| Prestation de soins de santé et support aux institutions sanitaires (structures fixes et/ou mobiles, interventions médicales, promotion de la santé, approvisionnement en intrants médicaux, logistique) / Health care delivery and support of institutions (fixed and/or mobile structures, medical interventions, health promotion, medical supplies, logistics) |
Long-term Program Goals: Development of a network of freestanding locally controlled and operated clinics serving marginalized communities; expanding the overall country-wide capacity to effectively engage these communities in high quality primary care services.
One-year Interim Program Goals: Establish or re-establish high-quality medical care and social support for marginalized populations in Haiti; position locally based organizations to take over program control and expansion.
Component One: Fully outfit temporary clinics with locally based physicians and other appropriate health professionals with expertise on HIV/AIDS, marginalized communities, and sexual/reproductive health.
Following the devastating earthquake of January 12, 2010, Housing Works developed an emergency response plan to provide relief and medical support to marginalized communities, including men and women living with HIV and AIDS. At that time, more than half of all Port-au-Prince clinics were completely destroyed, and there was little or no primary care available. Many Haitians living with HIV/AIDS, women, and children needed urgent care as a result of injuries sustained during the earthquake and aftershocks. Furthermore, a large population of Haitians living with HIV/AIDS had fled the capital, with a large number going to Saint-Marc, a city about 45 km north of Port-au-Prince. In response to the urgent need, Housing Works and Diaspora Community Services entered into a coalition with PHAP+, a national association of people living with HIV and AIDS, and two New York City organizations, AID for AIDS International and the Caribbean Women’s Health Association, in order to: (1) support the opening of a Port-au-Prince HIV/AIDS clinic; (2) support the reopening of the Centre Medico-social Port-au-Prince family health center; and, (3) open a clinic in Saint-Marc to serve Haitians living with HIV/AIDS and their families.
A testament to the group’s prompt response, the clinics were up and running by late January and were among the few primary and specialty HIV clinics (non-trauma clinics) operating in Port-au-Prince during the immediate aftermath of the earthquake. By mid-February, the three clinics recorded over 1,000 patient visits. Today, the coalition of agencies continues to share oversight and responsibility of the clinics and the ongoing relief efforts. For example, Diaspora Community Services provides fundraising and general oversight for the Centre Medico-social Family Health Center. Housing Works oversees logistical support for the greater program, which includes coordination of medical staff and supplies.
As envisioned in our emergency response plan, we are now moving into an interim implementation phase for our network of clinics. Anticipated to take approximately 12 months, this phase will lay the groundwork for local support and, eventually, local control of all sites.
During this time, the partners will transition from using US-based health providers and will recruit and train locally based physicians, nurses, health educators, and administrators. Furthermore, we aim to retain a high-level, locally based coordinator to oversee the clinics’ day-to-day operations, develop skills of newly hired staff, and prepare for the transition to local control.
Together with US-based partners, the coordinator will oversee implementation of the following program components outlined in this application.
Outcomes for Component One: (1) Delivery of culturally appropriate and responsive no-cost primary care services to children and young people living with HIV/AIDS or at-risk of infection; (2) delivery of culturally appropriate and responsive no-cost primary care services to adults living with HIV/AIDS or at-risk of infection; and, (3) preparation and planning for autonomous local control of clinic network.
Component Two: Develop effective health administration and procedures for all clinics, including electronic medical records and tele-medicine.
During the next twelve months, Housing Works, Diaspora Community Services, and on-the-ground professional staff will develop effective health administration practices and procedures for all clinics. This includes the following: (1) the implementation of a basic electronic medical records system; (2) hiring and training of clinic administration staff; (3) development of basic customer service practices; (4) retention in care training and implementation; and, (5) development of a tele-medicine program using VOIP and other technologies.
Inherent in our plan is the importance of maintenance in care for all clients. We envision all services to be free over the next twelve months and, as a result, visits will remain relatively high – up to 1,000 per month at each clinic based on current visits and projections. However, our aim is to increase return visits and to provide ongoing care and management of HIV disease and other STIs. Tele-medicine would allow the clinics to provide specialized care by consulting with medical specialists around the world. Currently, we have commitments from doctors in the United States and we envision the development of a medical advisory council that will provide ongoing consultation and expertise.
Outcomes for Component Two: (1) Adoption and implementation of technology enabled primary care for at-risk populations in Haiti; (2) improved patient care; (3) improved operational efficiency; and, (4) low-cost referral and specialty care.
Component Three: Development of a comprehensive and replicable sexual health curriculum for all clients/marginalized populations, especially those living with or at-risk of HIV/AIDS.
