Improving maternal and child health under the Muskoka initiative

The Grand’Anse department is a mountainous agricultural region whose health situation is marked by infectious and parasitic diseases and nutritional deficiencies. Cholera has become endemic. Child health is seriously affected (46% of children under 5 suffer from a fever syndrome).

The South department is mainly rural (78%). It is an area prone to risks of flooding and cyclones. The high level of deforestation, combined with marked poverty and high population density, makes the region extremely vulnerable to climate hazards. The department remains underserved in terms of health.

The Northwest department is very isolated. This rural department is characterized by vulnerability to climate hazards (drought), deforestation and erosion. The remoteness from health centers and poor quality of the road network pose a real problem in terms of access to healthcare. Less than 30% of childbirths take place in a health structure.

In 2015, AFD launched a call for proposals concerning a project to improve maternal and child health in the Grand’Anse, South and Northwest departments. A consortium led by Médecins du Monde was selected for the project implementation. This group has strong expertise in mother and child health and family planning. The project includes a gender-based component on violence, which is highly prevalent in Haiti. It fits in with the commitments made by France in Muskoka in 2010, which aim to increase France’s contribution to achieving Millennium Development Goals 4 (reduce child mortality) and 5 (improve maternal health).

The project aims to improve maternal and child health:

• Build the community’s capacities in order to encourage people to seek out maternal and child healthcare (MCH) and family planning (FP) and promote sexual and reproductive rights: provide effective access to MCH/FP healthcare, which will be increased by the activities to strengthen health centers and structure referral systems.
• Improve the quality of health structures and upgrade their mother/child and reproductive services: 21 health structures have been pre-identified (7 for each department). The strategy will be based on a skills transfer at several levels: Strengthen the departmental health departments and district health centers (DHC) to provide the population with access to high-quality and appropriate MCH/FP services.

This project aims to develop a major institutional support component for the health authorities. The institutions will receive technical and financial assistance in order to build their capacities to conduct and supervise the MCH/FP activities. Gender/adolescent health, integration of psychosocial issues: Gender-related violence is widespread in Haiti. 13% of women have been victims of sexual violence during their lifetime and 28% of women aged between 15 and 49 have been victims of physical violence. The project will take psychosocial issues into account in a cross-cutting manner. Nutrition: The project will work on malnutrition prevention, in conjunction with the Nutrition Strategic Plan 2013-2018: focus on prevention and awareness-raising activities, by integrating prevention and detection into reproductive health (RH) services. Special attention will be paid to the level of post-natal consultations.

• Reduction of maternal-child mortality rate, with an improvement in care before, during and after childbirth and greater financial and geographical access to care;
• Consolidation of a healthcare and referral system that is inclusive at all levels of the health pyramid and strengthening of health departments; Increase in access to and the use of MCH/FP services;
• Reduction of the geographical isolation of the hardest-to-reach communities by improving referral systems and supporting the most remote health centers;
• Greater community participation in national policy choices.