Thank you to all of our supporters for an amazing year at C2C!

While widespread protests and fuel shortages across Haiti made 2019 a year of many challenges, we also have so much to be grateful for. This year, we have served over 33,000 patients (up from 23,000 last year) and our imbedded social enterprise model recovered clinic operating costs at 80% across the entire network, further validating our sustainable health-delivery model. We secured significant new support from foundations and individuals and were recognized by the Innovations in Healthcare Initiative at Duke University in March and as a finalist for the Concordia P3 Impact Award in September. Even during very challenging times, we continued to provide high quality, sustainable primary care to communities who desperately need it. None of this would have been possible without your support!

Thank you again from all of us at C2C. Happy Holidays!

At Care 2 Communities, our main focus has always been to provide quality primary health care to communities in Haiti. Through our network of six clinics, we are able to treat approximately 3000 patients per month. In addition to primary health care, we offer different specialty programs, including our malnutrition program, which has operated for the past three years thanks to generous contributions from our supporters.

Through our malnutrition program, we have been able to save the lives of hundreds of children by providing nutritional aid in order for them to reach an adequate weight and maintain healthy growth. We admit children between the ages of 6 and 59 months with moderate and severe malnutrition, providing them each week with a peanut paste fortified with 13 vitamins and 10 minerals called Ready-to-Use-Therapeutic-Food (RUTF), also known as “Plumpy Nut,” or as Haitians call it, “Medika Mamba.” A moderately malnourished child will stay in the program for 6-8 weeks and a severely malnourished child will remain for up to 12 weeks. Children come once a week with their caregiver and are seen by a malnutrition nurse where they are weighed and their progress is assessed. The children are given a certain quantity of Medika Mamba sachets depending on the nurse’s evaluation. Only when they reach a desirable weight will a child be discharged from the program. 

On top of assessing every child in the program, our nurse gives educational talks about malnutrition on dedicated days and has a one-on-one conversation with each parent or caregiver. The educational lessons tackle different matters which are adapted to the general Haitian population. The nurse discusses subjects such as eating habits, Haitian food groups, vitamins and minerals, health issues, treating water, hygienic practices, diarrhea prevention and treatment, along with many other topics. The educational part of the malnutrition program is extremely crucial. The lessons offer caregivers the opportunity to improve their practices at home and deliver beneficial information that not only will help their child during the program, but also after reaching an ideal weight. In addition, the lessons can be passed on to other members of the household, friends, and neighbors. 

Another vital aspect of the malnutrition program is the community health workers, who ensure we reach as many children as possible. Due to parents often being ill-informed of the severity of their child’s malnutrition, our community health workers go into the field and screen children. This way, we can find these children at an early stage and be able to put them back on a healthy track. 

The vast majority of the children enrolled in the program come from some of the poorest households in remote areas every week to attend the malnutrition program. To help them with the burden of transportation, C2C gives each household a stipend. This gesture helps reduce dropout rates, ensures children come to the weekly weigh in, and eases stress on the caregiver accompanying the child.

Overall, because of this program and its dedicated staff, hundreds of malnourished children get the chance to have a brighter future.

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.