HAITI: PRISMA's Integrated Approach to Health

Through the integrated approach to health adopted by the Project for Integrated Management of Maternal and Child Health in Artibonite, otherwise known as PRISMA, over 90,000 children aged 0-5 have access to quality health services that are respectful and responsive to their rights and needs in the Artibonite region.

Drawing on its many years of experience in designing and implementing international health projects, as well as on internal assessments, CCISD’s team knows that improved healthcare service delivery alone does not necessarily lead to an increase in service utilization. For this reason, the PRISMA Project was designed according to an integrated approach to healthcare that strengthens not only health systems and healthcare institutions, but also community-based support.

In relation to child health, this approach is implemented through two complementary components. First, PRISMA focuses on quality obstetrical care for mothers and newborns for the purposes of promoting the healthy birth of children and reducing neonatal mortality rates. Then, it applies the Integrated Management of Childhood Illness (IMCI) strategy, promoted by Haiti’s Ministry of Public Health and Population (MoPHP).    

The IMCI strategy takes into account various factors that put children’s health at risk. It promotes preventive and curative elements that are implemented by families and communities, as well as by health facilities.

At the family and community levels, the success of the IMCI strategy is conditional upon the work of Multi-skilled Community Health Workers (CHW) whom, on top of strengthening the relationship between communities and health facilities, provide families with basic preventive services and guidance. CHWs also promote the adoption of key measures for improving child growth and development; disease prevention (i.e.: vaccination and growth monitoring); referral and assistance regarding institutionalized care, including assistance to pregnant women; and more.

In health facilities, the IMCI strategy ensures the accurate identification and appropriate treatment of childhood illnesses. It is also making upgraded care possible by ensuring that the right tools and equipment are being used, that the best practices are applied, and that the medicine and different vaccination and nutrition inputs are managed properly.

Promising results

Working together with the MoPHP to strengthen the maternal and child health program’s management, PRISMA contributes to increasing mothers and children’s access to quality healthcare.

Since it began, the project has provided support to improving the quality of obstetrical care and the implementation of the IMCI strategy by many ways, such as supporting the construction and restoration of health facilities, strengthening the medicine and input supply, donating equipment and training healthcare providers and CHWs.

Already, more pregnant women are seeking facility-based obstetrical care in the communities supported by the PRISMA project. In the end, this increase in service utilization contributes to preventing neonatal deaths.

The extent to which the different IMCI strategy interventions are implemented has also progressed. In 2014, 86.5% of the activities were carried out, while the year before, 83.5% of them were. Although small, this increase has had a positive impact on children’s health.

The same goes for the outreach strategy implemented by the CHWs in the three communes supported by PRISMA. Over the last years, a growing number of mothers and children aged 0-4 have taken part in the community gatherings organized by the CHWs. All in all, 55.4% of pregnant women and 71% of children aged 0-5 in the targeted communes have been reached. On the other end, 20 170 home visits have been conducted.

''It is the first time someone [speaking of CHWs] comes to talk to us about health in our area. We are thankful for the health worker PRISMA has provided us with'', said a member of the Atrel community, a remote locality of the Anse Rouge commune.

According to the project director, Martine Bernier, the increased presence of CHWs at the community level has largely contributed to improving families’ knowledge, children’s vaccination coverage, as well as their growth and nutritional status monitoring.

''In a year, the vaccination rate of boys and girls under 12 months went from 45.2% to 50.7. We have also witnessed an interesting increase in the amount of boys and girls the same age being weighed every month. The percentage has gone from 22% to 47.3%'', she said. ''These are encouraging results that confirm the potential of an integrated approach to health''.

This integrated approach goes beyond the efforts dedicated to the implementation of the IMCI strategy.

Over the last three years, PRISMA has supported complementary microprojects that aim to prevent the spread of diseases and improve children’s living conditions. In fact, through 45 water and sanitation initiatives, it has provided schools with latrines and improved the drinking water systems of communities.

PRISMA is very well received by key stakeholders, such as local authorities, health care institutions and population. Thanks to its holistic take on health, it was able to adapt its interventions to the local context for the benefit of Haiti’s child health.




Photo Credits: Émilie Drolet