The community of Savanne Longue in northeast Haiti has access to a community health center and a nurse assistant. However, they’re of little benefit to the community unless its members use them. And in Haiti, where health is traditionally considered the responsibility of health care providers, emphasizing the power of individuals and communities to influence health can be a challenge.
This need is particularly urgent in Savanne Longue, where 23% of the community are women of childbearing age and 12% are children 5 years old and younger. Improving the health seeking behaviors of its members is critical to improved health outcomes – especially related to childhood malnutrition.
According to the World Food Program, 50% of Haitians are undernourished. A study conducted by the country’s Ministry of Public Health and Population (MSPP) found that 5% are acutely malnourished, and 1% suffer from severe acute malnutrition. In all, one in five Haitian children under five are chronically malnourished and nearly half of all children are anemic.
The MCSP Services de Santé de Qualité pour Haiti (SSQH) project began its efforts to mobilize the Savanne Longue community by revitalizing a local health committee that had become ineffective and eventually dissolved. SSQH, which works with the MSPP to improve the health of Haitians nationwide, often works directly with communities to tackle their nutrition issues.
In Savanne Longue, this meant meeting with community members, including those who had been part of the defunct health committee. Discussions ensued on why the previous committee model failed and the importance of health committees to communities. Inspired community members joined the new health committee on a voluntary basis and signed a letter of commitment to work together to solve their community’s health problems.
In January 2017, Savanne Longue’s health committee was officially re-established with 13 members. To keep committees like these effective, SSQH uses the Community Action Cycle to help the community explore, identify, act on, evaluate and progressively improve identified health problems.
This process led the community to identify several health problems, including child malnutrition. After SSQH led them through mapping the community and analyzing drivers of health problems, malnutrition of children 0 to 59 weeks was classified as the priority concern. This conclusion was supported by a 2012 MSPP nutrition survey, which identified the northeast section of Haiti as having the highest prevalence (32.9%) of chronic malnutrition among children aged 6 to 59 weeks.
This community capacity-building approach not only helped to forge strong relationships between SSQH and community members, it also empowered residents to address their own health issues and improve their child feeding practices. For instance, the project organized a one-day event focused on nutrition, which included sessions on growth monitoring and infant and child feeding.
Mothers on the committee led the session, and SSQH provided local fruits and vegetables for participants to sample. Session leaders stressed the value of local – versus imported – food given Savanne Longue’s proximity to the Dominican Republic border. Imports are plentiful in the area, and there is a common misconception that imported food is superior.
To reinforce the information shared in the community-level education sessions, SSQH worked at the national level to design three Social and Behavior Change Communication materials on Infant and Young Child Feeding messages: a booklet on breastfeeding, which features a checklist on barriers to breastfeeding as well as advice on positioning and attachment; a leaflet on complementary feeding focused on nutrient-dense foods and feeding frequency; and a leaflet on maternal nutrition with messages on anemia prevention. Once produced, these materials will be distributed to both facility providers and community health workers for patient education.
After attending the sessions, Cléomide, a mother of two, began feeding her children local products such as cassava and vegetables, products that she’d previously sold to buy more processed foods like white rice and biscuits. “I used to participate in other activities organized by women leaders, but nutrition – although a problem in our community – was not addressed,” she said. “I didn’t know that the food we have can be good for our children. I was feeding my children because I knew they had to eat, but I did not take into account the nutritional value the foods should have.”
In the sessions, Cléomide also learned how to distinguish three groups of nutritionally valuable food: those that energize the body; those that build the body; and those that protect it. She also tracks her children’s health through growth monitoring sessions conducted by trained community health workers during regular pop-up health stations in the area.
Cléomide’s increased knowledge – and the improved health of her daughter – show that SSQH’s efforts in Savanne Longue community are bearing fruit. “My one and a half-year-old daughter weighed 6.9 kg (13 lbs) before I attended the awareness session,” she said. “After hearing the information, I began feeding my child with the recommended foods. During the last weigh in [a few weeks later], my child weighed 7.5 kg (16.5 lbs).”
Marie Jo Prosper, a health committee member who encouraged Cléomide to take part in the session, said she was proud to hear her testimony. After hearing Cléomide speak, she said, “When the committee prioritized malnutrition, I said to myself: finally, we will stop this habit of selling our good products to buy the rice that comes from elsewhere.”
The SSQH project continues to support the Savanne Longue health committee by participating in its meetings and providing technical assistance on topics identified by the committee.
“We can only thank SSQH for supporting the health committee and for the advice we have been given on several topics, like nutrition,” said Marie Jo.