Scaling Up Agents de Santé Communautaire Polyvalent in Haiti

The long-term goal is to achieve and sustain effective coverage of essential health services, serving as a model for national scale-up. To achieve this, the project addresses barriers of funding, human resources, and ASCP supervision. The project is led by Zanmi Lasante (ZL) in collaboration with the Haitian Ministry of Health (MSPP). The MSPP will have the necessary tools to coordinate all implementing partners and harmonize existing community health worker (CHW) programs into a unified ASCP structure. This will be fully integrated within the larger health system and aligned with national policies. The project has three objectives over a three-year period: 1. Align ZL's network of CHWs with MSPP's new requirements and standards for ASCPs. 2. Strengthen the continuum of care by developing linkages between communities and health facilities in Mirebalais. 3. Strengthen health information systems and data capacity to improve decision-making within the ASCP network. The project aims to achieve a national target ratio of 1 ASCP per 1,000 inhabitants. The ultimate goal is to improve and expand health services, strengthen the health system, and gather lessons to influence a successful nationwide scale-up of a unified ASCP structure. In the second year of the project, the project focused on completing the training of MSPP curriculum and continuous follow-up and mentoring of ASCP activities. The training modules were completed in April 2017 and January 2018, and the results showed a significant increase in participant knowledge. However, the project faced several challenges, including changes within the MSPP leadership, which affected the project's integration and progression. The project team requested that a new Health Minister's cabinet member be invited to the ASCP workshop in South Africa, and the MSPP representative expressed positive feedback. Another challenge was the implementation of a referral/counter-referral system between the community and health facilities. Steps were taken to prepare and engage primary care clinics in the areas, but the onboarding of staff at the Mirebalais University Hospital and the production of tools for the system remain pending. The disbursement of funds remains an issue, and vaccination reporting has been challenging due to the lack of resources at the MSPP local chapters. The project team has alleviated this issue by using a single register to list all antigens per child, allowing for both the per-vaccine indicator and complete vaccinations for the MSPP. ZL has collaborated with the MSPP for over 30 years, but the project's integration and progression have been affected by the MSPP's instability. The project team is working to engage the new MSPP representatives, as their collaboration is essential for the scale-up of the ASCP project and the certification of trained ASCPs in Mirebalais. Several key questions were addressed, including the ASCP requirement criteria, the best way to deploy ASCPs in relation to community needs, and the effectiveness of the joint model of training, certification, and certification. The MSPP is aware that the criteria may constitute a barrier to entry, but they are also essential to ensure that individuals chosen are able to provide quality services to the population. The project's criteria for ASCPs include age (20-35 years), academic level (at least 9th Grade and at most 12th Grade), and community approval (referred by a notable or respectably known member of the community). The MSPP has reinforced this aspect by updating the criteria and ensuring that individuals chosen are able to provide quality services to the population.