Improving emergency care services in urban areas in Haiti

Research theme

Context and challenges

In Haiti, one of the most vulnerable countries to natural disasters and earthquakes, structural deficiencies, that limit access to basic services and increase the chronic vulnerability of populations, are exacerbated by the profound weakness of state institutions. In 2018, more than 6 million Haitians, namely 59 % of the global population, lie below the poverty line of 2.41 USD a day.

The public health system lacks the resources to meet the health needs of Haitian citizens. Public expenditure on health remains among the lowest in the world, at 2% of Haitian GDP. Only 31% of the Haitian population has access to health care, due to the shortage of health professionals (there is currently one doctor and 1.8 nurses per 10,000 inhabitants), and the lack of medicines and medical equipment.

Road infrastructure is scarce and precarious, limiting people’s access to health services. Lack of road safety is a constant problem and accidents are often particularly fatal due to the lack of functional emergency services. Those in need of emergency care in Port-au-Prince often wait hours before an ambulance arrives. Most people choose to go directly to the health centre rather than call an ambulance, taking the first available vehicle. Although ambulances have the potential to improve access to services, they have significant limitations and the resources required to operate them are considerable.

In addition, the information needed to access health care services is not always available. Even when health services are available, people do not always know which service to consult, or how to consult it.

In this context, the role of the Haitian Red Cross (HRC) is extremely important because volunteers, as close as possible to the population, can disseminate and bring health information to communities, within households themselves, and thus remove some of the barriers to accessing appropriate information on health care and issues. Although they are not health professionals, volunteers can share essential basic hygiene information, which can help control the spread of diseases and epidemics. HRC volunteers, particularly in emergency situations, are also important points of contact and information within communities to improve knowledge and access to health services through the provision of first aid and referral to appropriate health facilities and services.

However, HRC volunteers do not necessarily have an easy access to the information required to provide relevant and timely referral services to their communities. That is why, at the request of the CHR, the Canadian Red Cross (CRC) has been working to improve a mobile application created a few years ago by the International Federation of Red Cross and Red Crescent Societies (IFRC), with the aim of making key information more easily accessible to CHR volunteers.

At the initiative of the Global Disaster Preparedness Center[1], the IFRC has developed a program[2] offering “National Societies”[3] access to two mobile applications for use by the general public and specific to each country. The “First Aid” application provides expert advice for managing most first aid emergencies, and the “Dangers” application provides information and advice on how to manage disasters and other situations beyond human control.

The CRC intends to enhance the “First Aid” application to make it a more useful tool for CHR volunteers, and thus develop the Haitian Red Cross’ capacity for health in emergency situations. Specifically, this project aims to add an additional module to the application to improve the Haitian Red Cross’ capacity to provide emergency care services including first aid, psychosocial support and referral support for cases of gender-based violence, and to improve access to emergency health services and epidemic prevention and control measures for men and women living in urban areas of Port-au-Prince.

Objectives and questions

The research will pursue two objectives, linked to the introduction of this innovation and responding to the need to investigate the right way to integrate it into the existing training system.

Although the application is an innovation with great potential as a training tool, not everyone has access to smartphones or sufficient digital literacy to benefit adequately from it in Haiti. Also, this tool is not intended to replace classroom training, but rather to complement it and serve as a resource for basic information. Thus, in order for it to be best adapted to the Haitian context and best integrated into the training provided by the CRH Training Center located in the Croix des prêts district of Port-au-Prince, it is essential to have a clear understanding of the way the centre operates and the methods used by it to transfer knowledge to trained people, including Red Cross volunteers. Who are the participants in these trainings? How do they work? Which methods are most appreciated by the participants of these courses? Do these methods ensure a subsequent application of the knowledge learned, particularly in first aid? What alternative methods would achieve better application of the knowledge provided in first aid?

90 people (75 volunteers and 15 staff) from the Haitian Red Cross in Port-au-Prince will soon be trained in the use of the new module of the “First Aid” application created by the Canadian Red Cross. Studying how this new tool is perceived and used by participants in this pilot phase would allow us to better adapt its content to the Haitian context and the profile of HRC volunteers. It will also provide an additional opportunity to understand the levers of use and non-use in Haiti of applications developed by the IFRC, as in previous research on the effectiveness of mobile applications in humanitarian contexts[4], including Haiti[5], and on the “First Aid” application[6]. Indeed, although these applications have been in place for several years in Haiti, their content has been translated into Creole and the ownership of a smartphone is quite common[7], their use has not met with the expected success. However, a correct use of these applications would make it possible to meet some of the country’s health needs in an efficient and cost-effective way. What is the perception and use of the “First Aid” application and its new module by trainers and trained people at the Haitian Red Cross Training Centre? How do trainers integrate this tool into training courses? Why is the application so little used by people trained by the Haitian Red Cross Training Centre? The content of the application can be a source of brake. The research should determine whether the content should be modified to address Haitian issues or practices.

[1] Global Disaster Preparedness Center (GDPC), Universal App Program. http://preparecenter.org/activities/universal-app-program

[2] Global Disaster Preparedness Center (GDPC), Universal App Program: First Aid. Frequently Asked Questions. http://preparecenter.org/sites/default/files/universal_app_program_faqs.pdf

[3] There are currently more than 190 Red Cross and Red Crescent National Societies around the world.

[4] https://www.preparecenter.org/resources/can-mobile-phones-improve-disaster-preparedness

[5] Humanitarian Innovation Fund: Case study –Mobile Technology: Listening to the voice of Haitians, http://www.elrha.org/wp-content/uploads/2015/01/FINAL-141215-Elrha-CaseStudy-MobileTechnology.pdf [14.05.2018]

[6] https://www.preparecenter.org/resources/comparative-review-first-aid-app

[7] According to a report published by Safitek in 2018, 88% of respondents had a mobile phone, including 66% a smartphone with internet access in the metropolitan area of Port-au-Prince.