A Haitian proverb says, “It’s easier to go to the mountains than to wait for the mountains to come to you.”
At Partners In Health, our mission to increase access to health care means that doctors and nurses don’t wait for patients to come to them. They go to the patients, especially those in the most remote areas.
In April 2013, PIH and our Haitian sister organization, Zanmi Lasante, began conducting mobile clinics, which extend the reach of the health care system into communities.
Mobile clinics take place in community hubs such as schools and churches. Community health workers identify under-served areas that would benefit from health services, find a community building that can host the clinic, and then spread the word that the team will be conducting a mobile clinic in advance of the daylong event.
Then, clinicians from PIH/ZL facilities set up shop in the chosen place, registering patients, providing check-ups, including tests for pregnancy and HIV, and prescribing treatments or referring them to follow-up care at stationary facilities. Because mobile clinics make it easier for patients to access care, they often reach the most vulnerable people—those who wouldn’t otherwise have access to health care.
So far, the approach has worked. Since spring, PIH/ZL has seen more than 33,000 patients at the mobile clinics, referring more than 450 people who tested positive for HIV to receive further care. The demand for care has exceeded PIH/ZL’s expectations.
“The communities we serve always welcome the mobile clinics,” said Dr. Kenia Vissieres, one of the project’s leaders. “They help us reach the most vulnerable patients with earlier prevention, diagnosis, and care.”
PIH/ZL’s mobile clinic team uses donkeys, motorcycles, and vehicles to transport staff and supplies to conduct clinics in some of Haiti’s hard-to-reach areas. Photo: Abraham Jacquet/Partners In Health
But mobile clinics don’t work if they occur in isolation, without follow-up. For example, women who are pregnant, patients diagnosed with diabetes, and people who test positive for HIV all need further care at stationary facilities.
To meet those needs, PIH/ZL staff designed health information and referral systems to ensure effective patient follow-up, and invested in software to collect information about patients’ visits to pass along to facilities for further care.
Data clerks have hauled laptops to mobile clinic sites and registered patients into a specially designed electronic medical record system. If patients require follow-up care, they receive a referral voucher that they take to the stationary clinic, where staff then have all the information about their mobile clinic visit.
It’s been challenging to put this referral system in place, especially when mobile clinic teams travel to remote areas with washed-out roads and no electricity. But it makes a huge difference in ensuring patients receive the care they need.
To learn more about the importance of the electronic information and referral system, we spoke with Gertruna Hilaire.
Gertruna Hilaire works as monitoring and evaluation coordinator for the mobile clinics project.
What kind of background do you have, and why were you interested in working on this project?
I have a bachelor’s degree in planning with extensive training in statistics. After three years working for the Haitian Ministry of Health and two years working in an HIV program, I wanted to face new challenges. That’s the main reason why I was really excited to join the PIH/ZL staff for two new projects—this mobile clinics project and a project to improve mental health care.
I hope that because we have gone to the mountains, people living there will have seen the quality of services available at the facilities. We hope that will encourage them to attend the clinics for their health problems.
How does the electronic medical record system make the mobile clinics more effective?
The electronic system helps us collect data about patients and their care to use our resources more strategically, both the effective provision of services at mobile clinics and the referral network of stationary facilities. It’s a database that allows us to securely keep the patients’ charts and help reduce the waiting time during mobile clinics for patients who are already registered.
The system has been created specifically for the mobile clinic project. We built on our previous experience in implementing the electronic medical record for program management at other sites where PIH/ZL works.
What have you learned about patients who come to the mobile clinics?
Distance and poor economic status are factors that limit access to health facilities. The mobile clinic data analysis has shown that the difficulty and cost of traveling to facilities impedes patients not only from getting treatment when they are sick, but also from knowing their overall health status—including whether or not they have HIV—and from getting certain medications.
How have you overcome the logistical challenges of using the EMR at mobile clinics?
Because we don’t always have access to electricity, we make sure that the laptops are fully charged before the mobile clinics. The teams are well trained in the simple software application being used.
What has the team learned about conducting mobile clinics from this project?
Our staff has learned how to organize mobile clinics in a way that allows us to collect data and report them properly. Before this project, mobile clinics used to be done, but we only recorded the number of people seen, and planning and resource allocation to the mobile clinics were not based on the data collected. Now, we can deploy our resources to communities most in need and ensure that those patients receive follow-up care.
What do you hope will be the lasting impact of the mobile clinics?
Now the staff is seeing this community activity as a strategy that can complement our efforts at the permanent health facilities. It will be good for us to increase the scope of services provided at the mobile clinics in order to cover other neglected conditions at the community level such as tuberculosis and mental health.
I also hope that because we have gone to the mountains, people living there will have seen the quality of services available at the facilities. We hope that will encourage them to attend the clinics for their health problems.