Mountains and Plains: Exploring Healthcare and Health Inequalities in Rural Haiti Eric Hulsey, MA

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Mountains and PlainsExploring Healthcare and
Health Inequalities in Rural HaitiEric Hulsey,
MA
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Overview

• Contextual Background
• Describe Project
• Previous research
• Methods
• Findings
• PH significance

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Introduction

• Hôpital Albert Schweitzer (HAS)
• Integrated rural health system
• Provides medical care and community health and
  development programs for 285,000 impoverished
  people in the Artibonite Valley of central Haiti.
   

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Project Description

• Inequalities in health and utilization between
  mountain and plains populations
• Explore barriers to accessing healthcare in a
  mountain community vis-à-vis HAS services

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Previous Research

• Geography and utilization (Rosero-Bixby 2004
  Perry and Gessler 2000)
• Trust in quality of care (Russell 2005)
• both personal and institutional
• User fees (Hjortsberg and Mwikisa 2002 Witter
  and Osiga 2004)
• proportional costs between different social
  groups
• Indirect costs (Hjortsberg and Mwikisa 2002)
• travel costs
• opportunity cost (time spent away from farming)
• Assumptions between access and utilization

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Methods

• Identified community of Damier Gesse
• Designed questionnaire
• Partnered with local agente santé (Manu)
• Semi-structured interviews with heads of
  households

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Damier
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Damier
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Damier
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Results

• 41 interviews (20-25 of households)
• Reported microbial etiology of illness
• Nearly all knew how to utilize HAS services
• All had visited the dispensary
• Most had visited the hospital

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Geographical Barriers

• Dispensary reported to be close
• not too far, when youre sick its far
• Hospital reported to be far
• send doctors closer to us, ..to school for the
  kids

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Perceived Quality of Care

• Most reported feeling better after HAS
  consultations BUT
• Dispensary
• Stock medicines
• They dont know how sick people are when they
  come
• Bring a real doctor closer so children wont die
  waiting for one
• Hospital
• Long wait times
• Treated differently/wait longer if from the
  mountains
• They do not care to search for our papers in the
  files

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User Fees

• Most reported difficulty paying
• Dispensary
• Every year they raise the prices
• Not expensive but money is not easy to come by
• They dont give you credit
• Hospital
• It's health you need they could give this to
  you free if you needed it

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Indirect Costs

• Costs associated with hospital visits
• I have to take something to sell so that I dont
  starve waiting all day for a doctor to see me
• Children are watched by a neighbor
• People (several) carry sick person to HAS on a
  door
• Loss of farming labor

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Local Practioners

• Dokte fey
• Often seen before a doctor
• Frequent consultations until ailment abates
• Local and trusted community member
• Variable payment schemes
• Marraine/Parraine
• Some pay more than HAS fees for this service
• Pay when you have it

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Discussion and Recommendations

• Assumptions between access and utilization
• ? User fees does not ? Utilization
• Strengthen dispensary services
• Home-based/mobile services
• Emergency transportation
• Explore capacities for partnership with local
  health practitioners
• Explore community-based healthcare financing

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Public Health Significance

• IOMs Core Functions of PH
• Assessment, Policy Development, Assurance
• Essential Services
• Evaluate effectiveness, accessibility, and
  quality of personal and population-based health
  services
• Findings emphasize importance of community
  participation to
• Assure the quality and accessibility of health
  services
• Identify context specific interventions

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Works Cited

• Hjortsberg, C.A. and Mwikisa, C.N. (2002). Cost
  of access to health services in Zambia. Health
  Policy and Planning, 17(1), 71-77.
• Perry, B. and Gesler, W. (2000). Physical access
  to primary health care in Andean Bolivia. Social
  Science Medicine, 50, 1177-88.
• Rosero-Bixby, L. (2004). Spatial access to health
  care in Costa Rica and its equity A GIS-based
  study. Social Science Medicine, 58, 127184.
• Russell, S. (2005). Treatment-seeking behaviour
  in urban Sri Lanka Trusting the state, trusting
  private providers. Social Science Medicine, 61,
  13961407.
• Witter, S. and Osiga, G. (2004). Health service
  quality and users perceptions in West Nile,
  Uganda. International journal of health planning
  and management, 19, 195207.

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Questions?