Interview with Our Community Health Program Manager
April 14, 2017
Miss Clotilde Saint Jean, RN, is an advanced nurse specialist in community health and has been helping lead our efforts to strengthen the provision of health care at our partner facility, Fort St Michel Hospital (FSM), for 6 years now. To her friends, she is known as “Tijo.” Tijo is an energetic and passionate advocate for the people of Cap-Haitien. She is quick with a smile or joke, but she is completely serious about her work. Asked to say a few words about her work, she shares the following:
“First I need to give you a little history and background. Konbit Sante has been working with Fort St Michel for a long time, beginning with supporting them in their TB and community health work. They hired the first 2 community health workers, which we call agents de santé (ADS) in Haiti, that the center ever had, and this began to make a big difference with things like vaccination for children. Gradually the number of agents de santé increased, as did the number of new activities, including prenatal visits, emergency room, and a maternity service, each with 17 beds.
My work started here in 2011 with a real focus on women’s and children’s health, with support from a grant from USAID. I could see that women were often not getting the prenatal care that they needed, so we started doing prenatal mobile outreach clinics to try to engage those women. At first we did this with KS-paid staff, but later integrated the staff from the center so that it would be more sustainable. While there were some benefits in terms of reaching more women, we also found that there were problems with this model because proper prenatal visits require labs that were not feasible to do in the field, and we had to send the women to the center for them. It seemed to us better if the women just received all of their prenatal care there, and we asked the agents de santé to encourage them all to do that. The ADS reported that many women didn’t have enough money to pay for the visits even though the fees are low, so we worked out an agreement to pay for those women who were not able to pay themselves… especially for the first visit, which has more tests and is more expensive. We found that we could support more visits of higher quality this way than with the mobile clinics for the same funds. Now we are extending that “fee exoneration” for all of the four prenatal visits that WHO recommends.
The collaboration is progressing little by little, and we have added additional staff to facilitate the work.
The main role of Konbit Sante is to help increase the quality of care at FSM. As part of that, we introduced the analysis of their monthly reports, and give them feedback, which they rarely receive otherwise, and use that to strategize about how to improve. For prenatal visits, the old data only said how many visits there were, but didn’t describe anything about the quality of those visits. For instance, it was difficult to see if women had received the required vaccines. The women didn’t have their own prenatal care cards to document the services they had received. Since there are problems with the medical records, those cards are important. There were problems with staff arriving late, which discouraged women from getting services. It took multiple days for a woman to have one prenatal visit; one for the exam, one for the labs, and one to come back to get the results for the lab. There is still a lot to do, but we are seeing improvements in all of these areas, especially due to the work of some of the key staff that Konbit Sante is supporting there.
My vision for the center is that it is a place that encourages a woman to come and receive good quality care, and is done in a timely way. I have a goal that the agents de santé know all of the pregnant women in the area, and are encouraging them to use these services. Because the population that we cover is so big, we need more of them to do this, but that is my goal. I also want to continue to work with the traditional birth attendants, because they are trusted by the women in the community.”