Securing Access to Reproductive Health and Family Planning in Post-Earthquake Haiti: A Conversation with Sandra Guerrier
MSH spoke with Sandra Guerrier, Ph, MSc, project director for the USAID-funded Leadership, Management & Sustainability Project in Haiti (LMS Haiti)—one of four MSH projects in the country.
Tell us about LMS and MSH’s presence in Haiti.
LMS started in Haiti in 2008 and has contributed towards building the capacity of the Haitian people to anticipate and respond effectively to challenges related to HIV and AIDS, reproductive health commodity security (RHCS), and family planning. Since 2012, the primary focus of LMS has been to strengthen local capacity to manage the supply chain of USAID-donated condoms and family planning commodities; and reinforce the capacity of the two Ministry of Health‘s central Directorates to manage commodity logistics in order to facilitate the delivery of quality family planning and other health services at the major public sector hospitals.
MSH currently has 4 projects in Haiti: In addition to the LMS project; we have the Supply Chain Management System (SCMS) that manages the supply chain of HIV and lab equipment; the Santé pour le Développement et la Stabilité d’Haiti (SDSH) project that mainly focuses on increasing the availability of essential social services and supports local service delivery organizations through performance-based contracts; and finally the newcomer, the Leadership, Management and Governance (LMG) Project, which focuses on strengthening the Ministry of Health’s management systems and practices including contracting mechanisms and health referral networks coordination. The four projects share three central strategies: supporting governance; capacity building and training for health systems strengthening; and supporting and strengthening supply chain management.
How does LMS address family planning needs?
LMS distributes USAID-funded family planning commodities, including oral contraceptives, interuterine devices and natural methods, such as cycle beads. LMS stores the commodities in a central warehouse located in Port au Prince and manages active distribution from the point of entry at the warehouse, directly to an average of 300 US Government (USG) sites that have functional family planning services. Monthly distributions are made throughout the 10 departments in Haiti. Last year more than 800 deliveries were made: 29,909,500 condoms; 874,250 Depo-Provera; 524,874 cycles of Microgynon and 6,293 Jadelle implants are among the commodities distributed at 279 USG sites.
LMS also works to strengthen the ability of personnel at all USG-supported sites and at the ministry level in the departments to manage the supply chain from pick up of commodities, to quantification of needs, to compliance with USG family planning regulations, tools utilization and management of stocks.
Within the Ministry of Health, there are around 599 institutions that provide family planning services. LMS has a direct impact on the 300 or so USG sites, where we take commodities stored in the regional warehouse in Port au Prince to each of these facilities. The remaining facilities get access to the family planning methods and condoms (that are funded through UNFPA) at the regional warehouses called Centre Departementaux d’approvisionnement en Intrants (CDAI), departmental Offices called Bureau Communal de Sante (BCS) or hospitals. LMS supports the Ministry in the transportation of those commodities from the central warehouse, called PROMESS, to all the CDAIs and facilities I just mentioned. Consequently, all the functional MOH warehouses in each of the 10 regional departments maintain supplies of all of the family planning commodities. Local facilities can go to the regional warehouses in their departments and supply themselves with the family planning commodities. Thus you have family planning commodities available in all regions.
How does the LMS presence play out on the community level?
LMS does not work at the community level: this was the mandate of our other MSH project in Haiti, Santé pour le Développement et la Stabilité. But we regularly go on supervision visits to the USG sites and, as I said earlier, do monthly deliveries of family planning commodities throughout the country. LMS also conducts trainings on Commodity Logistics & Management using the national curriculum for family planning logistics training, health information systems, and USG policy and legislative requirements for family planning to health care workers.
The focus of LMS training is on those individuals directly involved in supply chain management. At the facility level, our health care workers are commodity managers, warehouse supervisors and auxiliary staff involved in the supply chain for family planning commodities. Last year, more than 243 individuals were trained. We have a good relationship with the MOH at the centralized level but also at the departmental level, and this is a plus for us.
One key has been the good communication we maintain with communities where we work: One of our employee said that “The site managers, including those in the community, appreciate and applaud the frequency of our inspections and regular deliveries of family planning commodities.” The site managers said that “LMS/Haiti’s active distribution allows local workers to avoid traveling to the capital to access services. The people in the community trust us; they communicate and understand what they are doing and often offer help transporting the commodities where access is difficult and you have to go by foot.” The site personnel know the LMS team. They know they have a partner in us when we come into the field. This is a big plus for us and for the health system, as well as for the MOH.
