Postdoctoral research grant: Improvement of emergency care services in urban areas in Haiti

Research topic

Context and challenges

In Haiti, one of the nations most vulnerable to natural disasters and earthquakes, the structural shortcomings 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, or 59% of the population, live below the poverty line of $ 2.41 a day.

The public health system lacks resources to meet the health needs of Haitian citizens. Public health spending remains among the lowest in the world, at 2% of Haitian GDP. Only 31% of the Haitian population have access to health care, due to the shortage of health professionals (there is currently 1 doctor and 1.8 nurses per 10,000 inhabitants), the lack of drugs 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 deadly 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 center rather than calling an ambulance, taking the first vehicle available. Although ambulances can potentially improve access to services, they have significant limitations and the resources required to operate them are considerable.

Also, the information necessary to access healthcare 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 (CRH) is extremely important because the volunteers, as close as possible to the population, can disseminate and provide information relating to health in the communities, even within households, and thus removing some of the barriers to accessing appropriate health care and health information. Although they are not health professionals, volunteers can share essential basic hygiene information, which can help control the spread of disease and epidemics. HRC volunteers intervening in particular in emergency situations,

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

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

The CRC intends to enrich the “First Aid” application to make it a more useful tool for CRH volunteers, and thus develop the capacities of the Haitian Red Cross in matters of health in emergency situations. emergency. Specifically, this project aims to add an additional module to the application intended on the one hand to improve the capacities of the Haitian Red Cross to provide emergency care services including first aid, psychosocial support and support in referrals for cases of gender-based violence, and secondly 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 offering a lot of potential as a training tool, not everyone has access to smartphones or sufficient digital literacy to take advantage of it in Haiti. Also, this tool is not intended to replace face-to-face training, but rather to supplement it and serve as a resource on basic information. Thus, in order for it to be the most adapted to the Haitian context and to be integrated as best as possible into the training provided by the CRH training center located in the Croix des Prêt district in Port-au-Prince, it is advisable to carefully understand the mode of operation and the methods used by this center for the transfer of knowledge to those trained, including Red Cross volunteers.Who are the participants in these trainings? How do they work? What methods are most appreciated by the participants of these courses? Do these methods ensure subsequent application of the knowledge learned, in particular in first aid? What alternative methods would allow a better application of the knowledge provided in first aid?

90 people (75 volunteers and 15 staffs) from the Haitian Red Cross in Port-au-Prince will soon be trained in the use of the new “First Aid” application module created by the Canadian Red Cross. Studying the way this new tool is perceived and used by the participants in this experimentation phase would make it possible to better adapt the content to the Haitian context and to the profile of CRH volunteers. It will also offer an additional opportunity to understand the levers of use and non-use in Haiti of the applications developed by the IFRC, like previous research conducted on the effectiveness of mobile applications in a humanitarian context [4] , including understood in Haiti [5] , and on the “First Aid” application [6]. Indeed, although these applications have been implemented for several years in Haiti, their content has been translated into Creole and that the possession of a smartphone is rather common [7] , their use has not met with success. discount. However, a good use of these applications would make it possible to respond to certain health needs of the country in an effective and inexpensive way. What is the perception and use of the “First Aid” application and its new module by trainers and trainees from the Haitian Red Cross training center? How do trainers integrate this tool during training? Why is the application so little used by people trained by the Haitian Red Cross training center? The content of the application can be a source of hindrance. The research should make it possible to determine if the content must be modified to respond to Haitian problems 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  National  Red Cross and Red Crescent Societies worldwide.

[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.