In addition to the delivery of primary care services, the clinics will serve as the venue for the implementation of a comprehensive and replicable sexual health program for marginalized populations, especially those living with or at-risk of HIV/AIDS. The curriculum, to be developed by local staff including the program coordinator, will build upon the American Social Health Association's Know Your Body, Know Yourself framework. This framework stresses awareness of one's body and communicating sexual needs and limitations with partners. As appropriate, the curriculum will integrate CDC Evidence-based Interventions. For example, for MSM clients, we can adapt the d-up: Defend Yourself intervention, which uses MSM social networks to promote safer sex norms to decrease the number of cases of HIV among MSM. The intervention creates social change by mobilizing MSM leaders to engage and influence others in their network and influence their risk behaviors.
Outcomes for Component Three: (1) New, replicable sexual health and HIV/STI prevention curriculum; (2) reduced HIV and STI infection rates; and, (3) sexual health and HIV/STI prevention knowledge sharing among primary care-focused, Haiti-based prevention programs.
Component Four: Development of targeted outreach campaign to engage and return to care marginalized populations in comprehensive primary care services, sexual health education, and social support services.
Housing Works and its partners will develop a targeted outreach campaign to engage and return to care marginalized populations in comprehensive primary care services, sexual education, and social support services. Building on its on-the-ground network partners, the program coordinator and health educators will conduct the following outreach activities: (1) presentations and health screenings at community-based organizations serving marginalized populations; (2) tabling at community and cultural events; (3) radio interviews and other media outreach, including online; and, (4) flyer distribution and face-to-face recruitment at sites where MSM, transgender, sex workers, and other marginalized populations gather.
Outcomes for Component Four: (1) Recruit, engage, and provide return to care services for targeted populations – increase representation from approximately one-third to over one-half of all clients; (2) expand network of community partnerships; and, (3) map and continually update local “hot spots,” where marginalized populations gather/engage in risk behaviors.
Evaluation:
Within the context of this program, we will evaluate programmatic success based on the following deliverables:
1. Maintain overall enrollment of 1,000 per month at each site (walk-ins are expected to decrease as the country recovers from the January 12 earthquake).
2. Roll-out clinic administrative procedures and electronic medical records and upload client information for at least half of all visits.
3. Engage a minimum of 150 clients per month (at each clinic) in sexual health education program; adapt at least one CDC EBI at one site and enroll minimum required participants (will vary by EBI chosen).
4. Increase representation of marginalized populations among overall client enrollment from one-third to over one-half.
Within the broader context of its AIDS services, Housing Works and Diaspora Community Services will conduct formal quality improvement projects to evaluate the Haiti-based care network, adapting as necessary the current quality assurance and evaluation processes already in place across all agency program areas.
Program Sustainability:
As detailed within and expressed in our initial emergency response plan, the overall program goal is the development of a network of freestanding, locally-controlled and operated clinics serving marginalized communities and expanding the overall country-wide capacity to effectively engage these communities in high quality primary care services. The goals, objectives, and methods presented within will position the clinics for local control at the end of the twelve-month period. As part of the technical assistance provided by Housing Works, Diaspora, and other program partners, we will develop leadership and internal capacity to ensure the effective, seamless handover. As part of this process, we will identify long-term funding streams and develop a sliding scale fee structure (to be implemented following the interim period described within).
Partnerships:
As evidenced within this joint proposal and in the very title of our program, our response to the earthquake relies on the commitment and expertise of partners in New York and Haiti. PHAP+, a Haitian national association of people living with AIDS and HIV, oversees the administration of the Port-au-Prince HIV clinic: storage, inventory, and distribution of supplies; maintenance of a secure campground for personnel; securing translators; and, coordination of the receipt of personnel and goods. Diaspora Community Services (co-applicant) re-opened and resumed oversight of the Centre Medico-social Port-au-Prince. Currently, with Housing Works and other partners, Diaspora is implementing its interim clinic plan and actively soliciting funds to support long-term goals/objectives. Aid for AIDS continues to coordinate the collection, inventory and packing of medications, particularly antiretrovirals. Caribbean Women’s Association is using its ties in the Brooklyn Caribbean community, faith-based organizations and other relationships to leverage funds to purchase nutritional and other essential supplies that are not donated. Housing Works (co-applicant) continues to play a coordinating role – acquiring and delivering commitments of resources, including volunteer medical personnel. Housing Works is also maintaining vehicles and drivers and developing tracking systems to ensure that adequate records are being maintained and that results are being reported to all stakeholders.
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