Dominican Republic

Picture It: Why #IHeartHealthWorkers

intrahealth — Tue, 10 Oct 2017 19:15:47 +0000

Picture It: Why #IHeartHealthWorkers

intrahealth October 10, 2017

The Human Resources for Health Effort Index: A Tool to Assess and Inform Strategic Health Workforce Investments

intrahealth — Tue, 15 Aug 2017 19:03:09 +0000

The Human Resources for Health Effort Index: A Tool to Assess and Inform Strategic Health Workforce Investments 2017 intrahealth August 15, 2017

It’s tough to measure progress on an issue as big and complex as the health workforce. The HRH Effort Index helps.

Despite its importance, the field of human resources for health (HRH) has lagged in developing methods to measure its status and progress in low- and middle-income countries suffering a workforce crisis. Measures of professional health worker densities and distribution are purely numerical, unreliable, and do not represent the full spectrum of workers providing health services. To provide more information on the multi-dimensional characteristics of human resources for health, in 2013–2014, the global USAID-funded CapacityPlus project, led by IntraHealth International, developed and tested a 79-item HRH Effort Index modeled after the widely used Family Planning Effort Index.

The results of applying the index in Burkina Faso, Dominican Republic, Ghana, and Mali are detailed in this article published in Human Resources for Health.

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https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-017-02…

Countries Burkina Faso Ghana Mali

Projects CapacityPlus

Topics Measurement & Analytics Health Workforce & Systems

Series Human Resources for Health

By Alfredo L. Fort, Rachel Deussom, Randi Burlew, Kate Gilroy, David Nelson

How the Diplomatic Community Can Help Solve the Health Workforce Crisis

mnathe — Tue, 04 Apr 2017 16:52:16 +0000

How the Diplomatic Community Can Help Solve the Health Workforce Crisis mnathe April 04, 2017

April 04, 2017

Pape Gaye offers five steps diplomats can take to help more countries invest in health.

A few months back, I was in the Dominican Republic, standing before a crowd of government officials, local IntraHealth International staff members, and many others, as we talked about "ghost" workers.

A few years earlier, IntraHealth had worked with the Ministry of Health there, as part of a USAID-funded project, to conduct a payroll analysis. This may sound humdrum, but what we found was quite striking: some 10,000 individuals who were no longer working for the ministry were in fact still collecting salaries from it.

These ghost workers, as we call them, were draining the public health sector of more than $6 million per year, and as a result, health care for Dominicans was suffering.

As the ambassador spoke, I could see the audience's response.

Once these data came to light, officials were able to address the issue and reinvest the savings back into the health sector, hiring new health workers and providing much-needed raises for its existing workforce. It was a great success. The national health system became stronger and more Dominicans gained access to essential health care.

In fact, the number of family planning, prenatal, postpartum, and laboratory visits (including HIV testing) jumped by 517% in one region, from 1,981 visits to 12,237.

But it wasn't my account of these improvements that had the most profound effect on the officials gathered at that high-level event—it was the US ambassador's.

As then-Ambassador James Brewster spoke about those 10,000 ghost workers and reiterated the US's commitment to partnering with the Dominican Republic to reach universal health coverage, I could see the audience's response. The local government officials were focused, and energized to see this enthusiasm and commitment from such a high-level diplomat. They left eager to keep this thing we have together going.

Unfortunately, many of the Dominican Republic's health challenges are not unique. Worldwide, we face a looming shortage of some 18 million health workers, as well as chronically under-funded health sectors, lingering HIV epidemics, and alarming vulnerabilities to emerging health threats. International development organizations like IntraHealth are working hard to build local capacity for sustainable change, but we cannot do it alone.

The diplomatic community could be a key to resolving this crisis.

The Three Ds

Development and diplomacy are two of the three pillars that provide a foundation for promoting and protecting US national security interests abroad (the third, of course, is defense). In fact, American diplomats and ambassadors can be powerful advocates in international development and global health. We could be working together to help even more countries see that investing in their health workforces is one of the smartest moves they can make, both for the good of their populations and economies and for our global well-being.

