Online Program

Building a sustainable, community-based model of depression care into a government-run health care system: A case study of 11 major health care facilities in rural Haiti

Monday, November 4, 2013 : 8:45 a.m. - 9:00 a.m.

Shin Daimyo, MPH, Partners In Health, Boston, MA
Jean-Gregory Jerome, MD MPH, Monitoring, Evaluation & Quality, Zanmi Lasante, Haiti, Boston, MA
Eddy Eustache, Zanmi Lasante, Cange, Haiti
Gertruna Hilaire, Zanmi Lasante/Partners In Health, Boston, MA
Kate Boyd, MPH, Partners In Health, Boston, MA
Tatiana Therosme, Zanmi Lasante/Partners In Health, Boston, MA
Reginald Fils-Aime, MD, Zanmi Lasante/Partners In Health, Boston, MA
Handy Petit-Homme, Zanmi Lasante/Partners In Health, Boston, MA
Lamartine Dessalines, Zanmi Lasante/Partners In Health, Boston, MA
Rupi Legha, MD, Partners In Health, Boston, MA
Giuseppe Raviola, MD, MPH, Partners In Health/Harvard Medical School Program In Global Mental Health and Social Change, Boston, MA
Annie Michaelis, PhD, Partners In Health, Boston, MA
Kendall West, Boston University School of Public Health, Boston, MA
Christine Tebaldi, MS, RN, NP, McClean Hospital, Boston, MA
Gary Belkin, MD, PhD, MPH, New York University, Boston, MA
David Grelotti, MD, Partners In Health, Boston, MA
Stephani Zakutansky, Partners In Health, Boston, MA
Seiya Fukuda, Partners In Health, Boston, MA
Jenny Utech, Partners In Health, Boston, MA
Jessica McNavich, Partners In Health, Boston, MA
Emily Dally, MPH, Partners In Health, Boston, MA
Mel Rico, Partners In Health, Boston, MA
Vernet Etienne, Zanmi Lasante/Partners In Health, Boston, MA
Sheila Davis, DNP, ANP-BC, FAAN, Global Nursing, Partners In Health, Boston, MA
Kathryn Oas, Partners In Health, Boston, MA
Beatrice Romela, Zanmi Lasante/Partners In Health, Boston, MA
Helena Verdeli, PhD, Teacher's College, Columbia University, Boston, MA
Over the past 25 years—and particularly since the 2010 earthquake—Zanmi Lasante/Partners In Health has found a high prevalence and incidence of depression in its patients. However, given the high stigma surrounding depression in local communities, lack of a skilled mental health care workforce to address this need, a formalized structure, system, and locally defined science to find, assess, refer, and treat mental health issues, and a lack of financial resources to support such initiatives, these needs were unable to be effectively addressed by the existing health care system. However, long term strategic investments into mental health care from various avenues provided the resources to build the local Haitian capacity to address mental health issues that is based on a community based model of care. This presentation will focus on the first year of this three year initiative, which focuses on building the service delivery, clinical supervision, management, monitoring and evaluation, and capacity building of local community health workers, psychologists, social workers, nurses, and physicians to address the burden of depression in ZL/PIH's catchment area of 1.2 million people. The findings will provide a step by step road map on how to build mental health services into a government run health care system. Additionally, I will demonstrate not only that the most effective means to address mental health illness burden in low resource settings requires a community based approach whose core lies in partnership with and investment in local partners to ensure long term sustainability, but that this can be successful.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Design an integrated depression care model that integrates community based, primary, secondary, and tertiary care government run health facilities in a rural, low resource setting Identify strengths and gaps in community health worker, nurse, psychologist, social worker, and physician skill sets to create a complementary and integrated model of depression care Formulate evaluation indicators to establish and sustain quality improvement and supervision mechanisms for depression care system strengthening Demonstrate that success relies a close partnership with stakeholders ranging from community leaders to policy makers to ensure ongoing sustainability of depression care at a local and governmental level

Keyword(s): Mental Health System, Health Care Delivery

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Program Manager of the Grand Challenges Canada funded project to scale up community based mental health services in 11 Zanmi Lasante (PIH Haiti)/Government of Haiti run health care facilities, which is the focus of the presentation. I have a background in global mental health, quality improvement, systems building, policy making, capacity building and monitoring and evaluation, all in the context of low resource settings and government-related entities.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.