The Sustainable Health Application

Haiti is a class-based society where the government currently provides little, while private finances and family connections provide access to education, healthcare, and other basic life needs that are considered privileges. According to USAID Roughly 40 percent of Haiti’s population lacks access to essential health and nutrition services. The percentages are higher outside of the major cities.

Children who lack these privileges don’t grow up to believe they are entitled to education and healthcare, especially when their food, water, clothing, and homes aren’t sufficiently safe to provide the basic foundation for healthy living. Also, to the vast majority of children in Haiti, a hospital or clinic is not perceived as a place of wellness, but rather as a place of trauma and illness. We believe that by changing children’s current negative perceptions of healthcare and wellness, to one of open access and opportunity, they will have a greater sense of ownership of their well-being which will promote health-seeking behaviors for the rest of their lives. And we believe that starting with children will have lasting effects on future generations.  

Changing this perception requires a change in both how healthcare is delivered and accessed in Haiti. In order to teach the children that they have a right to healthcare, we need to create a place of wellness that they feel is theirs, where they feel safe and where help is available for all of their basic needs. We then need to give them the tools to manage and access information so they can take control of their own well-being. One key step is a Sustainable Health Application which is a pilot project that includes several operational and environmental initiatives:

• Implementation of a personal Electronic Medical Record (EMR) that identifies children on a personal tablet device using their thumbprint and is accessible to the children at any time of the day or night. Information is stored in the cloud and, because of the thumbprint identification, can follow the children wherever their lives lead them. The thumbprint is important because it is unique, but also because many of the children we work with don’t know their date of birth or no longer have, or never had, the healthcare ID card that the government issues. The EMR will always be their own and only theirs. Using a new technology, and developing a simplified software program allows for community health workings to easily do patient registration, vitals capture, diagnosis, treatment, case review and administrative task support. The software will contain understandable graphs and charts that allow the children direct physical interaction by answering questions and inputting information.  They will be able to see how they grow, thrive and develop, as they learn to use the information as a tool to maintain their well-being.
• Implementation of health education programming by Haitian community health workers trained to inspire trust in the children.  Programs will address topics such as young women learning about their reproductive cycle, issues related to puberty, and the importance of clean water and hygiene. Education modules will be delivered through the app with questions to assess understanding.
• The TB buddy system which will teach children the signs of TB and how to look for signs of TB in their family members (in this case, because our partner is an orphanage, they will look for signs in other children). Data will be collected via a nurse who will ask relevant preliminary screen questions.
• A Computer room that is set up specifically for children to do research on their own health. They can sign up for time and work with a counselor who will help them research, read and understand their health concerns. The app will require they sign in to their profile, provide information about what they are researching, and then provide information on what they learned from the session.

The Sustainable Health Application will ask several questions at the beginning and end of each session. This data will then be used to determine if the children are making progress toward taking control of their own well being by being able to describe their medical issues in more exact terms, determine if they are seeking the help of the medical professional within a reasonable time, taking their medications as prescribed independently, initiating their own research, helping others in their community, and following hygiene protocols, etc.

Examples of well seeking behaviors would be:

• Do the children seek help when they first feel ill without fear;
• Are the children able to use learned language to describe how they feel;
• Are the children learning to encourage and support their peers in seeking healthcare when needed without fear;
• Are the children taking responsibility for their prescribed medications;
• Are the children understanding that medications are not always the solution to their problems and that sometimes its diet, or rest or a change in lifestyle;
• Are the children accessing the provided clean water system appropriately;
• Are the children absorbing what they are learning through their own research.

Our current program serves the 90 orphans, 500 school children and a small staff of Fondation Montesinos, our partner organization in Haiti. When we started working with Fondation Montesinos, none of the children or adults had access to any primary care.

We believe that as adults, these children, who have learned to be in control of their well-being, including their health, nutrition and physical environment, can support healthy families and their community. Changing how an entire generation feels about education and healthcare can have lasting, sustainable effects on future generations. As adults, they will know how to be responsible for their financial, personal, family, and community's well-being.

