Being pregnant in Haiti is not easy, and in fact, can be very dangerous. Access to antenatal care is complicated and expensive. The neonatal, infant, child, and maternal mortality rates in Haiti are the highest in the Western Hemisphere and are comparable to the rates found in sub-Saharan Africa and Afghanistan.

The majority of pregnant women in remote areas only have access to maternal care through a nurse or an auxiliary nurse and may never see a doctor throughout their entire pregnancy. It is also typical for pregnant women to pay for services individually, meaning they pay for each separate lab test and medication or vitamin. Since many lab tests are necessary throughout the pregnancy to screen for infections, preeclampsia, and other complications, prenatal care can be expensive and most women will choose to do only certain tests or purchase only some of the medicines prescribed. Furthermore, ultrasounds are typically only performed in urban areas, requiring transportation, time, and money. They are also expensive, ranging from $10 to $20 per ultrasound, in a country where more than half of the population lives on less than $2.50 a day. As a result, most women will go their entire pregnancy without even one ultrasound.

Since the inception of C2C’s Maternal Health Program in 2015, it has undergone several different iterations. Currently, the program is available at two of our six clinics, in Acul du Nord and in Camp Coq. For a small fee (varying from $2.50 to $3.50 USD), pregnant women have access to a complete prenatal visit with a certified midwife as well as a consultation with an OBGYN if the situation requires it. Pregnant women are encouraged to attend a minimum of five visits during their pregnancy and receive at least two ultrasounds. A complete prenatal visit includes preventive and diagnostic lab testing, essential prenatal vitamins containing folic acid and iron, and all other necessary medications to treat any infection or issue that may arise during pregnancy. We provide personalized education and counseling at every visit, encouraging each future mother to give birth in a health facility rather than at home.

In 2019 alone, we have performed more than 1500 individual prenatal visits for over 400 pregnant women. On average, 80% of our patients complete at least four prenatal visits during their pregnancy, as recommended by the WHO, compared to Haiti’s national average of 67%. 66% of women who receive prenatal care and counseling at C2C choose to give birth in a health center rather than at home, a much higher rate than the national average of 39%.

At C2C, we aim to provide high-quality prenatal care in remote areas by bringing medical expertise to communities that previously did not have access. Pregnant women in our Maternal Health Program can see an OBGYN in the event of any complications and have access to as many ultrasounds as needed for their specific pregnancy. Because our low bundle price offers comprehensive services for just one small fee, all of our patients get the lab tests and medications they need in order to have a healthy pregnancy, and ultimately, a healthy baby.  

Because we believe so strongly in our program and because maternal and neonatal complications and deaths are still extremely prevalent in Haiti, we are prioritizing the expansion of our program to more clinics to reach more people and increase our impact.

To support C2C as we expand our Maternal Health Program to another clinic, please visit our campaign site. Thank you!

C2C is joining the Global GivingTuesday Movement to expand our Maternal Health Program to another C2C Clinic. 

GivingTuesday, taking place December 3rd, is a global day of giving that harnesses the collective power of individuals, communities, and organizations to encourage giving and to celebrate generosity worldwide. Every year, on GivingTuesday, millions of people across the globe mobilize to show up, give back, and change their communities. The goal is to create a massive wave of generosity that lasts well beyond that day, and touches every person on the planet.

As we focus on expanding our scope of care in Haiti, one of our main priorities is to also expand our Maternal Health Program as part of our primary care services that we offer to every community we serve. Too many women in Haiti do not have access to essential maternity care, which explains why Haiti’s maternal mortality ratio, at an estimated 521 deaths for every 100,000 live births, is the highest of any country in the Western hemisphere.

By partnering with GivingTuesday, our goal is to launch this program at the next C2C clinic at the start of the new year. We need your help in making this program a reality at one more C2C clinic through a financial donation of your choosing. Any contribution that you can make would be greatly appreciated and will help us achieve our goal of improving maternal and infant mortality rates in Haiti, one community at a time.

Stay tuned for next week when we will share the inner workings of C2C’s Maternal Health Program and provide an inside look at what a typical visit looks like. We hope you join C2C’s GivingTuesday initiative by visiting our campaign page!

