On World Health Day of this year, the WHO is reminding us of the critical need to create sustainable "wellness-oriented societies" that are committed to ensuring equity in health. As part of our Project in Support of the Mother-Child Health Continuum (ACOSME), which was implemented since 2016 in Haiti, one of the strategic focuses is based on community mobilization through the establishment of Women’s committees of health care services users (CFUs), in the areas of intervention of the project (Cap-Haitian, Quartier Morin, Limonade, Grande Rivière du Nord, Bahon). The goal is to help reduce maternal and infant mortality rates in Haiti by improving the access to health services. The CFU is fully committed to raising awareness on equitable and strengthened access to health care for the well-being of the community.
Haiti is faced with high maternal and infant mortality rates, limited capacities, scarce health resources, and a propensity to rely only on traditional medicine. For example, access to vaccination and consultations for adults, particularly pregnant women and girls, is often lacking. Moreover, most services have to be paid for and communities do not have the financial means to afford them.
In addition, it remains a challenge for people living in remote areas of the region to benefit from a health institution that is close by, provides permanent services and is accessible both financially and geographically. The precarious state of the roads and the limited availability of motorized transport make it difficult to transport patients to the hospital on time. The population is neither well-educated nor aware of these health issues. All of these factors hinder the optimal use of health care institutions and the wider use of health services.
The ACOSME project is designed to improve the availability and quality of essential services, particularly those that meet the needs and rights of mothers, pregnant women, newborns and children under five, as well as to increase the use of health services. From the very beginning, the primary beneficiaries were women, who were considered essential in order to raise awareness about health services. This is how Women’s committees of health care services users (CFUs) were established.
A committee is a group of women who mediate between health institutions and the population and who promote the use of services offered by these institutions in the community. They also help improve community knowledge and commitment; strengthen relationships between health institutions, health providers, and the community; help women's empowerment; help advance and promote the provision of services; and encourage the use of health services.
The CFU supports and promotes women's ownership and agency. It encourages the emergence of women leaders and helps to shape gender norms and power relations between women and the health care system.
As genuine volunteer spokespersons, the women members communicate oral messages during visits to churches, schools or in the market. They also participate in home visits, community meetings, cultural activities (theater, patronal feast), as well as in workshops on gender-based violence and nutrition. The goals of these activities are to inform and raise awareness in the community on health issues and to promote the use of services offered by nearby health institutions. The implementation of micro-projects or the Covid-19 pandemic were catalysts that intensified the activities of the CFUs in the communities.
The success of these committees can be explained by several factors: the community's acceptance of the project and the motivation and confidence of the women members to support, educate and raise awareness in the communities. The participation and support of the project's institutional stakeholders (Haiti Northern Health Department (DSN), CECI, and International Health Unit (USI)) also had an impact.
However, two challenges remain for the CFUs: limited organizational capabilities and insufficient financial and material resources. As genuine volunteer spokespersons, the women members communicate oral messages during visits to churches, schools or in the market. They also participate in home visits, community meetings, cultural activities (theater, patronal feast), as well as in workshops on gender-based violence and nutrition. The goals of these activities are to inform and raise awareness in the community on health issues and to promote the use of services offered by nearby health institutions. The implementation of micro-projects or the Covid-19 pandemic were catalysts that intensified the activities of the CFUs in the communities.
As a result, the support of the ACOSME project guides and assists the CFUs on an ongoing basis from an economic, organizational and logistical standpoint.
While there are some constraints, their implementation shows great potential for sustainability.
"Solidarity between the different actors of the community and social cohesion are the key factors to ensure the sustainability of the initiative". A community mobilization representative
The factors for success are the increase in the technical and organizational capacities of the CFUs through ongoing training and monitoring, the support of the DSN and the search for new partners in their areas of activity to support micro-projects implemented by the committees and to increase their involvement (motorcycles ambulances, as well as drilling boreholes to ensure water availability).
The CFU supports the raising of women’s' profiles in their communities and provides a space for women to express themselves and exercise their leadership and commitment to their health and collective well-being.
