Previous

As healthcare planners increasingly make quality of care a priority in reproductive health (RH) care programs, Haiti is one of the countries that is taking a leadership role in addressing issues of quality in RH services. Applying lessons learned from the quality movement in industry and medicine, RH healthcare staff are adapting quality approaches for their programs. One of the most important principles to support this movement is putting clients’ needs first.

If the healthcare system is to meet the needs of RH clients, they must be given access to a full range of contraceptive methods and have the right to choose a preferred contraceptive method. In Haiti, one of the greatest challenges for national RH planning is how to bring services to poor, hard-to-reach and high-risk groups. Presently only 25% of the population has access to health clinics that offer at least four contraceptive methods. The government, donors and health community recognized the need to improve quality of services and came together on the eve of the new 5-year bilateral program to make recommendations for improved RH services for Haitian women and families.

From 15 to 17 November 1999, a Quality of Care (QoC) conference was held at the Xaragua Conference Center outside of Port au Prince, Haiti. Dr. Jean-Robert Brutus facilitated the workshop with a panel of Haitian leaders for 50 participants from the public and private sectors. AOPS (a Haitian service delivery organization), Family Health International (FHI) and JHPIEGO, with USAID support and Ministry of Health (MOH) collaboration, sponsored the workshop. Staff from the bilateral program [(HS-2004/Management Sciences for Health (MSH)] and INHSAC (a Haitian public health training institution) also played important roles in planning and logistics.

Highlights of Conference Recommendations

• Disseminate the national service delivery guidelines (SDGs) by January 2000 (recommended by 5 of the 6 groups).

• Produce visual aids for service providers highlighting key information in FP/RH from the SDGs.

• Promote use of the SDGs by service providers.

• Increase and improve quality supervision (involving updates with those who supervise).

• Standardize a 5-day training course in infection prevention (noting that the MOH has promoted use of 5-day infection prevention courses to ensure a more thorough understanding of infection prevention).

• Conduct training and increase advocacy for the improvement of infection prevention practices.

The private and public sectors work together in Haiti to develop recommendations for improved quality of family planning services. Dr. Ernest Viel, MSPP, and Mme Thissy Jacques, MSPP, work with members of the NGO community.

Dissemination of Haiti’s Revised National Service Delivery Guidelines

The MOH also announced the recent launch of its revised national SDGs, sponsored by MSH, which marks the first revision to the Haiti SDGs and the first MOH effort to disseminate the SDGs nationally. The tentative dissemination plan approved by the MOH is to:

• Officially present the SDGs to international agencies, the central directorates of the MSSP (Ministry of Health and Population Services), professional associations and teaching hospitals, medical and paraprofessional schools.

• Conduct a workshop to present the manual of norms to department leaders and instruct them in the use of the manual through training and supervision, focusing on the document’s most essential elements.

• Conduct a workshop with heads of institutions, service providers and local nongovernmental organizations (NGOs) to present the manual of norms at the departmental level. Instruct these workshop participants in use of the manual through training and supervision, focusing on the document’s most essential elements.

• Develop visual aids to support the use and application of the norms in the field.

• Assess the usefulness and impact of the norms.

Followup to the QoC Conference

A followup committee will coordinate and synthesize workshop recommendations. This group will also draft a final report with realistic recommendations. The brief report will be shared with all participating agencies. After this, it is hoped that these participating agencies will advocate for meetings at the local level to translate these recommendations into action plans at their respective service delivery sites. Advocacy with the MOH to continue leadership in the QoC initiatives is also vital to the forward momentum for improved quality of care services.

---

 

Contraceptive Pearls Progestin-only pills and breastfeeding Q: I understand that if a breastfeeding woman wants to use oral contraceptives, it is best that she use progestin-only pills (POPs) rather than estrogen-containing oral contraceptives, but I’ve heard that POPs are not very effective. How effective are they? A: Very effective when taken during breastfeeding. The beauty of it seems to be that there is something of a synergy between the contraceptive effects of the POPs and that of breastfeeding. FHI conducted a very large clinical trial of POPs in 22 facilities in Africa, Latin America and the Caribbean. Women had a variety of breastfeeding practices and some were already menstruating. The life-table pregnancy rate was 1.2 per 100 women. Source: J Shelton, HPN Office, USAID/Washington Dunsen TR et al. 1993. Contraception 47: 23-35. Spermicides and STDs Q: I’ve heard spermicides may be protective against STDs such as gonorrhea. Is that true? A: Yes—at least against some STDs, although the protection is only modest. The weight of evidence indicates that methods with adequate nonoxynol-9 (the most commonly used spermicide) protect against the bacterial STDs such as chlamydia and gonorrhea. The reduction in risk is only on the order of about 20% or so across studies. While this level of protection is not great, it may at least offer some protection that women can themselves control. Source: HPN Office—USAID/Washington

More

Back to MAQ Bulletin