Here are five steps the diplomatic community can take to help solve our global health workforce crisis:

Encourage officials to focus on the health workforce and commit to building strong primary health care services in their countries. Urge them to collect data, budget and plan for the health sector, and make sure health workers are stationed where they're needed most (not just clustered in the cities).
Push one another to do more. The diplomatic community is close-knit. There is great potential for coordination among the diplomatic corps around key health issues, such as we've seen with the global health security agenda.
Promote South-to-South collaboration. Ambassadors move from country to country, which means they're ideally positioned to spot parallels and broker knowledge exchange.
Understand the potential of community health workers. You find them in the most vulnerable regions, always on the front lines of care, containing outbreaks and epidemics. Community health workers' contributions to the health system should not be underestimated. Take Nigeria, for example. When Ebola arrived in the huge urban center of Lagos, it was contained immediately, thanks in part to the country's strong networks of community health workers.
Help build a culture of technology, data, and public-private partnership. Public sectors in low- and middle-income countries can easily fall behind when governments underinvest in technology. Encourage officials to train more IT engineers and collect more and better data in the health sector. The US has a lot of expertise in this area, as do many local private-sector companies, and the diplomatic community can help bridge the gap.

Organizations like IntraHealth work across countries and continents. We act as ambassadors for health to the governments in all countries where we work. And health workers ultimately act as ambassadors for health in their communities.

But we call on the diplomatic community to use its words and deeds—which carry great weight—to work with us to solve this crisis that affects us all.

This post was originally published in American Diplomacy.

Happy World Health Worker Week! Join the conversation: #HealthWorkersCount #WHWWeek

By Pape Amadou Gaye

Founder & President, Baobab Institute

Health workforce development World Health Worker Week Health Workforce & Systems

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Human Resources for Health Country Commitments: Case Studies from the Dominican Republic, Kenya, Mali, and Uganda

Anonymous — Thu, 06 Oct 2016 19:02:47 +0000

Human Resources for Health Country Commitments: Case Studies from the Dominican Republic, Kenya, Mali, and Uganda 2015 Anonymous (not verified) October 06, 2016

The Dominican Republic, Kenya, Mali, and Uganda share their experiences over the last two years in defining, implementing, and measuring the HRH commitments they made at the 2013 Global Forum on Human Resources for Health in Recife, Brazil. The case studies provide insights on how global accountability, such as commitments made to international stakeholders, can catalyze action and advance national health objectives.

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Countries Kenya Mali Uganda

Topics Health Workforce & Systems

Publisher IntraHealth International

“I Can Improve Things”: An HIV Peer Counselor in the Dominican Republic

Anonymous — Tue, 27 Sep 2016 13:43:56 +0000

“I Can Improve Things”: An HIV Peer Counselor in the Dominican Republic

Anonymous (not verified) September 27, 2016

June 11, 2014

This post originally appeared on the CapacityPlus blog.

“It was very, very bad treatment that I received,” recalls Mercedes (not her real name), a young mother living with HIV.

Five years ago—at one of the largest maternity hospitals in the Dominican Republic—she was diagnosed as HIV-positive. Although she enrolled in the hospital’s program to prevent mother-to-child transmission (PMTCT), she felt discriminated against for her status, and that the health workers’ actions toward her lacked compassion. But she decided her experience as a victim of stigma would not stand in her way of helping other HIV-positive pregnant women. “I can provide better information to patients” Two years later Mercedes met a staff member at the hospital who asked if she wanted to work as a volunteer HIV peer counselor. This was her chance to make a difference. “I can be there,” Mercedes replied. “I can improve things. And I can provide better information to patients.” Although the Dominican Republic is characterized as a low-prevalence country, HIV prevalence among pregnant women has been estimated as high as 4% in some regions. Stigma makes it difficult for clients to ask questions and get the information they need to cope with their diagnosis and navigate treatment. HIV peer counselors play an important role in countering this. They are able to relate to clients’ situations; provide resources on treatment, support groups, and clients’ rights; and if appropriate, share their own stories of how they have managed the disease. Mercedes received training and studied hard. And just a few months ago, after serving three years as a volunteer, her position became official and she began to receive a salary.

