Opportunities to catalyze improved healthcare access in pluralistic systems: a cross-sectional study in Haiti

Abstract

SUMMARYIntroductionGains to ensure global healthcare access are at risk of stalling because some old resilient challenges require new solutions. Our objective was to study a pluralistic healthcare system that is reliant on both conventional and non-conventional providers to discover opportunities to catalyze renewed progress.MethodsA cross-sectional study was conducted among households with children less than 5 years of age in Haiti. Households were randomly sampled geographically with stratifications for population density. Household questionnaires with standardized cases (intentions) were compared to self-recall of health events (behaviors). The connectedness of households and their providers was determined by network analysis.ResultsA total of 568 households (incorporating 2900 members) and 65 providers were enrolled. Households reported 636 health events in the prior month. Households sought care for 35% (n=220) and treated with home remedies for 44% (n=277). The odds of seeking care increased 217% for severe events (aOR=3.17; 95%CI 1.99-5.05; p< 0.001). The odds of seeking care from a conventional provider increased by 37% with increasing distance (aOR=1.37; 95%CI 1.06-1.79; p=0.016). Despite stating an intention to seek care from conventional providers, there was a lack of congruence in practice that favored non-conventional providers (McNemar’s Chi-squared Test p<0.001). Care was sought from primary providers for 68% (n=150) of cases within a three-tiered network; 25% (n=38/150) were non-conventional.ConclusionAddressing geographic barriers, possibly with technology solutions, should be prioritized to meet healthcare seeking intentions while developing approaches to connect non-conventional providers into healthcare networks when geographic barriers cannot be overcome.

A nighttime telemedicine and medication delivery service to avert pediatric emergencies: An exploratory cost-effectiveness analysis

“…INACT-1 found that families sought care for 32% of pediatric health events. 23 The 2016 DHS in Haiti found that children under 5 sought care for 40.4% of acute respiratory infections and 32.9% of diarrheal cases. 33 These figures were averaged to estimate 35.1% of families with a sick child seek care.…”

“…During INACT-2, 30% of families paid in full and 25% paid in part (250 gourdes, 2.89). 23 We conservatively assumed the same ratio for these analyses. Daily wages were estimated from the mean per capita gross national income.…”

“…1 Respiratory infection and diarrheal disease are major contributors to this burden, accounting for over half of hospitalizations and over a third of deaths of hospitalized children. 22 To better understand barriers to pediatric healthcare in Haiti, we conducted a needs assessment to identify differences in household healthcare seeking intention ('would do') and behavior ('did do'); 23 this initiative was part of the Improving Nighttime Access to Care and Treatment Study (INACT-1). In this needs assessment, households expressed an intention to seek care from a provider within conventional networks, but because of cost, distance, and nighttime hours, in practice sought care from disconnected providers near to the household.…”