A Forgotten Remote Health Center Gets a Second Chance

Ensuring the quality of care in health institutions, especially of those in hard-to-reach areas, is a constant source of concern for public health authorities in Haiti. The Morne à Brûler health center, located in the third communal section of la Vallée de Jacmel, 100 km southwest of Port-au-Prince, is an example of this challenge.

Although the health center should have been serving a catchment population of 10,267 inhabitants, it was nonoperational for three years. The staff were not providing the quality of care expected by the community, who found they lacked professionalism and proper bedside manner, and as a result, the community forced the staff out. In a situation like this, how can the government regain the trust of its population and ensure proper management within health institutions?

Interestingly, the COVID-19 pandemic served as a catalyst to help answer this question. Haiti’s Ministère de la Santé Publique et de la Population (MSPP) is aware that the pandemic has led to the disruption of health services, threatening the continuity of care for common illnesses that constitute the highest percentage of morbidity and mortality in the country. As such, the MSPP, with support from the USAID Health Leadership Project (HLP), organized a joint mission to assess the quality of services provided by health institutions in the different departments.

The MSPP requested both financial and technical support from HLP to carry out this work. HLP trained managers at the central level on the behaviors that supervisors should adopt when supervising medical staff; on building teams to conduct activities in the field; and on updating supervision tools, such as adding checklists for mission visits.

It was during this mission that Dr. Ted Lazarre, a Technical Manager of the MSPP’s Direction d’Organisation des Services de Santé (DOSS), discovered that the health center of Morne à Brûler had not been operating for three years. This created a hardship for this community, most of whom could not afford to pay for transport to the nearest health center, and instead had to walk for two hours in each direction to access care.

Eager to ensure access to quality services for the population, drawing upon HLP’s training, Dr. Lazarre and his team applied good governance practices, such as engaging stakeholders, establishing a common vision, and promoting proper management of resources to respond to this challenge. With support from HLP, the team organized a community meeting with religious and departmental leaders in the area to identify and agree on a sustainable solution and way forward. Together, the community was able to set a date for reopening the facility, assign roles and responsibilities for cleaning the center, and make available the necessary human and material resources.

HLP provided vital support in coordination efforts between members of the health teams and the departmental directors to get their approval at the different steps needed to reopen the center. The departmental management teams and the community agreed that during this time, health staff from the nearest health center would come to work at the health center two days a week on a rotational basis to ensure continuity of care. Thanks to the fact that the building and the equipment had remained in very good condition, and that there remained adequate stock of unexpired medicine and supplies, the center was able to open its doors in just one week. The population has since been able to benefit from the services offered by the center, including vaccinations and consultations with general practitioners.

Dr. Lazarre, observing the results of his team’s intervention, is delighted with the work that has already been done:

“This work made me feel useful. I can see the concrete results of this assessment visit for the population. This assessment contributed to a better evaluation of the needs and constraints of the center to improve the health of the population.”

As a result of the contact established with the DOSS, the commune now has the tools and resources to continue discussion and negotiations with the MSPP to ensure that well-trained health personnel will be permanently deployed to work at Morne à Brûler. The actions of Dr. Lazarre and Morne à Brûler community leaders have shown that “men anpil, chay pa lou” (many hands make light work).