Health Policy and Planning Advance Access originally published online on March 24, 2006
Health Policy and Planning 2006 21(3):217-230; doi:10.1093/heapol/czl005
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Reducing under-five mortality through Hôpital Albert Schweitzer's integrated system in Haiti
1Former Director General and CEO, Hôpital Albert Schweitzer, 2Director, Haitian Institute for Child Health, Port-au-Prince, 3Former Special Assistant to the Director General and CEO, Hôpital Albert Schweitzer, 4Former Medical Director, Hôpital Albert Schweitzer, 5Former Director of the Community Health Division, Hôpital Albert Schweitzer and 6Co-Founder, Community Health Division, Hôpital Albert Schweitzer, Haiti
Correspondence: Henry B Perry, MD, Future Generations, HC 73 Box 100, Franklin, WV 26807, USA. Tel: + 1 304–358–2000; Fax: + 1 304–358–3008; E-mail: henry{at}future.org
Background: The degree to which local health systems contribute to reductions in under-five mortality in severely impoverished settings has not been well documented. The current study compares the under-five mortality in the Hôpital Albert Schweitzer (HAS) Primary Health Care Service Area with that for Haiti in general. HAS provides an integrated system of community-based primary health care services, hospital care and community development.
Methods: A sample of 10% of the women of reproductive age in the HAS service area was interviewed, and 2390 live births and 149 child deaths were documented for the period 1995–99. Under-five mortality rates were computed and compared with rates for Haiti. In addition, available data regarding inputs, processes and outputs for the HAS service area and for Haiti were assembled and compared.
Results: Under-five mortality was 58% less in the HAS service area, and mortality for children 12–59 months of age was 76% less. These results were achieved with an input of fewer physicians and hospital beds per capita than is available for Haiti nationwide, but with twice as many graduate nurses and auxiliary nurses per capita than are available nationwide, and with three cadres of health workers that do not exist nationwide: Physician Extenders, Health Agents and Community Health Volunteers. The population coverage of targeted child survival services was generally 1.5–2 times higher in the HAS service area than in rural Haiti.
Discussion: These findings support the conclusion that a well-developed system of primary health care, with outreach services to the household level, integrated with hospital referral care and community development programmes, can make a strong contribution to reducing infant and child mortality in severely impoverished settings.
Key Words: child mortality, local health systems, integrated systems, community, severely impoverished settings
1This conclusion was based on the following assumptions: 4% of mothers are HIV-positive, the rate of mother-to-child transmission is 33%, and 90% of HIV-positive newborns will die before the age of five. According to these assumptions, 11.9 children per 1000 live births will die before the age of five from HIV infection. This is equivalent to 19% of under-five mortality (11.9/62.3).
2If the under-five mortality due to HIV/AIDS in Haiti is also 11.9 deaths per 1000 live births, then the percentage of under-five deaths in Haiti due to HIV/AIDS is 8.0% (11.9/149.4).
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  H. Perry, W. Berggren, G. Berggren, D. Dowell, H. Menager, E. Bottex, J. R. Dortonne, F. Philippe, and M. Cayemittes Long-Term Reductions in Mortality Among Children Under Age 5 in Rural Haiti: Effects of a Comprehensive Health System in an Impoverished Setting Am J Public Health, February 1, 2007; 97(2): 240 - 246. [Abstract] [Full Text] [PDF]
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