“Eternally restarting” or “a branch line of continuity”? Exploring consequences of external shocks on community health systems in Haiti

• DOI: 10.7189/jogh.11.07004
• Publication Date: 2021-03-19T17:55:51Z
• Authors: Pooja Sripad; Alain Casseus; Sarah Kennedy; Benito Isaac; Kenia Vissieres; Charlotte E Warren; Ralph Ternier
• Keywords: Community Resilience

Community health systems (CHS) are integral in promoting well-being humanitarian settings, like Haiti, a country plagued by disruptive socio-political and environmental shocks over the past two decades. Haiti's community workers (CHWs) as critical intermediaries have persisted throughout these contextual shocks. This study explores how influence CHS functionality resilience Haiti.We applied an inductive deductive qualitative approach to understand lived experience of actors. A desk review peer-review grey literature searched 393 identified 25 relevant documents on policies, guidelines, strategies implemented last fifteen years Haiti. In-depth interviews with policy program stakeholders (n = 12), CHWs 24), CHW supervisors auxiliary nurses 15) were conducted.Various - political transitions, natural disasters, disease outbreaks describe protracted complex setting reveal distinct influences (challenges enablers), resilience, mediating factors (eg, policy, financing, governance, parallel systems). Consequences civil unrest lockdowns (political transitions), internal displacement infrastructural damage (natural disasters), livelihood depletion food insecurity disasters outbreaks) affect functioning. is rooted their generalized scope work, intrinsic motivation, history community, trusting relationships, self-regulatory capacity, adaptability. Mental safety among actors communities they serve pose challenges while reinforcing collaborations that promote coverage support sustain CHS. Participants recommended government for CHWs, stewarded complemented partners, sub-national autonomy, integration disaster preparedness all CHWs.Political Haiti continue profoundly functioning, despite mitigating programming efforts. relevance maintaining primary care crises suggests propositions can be explored settings globally.