“I never thought they would give me a salary”In the Dominican Republic, CapacityPlus works with the Ministry of Health to improve the availability and quality of PMTCT services through strengthening human resources management policies and practices. CapacityPlus provided technical assistance to the Ministry to include HIV peer counselors and other types of health workers in the Civil and Administrative Career Track and integrate them into the Health Career Track. To do so, the Ministry redirected funds it saved through an ongoing process to eliminate ghost workers (individuals who receive a salary but are not working) from hospital payrolls. The Ministry identified over 10,000 ghost workers through a payroll analysis supported by CapacityPlus. “I never thought they would give me a salary,” Mercedes says. “And when the salary arrived, thanks be to God because I needed it! I have two children; and their father, he died [from HIV].” While Mercedes is grateful for the monetary recognition of her work, the only real difference is the paycheck. Her commitment to pregnant women and preventing the transmission of HIV to infants has always come first, and being a volunteer did not limit her daily tasks and responsibilities. “I am here because I like to work with people living with HIV,” says Mercedes. Most importantly, she is able to foster hope as she shares her own experience. “I am here to help”Every day Mercedes seeks to combat discrimination and stigma against PMTCT clients in her hospital. And she sees the impact of her work in the lives of her clients. She says they attend more prenatal visits, adhere to their antiretroviral treatment, and bring their infants for recommended follow-up visits. These changes are the best type of feedback that she could receive.

One young woman stands out to her. “There was a patient who came in with her grandmother, her brother, her entire family. She came crying and screaming, ‘I don’t know what they’re bringing me here for. Enough! Let me die! I’m already positive, I’m no longer able to be saved. People who have AIDS are going to die.’” Mercedes relived what she’d felt at the time she was diagnosed.

She told the client, “I am here to help. I’m here to show that yes, you can. I have a child that was born in this program and my child is negative. If you do your part, you can too.”Throughout her pregnancy, the young woman returned to the hospital whenever she had a fever or a headache to get Mercedes’s advice. The young woman gave birth and keeps pushing ahead. She is studying psychology now so she can also help others. “She calls me and tells me, ‘Mercedes, I don’t know how to thank you, because I thought I was going to die.’ To me that is something I will never forget: to know that I helped someone get out of such depression.”

Mercedes sees her situation as a counselor living with HIV as an advantage. “Sometimes, the patients don’t like talking with everyone,” she explains. “But if you tell them, ‘I am also HIV positive just like you,’ the patient opens up. It’s not the same to talk to a person who is not positive. And for me this is very pleasing.” Photo by Wendy Tactuk (women wait outside of Maternidad Nuestra Señora de la Altagracia Hospital in Santo Domingo, Dominican Republic)

By Ángela Diaz Fermin

Former PMTCT advisor/technical manager, CapacityPlus, IntraHealth International

By Alex Collins

Former health workforce technical advisor, IntraHealth International

HIV & AIDS

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HIV Peer Counselor in the Dominican Republic Shares Impact of His Work

Anonymous — Tue, 27 Sep 2016 13:43:44 +0000

HIV Peer Counselor in the Dominican Republic Shares Impact of His Work

Anonymous (not verified) September 27, 2016

October 09, 2014

Alfredo Felix is a peer counselor with the Department of HIV at Jaime Mota Regional Hospital in Barahona, Dominican Republic. “I’ve always felt motivated to work in the community to inform people,” he says. The area shares a border with Haiti and has a large immigrant population at risk for HIV.

Peer counselors like Alfredo play an important role in countering the effects of stigma, which can make it hard for people to seek information about HIV and follow through with treatment. Alfredo tells a story about someone he helped:"There was a patient who was a bit fragile and came in for his consultation, and we tried to educate him about his health condition. Later the patient returned home, and we lost contact with him. I thought to go out to the countryside, and there I was able to contact the patient and speak with him. I insisted that he come back to the health center. When he did return, he was even more fragile, and we worked with him again, educating him and getting him on medication. Now, the patient is better, he’s stronger, and is thankful for the work [that we do].

"Alfredo recently took part in a workshop to improve the quality of services to eliminate mother-to-child transmission of HIV and congenital syphilis. The workshop was designed and delivered by the Directorate of STI/HIV/AIDS (DIGECITSS) and the health services network (REDES) along with CapacityPlus. Alfredo called it “very important, because it’s intended to improve the quality of services that are offered, to train good human resources [for health], so that these human resources—by being trained and empowered—provide better services for the community.

”The workshop has since been replicated in seven out of the nine health regions in the country and reached over 200 health workers.

