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“Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti
BACKGROUND: Community health systems (CHS) are integral in promoting well-being in humanitarian settings, like Haiti, a country plagued by disruptive socio-political and environmental shocks over the past two decades. Haiti’s community health workers (CHWs) as critical intermediaries have persisted...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society of Global Health
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956116/ https://www.ncbi.nlm.nih.gov/pubmed/33763218 http://dx.doi.org/10.7189/jogh.11.07004 |
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author | Sripad, Pooja Casseus, Alain Kennedy, Sarah Isaac, Benito Vissieres, Kenia Warren, Charlotte E Ternier, Ralph |
author_facet | Sripad, Pooja Casseus, Alain Kennedy, Sarah Isaac, Benito Vissieres, Kenia Warren, Charlotte E Ternier, Ralph |
author_sort | Sripad, Pooja |
collection | PubMed |
description | BACKGROUND: Community health systems (CHS) are integral in promoting well-being in humanitarian settings, like Haiti, a country plagued by disruptive socio-political and environmental shocks over the past two decades. Haiti’s community health workers (CHWs) as critical intermediaries have persisted throughout these contextual shocks. This study explores how shocks influence CHS functionality and resilience in Haiti. METHODS: We applied an inductive and deductive qualitative approach to understand the lived experience of CHS actors. A desk review of peer-review and grey literature searched 393 and identified 25 relevant documents on community health policies, guidelines, and strategies implemented over the last fifteen years in Haiti. In-depth interviews with policy and program stakeholders (n = 12), CHWs (n = 24), and CHW supervisors and community health auxiliary nurses (n = 15) were conducted. RESULTS: Various shocks – political transitions, natural disasters, and disease outbreaks – describe Haiti’s protracted complex humanitarian setting and reveal distinct influences on CHS functionality (challenges and enablers), resilience, and mediating factors (eg, policy, financing, governance, parallel systems). Consequences of civil unrest and lockdowns (political transitions), internal displacement and infrastructural damage (natural disasters), and livelihood depletion and food insecurity (natural disasters and disease outbreaks) affect CHS functioning. CHW resilience is rooted in their generalized scope of work, intrinsic motivation, history in the community, trusting relationships, self-regulatory capacity, and adaptability. Mental health and safety among CHS actors and communities they serve pose challenges to CHS functionality and resilience, while reinforcing collaborations that promote CHW coverage and support and sustain CHS. Participants recommended government support for CHWs, collaborations stewarded by the government and complemented by partners, sub-national autonomy, and integration of disaster preparedness for all CHWs. CONCLUSIONS: Political transitions, natural disasters, and disease outbreaks in Haiti continue to profoundly influence CHS functioning, despite mitigating policy and programming efforts. This study documents the relevance of CHS in maintaining primary health care for a country in protracted crises and suggests that propositions of CHW resilience can be explored in complex humanitarian settings globally. |
format | Online Article Text |
id | pubmed-7956116 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | International Society of Global Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-79561162021-03-23 “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti Sripad, Pooja Casseus, Alain Kennedy, Sarah Isaac, Benito Vissieres, Kenia Warren, Charlotte E Ternier, Ralph J Glob Health Research Theme 3: Community Health Initiatives BACKGROUND: Community health systems (CHS) are integral in promoting well-being in humanitarian settings, like Haiti, a country plagued by disruptive socio-political and environmental shocks over the past two decades. Haiti’s community health workers (CHWs) as critical intermediaries have persisted throughout these contextual shocks. This study explores how shocks influence CHS functionality and resilience in Haiti. METHODS: We applied an inductive and deductive qualitative approach to understand the lived experience of CHS actors. A desk review of peer-review and grey literature searched 393 and identified 25 relevant documents on community health policies, guidelines, and strategies implemented over the last fifteen years in Haiti. In-depth interviews with policy and program stakeholders (n = 12), CHWs (n = 24), and CHW supervisors and community health auxiliary nurses (n = 15) were conducted. RESULTS: Various shocks – political transitions, natural disasters, and disease outbreaks – describe Haiti’s protracted complex humanitarian setting and reveal distinct influences on CHS functionality (challenges and enablers), resilience, and mediating factors (eg, policy, financing, governance, parallel systems). Consequences of civil unrest and lockdowns (political transitions), internal displacement and infrastructural damage (natural disasters), and livelihood depletion and food insecurity (natural disasters and disease outbreaks) affect CHS functioning. CHW resilience is rooted in their generalized scope of work, intrinsic motivation, history in the community, trusting relationships, self-regulatory capacity, and adaptability. Mental health and safety among CHS actors and communities they serve pose challenges to CHS functionality and resilience, while reinforcing collaborations that promote CHW coverage and support and sustain CHS. Participants recommended government support for CHWs, collaborations stewarded by the government and complemented by partners, sub-national autonomy, and integration of disaster preparedness for all CHWs. CONCLUSIONS: Political transitions, natural disasters, and disease outbreaks in Haiti continue to profoundly influence CHS functioning, despite mitigating policy and programming efforts. This study documents the relevance of CHS in maintaining primary health care for a country in protracted crises and suggests that propositions of CHW resilience can be explored in complex humanitarian settings globally. International Society of Global Health 2021-03-10 /pmc/articles/PMC7956116/ /pubmed/33763218 http://dx.doi.org/10.7189/jogh.11.07004 Text en Copyright © 2021 by the Journal of Global Health. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License. |
spellingShingle | Research Theme 3: Community Health Initiatives Sripad, Pooja Casseus, Alain Kennedy, Sarah Isaac, Benito Vissieres, Kenia Warren, Charlotte E Ternier, Ralph “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti |
title | “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti |
title_full | “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti |
title_fullStr | “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti |
title_full_unstemmed | “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti |
title_short | “Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti |
title_sort | “eternally restarting” or “a branch line of continuity”? exploring consequences of external shocks on community health systems in haiti |
topic | Research Theme 3: Community Health Initiatives |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956116/ https://www.ncbi.nlm.nih.gov/pubmed/33763218 http://dx.doi.org/10.7189/jogh.11.07004 |
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