Reducing Mortality: Albert Schweitzers Integrated System - Assignment Example

Reducing Under-five Mortality through Hoˆ pital Albert Schweitzer’s Integrated System in Haiti Question Firstly, HAS remarkable gains in the population coverage of immunization and other child survival services can be attributed not simply to its individual programs but to its holistic comprehensive approach (the community-based primary health care programme, the hospital referral services, and the community development activities). This I think is critical because this approach has directed the focus and has laid down the importance of each of HAS’s programmes and activities to the overall objective of HAS’s in reducing Haiti’s under-five mortality. So nothing is wasted and all resources (human, time, finances, expertise, materials) are maximised. Also, HAS’s approach reflects its broader understanding of Haiti’s under-five mortality problem, that it was able to develop Haiti’s available resources to sustain its programmes, for example empowering the community with health knowledge and inspiring them to be a positive force strengthening HAS’s primary health care (PHC), which resultantly led to their cooperation and active involvement in the program; that it did not confine its programme to the hospital-home framework but extended these to the ecological, cultural, social, and economics aspect of the problem, which further educate the people and made them more health conscious; and that HAS has proven its sincerity to help improve Haiti’s health condition enabling HAS to gain the trust and confidence of the people therefore their cooperation to HAS’s programmes. Secondly, HAS gains can also be attributed to its efficient and committed personnel, without which HAS’s programmes will not be carried out effectively. And thirdly, HAS gains can also be attributed to its technical, financial, and organisational capacity to plan and implement such kind of health programme/services in an impoverished country, which government lacks not only the capacity and ability, but most importantly the willingness to decisively act on this country’s health issue. Question # 2 The Alma-Ata international conference categorically stated that, “The people have the right and duty to participate individually and collectively in the planning and implementation of their health care” (Declaration of Alma- Ata 1978, sec. 4), and defined primary health care as: essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self-determination (sec. 6). These two quoted sections imply that the community participation in PHC Alma-Ata is espousing refers not simply to the people’s reactive response to a PHC programme, but an empowered community participation. Meaning, the community is part of the whole process of the assessment of its health condition, to deciding on resolutions, planning out and implementing these resolutions. In short, the community should be an active partner of the agency (government and NGO) sponsoring the PHC, because it is only through this way that the community will be empowered and the programme will become sustainable. Judging from this framework, I could say that HAS’s community-based PHC is not yet at par with Alma-Ata’s concept because HAS’s community participation is still limited to Community Health Volunteers as integral members of the HAS’s health teams, and the promotion of community development activities addressing the underlying causes of childhood mortality, including lack of financial resources, education, clean water and sanitation. As I see it, HAS has only treated the community as a support to its health programmes, which is falls short of the Alma-Ata’s concept which is active partnership with the community. If HAS continuous to treat the community at this level only, it will not be able to fully empower the communities which ultimately will result to the problem of the programmes’ sustainability. This in fact is Alma-Ata’s main goal, to help empower communities for them to be able stand on their own. Question # 3 The impact of HAS has been monitored and evaluated based on its geographically defined population utilising HAS internal programme reports and interviews with HAS staff and omparing HAS data with Rural Haiti and Haiti nationwide of which HAS has difficulty getting comparable data. The approach used was that of Donabedian’s (1988) typology: (cited in Perry et al. 2006, 221). These approaches have managed to capture the impact of HAS on two levels: on its 7 functional and on Haiti nationwide. Although it could have been better, if the impact have been compared on HAS areas at different years in order to see the trend and this would also show when could have been the dramatic improvement and what was done during that year? Nevertheless, the present study still has captured what it meant to capture. Laying down the inputs provides us an expectation on how far HAS services can reach. Knowing the utilisation of the inputs – whether or not these are made easily accessible to all – gives us the idea if the processes are responsive to the people’s culture, geographical location, economic status, and consciousness; or if the processes are problematic. While, getting of the population coverage of services whether massive or limited may lead us to find out if the programme is not acceptable to the people, if the health workers are simply inefficient, or if HAS is not trusted by the people. Finally, whatever the outcome of the programs and interventions could be easily evaluated to which it should be attributed to. The processes, outputs and outcome are statistically measured as against the HAS service areas population. Meaning, the higher the percentage, the greater is the impact of HAS. The impact of HAS is further established when it was compared with Haiti’s national data, despite its inadequacy. This alone reflects Haiti’s problem on the systematic monitoring of its health issue. Question # 4 HAS has been able to keep its program costs so low, because it has wisely chosen its most efficient and most needed personnel at lesser cost. Particularly, instead of hiring many expensive doctors, which is the common practice in Haiti, HAS relied greatly on lower-level personnel (nurses, physician extenders, and health agents) and community volunteers and lesser on physicians. To make this work, HAS ensured to have a core of higher-level supervisory staff with the professional expertise to provide appropriate support and training for its mid-level category of workers (Physician Extenders, Health Agents and Community Health Volunteers). The mid-level workers do not work independently, but are integrated to the health team. In effect, the health team is a comprehensive health team that can provide the immediate services needed in the community. So, those beyond the health teams services are only those referred to the hospital. This did not only lower the cost on personnel, but even brought to household the services which have resulted to lesser hospital beds and lesser hospital expenses. Bringing the services to households keeps HAS expenses lesser not only in its inputs but also in training and making families aware of the program. This also further lessens the burdens of the families in going to hospitals. This system of HAS could be sustainable if HAS further improves its community based PHC as espoused by Alma-Ata Declaration. Although what HAS has is already a good start and has only to be improved to the right direction. I think; this can also be replicated in other low-resource environment provided there is an agency (government, private, or NGO) committed and knowledgeable enough to start and pursue such kind of program. Without this, I guess this cannot be possible Question # 5 In some way, I agree that the list of community development services provided by HAS (Table 3) lacks a few important components that can make the program truly comprehensive in nature and more effective. Although it has assured a clean source of water (community wells, springs capped, water filters), a safer environment against possible sources/carriers of contagious diseases (latrines constructed, sick animals treated, animals vaccinated, veterinary agents trained), a fresher air (tree seedlings planted), an economically empowered women (savings and loan groups), HAS missed addressing the communities’ waste disposal system which impact could overturn the positive effect of the enumerated community development services provided by HAS. For example, if the community simply throws its wastes anywhere and without even bothering segregating them, then this may contaminate water sources that may cause diseases to all living things. Second, HAS should help the community develop their livelihood projects utilising local resources in order to develop the economy of the community and be able to provide local employment. In this manner, the economic base of the community will be strengthened giving them the capacity to further improve health services. Third, HAS also missed addressing the literacy level of the community which is very important. How can one assure that the mother has taken the right medicine if she doesn’t know how to read? Fourth, I believe it is necessary to educate parents regarding proper health and nutrition for them to be able to know what to feed their families. Lastly, sustainable agriculture should also be addressed to help them develop a sustainable source of their food. Works Cited Declaration of Alma-Ata. 1978. International Conference on Primary Health Care, Alma-Ata, USSR, September 6-12. Pan American Health Organisation. Accessed 10 June 2010. Available at http://www.paho.org/English/DD/PIN/alma-ata_declaration.htm Perry, H., Cayemittes, M., Philippe, F., Dowell, D., Dortonne, JR, Menager, H., Bottes, E., Berggren, W., and Berggren, G. 2006. Reducing under-five mortality through Hoˆ pital Albert Schweitzer’s integrated system in Haiti. School of Hygiene and Tropical Medicine (24 March): 217-30. Read More