CapacityPlus provides assistance to the Ministry of Health to improve the human resources management systems that will strengthen the health workforce needed to contribute to an AIDS-free generation and the country's goals to reduce mother-to-child transmission of HIV to 2% or less and the incidence of congenital syphilis to 0.5 cases per 1,000 live births or less by 2015. The ministry’s efforts have already led to improved access to health services through increased availability of skilled health workers, the elimination of traditional user fees, and an increase in national health insurance members receiving subsidized care. Alfredo’s region received an influx of 234 new health workers, resulting in a 500% increase in the number of patient consultations for HIV and syphilis prevention, prenatal care, and family planning between 2012 and September 2013.

The coverage of services—including early detection of HIV and syphilis, family planning (particularly for HIV-positive women), and access to prenatal care for HIV-positive women—has risen in many regions. Increasing coverage of HIV services at the primary level results in improved coverage up the chain, with more HIV-positive individuals being referred for treatment and contraceptive options and more HIV-positive pregnant women and their babies cared for, to further the goal of an AIDS-free generation.

For Alfredo, the best part of his job “is when I see a patient who’s in poor health and later when he comes [back] to us, we can see how he’s been strengthened and recuperated.” He shares his thoughts in this one-minute video.

Help CapacityPlus spread the word about strengthening the health workforce. Follow us on Twitter and like us on Facebook.

Photo by Alex Collins.This blog post was originally published on the CapacityPlus blog.

By Alex Collins

Former health workforce technical advisor, IntraHealth International

By Sarah Dwyer

Former communications manager, IntraHealth International

Education & Performance Management and Performance Family Planning & Reproductive Health HIV & AIDS Health Workers

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10 Health Workers Who Inspired Us in 2014

Anonymous — Tue, 27 Sep 2016 13:43:30 +0000

10 Health Workers Who Inspired Us in 2014

Anonymous (not verified) September 27, 2016

December 30, 2014

We met some amazing health workers this year. They work hard every day to keep their communities healthy—and many put their lives on the line to do it.As 2014 comes to a close, we’re thinking of these health workers—and many more than we can list here—who’ve inspired us this year.

1. Ebola Fighters

TIME named Ebola fighters Person of the Year in 2014. The editors couldn’t have made a better choice.Since March, health workers have been on the front lines of the Ebola epidemic. Hundreds from their ranks have died.But many still show up for work every day, at great personal risk. Their efforts to contain the disease will likely save millions of lives.Read: Why Health Workers Are Time Magazine’s Person of the Year

2. Dr. Eno Biney

Dr. Eno Biney is an emergency medicine specialist at the Komfo Anokye Teaching Hospital in Kumasi, the second-largest city in Ghana. She’s part of a new cohort of health workers that are changing the way emergency care happens in the country.“I chose to specialize in emergency medicine because I realized that it was one of the most lacking specialties in our country,” Eno says. “There wasn’t any form of organized emergency treatment of patients.” Watch: Emergency Care Comes into Focus in Ghana

3. Professor Kalilou Ouattara

“Fistula is not an illness, it is a careless neglect,” says Professor Kalilou Ouattara of Mali. “It is a failure to help someone in danger.”When IntraHealth first started strengthening obstetric fistula services in Mali, Professor Ouattara was the only surgeon who knew how to treat complicated cases. Now he’s trained 13 others—and will train at least 15 more.Read: More Surgeons Like Professor Kalilou Ouattara

4. Fatimata Touré, International Woman of Courage

When Gao, Mali, was attacked in 2012, extremist rebels took over the local hospital and turned many clients—including 20 women who were recovering from obstetric fistula repair surgeries—out of their hospital beds and onto the streets.Fatimata Touré helped find the women and made sure they had shelter and care.That’s one reason US First Lady Michelle Obama presented one of ten International Women of Courage Awards to Fatimata this year.Read: After a Lifetime on the Ground, a Day in the CloudsandState Department Honors Malian Community Mobilizer with International Women of Courage Award

5. Nurse Joyce Samson Kiribiti

Nurse Joyce Samson Kiribiti is usually hard at work in the Shinyanga Regional Hospital in Shinyanga region, Tanzania. But she takes time away from her usual duties to help out at a rural HIV outreach clinic, providing around 10 voluntary medical male circumcisions per day.Joyce loves working at the outreach clinic. But her favorite job as a nurse?"I love delivering the mommies," she says.Read: Meanwhile, in the VMMC Tent

