Increasing access to skilled deliveries through incentives in Haiti

In early 2008, with external funding, the Haitian Ministry of Health (MSPP) and World Health Organization (WHO) began a countrywide program to increase pre- and post-natal care and to increase the number of facility-based births to decrease Haiti's persistently high maternal mortality. This free obstetrical care program, [Soins Obstetricaux Gratuites (SOG)], has resulted in increases in births at many facilities, but has also experienced extreme programmatic and infrastructure challenges. The program provides a financial incentive to three parties: the mothers who deliver at clinics, the traditional birth attendant (matron) who refers patients for deliveries, and reimbursement to the facilities who provide the pre- and post-natal care and deliveries. In the Central Plateau and Artibonite regions where Partners In Health and Zanmi Lasante have been involved in the implementation at MOH facilities, 10 facilities and 2 facilities respectively have participated in SOG activities. At the majority of facilities, institutional births and prenatal visits have increased. However, it is too early to predict if the increases will be sustained. Challenges include increased reporting requirements, delayed compensation, lack of funds for facility expansion and improvements, and lack of funds for increases in staff commensurate to increased client load. Specific clinic numbers and challenges will be further analyzed and presented. While this is a commendable model to reduce maternal mortality and provide free maternal care, its successful implementation requires additional support and improved systems.