FPA-65

Final Project: Consultation Report

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Introduction

This project focuses on the health changes in Haiti as well as the analyses the its impact on the general health of the Haitian. According to World Health Organisation (2018), Haiti is considered as the poorest country in the Western hemisphere and it is ranked 68th on the UNDP Human Poverty Index scale. More than 65% of the Haitian live under the national poverty line. Like several other underdeveloped or developing countries, Haiti is affected with global health challenges such as high rate of non-communicable diseases associated with deaths as well as childhood (under the age of five) mortality and maternal mortality. Despite the fact that the rate of maternal mortality has reduced between 1990 to 2013 by 45%, maternal mortality continued as one of the major health challenges affecting individuals in the Western and Caribbean area with a significant rate of 350 per 100,000 live births (Douglas, 2018). Considering the fact that the global maternal mortality rate has decreased to 210 per 1000 live births, it has become obvious that Haiti needs immediate and effective intervention to help reduce their rates. According to Shah (2018), it is identified that a woman dies from childbirth in Haiti every 20 minutes.

Core determinants of health: There are wide range of health determinants of the Haitian population affecting the global health challenge. In terms of high maternal mortality rate, there are several health determinants affecting the population. First, cultural factor is considered to play a vital role maternal mortality rate because seeking prenatal care is not a norm in countries such as Haiti. In Haiti, the process of child-baring is considered as a natural occurrence and where the support of a trained professional is not sought specifically in the rural areas. Secondly, social factors such as access to healthcare. In Haiti, several women experience various challenges in accessing healthcare and these challenges could be time, cost, transportation, economic accessibility and physical accessibility. According to White et al (2016), about 50% of rural Haitian women were unable to access healthcare facilities, while 83% could not access healthcare because of financial constraints. Other health determinants affecting the Haitian population is lack of education, as the study by White et al (2016) identified that women are not aware of the reason why they die during their pregnancy period and some other studies identified that high level of education is associated with the possibility of making use of maternal health services as we;; as having a skilled birth attendant during childbirth.

Root causes and negative outcome: There are several factors contributing to high maternal mortality rate around the world. According to Hagaman (2013), the direct cause of death accounted for about 86% of all maternal deaths around the world in 2015. However, the root cause of this maternal mortality has been traced to maternal hypertensive disorders, unsafe abortion procedures, obstructions and complications during labour as well as haemorrhage. In 2016, direct complications resulted for about 87% of the total death in Haiti.

The Global Health Problem

Intervention components: There are wide range of components designed and implemented programs to reduce and mitigate the rate of maternal mortality in Haiti. First, various education programs were developed to improve the knowledge of women on the importance of prenatal and antenatal checks during the period of pregnancy. In addition, the program has also improved the knowledge of women in seeking for trained childbirth attendance during childbirth so as to prevent any complications. The government has also developed more healthcare facilities with more trained professionals such as midwives to improve the accessibility of Haitian women to healthcare services. In addition, more private clinics and NGOs who provides low-cost service has been developed to help women especially low-income and mid-income population to access healthcare services. Although this developed component has been effective in mitigating maternal mortality rate in Haiti, there are some factors influencing its effectiveness such as; financial constraints.

Stakeholders

There are wide range of stakeholders involved in addressing the issue of high maternal mortality rate around the globe including Haiti. The World Health Organisation has successful developed and implemented programs to reduce and mitigate the rate of maternal mortality in Haiti. First, various education programs were developed to improve the knowledge of women on the importance of prenatal and antenatal checks during the period of pregnancy. In addition, the program has also improved the knowledge of women in seeking for trained childbirth attendance during childbirth so as to prevent any complications. The government have also developed some hospitals to provide high quality services such as prenatal and antenatal to pregnant women in Haiti as well as ensured that these women have been properly taken care of by trained professionals such as midwives to attend to them during childbirth. Some private clinics have also been developed to provide similar services to low-income and mid-income Haitian women.

Each of these stakeholders have been significant in addressing the issue of high maternal mortality in Haiti. The World Health Organisation has improved the knowledge of these women to start attending medical check-ups such as prenatal and antennal during pregnancy. The public and private hospitals have provided low-cost healthcare services to these women and have also ensured that they are properly taken care of by trained professionals such as midwives. The developed private clinical haves partnered with NGOs to reduce the cost of healthcare provided to these individuals. The aim of this partnership is to encourage as well as enable low-income and mid-income women to access these healthcare services. There are wide range of obstacles experienced by stakeholders in addressing the global issue of maternal mortality and these includes; financial constraints, resistant of treatment by some women as well as inability of the stakeholders to access some areas such as the rural areas.

Stakeholder (affected populations): Considering the issue of increased maternal mortality Haiti, several stakeholders have contributed in one way or the other to ensure that this public health issue is resolved. However, the immense contribution of these stakeholders of the affected population has made it possible for health facilities to be easily accessible. Their involvement has also improved the knowledge of women especially pregnant women on the importance of hospital visits before, during and after pregnancy to decrease the incidence of infant and maternal mortality. Their involvement has made the cost of healthcare services low thereby making possible for the deprived population to afford their healthcare services.