6. Alfred Felix, HIV peer counselor

Every day Alfredo provides HIV education and gets HIV-positive clients on treatment. He’s a peer counselor with the Department of HIV at Jaime Mota Regional Hospital in Barahona, Dominican Republic.“I’ve always felt motivated to work in the community to inform people,” he says.Read: HIV Peer Counselor in the Dominican Republic Shares Impact of His Work

7. Habiba Shaban Agong, senior nursing officer

In Habiba's rural Ugandan health center, she says, “things were really a bit appalling.”There weren’t nearly enough health workers to meet client demand. Water was unreliable, beds were broken, and mattresses were torn.But Habiba made some changes after attending a Human Resources for Health Leadership and Management Program. Now she and her colleagues are delivering more babies and child mortality in her facility is dropping.Read: A Nurse Midwife’s Experience with Leadership and Management Training

8. Dr. Christian Osae Obirikorang

What's most exciting about being a lecturer of molecular medicine at the School of Medical Sciences in Ghana? Dr. Obirikorang tells us.“We are going to improve knowledge transfer from the faculty members to the students,” he says. “It's going to improve the whole health system, at the end of day.”Watch: Dr. Christian Osae Obirikorang: "I'm a Health Worker"

9. Nurse Phylis Cherono Siele

Phylis Cherono Siele is a nurse in the comprehensive care unit at Tenwek Mission Hospital in Kenya. In this one-minute video, she tells viewers about her happiest day at work.Watch: One Nurse’s Best Day at Work

10. The Bakel District Health Team

In Bakel, a rural district in northeast Senegal, there is no hospital—just one health center, 19 health posts, and seven health huts. Working in those facilities are two doctors, three pharmacists, eight nurse midwives, and 23 nurses and nursing assistants.They, along with 52 community health workers, care for all 96,000 people in Bakel.But the Bakel District Health Team is known for consistently offering high-quality care despite the challenges. That’s one reason they won this year’s Health Innovation Award.Read: Outstanding Senegalese Health Workers Honored at Second Annual Health Worker Awards Ceremony

By Margarite Nathe

Strategic communications advisor, IntraHealth International

Community Health Workers Clinical Officers Midwives Nurses Physicians Ghana Kenya Liberia Mali Senegal Uganda

Photos

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Words Matter in Our Global Commitments to Advance National Health Workforce Strategies

Anonymous — Tue, 27 Sep 2016 13:43:04 +0000

Words Matter in Our Global Commitments to Advance National Health Workforce Strategies Anonymous (not verified) September 27, 2016

November 23, 2015

Last week, during a discussion on the Paris Climate Conference broadcast on National Public Radio (NPR), the chief negotiator for the US to the conference pointed out that, in international declarations and multi-country agreements, words matter. With respect to carbon emissions and global warming, NPR’s Ari Shapiro noted, “so the fate of the world hinges on the difference between ‘shall’ and ‘should.’”

It’s much easier to say we should take action than we shall—and even harder to actually do it.

What does it take for a country to follow through on its commitments?

When countries make commitments to the global community, to each other, and to their own populations, their words can shape national policies and global security. But what does it take for a country to follow through?It’s a pertinent question, whether we’re talking about the 160 countries that made commitments on climate change in Paris, or the countries that promised two years ago on the global stage to increase investments in their own health workforces.

In November 2013, during the Third Global Forum on Human Resources for Health in Recife, Brazil, more than 80 countries came together to discuss the global health workforce crisis—including the shortage of 7.2 million doctors, nurses, and midwives worldwide—and committed to changing the status quo.

Ministries of health, education, labor, and finance joined international companies, donors, development agencies, and civil society members to advocate for investments in health workers and influence political will to support systems-strengthening policies. Many national governments committed to achieving their own country-specific health workforce objectives.

As we approached the two-year anniversary of the forum, IntraHealth International worked with counterparts in the Dominican Republic, Kenya, Mali, and Uganda—four of the countries that made pledges in Recife—to see if their commitments have made a difference.We found that the answer is yes: each country has made progress in a different way, and each has used its commitments to bring stakeholders together, mobilize resources, validate or justify plans and strategies, and develop indicators for monitoring progress.

And of course, many faced challenges.

THE DOMINICAN REPUBLICApproach: Folded its Recife commitment into an existing framework developed in 2010, called A Decade of 20 Goals for Human Resources in Health. This helped the country tap into existing resources and stakeholder groups to meet its commitments.