Still it’s a challenge every day Haiti is a country prone to crisis—either political or environmental—so you never know what to expect. On January 7, 2010 we had the devastating earthquake. The same year, we had a nationwide cholera outbreak in October. The earthquake generated more pressure on the already weak health system. What used to be a priority suddenly became a crisis or an emergency, of humanitarian proportion, a matter of life and death. The traditional network structures were dismantled and deficient for provision of emergency care. We witnessed the emergence of camps and shelters and since there were no contingency plans for facing a disaster of this magnitude, the priorities were shifted from health to survival.
There were lots stakeholders taking initiative—but without proper coordination from the authorities. Reduplicated efforts around the same problems made it difficult to accomplish meaningful results and efficient decision-making. But despite all this, LMS made sure that adequate coverage of family planning needs was rapidly in place. We immediately brought supplies to the USG network and the MOH’s central distribution sites in order to make the commodities available to everyone.
LMS/Haiti also transported cholera commodities such as chlorine tabs, oral rehydration salts, antibiotics, and disposable medical materials to the CDAI’s .This targeted support helped ensure that donations for cholera relief were well managed throughout the national distribution system, from the central level to the service delivery points, and that cholera patients, including HIV and AIDS patients, received the donated cholera commodities.
The coordination with the MOH’s Directorate and other USG partners working to strengthen the national commodity chain management and distribution systems is a real challenge. There’s a lot of staff turnover at the central and at the site level. Sometimes you come to the health facility and it’s not the same person that is now in this strategic position or that individual is not the right person for that position and you have to start the training all over again.
You are a pharmacist by training. How did you end up in public health and family planning?
I think I always wanted to be in health because of the background of my family. My father and brother are both doctors, even though I was never fully comfortable with practicing medicine myself, which led me to being a pharmacist.
I was born and raised in Canada, and I first came to Haiti as an adolescent and saw all this poverty that I wasn’t used to. I could not understand how you could see so much misery and luxury coexisting at the same time. Even though I knew I could not change the world, I always wanted to make a difference somehow. After my studies at the Faculté de Médecine et de Pharmacie in Haiti, I worked in the private sector for four years as a pharmacist at a local manufacturer, one of the two or three companies, that does medicines at low cost.
Next I went to work with the World Health Organization (WHO) for 12 years in their essential drugs program as the pharmaceutical Department Chief. I was more in touch with the field and had real, technical interactions with the Ministry in Haiti and gained understanding of health services and project management.
With LMS, the primary mandate was for family planning. I learned a lot about women’s health and rights. I have connected with the people and have done many more field mission than I ever did while working in PAHO/WHO. I’ve learned that how small steps can make a big difference. The approach we had with the LDP towards health professionals was also an interesting experience.
What has LMS learned about addressing family planning needs in the wake of the earthquake and cholera crises?
After the earthquake in 2010, the LMS office was destroyed and we maintained the LMS warehouse inside a big tent. Many of us were afraid to go inside the warehouse. But there was a team spirit that united us and we stood together. We couldn’t let the changes we had made waste away.
One of the main challenges post-earthquake was the coordination among partners and organizations that were supporting the Ministry. When we have institutions or organizations that are doing logistics, distribution, supply chain, order requests, we must coordinate ourselves in order to really have a pertinent and firm result in family planning.
After the earthquake, you know that we had an emergence of camps, of shelters. Everyone was doing everything and anything at the same time. There was condom distribution in the camps—but those organizations that were doing that had no coordination with the MOH, so the authority didn’t know what was going on. We had an emergence of small mobile clinics, and those partners were delivering family planning services throughout the camp or throughout the shelters—but the Ministry wasn’t aware of that either. And the ministry itself was not coordinated within the different entities.
Were there lessons learned from earthquake response that were valuable for responding to the cholera outbreak?
Yes, I think that we had a better understanding of what the situation in time of crisis is. We had a strong communication channel with the MOH, which is why, at the time of the cholera outbreak, we were one of the first partners the MOH approached to get support with logistics as well as with programs. We helped them put into place clusters in every department. We had pharmacists and logisticians stationed in each department in Haiti, whose work was to evaluate all the donations, all the commodities that were received in Haiti for the cholera outbreak and to do a proper inventory of what was on site and what was being distributed—so that the ministry could have information concerning what was in the country.
Those pharmacist logisticians were placed in all regions in Haiti and were a support that the Ministry really appreciated. We helped the Ministry have information, really exact information, concerning the commodities that were received during the cholera outbreak.