Assessing the quality of primary care in Haiti

Gage, Anna; Leslie, Hannah H; Bitton, Asaf; Jerome, J. Gregory; Thermidor, Roody; Joseph, Jean Paul; Kruk, Margaret E

doi:10.2471/blt.16.179846

Cited by 54 publications

(68 citation statements)

References 26 publications

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“…In Haiti, as in other low-income countries, care of chronic NCD conditions is accomplished primarily in health centers and hospitals, as opposed to community-based dispensaries [5]. However, there are significant barriers to chronic care access in rural Haiti [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Kwan

Yan

Isaac³

et al. 2020

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Background: Poverty is a major barrier to healthcare access in low-income countries. The degree of equitable access for noncommunicable disease (NCD) patients is not known in rural Haiti. Objectives: We evaluated the poverty distribution among patients receiving care in an NCD clinic in rural Haiti compared with the community and assessed associations of poverty with sex and distance from the health facility. Methods: We performed a cross-sectional study of patients with NCDs attending a public-sector health center in rural Haiti 2013-2016, and compared poverty among patients with poverty among a weighted community sample from the Haiti 2012 Demographic and Health Survey. We adapted the multidimensional poverty index: people deprived ≥44% of indicators are among the poorest billion people worldwide. We assessed hardship financing: borrowing money or selling belongings to pay for healthcare. We examined the association between facility distance and poverty adjusted for age and sex using linear regression. Results: Of 379 adults, 72% were women and the mean age was 52.5 years. 17.7% had hypertension, 19.3% had diabetes, 3.1% had heart failure, and 33.8% had multiple conditions. Among patients with available data, 197/296 (66.6%) experienced hardship financing. The proportions of people who are among the poorest billion people for women and men were similar (23.3% vs. 20.3%, p > 0.05). Fewer of the clinic patients were among the poorest billion people compared with the community (22.4% vs. 63.1%, p < 0.001). Patients who were most poor were more likely to live closer to the clinic (p = 0.002). Conclusion: Among patients with NCD conditions in rural Haiti, poverty and hardship financing are highly prevalent. However, clinic patients were less poor compared with the community population. These data suggest barriers to care access particularly affect the poorest. Socioeconomic data must be collected at health facilities and during community-level surveillance studies to monitor equitable healthcare access. Highlights:• Poverty and hardship financing are highly prevalent among NCD patients in rural Haiti.• Patients attending clinic are less poor than expected from the community. • People travelling farther to clinic are less poor. • Socioeconomic data should be collected to monitor healthcare access equity.

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Section: Introductionmentioning

confidence: 99%

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Kwan

Yan

Isaac³

et al. 2020

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“…Access to health care facilities is also limited in Haiti. Only 23% of the population has access to primary care of good quality (Gage et al, ). At a primary care clinic in Leogane, it was noted that a majority of women were coming to be treated for UTI symptoms.…”

Section: Introductionmentioning

confidence: 99%

Access to clean water and urinary tract infections in Haitian women

Andersen

Dowdell

2019

Public Health Nursing

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Objectives Access to clean water is a global concern. For women living in developing countries, the lack of clean water increases their risk of bacterial infections, such as a urinary tract infection (UTI). The purpose of this study was to examine if the location of water source has a relationship with the rate of UTIs in women who lived in the Léogâne area of Haiti. Design Descriptive, correlational, retrospective chart review used de‐identified data from medical intake flow sheets. Sample A total of 311 medical intake flowsheets with 32.4% of the sample were treated for a UTI. The majority of women were between the ages of 20 and 44 years. Results The youngest group, ages 10–14 years, were more likely (83.3%) to be diagnosed with a UTI (X2 = 7.956, df = 3, p < .05) when compared to the other age groups. The location of water source also had a relationship with UTI, with women who reported using pump water more likely to be treated for a UTI than those who reported using short‐well water (X2 = 4.318, df = 1, p < .05). Conclusions Although the study only involved Haitian women, the concepts of access to clean water, reducing bacterial infections such as a UTI, and health promotion are useful for any provider practicing in or going to a developing country.

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“…For example, performance on these core items is only slightly better than on more demanding metrics of performance (i.e. adherence to guidelines) in antenatal care, and even lower in sick child care [1][2][3]. Overall, quality of care is worse for sick child care compared to antenatal care or family planning services [1,21].…”

Section: Discussionmentioning

confidence: 99%

Clinical performance among recent graduates in nine low‐ and middle‐income countries

Lewis

Roder‐DeWan

Malata

et al. 2019

Tropical Med Int Health

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SummaryObjectivesRecent studies have identified large and systematic deficits in clinical care in low‐income countries that are likely to limit health gains. This has focused attention on effectiveness of pre‐service education. One approach to assessing this is observation of clinical performance among recent graduates providing care. However, no studies have assessed performance in a standard manner across countries. We analysed clinical performance among recently graduated providers in nine low‐ or middle‐income countries.MethodsService Provision Assessments from Haiti, Kenya, Malawi, Namibia, Nepal, Rwanda, Senegal, Tanzania, and Uganda were used. We constructed a Good Medical Practice Index that assesses completion of essential clinical actions using direct observations of care (range 0–1), calculated index scores by country and clinical cadre, and assessed the role of facility and clinical characteristics using regression analysis.ResultsOur sample consisted of 2223 clinicians with at least one observation of care. The Good Medical Practice score for the sample was 0.50 (SD = 0.20). Nurses and midwives had the highest score at 0.57 (SD = 0.20), followed by associate clinicians at 0.43 (SD = 0.18), and physicians at 0.42 (SD = 0.16). The average national performance varied from 0.63 (SD = 0.18) in Uganda to 0.39 (SD = 0.17) in Nepal, persisting after adjustment for facility and clinician characteristics.ConclusionsThese results show substantial gaps in clinical performance among recently graduated clinicians, raising concerns about models of clinical education. Competency‐based education should be considered to improve quality of care in LMICs. Observations of care offer important insight into the quality of clinical education.

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Assessing the quality of primary care in Haiti

Cited by 54 publications

References 26 publications

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

High Poverty and Hardship Financing Among Patients with Noncommunicable Diseases in Rural Haiti

Access to clean water and urinary tract infections in Haitian women

Clinical performance among recent graduates in nine low‐ and middle‐income countries

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