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Haiti's Vulnerable Accessing Affordable Health Services

Introduction and Overview

Summary: Haiti is still on the long road to recovery after the devastating earthquake that struck in 2010. While the Ministry of Health is committed to providing care, there is a need to reach some of the most vulnerable that cannot always be filled. By charging a nominal fee-for-service and receiving donor funding, some clinics are able to offer high-quality care to those most in need.

Minister of Health, Dr Florence Duperval Guillaume said in a meeting with PANCAP Director, Dereck Springer, “Social marketing is not to exploit vulnerable patients. It is to ensure that the vulnerable patient is responsible for his or her own health. Social marketing improves the use of the services.” She emphasised the recognition that Haiti needs to eventually become less reliant on donor funding, so clinics that operate on a social franchise model should be encouraged. “We need to reduce donor reliance. At what point can we self-sustain and allow donors to withdraw?” she asks.

Clinics operating as a social franchise can help reduce this donor dependence.

Goal: Sustainable, affordable, high-quality health services for vulnerable populations

Target: Men, women and at-risk youth [Commercial sex workers (CSWs), transgendered persons, men who have sex with men (MSM), economically vulnerable men and women]

Who: The Eben Ezer Clinic and GHESKIOS Centre will be highlighted here.

The Eben Ezer Clinic

GHESKIOS2Population Services International (PSI) receives support from the German Development Bank (KfW) and the Pan Caribbean Partnership on HIV/AIDS (PANCAP) to implement the final stage of the Caribbean Social Marketing project (CARISMA), and transition to sustainable programming for sexual and reproductive health (SRH) in Haiti, the Dominican Republic, and the wider Caribbean region. PSI makes it easier for people in the developing world to lead healthier lives and plan the families they desire by marketing affordable products and services. 

The Eben Ezer clinic in Croix des Bouquets offers a broad range of integrated health services, and is affiliated with PSI, Haiti’s Plis Kontwol social franchise network. Plis Kontwol was launched in late 2013 and has 14 affiliated clinics, including the Eben Ezer clinic. Plis Kontwol clinics offer comprehensive family planning services, cervical cancer screening using visual inspection with acetic acid (VIA) and cryotherapy. According to PSI research, these reproductive health partnership services averted 2,104 unintended pregnancies in 2014.

Services Provided

The Eben Ezer clinic takes a comprehensive approach to health,offering integrated health services. When a woman enters the clinic for a family planning consultation, her provider also offers her an HIV test and cervical cancer screening. If she has children, her provider will re-enforce the importance of hygiene and sanitation to prevent diarrhea. In encouraging a holistic approach to health, the Eben Ezer team helps clients not just to seek treatment, but also to consider prevention.

The Eben Ezer clinic offers antenatal care, delivery and post-partum care. Each service sought is treated as an opportunity to provide integrated care, including information and services related to family planning, hygiene, as well corresponding tests and services.

All clients entering the Eben Ezer clinic are eligible for no-cost, HIV testing, including pre- and post-test counselling. According to the director, approximately 95 percent of clients opt to receive an HIV test.

While the Eben Ezer clinic offers extensive services, it also employs a robust referral service for all of its health intervention areas for tertiary care. Although the clinic provides basic antiretroviral treatment, clients are also referred to more extensive treatment sites for care. 

The clinic has a small pharmacy where clients can purchase family planning methods. In the photo above, Director, Dr Dorcil holds a family planning product provided by PSI. By making affordable family planning options available and stocking a full range of short- and long-term methods, clients who were previously unable to access the contraception they needed are now able to immediately select the method they prefer, thus increasing contraceptive use in the community. Each new user helps to strengthen the total market for family planning products in Haiti and to build the country’s private sector response.

Success and sustainability

The Eben Ezer clinic is a for-profit clinic that offers affordable health services to the surrounding community. Despite operating in an economically disadvantaged area, the Eben Ezer clinic has always charged an affordable fee for services, which are displayed on a standardised price list. At the Eben Ezer clinic, a family planning consultation, including method provision, costs approximately US$5.

By keeping prices low, but recuperating costs and generating a small profit, the Eben Ezer clinic is almost completely independent of donor funding. The only reliance on donors has been for the provision and training of the cryotherapy services, and the provision of family planning options including pills, injectables and IUD by PSI. The clinic is able to pay its staff of doctors and nurses at a rate comparable to other hospitals and clinics, and is able purchase medical supplies. 

Clients are willing to pay an affordable fee to access these services, which may be closer to home than their nearest Ministry of Health Clinic and may involve less waiting. They know they know they are getting high-quality care.

GHESKIO, Institut National de Laboratoire et de Recherches (INLR), Port -au-Prince

Under the direction of Dr Jean William Pape and located across the street from one of the city’s largest slums, dubbed the “City of God,” the GHESKIO (a French acronym for Haitian Study Group on Kaposi Sarcoma and Opportunistic Infections) Centre reaches some of Port-au-Prince’s most vulnerable and at-risk citizens.

Services Offered

The GHESKIO Centre provides a full complement of services to all who come through the doors. For example, any person coming for an HIV test will be evaluated for syphilis and other sexually transmitted infections (STIs) including the human papilloma virus (responsible for cervical cancer.) If the person presents with chronic cough, the diagnosis and eventual treatment of tuberculosis will be done the same day. All are offered family planning services and counselling. Nutritional support is also provided, particularly for women and children.

Because GHESKIO is focused primarily on infectious diseases that can be transmitted within the family, patients are asked to bring their partner and children for evaluation. In this way, Dr Pape and the team can identify more problems earlier and treat them more effectively. 

Dr Pape has been on the forefront of HIV care since the first days of the epidemic. The centre continues to provide testing, care and treatment, including effective prevention of mother-to-child transmission of HIV, neonatal male circumcision, post-exposure prophylaxis and early initiation on to antiretroviral treatment.

In addition to basic health services, the centre offers the local community other interventions to improve overall quality of life. This includes economic opportunities through microcredits and job opportunities and education. There is a primary school and a vocational art school on campus, and over 1000 scholarships provided are provided annually for recipients to attend other schools. Community development is achieved by peer educators who work in the slums to find those needing care and bring them to the clinic. Since they have been working in the community, he reports that the response has been completely positive.

Success and sustainability

Much of the funding for the Centre’s research work comes from competitive grants from Dr Pape’s alma mater, Cornell University, through the National Institute of Health. Support for services comes largely from PEPFAR, the Global Fund and UN agencies. Recently the centre opened a general fee-for-services clinic to recoup some of the costs, and the clients now have a value attached to the care they are receiving.

In the face of diminishing donor funds and global shifts on health funding, the Ministry of Health of Haiti recognises the important role clinics such as these will play. PANCAP sees these models as replicable best practices that other countries can and should adopt. Future collaboration will be planned.

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CMLF News Issue #7
27th January 2016