We have an established program of almost 10 years, with a small community of staff and children at Fondation Montesinos in Titanyen Haiti, whom we have built trust with, and for whom can provide healthcare and educational services. Since the Orphanage isn’t an adoption orphanage, we can work with a set of children aged 3 to 18 and track how well our application is working to change their perception of healthcare to determine whether the application has increased well-seeking behaviors.

We have already built an energy efficient, clinic building. The design is the result of a program we ran with the children in which they made drawings, wrote songs, and built models of what they wanted their healthcare building to look like. The building is both a promise for a lasting commitment as well as an example of our partnership with them in their development.

We understand that overall, this data is more qualitative than quantitative, but we feel it is in an important first step in data collection to truly understand what it means to teach children that they have a right to a healthy life.

We need technical help developing the application. Therefore, we need financial help to pay for this technical help.

We think that our approach is new because it is not simply medical or financial or educational but all of the above. It addresses more that the lack of healthcare, more than the lack of money for healthcare, and more than the lack of knowledge about health. It starts with perception and develops new behaviors. It also uses resources that are already in place (community health workers) as the main staff and inexpensive technology (personal tablet devices). We expect it to have broader positive impacts because children will grow up to influence their own lives, and those of their family, friends and larger community for the better.

We do understand that it is a very long-term investment. We need to follow our program and the children for as many as 20 years to see generational change. We understand that programs like this are not often funded because results take a very long time to determine. However, we believe that, if we are able to change how as few as 500 children think about their wellbeing, this could impact more than low-income countries and have effects on how healthcare is delivered anywhere in the world.

Our impact goals for the next year are to enroll and develop trust with all of the participant. We will then be able to get a baseline read on where the children are with their perceptions of healthcare and their ability to take responsibility for their own well-being. In 5 years, we hope to see progress toward trust in the healthcare system and well seeking behaviors from all participants as described above.

The application will ask questions before and after each session. The session could be with the nurse, the doctor, the psychologist, the health educator or the supervisor working with the children on independent computer research. The data we extract from the answers will help determine if the children are improving in their ability to take control of their own health. For example, the question that asks how long it took them to seek any kind of help from the time they first noticed a problem and what help they sought, will be important indicators of how much children believe they have a right to a healthy life and know how to pursue that right. Another example would be if a child is brought in with the help of a peer. If children are learning to recognize that others need help, and to act as a support system, they are also learning how to be responsible for others.

Our theory of change is definitely qualitative rather than quantitative. However, if children begin to see healthcare as a right and they learn to access it appropriately, then we know we have had an impact. We would follow up our work in the long term by following the progress of the children as they grow into adults through interviews, personal visits and application surveys. 

Our core technology is a new application that we are developing that is used on a mobile tablet. It is interactive which is why it will capture the attention of the children. It also uses a thumbprint for identification which allows children to understand it as their own, and also reduced the burden of paper documentation or and ID card which is an unreliable means of tracking a patient, especially in Haiti.

Our nurse, psychologist and educational specialist, as well as the physician we contract with for more serious health needs collect the data. They are paid by our organization and believe in the mission. 

Our Board is made up of Americans and Haitians. Our staff is completely Haitian of various socio-economic backgrounds. We feel we meet diversity requirements.

We support all of our work through fundraising. We don't sell any products. We only provide a service. All of our Board Members work pro-bono.

For the foreseeable future, we are only sustainable through grants and fundraising. Should our concept be successful, our educational materials, methods and the health app that we are building could be sold for a profit.

We have been operating for more than 12 years. We've been able to raise sufficient funds to lay the groundwork for this program. We have constructed a fully off the grid healthcare clinic building and we have been paying staff for years. We've also installed an RO water system that we pay a staff member to maintain. And we've run nutritional programs, physical education programs, and other construction projects through fundraising.

We have also built trust which the children, several of whom have had severe health problems (a club foot, major psychological trauma and a breast mass). We've also kept them safe by paying for security measures despite the kidnappings and violence that is gripping the country now and has been for years.