This week, C2C was honored as a P3 Impact Award Finalist at the Concordia Annual Summit in New York. Founder & President Elizabeth Sheehan and Executive Director Scott Schroeder presented C2C’s Public-Private Partnership (P3) with the Haitian Ministry of Health to deliver high-quality primary care at rehabilitated government clinics. C2C was considered among a very diverse set of five finalists.

It was a wonderful opportunity to outline the model we have developed in partnership with the Ministry of Health. We emphasized that the challenge in Haiti wasn’t access to healthcare, it was access to quality care. While 90% of the population lives within 5 kilometers of a primary care facility, only 23% lives near a clinic that offers high-quality care. Through years of studying the data and market research behind this gap, we saw that the pathway to a healthcare revolution in Haiti is the rehabilitation of the community clinic network controlled by the Ministry.

This is exactly what our Public-Private Partnership does; C2C works with the Ministry to identify the clinics most in need and upgrades the entire health support platform by introducing the systems and technology that are needed for efficient, high-quality healthcare delivery. The Ministry of Health provides the existing clinic buildings, clinical staff salaries, and centralized support. C2C uses revenue from very low patient fees and services and reinvests it back into the clinic network, resulting in 80% cost-recovery, even with patient fees 20% lower than under government management.

Our P3 has created some incredible results: 30,000 patients served annually across six clinics, quality assessment scores doubled in healthcare delivery post-C2C intervention, and a quarter of a million dollars in earned revenue infused back into the healthcare system.

The Concordia Summit gave C2C the opportunity to share our catalytic partnership with a broad and influential international community. It was also a time for incredible learnings and insights into P3s around the world, as well as other urgent topics such as climate change, global health, and women’s empowerment. It was a very busy week as Concordia coincided with the UN General Assembly and other important gatherings, and C2C is honored to have had the opportunity to learn from inspiring voices in our field and beyond. 

We are grateful to Concordia, the UVA Darden School of Business, and the US Department of State’s Office of Global Partnerships for selecting C2C as a finalist for this prestigious award, as well as to our team in Haiti and in the US, including our Board of Directors, for all of their hard work that made this possible.

Electronic Medical Records systems (EMR) are promising and have the potential to bring many benefits for healthcare in the developing world. However, they also present many obstacles, from implementation to reporting. At C2C, we have employed an EMR system since 2014 and we have had to find creative and innovative solutions to face these challenges.

Benefits of EMR systems: 

One of the first and most important benefits of an EMR system, especially in the developing world, is the increased ability to identify patients from visit to visit. Usually, healthcare practitioners in resource-constrained settings have a hard time identifying existing patients due to inconsistent name spelling and lack of identity cards. Our EMR system permits us to access a patient file with all its relevant information, whether a patient last came to the clinic two days or two years ago, which improves the continuity of care. Our EMR system also improves our efficiency of some time-consuming or error-prone tasks such as writing down all lab results. Some specific features, such as mandatory fields for staff members ensure that all the correct information is recorded adequately. 

A truly effective EMR system provides our doctors and nurses with tools for effective case management proving speedy access to past patient records, including lab results and medications purchased helping them to make better decisions for the care of the patient. Our increased availability of good quality data also contributes to decision making and allocation of our limited resources. Planning and management go hand in hand with an effective EMR system. Having all our patient data as well as our inventory data centrally stored and easily accessible facilitates supply chain management and helps us reduce medication stock-outs. Thanks to our EMR report-generating capabilities, complying with the Ministry of Health reporting requirements takes our staff significantly less time, leaving them more time to focus on education and care for the patients. Overall, our EMR system helps our staff to provide better, more personalized patient care.