Evidence-Based Intervention

There are wide range of interventions developed to address the global health issue of high rate of maternal mortality in Haiti and these interventions have been effective in addressing the health issue to some extent. However, these interventions include;

Training traditional birth attendants: According to Bergstrom (2011) several childbirths in Haiti are supported by traditional birth attendants (TBAs) who gain their skills through apprenticeship and experience instead of going for formal training that is characterised as skilled birth attendants (these are nurses, midwives and doctors). The World Health Organisation has established wide range of programs to provide short-training and educational courses to TBA in order to educate them on how to respond to minor complications as well as identify major complications and refer them to appropriate professionals. According to WHO (2018), these training exercises provided to TBA have been able to minimise maternal mortality rates. On the other hand, Carroli (2017) revealed that there is insufficient strong evidence regarding the fact that training TBAs is an effective approach to minimise mortality rate in Haiti. However, the evidence available revealed that TBA-training improves the general knowledge among TBAs and may minimise infant mortality but does not have a significant effect on maternal mortality (Kidney, 2009). Furthermore, the study by Piper (2017), aimed at identifying the relationship between TBAs training and maternal mortality. Findings from the study identified that improved TBA training did not result to significant decrease in the rate of maternal mortality but led to a slight decrease in the new-borne mortality. Therefore, it was difficult to conclude that TBA training reduces maternal mortality due to several reasons such as lack of medical services to which to refer women with major complications, training that is insufficient to give TBAs the skills to perform life-saving interventions and barriers to learning resulting from lack of formal educations among TBAs.

Skilled birth attendants: The number of skilled-birth attendants have been increased in wide range of health facility to minimise maternal mortality (Levine, 2017). The available evidence on the use of skilled-birth attendance mainly dependence on non-experimental analysis and it is still not clear if or by how much it may minimise maternal mortality. Findings from the available studies revealed that increased in the number of skill-birth attendants has slightly reduced maternal mortality but not to a large extent (Levine, 2017). The challenges associated with the intervention of improving the number of skilled-birth attendants in health facility is inadequate supply of quality doctors and midwives, lack of health facilities to which to refer complicated issues and reluctance among women to make use of such services.

Clean delivery kits: According to WHO (2018), about 15% of maternal mortality were as a result of infections. Programs to provide clean delivery kits were implemented to minimise infections among women who are delivering at home and in health centres and among their infants. According to Graham (2017), a clean delivery kits should contain clean razors and cord ties for cutting umbilical cord, soap for washing vagina and hands, plastic sheets for creating a clean delivery surface and a pictorial instructions sheet for directing mothers and their attendants on how to make use of some other items contained in the kit. Therefore, findings from Graham (2017) identified that maintain a hygienic and clean delivery kits reduces infant and maternal infections and at the same time reduces infant and maternal mortality. The weakness of this intervention is that clean delivery kits may be contaminated and thus, gets mothers or infants inflected during the period of use.

Ethical considerations: While implementing the interventions to address the issue of increased maternal mortality, there are wide range of ethical considerations should be made. First, the decisions and choices of the women involved should be respected. Also, the laws and legislations guiding the practice of immunization and vaccination should be complied with. The right of every individuals involved should be respected while implementing the laws.

Recommendation

Considering the high level of maternal mortality in Haiti, wide range of interventions has been developed to bring the rate to a minimal level. Although these interventions have been effective but can be improved to offer a better service to the Haitians. To improve the provided intervention, the following recommendations has been made:

· It is recommended that skilled care should be provided to mothers before, during and after childbirth. In addition, they should be encouraged to have various antenatal care visits where they should be attended to by skilled care workers. This service should be made free if possible or should be of low-cost because many Haitian women have no access to such services due to poverty.

· It was identified that most of the Haitian women in the rural areas were attended by unskilled birth attendant and this was the major reason for high maternal mortality within the region. Therefore, it is recommended for educational programs be developed to educated them. Some efforts should also be channelled to community mobilization as well as the prediction and prevention of pregnancy complications.

· The level of ignorance was also recognised as one of the major determinants of the high maternal mortality in Haiti, it is therefore recommended that access to basic and higher education for both boys and girls should be made available so as to promote a sustainable development within the country. In addition, the act of improving the level of education will affect the Haitian population positively in several ways such as reducing the level of poverty and at the same time increase gender equality as well as reduce maternal mortality.

Implementation

In order to effectively implement the recommendations to improve the developed interventions, the Haitian Governments needs to build more health facilities especially within the rural areas where such facility is lacking or minimal. In addition, the private and the public health facilities such ensure that they have a well-trained work attendant to attend to women before, during and after childbirths. The World Health Organisation and various other NGOs involved in public health should develop education programs to educate the public (especially women) on the importance of antenatal and regular hospital visits during and after pregnancy. Lastly, the childbirth attendants who are not well-trained should endeavour to attend the training programs developed by WHO to improve their knowledge and skills regarding childbirth and its associated complications.

The level of success of the developed intervention to address the issues of high maternal mortality in Haiti can be measured by comparing the rate of maternal mortality before and after the interventions were established. According to World Health Organisation (2017), the rate of maternal mortality in Haiti was identified to be decrease by 15% since the implementation of various interventions.

Limitations: While implementing the developed interventions to address the issue of increased maternal mortality, some barriers and limitations affected the effectiveness and success of the interventions. First, insufficient financial resources prevented the intervention from being implemented in all areas. In addition, inadequate skilled labour attendants have made it difficult for these interventions to function effectively this is because there are few continuing education opportunities for midwives and nurses to reinforce their skills as well as obtain support from peers and learn about advances in medical care.

Conclusion

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References