Hospital Albert Schweitzers Program - Book Report/Review Example

Journal review: Henry Perry et al, "Reducing under-five mortality through Hospital Albert Schweitzer's integrated system in Haiti" 2006; 21(3):217-230. . The Hospital Albert Schweitzer program has made remarkable gains in the population coverage of immunization and other child survival services The integrated system of community based health care, provided by Hospital Albert Schweitzer (HAS) has promoted child survival services, for instance, the population coverage of immunization. Some activities were carried out to facilitate this program. These activities included interviews; women who lie on the productive age were interviewed and it was found that, 23290 births and 149 births were recorded for the period of five years; from the year 1995 to 1999. More over, under five mortality rates were found to be 58 percent lower in HAS while those for children of twelve to fifty nine months of age, was found to be 76 percent less. This information was achieved through physicians. These findings make a very clear indication that, that the system of primary health and community development is improved in the HAS. Community development programs are essential in reducing infant and child mortality. The HAS' program has managed to reduce mortality since it contains the following features: peer-to-peer health education, mobile clinics and rally posts, 1500 volunteer community health workers, involvement in the planning, evaluation and implementation of services and referrals to higher levels. In addition to that, they have eighty paid agents, where each agent is assigned four hundred to five hundred house holds. These agents make frequent home visits and monthly Rally posts for monitoring, counselling, referral and immunizations. They also have monitors who train the midwives and supervise the community-based programs. Tuberculosis agents are meant to follow the tuberculosis contacts and to provide direct therapy for the tuberculosis patients. HAS programs are generally intended to promote equity and to ensure that health facilities reach every home. This has been ensured through their various activities. The version of community participation applied in the program is not similar to the one espoused in the Alma Ata declaration. The community participation in the HAS program is not similar to that of the Alma Ata declaration because the development activities of HAS are evenly distributed, unlike those of Alma Ata declaration. In addition to that, health activities and development programs are hardly combined into single comprehensive system for the population in the Alma Ata. The other thing that brings difference is the factor of geography; geographical and financial factors that are faced in Alma Ata declaration are barriers which affect the curative care. According to Alma Ata declaration, only a third of the children receive intensive child survival service from NGOs, but the rest receive very limited child survival service from the health ministry. The survival services include: vitamin A supplementation, immunizations, treatment of pneumonia, treatment of diarrhoea and basic health education. The percentage of children receiving high dose of vitamin A medicine as per the research is higher in HAS; 2.8 times greater. The percentage of children receiving full recommended series of immunization is twice greater in HAS. Similarly, the percentage of most rece4nt births attended by a trained health care attendant is almost 12.5 times higher, the prevalence of breastfeeding is almost twice higher, and the children with symptoms of respiratory diseases are less. In addition to that, the percentage of women receiving two more prenatal visits during pregnancy, and the number of women receiving tetanus treatment are both higher in HAS. In general, the health services in HAS of higher quality and more improved that the health services of the Alma Ata declaration. Types of monitoring and evaluation used to assess the impact of HAS and how these approaches managed to capture the impact of HAS Ecological method has been used to compare data from two geographical populations. These approach has managed to capture the impact of HAS, since it shows how better the health services of HAS are, compared to those of other areas like Haitian. This method has managed to show utilization of services, impact on mortality and population coverage of service. The determination of input; hospital facilities and manpower resources, has been obtained through interviews that are carried out with their staff. The other approach that has been used is getting data from the national review which was published in the year 1996 (PAHO/WHO1996). The review contains national data which is of great importance in the process of analysis. Process data of HAS can also be obtained from the internal program reports. The data obtained deals with the coverage of the child survival services. Other approaches that are used include the use of the two sources containing the information on child survival services; a 2000 survey of HAS which was carried out by Institute of Child Health (IHE 2000) and 2001 survey of 224 women who gave birth during the previous six months. Research shows that, for both surveys, interviewers explained the nature of survey to the respondents. The interviewers normally explain the right of refusal as well as assuring them that their responses would remain confidential. Apart from the two surveys, 2000 national demographic and health survey by Cayemittes et al. 2001 was used to obtain coverage data for Haiti nationally. Socioeconomic characteristics of HAS were obtained from 2000 survey, based on 780 household heads. These approaches that have been used have played a major role in capturing the impact of HAS The HAS system costs only US$19 per capita annually to deliver health and community development services. The program has been able to keep costs so low. According to research, HAS system costs only US $19 per capita annually to deliver community development and health services. The major contributing factor is the nature of their system; it is community based. The system consists of volunteer health workers, who do not require much salary. These volunteer workers provide health education to the youth, assist with referral to higher levels of care and assist with mobile clinics. Furthermore, one paid health agent serves up to 500 households. The agents make regular home visits and rally posts for immunizations. Their mobile clinics ensures that HAS keeps the programs costs so low since they have auxiliary nurses who visits isolated communities, every two to three months, to provide curative and family planning services and to give referrals to patient if indicated. The nature of their program also contribute to their low costs because it is designed to promote equity by enabling that the needy have access to the essential services, and ensuring that the medical services reach every individual and home. HAS system has strengthen the role of midwives and traditional healers by training them and involving them in the health system as integral members, hence reduces the expenses that could have been incurred in employing other professional health agents; hence make the cost of medication so low. The HAS system promotes vegetation and reforestation by selling seedlings and providing technical assistance. In addition to that, it also provide opportunities for micro-credit for women by creating savings and loan groups, promoting production of handicraft and purchasing them later for resale at HAS outlets. It also promotes agricultural production and animal husbandry. These productive activities enables the HAS system to maintain the low cost of medication. Moreover, the system could be sustainable and replicated in other low-resource environments if they rely on foreign donors and expertise. It can be argued 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. The list of community development services provided by HAS lacks few important components that can make the program truly effective and comprehensive. There are many reasons that make this system not fully effective and not truly comprehensive. Research shows that, many of the studies lack adequate comparison groups and in addition to that, they do not provide the supporting evidence concerning the inputs, population coverage, and processes that support their assertions. One of the assertions is that, the observed mortality difference can be attributed to health programs. Furthermore, little is known about the delivery strategies which are capable of maintaining and achieving high population coverage for certain interventions in health system and cultural context. The fact that the system has volunteer health workers makes it not effective. This is because paid labour is more effective than the unpaid labour. Volunteers normally lack motivation; hence service delivery is not comprehensive. In addition to that, one volunteer serves many households, making the service delivery not efficient. One paid agent serves up to 500 hundred households, hence not effective because five hundred households are many for one agent. Moreover, the midwives are being trained by the monitors; this implies that the midwives are not professionals, neither are the trainers. The fact that their services are provided free of charge indicates that quality of services is very low. Counselling and health education is done voluntary. Since thy counsellors and education lack motivation, for instance salary, they end up delivering poor services to the public. However, HAS operates a very comprehensive program for tuberculosis. Some areas have to be streamlined in the HAS program so that effective and comprehensive services could be delivered to the people. Read More