A challenge: Achievements prior to the forum were sometimes attributed to the commitment made there, making it difficult to evaluate the impact of the commitment itself.

KENYAApproach: Aligned its commitment with the country’s new decentralization strategy and included measurements of success in the monitoring process established for the new governance model. By strategically positioning its commitments with national health development strategies, Kenya was able to maintain support and demonstrate progress.

A challenge: Ensuring that the new specific health workforce objectives were fully incorporated into the new national decentralization strategy.

MALIApproach: Achieved one of its objectives by making great progress in developing its electronic health workforce information management systems. IntraHealth helped Mali establish the iHRIS management system, which has improved the country’s workforce planning and management.

A challenge: Did not identify benchmarks or define a monitoring process to track progress, so the country’s other objectives did not gain the same traction.

UGANDAApproach: Used the process of developing its commitment as an advocacy tool, mobilizing local champions and implementers to define the objectives to ensure that they would be implemented and monitored. This inclusive process helped officials advocate for greater investments in the health workforce.

A challenge: Continuing momentum to ensure the national and district-level governments followed up on pledges to invest more strategically in the health workforce.

These countries have shown us that commitments can be used as advocacy tools to bring stakeholders together behind new policy objectives, to maintain momentum behind existing strategies, and to garner resources and political will through added global influence.

If we’ve learned one thing since the 2013 forum, it’s that global commitments must be tied to measurable action plans.

Even so, because the language of commitments must be broad enough to achieve consensus, they must be tied to specific indicators in a monitoring framework to measure and demonstrate progress to national and global constituencies.

If we’ve learned one thing since the 2013 forum, it’s that global commitments must be tied to measurable action plans.

We’ve also learned that when a country makes a commitment in a global setting, the country—and the global community—should have some sort of accountability mechanism to make sure that the national government is held answerable, even when there may be a lack of transparency on the local level or when the population in a country doesn’t have the means to influence decisions.

Global opinion matters, and a global accountability framework can provide a mechanism through which advocacy can influence change and bring about improvements. Many speculate that the Millennium Development Goals helped countries make significant improvements largely because their governments felt accountable to the global community.

As we implement the upcoming Global Human Resources for Health Strategy, which will be presented for ratification to the World Health Assembly in May 2016, and work to achieve the Sustainable Development Goals, advocates and policy-makers can use the lessons of these four countries and others and take advantage of the global platform and make their voices heard.

And they should use those voices not to say “We should create a stronger, healthier world”—but “We shall.”

By Allison Annette Foster

Former senior advisor for human resources for health, IntraHealth International

By Laura Hoemeke

Former Director of Health Policy & Systems

Policy & Advocacy Health Workforce & Systems Global Forum on Human Resources for Health Kenya Mali Uganda

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Voices from the Field: Community Mapping In Bateyes

Anonymous — Wed, 14 Sep 2016 13:13:42 +0000

Voices from the Field: Community Mapping In Bateyes Anonymous (not verified) September 14, 2016

January 02, 2005

“The maps will help us in the future so that the government will take us into account in development plans.”

Altagracia Feliciano, a health promoter in Batey Esperanza, Dominican Republic, recently participated in a community mapping exercise conducted by the PRIME II Project as part of a new reproductive health program in the country’s bateyes. Home to former sugar cane workers displaced when the industry was privatized, the bateyes are characterized by substandard living conditions.

Mapping the houses in the seven bateyes where PRIME II will work was an integral component of baseline activities for the future evaluation of the program. The maps will also be used to designate which households will be served by each of the health promoters who will be trained through the intervention. But for Ms. Feliciano and the other promoters, who drew the first versions of the maps with technical assistance from PRIME, the maps quickly assumed broader significance. Provincial agencies involved in delivering a variety of services are interested in using the maps, and mayors and community officials have requested copies.

Residents of the bateyes also became active in the mapping process, which commenced with the spectacle of two “gringos” standing atop a tin roof pointing and looking around. Community members initially failed to understand what this sort of exercise could possibly have to do with a program to improve their health. But the maps soon became symbolic in other ways. In communities that had never been charted on paper, the maps provided a newfound sense of place and pride. “You can see where your house is and that makes you feel good,” said one community member. “And anybody can find us here with the map, no matter where they’re from.”