Challenges of EMR systems:

With that being said, most organizations trying to implement an EMR in a low-resource, low-connectivity setting face many challenges similar to what C2C has faced in the past. The first challenge is low internet connectivity in most communities we serve. Internet connectivity is key to backing up clinical data to the cloud for reporting and decision-making purposes. To overcome this obstacle, we have had to take time to train non-tech staff to do manual backups of the data to ensure timely information syncing. The second biggest issue that we faced is in regards to our staff of healthcare professionals. Cell phone and computer penetration is still low in Haiti, and some staff members had never worked with a tablet or a computer before working in our clinics. This requires spending extra time on training, offering continuous support for the staff and doing frequent data quality analysis to course-correct mistakes quickly. This issue is compounded by the fact that our clinics sometimes face staff turnover, requiring us to repeat this process. Finally, low-computer literacy, as well as occasional bugs and glitches, often contribute to limited trust in the system by the staff. For now, most clinics find it necessary to retain some kind of paper-based workflow to reassure the staff that data will not be lost but also to serve us in case of a bug or unexpected system shutdown.

The key for an EMR system to fully provide all its potential benefits to an organization is staff engagement and participation. Involving users (staff) from the conception of the system to the deployment and updates ensures that they will better understand, trust, and use the system efficiently. This process is time-consuming and requires constant supervision and follow-up, but an EMR system is only as good as its user inputting the data. We know that it’s the C2C staff who is at the core of the success of our EMR system.

C2C’s health services are not only offered in our clinics; community health education is an extension of our clinical activities into the community. One of the activities provided by our community health workers (CHWs) is a rally post in a different community once a week. 

At this week’s rally post, the CHWs discussed hypertension and checked the blood pressures of community members. The first half of the rally post is dedicated to education, while the other half is spent doing blood pressure checks. This service is completely free. It is an opportunity for people to easily access blood pressure checks without having to go to a clinic. Our CHWs also use this time to inform community members about C2C’s clinical services. 

At our latest rally post, we had a great turnout of about 100 people. These are popular events in the community, where people can come together to get their questions answered and check on their health. 

As we recently announced in our last blog, C2C has been selected as a Finalist for the 2019 P3 Impact Award! The P3 Impact Award was created by Concordia, the University of Virginia Darden School Institute for Business in Society, and the U.S. Department of State’s Office of Global Partnerships to recognize and honor leading public-private partnerships (P3s) that improve communities around the world. 

We wanted to share with you the feature that the Darden School of Business recently published about C2C’s partnership with Haiti’s Ministry of Health on its Ideas to Action website. You can access the full feature here to learn more about how our partnership is working to deliver sustainable primary care to low-income families in Haiti through a social enterprise model. 

In the meantime, stay tuned for more news of the P3 Impact Award as we get ready to attend the 2019 Concordia Annual Summit in New York City on September 22-24. 

Thank you for your continued support!

Dear Friends, 

We are so excited to announce that C2C was recently selected as a Finalist for the 2019 P3 Impact Award for our Public-Private Partnership to deliver sustainable, primary health care with Haiti’s Ministry of Health! 

The P3 Impact Award was created by Concordia, the University of Virginia Darden School Institute for Business in Society, and the U.S. Department of State’s Office of Global Partnerships to recognize and honor leading public-private partnerships (P3s) that improve communities around the world. The award seeks to highlight leading practices and actionable insights in the P3 arena by any cross-sector collaboration that features public, private, nonprofit, or non-governmental organizations and addresses societal problems.

Our partnership with the Ministry of Health demonstrated many positive innovations in its design, structure, and implementation. We are thrilled to be presenting our learnings and experience with the global audience convening at the 2019 Concordia Annual Summit in New York on September 22-24.
 

The P3 Impact Award winner will be recognized on the main stage of the Concordia Annual Summit, the largest gathering alongside the United Nations General Assembly. Stay tuned for information to come about this prestigious award and C2C’s involvement! 

Thank you for your continued support of our work to bring sustainable health care to Haiti! 

During my recent trip to Haiti, I had the pleasure of sitting down with Dr. Richard, who has been at our Cité Chauvel clinic since it opened in April 2017. Dr. Richard shared with me his perspective on C2C’s clinics and the growth of the organization overall.

“A lot of things have changed since the clinic first opened,” he began, “At first, we did not have nearly as many patients. The staffing was not where it is now. We currently have a social service nurse, doctor, and lab tech [in addition to our permanent staff]. We also have a formalized relationship with the Ministry of Health now which I think is very good.”

In terms of Dr. Richard’s vision for the future of C2C’s clinical services, he has many ideas on how to improve staff training and create access to care for people who might not otherwise have it. 

