Improving Primary Health Care Services of Hôpital Albert Schweitzer

The Hôpital Albert Schweitzer (HAS) was founded in 1956 as a small hospital in rural Haiti. The charitable health institution has grown constantly over the years and is currently serving a district with over 300.000 inhabitants. It comprises a 190-bed hospital and a wide range of Primary Health Care (PHC) services including 7 dispensaries and a network of outreach health workers.

At present, the hospital is increasingly overwhelmed with patients. The patients - after travelling up to ten hours or more from isolated mountain villages to the hospital – often have to wait hours before seeing a doctor and have to sleep on the floor at night because all beds are occupied. The physicians feel that they spend a considerable part of their working time treating patients that could have been treated at the PHC level. On the other hand, the capacities of the dispensary level are relatively limited in terms of infrastructure and professional staff.

In this situation, the Verein Partnerschaft Kinderspitäler Biel-Haiti, a long-term partner organization of HAS, decided to perform an evaluation of the accessibility and utilization of the different health services offered by HAS. The aim of this community-based survey was to elaborate a proposal on how to strengthen the PHC services and thus relieve the hospital. The study was carried out by Maurice Fritzsche in the form of a master thesis under the supervision of the Swiss Tropical Institute.

An analysis of the available data revealed worrisome inequities in access to health services within the district. In focus group interviews with both the health care staff and the population of the district it could be confirmed that all upgrading of the PHC services would be welcomed. The main priorities for the population are better accessibility, expanded emergency services and improved physical infrastructure of the PHC services. The staff prioritizes interventions to improve training, supervision, availability of drugs, material and professional staff so that patient load from the hospital outpatient clinic could be taken over by the PHC level.

The integrative analysis of the findings resulted in a plan of action which proposes interventions on the different service levels with a focus on strengthening community participation. The overall goal is to shift priorities from a hospital-centered system to a more PHC-focused one and to reduce the identified inequities in access to health care.

The proposal was accepted unanimously by the Board of Directors of HAS in May 2005. Dr Chandon Chattophadhyay, Swiss Pediatrician and specialist in Tropical Medicine and Public Health, is currently in Haiti in order to assist in the implementation of the recommendations of the study.

In addition, the study formed the basis for a collaboration with the Berne Highschool of Architecture in a project planning the reconstruction of the dispensaries of HAS. A request for funding of the reconstructions was accepted by the Swiss Agency for Development and Cooperation (SDC) in August 2005.