SPOTLIGHT: HOPITAL SAINT-MICHEL RENOVATION
Hôpital Saint-Michel (HSM) serves as the public departmental hospital for Jacmel, the capitol and largest city in the South-East Department of Haiti. For years, HSM greeted patients with poor accommodations and inadequate waiting rooms and consultation space.
Starting in 2009, providers and managers met many times to assess options to improve clinical, administrative, and shared space, as well as the integration of services, but a lack of funds hindered renovation plans. Many other activities were undertaken with the goal of providing a more welcoming space in order to increase patient visits, increase HIV testing, and improve the overall HIV care and treatment program. Fortunately, at the end of 2013, through the PEPFAR – Center of Excellence (COE) Program and funds allocated by the Centers for Disease Control and Prevention (CDC), plans to renovate the outpatient clinic were revitalized, and renovation work began in January 2014.
HSM now has a spacious outpatient clinic that supports an efficient patient flow and improved integration of services, including general consultations; voluntary counseling and testing; prevention, care and treatment of HIV patients; treatment of tuberculosis; care of emergency cases; archive space; and an overall environment respectful of patient dignity and conducive to quality care services.
Training course materials developed and delivered, in collaboration with the MSPP, include:
- HIV/AIDS Stigma and Discrimination in Caribbean Health Care Settings: Trigger Scenarios (Stigmatisation et discrimination liées au VIH/SIDA dans les dispensaires de soins de santé des Caraïbes: scenarios à méditer). Facilitator guide in French and video scenarios in Haitian Creole.
- Training Trigger Tapes for the Therapeutic Management of PLWHA (Scénarios pour la Formation de la Prise en Charge Thérapeutique des PVVIH). Facilitator guide in French and video scenarios in Haitian Creole.
- National Care and Treatment of People Living with HIV Curriculum (Prise en charge thérapeutique complète des personnes vivant avec le VIH). Facilitator and participant manuals in French.
- The Chance (Chans). Video in Creole (subtitles in English) with accompanying discussion guides for general public and clinicians.
I-TECH has successfully developed curricula for:
- Management of acute diarrhea
- Prevention with Positives
- Care for most-at-risk populations (MARPs)
The principal strategic directions outlined by the Ministère de la Santé Publique et de la Population (MSPP) in Haiti with regard to HIV/AIDS are to reduce its prevalence, reinforce prevention efforts through increased testing and treatment of sexually transmitted infections and HIV, and eliminate the transmission of HIV from mother to child.
I-TECH’s programs contribute to these national goals in Haiti by introducing clinical mentoring that helps strengthen HIV- and AIDS-related services through improved service delivery at medical and laboratory facilities; training and task-shifting to support human resources for health; and developing integrated health information systems. I-TECH also developed a web-based training management tool (TrainSMART) used by the MSPP. In 2011, I-TECH began supporting the MSPP in its rollout of new malaria diagnosis and treatment guidelines through clinical mentoring and surveillance. In 2012, I-TECH began supporting the MSPP nutrition national program through clinical mentoring and surveillance. I-TECH clinical mentors also helped the National TB Control Program (PNLT) revise the national TB curriculum and train providers on TB management and care.
Improved service delivery
- Quality HIV care. I-TECH supported the extension of quality HIV care to 34 sites of the MSPP care and services network. In addition I-TECH is providing clinical mentoring to 18 sites in the MSPP care and services network.
- Centers of Excellence. I-TECH works closely with three Centers of Excellence (CoE) in Haiti: Hôpital Nos Petits Frères et Soeurs in Port-au-Prince, Hôpital Saint Antoine in Jérémie, and Hôpital Saint Michel in Jacmel. Each CoE follows a detailed improvement plan centered on providing quality services to the patients they serve.
- Building capacity in cervical cancer screening and treatment. I-TECH partners with seven hospitals in Haiti to strengthen reproductive health services by integrating cervical cancer screening and treatment of cervical precancerous lesions: The State University Hospital of Haiti (HUEH), Hôpital Universitaire de la Paix, Centre Obstétrico-Gynécologique Isaïe Jeanty et Léon Audain, Hôpital de Carrefour, Hôpital Nos Petits Frères et Soeurs, Hôpital Saint Antoine in Jeremie, and Hôpital Saint Michel in Jacmel. The focus of the technical assistance is to train clinicians in the visual inspection with acetic acid (VIA) method for screening cervical cancer and in the treatment of cervical precancerous lesions with cryotherapy. Equipment and supplies were also provided to the sites.
