Partnership for Primary Health Care in Rural Haiti
by Robin C. Davis
Executive Director, Global Health Action
Email: gha@globalhealthaction.org

Effective primary health care is a grassroots activity in which people seeking to meet their own needs play a vital role. The initiative described in this article originated at the local community level. It developed through the collaboration of a local Haitian priest, the Community-based Haitian Pastors= Association that he led, and a private international organization. Together they combined resources to create a program that responded to the needs of the community.

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The president of the pastors= association was the Rev. Octave Lafontant, an Episcopal priest at Darbonne, Haiti. He contacted Robin Davis of Global Health Action (GHA) in Atlanta, Georgia, for help. They met several times with Haitian community leaders and pastors in Haiti to discuss establishing a community health care training program for the Leogane District. Together, the Haitian leaders and Global Health Action designed and implemented the INSA/Haiti Community Health Worker (CHW) Training Program, using the WHO model for CHWs. Program developers based the course content on the main Haitian health problems identified in the government program and the specific health-related issues within the participating communities. GHA added its expertise in developing and designing the curriculum, with emphasis on community participation and project planning, two core content areas addressed in all GHA training programs.

The first class was held in 1982 at an Episcopal facility at Darbonne. To date, more than 800 Haitian community health workers have completed the program. The exciting news is that the demand for training remains strong. Fifty new community health workers complete the training program each year. Trainees now come from all regions of Haiti, including the island of La Gonave. CHWs represent all denominations.

Community health workers learn health promotion and basic health care C how to prevent and treat disease and infection; the importance of hygiene, clean water, immunizations, prenatal and postnatal care; and family planning. With this knowledge, they have the skills to prevent or treat 80% of illnesses that occur. Haitians living in rural communities served by a health worker no longer have to walk six to eight hours down treacherous mountain paths to reach a clinic or hospital for basic health care. In the Leogane District and in Haiti itself, the rate of malnutrition has decreased from 50% to 30%. Cases of tetanus have almost disappeared because of preventive measures taught by CHWs.

What accounts for the 16-year success of this training program which has continued even in times of political and civil unrest?

• The collaborating partners listened to the people in the communities and developed a training program that the people requested and needed.

• Creole, the language of the people, is the language of instruction; the training staff is Haitian.

• A health professional in a local region must endorse the community health worker and provide clinical supervision after training.
• Communities and/or churches identify and select candidates for training.

• Working through existing community church groups strengthens the community network and bond that are already present and functioning within a community. In many rural communities, a church building is the only facility for community gatherings.

• Many health workers often have another job in the community and incorporate health messages in their everyday work, e.g., lay pastor/CHW

• One organization, with a long-term focus on development, has been the primary funding agency.

• The use of methods, technologies, approaches, supplies, and materials that are appropriate for Haiti foster long-term sustainability.

At this time, Sainte Croix Hospital has assumed most of the responsibility for the program; GHA=s role is becoming more that of program evaluator and consultant. As part of this process, GHA conducts an on-site program evaluation every five years. Staff share the results with the Haitian training and administrative staff, as well as with program funding agencies. In addition, key Haitian training and administrative staff have completed GHA=s International Health Management Course in Atlanta, Georgia.

GHA also serves as a link between U.S. churches and the Haitian program coordinator, helping to identify Haitian communities where health training is needed. Through mission outreach programs, U.S. churches often partner with and support specific communities. They learn that training a local health care worker is often a more appropriate way to address the ongoing health needs in a community than sending U.S. work teams for short periods of time. Through health training, Haitians learn to help themselves and their communities on a continuing basis.

What are the challenges to continuing these and similar training programs? The primary funding organization for the health worker program is beginning to limit expansion of its projects in Haiti. The expansion of current programs or the development of new programs will, most likely, require new funding sources. Much of the new funding available today goes directly to the in-country grassroots organization. Thus, enhancing the leadership, management, and fund-raising skills of the Haitian staff is essential for the ongoing success of these projects, as well as for new initiatives. Ultimately, to be successful and sustainable, these projects begin at the grassroots level and are maintained and expanded by Alocal@ leaders. International organizations play a vital role in fostering this process throughout the life of a program.