“I would like to improve communication between doctors and patients in our clinics,” he explained, “because they don’t always teach that in medical school here as much as they should. If we could also partner with medical schools to improve training, it would have a broad impact on the quality of care of our clinic network and would also spread the word about C2C’s work.”

When it comes to continuing education for existing C2C staff, Dr. Richard said “I would like to establish a continuous training program with all the staff in a certain subject. There are gaps in education that I would like to fill to improve capacity. Even if the whole team met just once a year, I think it would be very beneficial.”

Dr. Richard would also like to expand access to C2C’s services even further. He told me about a patient story that particularly stuck out to him. “A nineteen-year-old came in with her baby. They were on the street and someone found them. The woman couldn’t walk, and although she had the money to get medical treatment for her child, she did not have enough to take care of herself, too. I talked to the rest of my team to see what we could do for them. The woman had gastroenteritis, so we took care of her and bought her food as well because neither of them had eaten. She got much better and so did the child because we were able to give them the medicines they needed. We sent them home very healthy. In the future, I would like to create more opportunities to help patients like that who cannot afford regular medical care.” 

Dr. Richard is clearly an integral part of the C2C team, and although he has already contributed so much to our work and to Haiti, he still has many professional goals he is working towards. “I want to continue to learn from people and be able to share my experiences with staff in the other clinics in the near future. I hope I can serve the organization in even more ways than what I’m doing now.”

We are truly lucky to have Dr. Richard as part of our team. Due to leaders like him in our clinics and in the field, we are able to assess the needs of the communities we serve and provide them with the quality care they have come to expect from C2C.

“Primary health care is rooted in a commitment to social justice and equity and in the recognition of the fundamental right to the highest attainable standard of health, as echoed in Article 25 of the Universal Declaration on Human Rights: ‘Everyone has the right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and medical care and necessary social services […]’.” 

-World Health Organization, “Primary health care,” 27 February 2019

Growing up, healthcare wasn’t something I ever had to think about. I saw a doctor once a year, a dentist twice a year, a physical therapist when my back hurt, even support for my mental health and a set braces to straighten my teeth. My school had a nurse that took care of me when I broke my ankle attempting to play basketball, and in health class, we had a sexual education unit. I didn’t do anything to earn these things and they didn’t cost my family much if anything. I only had access because I happened to be born in an area with a decent healthcare system in place. There were plenty of providers in my area (even though it was rural), my family had the money for copays and medicines, appointments could be scheduled so I didn’t have to miss school, we had our own car to get to the doctor’s office, and in general it was very easy to find the time and resources to be healthy. 

This makes me extremely privileged, a lesson that I was reminded of constantly on my first visit to Haiti this month. Though I have been with C2C for a few months, this was my first time seeing the clinics up close, and I was fortunate enough to speak with several staff members and patients. From these conversations, I quickly realized that C2C’s model for comprehensive primary care really does have the intended impact and potential to transform a healthcare landscape that is saturated with many temporary solutions. 

It’s no secret that there are a lot of NGOs in Haiti focused on healthcare, so why is primary care so important? Trust is certainly a factor. Many of C2C’s patients come to our clinics because they have family and friends that have had good experiences with our services. As Dr. Samuel noted in a prior blog, before we even open a clinic, we take the time to build a relationship with the community and inform them about our services. We believe that healthcare delivery with a focus on community forms a strong foundation for effective health systems. Unlike mobile clinics that offer free services or other providers that might only have a contract in Haiti for a few years, C2C’s clinics are here to stay; they function within a broader healthcare landscape. Our clinic staff are members of the communities they serve, so there is a level of trust that exists and which allows patients to feel comfortable seeking out care for their health concerns and thus recommending our clinics to family and friends.

The importance of the relationship between clinic and community is evidenced by the example of chronic disease. A patient might visit a mobile clinic and find out that they have hypertension, diabetes, or another disease which requires treatment for the rest of their life. That clinic may provide free medicine for a few weeks, but once it leaves the community, how does the patient treat the disease in its absence? Indeed, without proper primary care, it is difficult to effectively address patient needs long-term.