- Malaria surveillance. The National Program for the Eradication of Malaria in Haiti works with I-TECH to implement the MSPP protocol for the testing and treatment of malaria. Malaria surveillance reports and indicator dashboards are now available in the electronic medical records (EMR) system iSanté.
- Nutrition surveillance. I-TECH trains doctors and nurses on taking anthropometric measurements and screening patients for nutritional deficiency according to the national protocol at 23 sites of the national monitoring network. I-TECH clinical mentors provide follow-up on-site training to ensure the guidance is being followed. Nutrition surveillance reports are also available in the EMR iSanté.
- Continuous Quality Improvement (CQI): In partnership with CDC, I-TECH helps the MSPP to implement the national care improvement program, Healthqual, by training providers on quality improvement concepts and using data from the EMR iSanté for clinical decision making and care improvement.
Strengthening and scaling up iSanté, the national electronic medical records system
At the request of the MSPP and the Centers for Disease Control and Prevention Global AIDS Program in Haiti (CDC GAP), I-TECH began developing iSanté in 2005. iSanté supports health care workers and clinics to manage and utilize patient data, and facilitates timely and accurate reporting on national HIV service delivery and surveillance. iSanté is used at 115 hospitals and clinics around Haiti and includes more than 450,000 patient records. The system includes patient care summaries, population-level data dashboards, automated program reports, epidemiological monitoring, and indicator reporting, and is linked to computerized lab results. I-TECH also provides technical assistance to clinicians and records officers to use iSanté at point-of-care.
Currently, I-TECH is facilitating an evaluation of the MSPP-led “smartcards” pilot at five sites in the West Department. The smartcard is designed to complement the use of the EMR iSanté at point-of-care by allowing providers to pull up a patient’s medical record via a card reader. In addition, fingerprinting functionality was added to the EMR to facilitate deduplication and record retrieval.
In partnership with the CDC's Regional Information Officers, Tulane University Technical Assistance Program and others, I-TECH reinforces data quality and data completeness through system modifications, training, and onsite technical assistance. I-TECH has developed national standardized training modules on data management and the iSanté system.
Developing and implementing a national laboratory information system
At the request of the MSPP and CDC GAP, I-TECH began development and planning for the implementation of a laboratory information system (LIS) in 2007. Haiti's National Public Health Laboratory, in close partnership with I-TECH, established the National LIS Working Group, which made rapid progress in developing, pilot testing, printing, and disseminating nationally standardized, paper-based tools for laboratory information management.
These paper tools lay the foundation for the development and rollout of an electronic LIS, OpenELIS, which is now operational at 25 sites across Haiti. OpenELIS has improved the way clinicians and lab technicians order and process lab results by improving management capabilities, cutting back on turnaround time for results, and allowing for better data quality and monitoring. OpenELIS is designed to manage laboratory data, activity, and workflow and to produce patient test result reports. In Haiti, I-TECH LIS Officers train laboratory managers and technicians to use the system and generate reports for analysis. Interoperability between iSanté and Open ELIS allows clinicians to quickly provide HIV and primary care patients with lab results and make treatment decisions.
Expanding and improving pre-service and in-service training
With the MSPP, I-TECH also revised pre-service training materials for the National Nursing School's (Ecoles Nationales d'Infirmières) curriculum. The new curriculum, which offers a bachelor's degree in Nursing Science (BNS), was validated in January 2014. Faculty mentors conduct follow-up visits to support faculty members to incorporate new teaching methods into their courses. I-TECH also helped the faculty of the National Schools of Laboratory Technology revise the laboratory curriculum to be able to offer a bachelor’s degree in Biomedical Science. Faculty was trained on the use of this new curriculum.
I-TECH also works in partnership with the local training organization Institut Haïtien de Santé Communautaire (INHSAC) to develop and implement training for health care workers. INHSAC has trained more than 1,100 physicians, nurses, psychologists, social workers, laboratory technicians, pharmacists, and auxiliary health staff in areas including prevention of mother-to-child transmission of HIV (PMTCT), voluntary counseling and testing and rapid testing, and comprehensive psychosocial support for people living with HIV/AIDS.