Background
Haiti has the highest maternal mortality ratio in the Latin American and Caribbean region
at 380 per 100,000. While a high percentage of women seek prenatal care, a majority (64%)
deliver at home with traditional birth attendants (TBAs). In this study, we sought to: 1)
assess the views of men and women of reproductive age in the health district of Jérémie
regarding risk factors for adverse maternal outcomes during the perinatal period, and solicit
opinions about whether a proposed Community Obstetric Technician (COT), trained to
assist at routine home deliveries and refer complications, would be an effective
intervention; and 2) to assess the acceptability to TBAs, community leaders and policy
makers of a program to train the literate children of TBAs or other literate community
members to become COTs.
Methods
We conducted four focus groups and 38 semi-structured interviews across seven different
subgroups: women and men of reproductive age; women who recently delivered at the
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regional hospital; TBAs; Ministry of Health policy makers; community leaders; literate
children of TBAs; and other literate young people in the community.
Results
Participants cited distance and costs as the main barriers to delivering in the hospital. They
expressed a desire for more skilled birth attendants in their community. TBAs welcomed
the idea of more highly trained community-based provider. TBAs and community
members were receptive to the idea of TBAs’ children being trained to serve in this role.
Ministry of Health participants described an underfunded health system with staffing needs
at all levels. They recognized a need for more community-based services, but favored
current strategies (focusing on strengthening institutional services) and noted limited
resources.
Conclusions
A community obstetric technician is an acceptable option for women in this region. Policy
considerations include placement of COTs in areas furthest away from health facilities;
identification of COT candidates from the communities where they are needed; provision
of COT services for free or on a sliding scale; and integration of COTs into the existing
health system. The Ministry of Health should consider how to address a need for skilled
community-based personnel and a referral system to higher-level facilities.