It is so clear to me from just this one trip that there is much more dignity in primary care. It’s not a handout or a temporary fix–our services become a part of our patients’ lives, a reliable center for healthcare where they can feel confident that they will be welcomed, respected, listened to and treated with a friendly smile and genuine care. 

I heard from several patients who remarked that our “one-stop-shop” approach has been effective for providing treatment while also being time- and cost-effective. One of our nurses commented that at other clinics and hospitals she has worked, patients would come in for their consultation, but would not follow up to see through the rest of their treatment. At C2C, consultation, lab tests, and prescription distribution occur all in one visit which improves adherence to treatment. She also spoke to the power of our electronic medical records (EMR) system, explaining that at other health facilities, a patient may come in for treatment three days in a row, but there would be a different record for each visit. With our EMR system, she can track the progress of the patient and provide better care.

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As our clinic network grows and expands, I am excited to see how C2C’s model can scale across Haiti and beyond. I have come away from this trip with renewed gratitude for the access I have to healthcare in my own life and the confidence that our organization will continue to improve community access to affordable, reliable, high-quality healthcare in Haiti.

Dear Friends,

As we begin the work on rehabilitating the clinic site in Roche Plate, we wanted to give you a behind-the-scene look into C2C’s process for opening a new clinic! 

Step 1- Agreement with the Ministry of Health:

During the first stage in the process of opening a new clinic, members of our Haiti leadership team meet with the Departmental Director of Health to review the list of clinics that the ministry would like us to take on. Our team visits each clinic and meets with the staff to get a sense of what the partnership will look like for C2C, the existing clinic staff, and the community.

Step 2- Market Research & Analysis:

A key component of C2C’s process for choosing which clinic to renovate is to first review the Ministry reports of potential clinics we can improve through our Public-Private Partnership. Then, we compile and analyze data about the clinics and the communities they serve. After lengthy internal discussions, C2C works closely with the Ministry to weigh the pros and cons of each clinic site, taking into account the Ministry’s priorities, needs of the catchment area of the site, and renovation costs. We also make sure to survey the economic conditions of the communities in order to set our service rates fairly and to consider the needs of the community. Once this process is over, we make the final decision about which clinic to rehabilitate.

Step 3- Clinic Site Renovations:

This is the stage where the clinic transformation truly begins. Our Haiti team gets bids from local contractors for the renovation project. Once we choose the contractor, the physical renovation begins to take place: we ensure that the building is structurally safe and meets the needs of our clinic services; the waiting area is welcoming; and that the entire facility provides patients with a high-quality experience that they will feel comfortable returning to for all of their primary care needs.

Step 4- Staff Training:

At C2C, we want to make sure our staff is able to provide the high-quality care people have come to expect from us. We integrate the core value of “bon acceuil” into our visual brand by adopting a tagline: Sante’w se Priyorite’n (Your Health is Our Priority). We make sure to weave this tagline by infusing every client interaction with our clinics, which starts with our friendly staff. We also train all staff members on our electronic medical records system to support our mission in providing efficient, high-quality care.

Step 5- Community Relations:

We believe it is of utmost importance to build trust between C2C and the community that we aim to serve, and we do this through community building. We meet with local political leaders, elders, local priests, directors of schools, and many personalities that play a big role in their community to build our working partnership. While community members may have visited the clinic before as a public dispensary, we aim to improve upon their past experiences by providing high-quality primary care services that are also affordable and convenient, along with our accessible services such as our on-site pharmacy and laboratory. Also, through our community health program, our agents educate community members on the importance of primary care and how C2C works to respond to their needs.

Step 6- Grand Opening:

Once our clinic is fully renovated, our staff is trained, and the community is familiar with our services, we add the finishing touches such as ensuring that our pharmacy is fully-stocked and that we have all of the necessary supplies and equipment. On opening day, we have a welcome ceremony to celebrate our new clinic as well as our new partnership with the community!

In collaboration with the Ministry of Health, C2C’s next clinic will be our first in the Northeast Department. This is an exciting time for our organization, as we prove how our model can scale across Haiti and beyond. The clinic, located in Roche Plate, is projected to open this fall. Stay tuned for more updates!