The enthusiasm generated by the maps bodes well for the implementation of PRIME II’s intervention, which will tap into the vibrant culture of the bateyes through the health promoters and the popular medium of local radio. In collaboration with the Dominican Institute for Community Action, PRIME is training 35 promoters in reproductive health skills using a curriculum developed by project partners Intrah, PATH and TRG that emphasizes the promoters’ role in family planning education, community-based provision of family planning methods, and HIV/STI prevention. The radio programs, covering specific topics in reproductive health, will be followed by community discussions led by the promoters.

If, as Ms. Feliciano hopes, the maps generate additional development projects to help the impoverished and neglected bateyes, then they will have succeeded as a mini-intervention of their own: a fortuitous synergy of improved reproductive health care and community identity and empowerment.

The PRIME II Project works around the world to strengthen the performance of primary-care providers as they strive to improve family planning and reproductive health services in their communities.

PRIME Voices #8, Dominican Republic: Community Mapping in Bateyes, 12/18/01.

Community Health

Voices from the Field: Involving Communities In Quality Services

Anonymous — Wed, 14 Sep 2016 13:13:41 +0000

Voices from the Field: Involving Communities In Quality Services Anonymous (not verified) September 14, 2016

January 02, 2005

“Our job is to ensure that our community members get the quality services they need. If someone is dissatisfied with the attention they receive in the clinic, they come to me and I help solve the problem.”

As a member of the Clinic-Community Committee, Juana Tavarez meets regularly with the staff of Centro Diagnostico, a family planning and reproductive health care clinic on the outskirts of the Dominican Republic’s capital city, Santo Domingo. Juana’s neighbors know they can tell her about their expectations and experiences with clinic services and that she will make sure their concerns are addressed by clinic staff.

The PRIME II Project is using its Consumer-Driven Quality (CDQ) approach to assist Centro Diagnostico’s administrators in identifying and implementing effective tools to gather and apply such consumer input. Dialogue with community spokespersons like Juana Tavarez recognizes client satisfaction as an essential component of the clinic’s strategy to ensure financial stability by providing high-quality, accessible services. “Involving people from the community is critical,” says clinic director Dr. Jose Gregorio Aponte, “because they will always have the best idea of how to better their own quality of life.”

To introduce community leaders to Centro Diagnostico and the CDQ concept, PRIME II helped organize five meetings in the neighborhoods surrounding the clinic. A series of six participatory group activities, adapted from PRIME partner EngenderHealth’s Community COPE methodology, were then held to collect consumer feedback about reproductive health needs and perceived barriers to services, and to identify community spokespersons. Another series of meetings brought these community spokespersons and clinic staff together to clarify their roles in the Clinic-Community Committee.

Opened in October 2001 to serve residents of low-income neighborhoods, Centro Diagnostico is operated by ADOPLAFAM, a nongovernmental family planning organization. Recognizing that one of its major donors, USAID/Dominican Republic, is reducing overall population funding, ADOPLAFAM set a goal of having 70% of the clinic’s clients pay full fees. Coupons for free services were made available, however, to get Centro Diagnostico off the ground, and only 28% of clients were paying for services as of December 2001. Exceeding expectations, the number of clients attending the clinic more than doubled between the first trimester and second trimester of 2002; by August, 83% of clients were paying for services and monthly clinic income was almost twice the total from January. “The increase in patient numbers and income is a result of all the community work we have done,” attests Dr. Aponte.

The willingness of clients to pay for family planning and other reproductive health services can be related to the perceived quality of those services. At Centro Diagnostico, requests gathered from community members during CDQ activities have resulted in direct improvements to the clinic. Two additional gynecologists, including a female, have been added to the staff, along with a cardiologist and two psychologists. A ceiling has been completed and curtains installed to ensure privacy in examining rooms, a television and VCR showing educational videos have been set up in the waiting room, and a generator has been purchased to ensure electricity for cold storage so that free vaccines can be offered.

“With PRIME, we have gone to places and reached communities that I had never worked with or met before,” says Reina Gomez, a volunteer health promoter with ADOPLAFAM for 13 years. “We work much more with neighborhood leaders, Parents and Teachers Associations… and this, to me, is invaluable. It’s great to work with a project that completely supports and encourages community work.”

The PRIME II Project works around the world to strengthen the performance of primary-care providers as they strive to improve family planning and reproductive health services in their communities.

PRIME Voices #14, Dominican Republic: Involving Communities in Quality Services, 11/14/02.

Quality of Care