Improving access to care and community health in Haiti with optimized community health worker placement

Abstract

The national deployment of polyvalent community health workers (CHWs) is a constitutive part of the strategy initiated by the Ministry of Health to accelerate efforts towards universal health coverage in Haiti. Its implementation requires the planning of future recruitment and deployment activities for which mathematical modelling tools can provide useful support by exploring optimised placement scenarios based on access to care and population distribution. We combined existing gridded estimates of population and travel times with optimisation methods to derive theoretical CHW geographical placement scenarios including constraints on walking time and the number of people served per CHW. Four national-scale scenarios that align with total numbers of existing CHWs and that ensure that the walking time for each CHW does not exceed a predefined threshold are compared. The first scenario accounts for population distribution in rural and urban areas only, while the other three also incorporate in different ways the proximity of existing health centres. Comparing these scenarios to the current distribution, insufficient number of CHWs is systematically identified in several departments and gaps in access to health care are identified within all departments. These results highlight current suboptimal distribution of CHWs and emphasize the need to consider an optimal (re-)allocation.

Improving the efficiency of scale-up and deployment of community health workers in Mali: a geospatial analysis

“…5,18,[23][24] However only three previous studies have used geospatial analysis to assess the efficiency of CHW deployment at national scale using robust modelling approaches. [20][21][22] Champagne et al compared the efficiency of various CHW deployment scenarios in terms of optimising geographic coverage of the estimated population in Haiti. 22 five deaths, and Pf malaria cases, respectively, and found that the existing CHW networks were inefficiently deployed across all three targeting metrics.…”

“…[20][21][22] Champagne et al compared the efficiency of various CHW deployment scenarios in terms of optimising geographic coverage of the estimated population in Haiti. 22 five deaths, and Pf malaria cases, respectively, and found that the existing CHW networks were inefficiently deployed across all three targeting metrics. 20,21 However, unlike our study, these previous studies did not compare the efficiency of approaches for optimising the scale and deployment of CHWs nationally across each of these outcomes of interest.…”

“…Global strategies and frameworks from the WHO call for optimising the distribution of HRH and geographical accessibility to integrated PHC services. 18,[22][23] Geospatial analysis using geographic information systems (GIS) can be a powerful tool in the HRH toolkit in this regard. However few countries have used geospatial analysis to optimise the scale and deployment of HRH.…”

“…33 To our knowledge, only three countries have used geospatial analysis with a modelling approach based on travel-time to explore the optimization of the scale and deployment of CHWs at national scale. [20][21][22] In Mali, CHWs -known as Agents de santé communautaire or CHWs -have been a central part of the country's HRH at the community level since 2008. At the time of writing, the Ministry of Health and Social Development (MSDS is the French acronym) country was updating the national community health strategy in the context of a new health sector development plan and ongoing health system reform aiming to achieve UHC through primary health care.…”

“…33 To our knowledge, only three countries have used geospatial analysis with a modelling approach based on travel-time to explore the optimization of the scale and deployment of CHWs at national scale. 20-22…”