, the dikes on either side uneven and crumbling. Later, I found out that this was the Artibonite river, source of the epidemic. It was constrained and channeled some 25 years ago as part of a “whole valley development plan” which included promotion of rice cultivation. The rice is largely gone and the dikes are frequently overrun by the river which floods the surrounding countryside isolating some villages, sometimes for long periods of time.

Fragile states such as Afghanistan, the Democratic Republic of Congo, Haiti, Liberia, and Southern Sudan have among the worst health statistics – especially for women and children.  For political, economic, security and other reasons they can be extremely challenging work environments. Despite this, I have been deeply inspired to see what local health leaders have achieved when they have created strong partnerships among government, donors,  non-governmental organizations and where possible the private sector.  The charismatic former minister of health from Afghanistan, the  medical director of an urban clinic in northern Haiti, and the director of Torit hospital in Southern Sudan stand out as examples of local leadership in action under circumstances that would immobilize many of us.

In fragile states, constraints on governments often prevent them from simultaneously building their stewardship role and immediately expanding service delivery. Supporting the Ministry of Health to establish a basic package of health services, train local organizations to implement those services, and provide incentives (such as through performance-based financing) is critical to success. Additionally, the goal should be to move from many plans and actors across districts to one health plan with committed partners. 

Pages