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Reducing Maternal Mortality in the Nippes Department of Haiti

Learning Outcomes

1. Analyze components of global health interventions for determining their ability to effectively address or mitigate a global health challenge 

2. Analyze the role of global health stakeholders and the affected populations in addressing global health challenges

3. Determine the impact of cultural and ethical considerations of affected populations on developing intervention strategies for global health

4. Recommend evidence-based intervention strategies for addressing global health challenges

5. Analyze global health challenges for the various issues they present to intervention strategies

Haiti, the poorest country in the Western Hemisphere, also has the highest maternal mortality rate. In the Southwest region of the country, rates are unusually higher than in other parts. One region in particular has significantly high numbers. The Nippes department of Haiti (a department in Haiti is similar to a state in the United States), which has a substantial rural region, has a much higher maternal mortality rate than other departments within the country.

You are being hired by the World Health Organization (WHO) to recommend a solution to reduce the maternal mortality rate in the Nippes department of Haiti. You have been given the following information about the Nippes department and the situation:

1. There is one government hospital in the region, and it is known for providing poor-quality services and being understaffed. It is quite far for people who live in the rural regions, and reliable transportation is difficult to come by.

2. While there is limited infrastructure in the region, cell phone service is decent, and most families have at least one cell phone.

3. There are two known private clinics in the area, run by nongovernmental organizations (NGOs) from the United States, that employ an all-Haitian staff. 

4. These clinics offer only primary care services, but do have women in labor that come several times per month. These women often come to the clinic with complications. About half of these cases end up in either maternal or infant death (or both).

5. There may be more clinics in the area, but this variable is unknown. Haiti has the second-highest number of NGOs per capita in the world, but many of the organizations are unregistered in the country because there is no formal way to track them.

6. Most of the women in the Nippes Department, particularly in the rural areas, rely on traditional birth attendants (TBAs), also called matrons. These are people with no clinical training, but they may be village matrons because of a family history (i.e., their mothers were a matrons, grandmothers was a matrons, etc.).

7. Because of their lack of clinical training, TBAs often cannot recognize birth complications until it is too late, and they are unskilled to handle those types of situations.

8. Most women in the rural regions in Haiti culturally prefer the birthing services of a matron to those of a skilled birth attendant (e.g., midwife).

9. The matrons are resistant to an intervention that threatens to decrease their clientele.

Given this information and additional research, make a recommendation to WHO for the implementation of an evidence-based intervention that can help decrease or mitigate this health challenge in Haiti. The recommendation must incorporate the needs of all stakeholders in this population and help reduce the maternal mortality rate. Evidence must be used throughout to support your claims and recommendation.
Case Study Scenario Application to Final Project: For the final project in your course, you will analyze the global health challenge presented in the abovescenario to inform the creation of a consultation report on what can be done differently to mitigate the health challenge. You will need to do additional research on the country, stakeholders, and health challenge in order to conduct your analysis. Finally, you will be required to make recommendations for an evidencebased intervention to help mitigate or address the global health challenge presented in your scenario. You will need to defend those recommendations and discuss how they will impact the population and stakeholders. Supportive evidence will be required throughout your analysis and recommendations.

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