SDSH

People of Haiti: We remember your struggle. We applaud your success. We reaffirm our commitment to work, shoulder to shoulder, to support your efforts to improve health …

This year marks the 5^th anniversary of the catastrophic earthquake (January 12, 2010) that devastated Haiti’s already-fragile health system. For the next several weeks, we are featuring Improving Health in Haiti: Remember, Rebuild, a blog series of retrospective and fresh content based on MSH’s thirty-plus years of working shoulder-to-shoulder in partnership with the people of Haiti to strengthen and rebuild the country’s health system.

Marie Madelaine Thomas receives antiretroviral therapy through an SDSH-supported clinic. Since August 2012, SDSH has provided ART to more than 3,665 individuals.

In recent years, Haiti has endured some of the greatest misfortunes in its history, including hurricanes, floods, the devastating 2010 earthquake, and the cholera epidemic that followed. These natural disasters and public health crises have added to the harm already caused by the country’s widespread poverty, social and political unrest, and under-resourced health system. Haiti’s fragile population is further plagued by the highest HIV prevalence in the Western Hemisphere at 1.9 percent, which translates to roughly 120,000 HIV-positive individuals and 93,000 children who have lost their parents to AIDS (UNAIDS, 2011).

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.

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).

January 12, 2011 marks the one year anniversary of the earthquake that devastated Port-au-Prince, Haiti. I have the good fortune of visiting MSH’s USAID-funded SDSH (Santé pour le Développement et la Stabilité d’Haíïti) project team in Port-au-Prince this week, and I traveled out into the city to see the devastation the earthquake caused.

It has been a catastrophic year for Haitians. The Haitians themselves say this, a people who are used to dealing with poverty, combined with yearly hurricanes, and near constant political instability. However, one thing has been made clear to me in the past few days that I have been on this island: Life Goes On.

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.

(Read Part I)

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.