Contextual factors influencing the delegation of tasks to Multi-skilled Community Health Workers in Haiti

Abstract

In Haiti, the delegation of tasks to Multi-skilled Community Health Workers (locally called ASCP) is a strategy implemented by the Ministry of Public Health and Population to improve universal health coverage. To contribute to the successful implementation of this strategy, this article reports on a case study of its implementation in the northern health department of Haiti. More specifically, this article provides information on the contextual factors that facilitate or hinder the implementation of task delegation to ASCP. The results obtained show notable progress in the implementation of task delegation to ASCP in the northern health department of Haiti. These mainly concern the following activities: selection, training, and deployment of ASCPs, endowment of work materials, supervision, collection and analysis of data on the results obtained. In September 2019, 215 ASCPs were active in the department. This corresponds to 44.3% of the 485 ASCPs planned to cover the department’s needs. Several contextual factors hindering or facilitating the implementation of this intervention were also identified with 35 resource persons during semi-structured interviews. These relate to the planning and monitoring of the implementation of the intervention (cited by 12 out of 35 people), the institutional context (10/35), and political (17/35), structural (30/35) and environmental factors (7/35). This study highlights several contextual factors that need to be considered to ensure the successful implementation of the delegation of tasks to ASCP in Haiti and possibly in other contexts.