Maternal And Newborn Health

Local Clinics Improve Health Services in Honduras

Article from USAID - Honduras

By: Samantha Croasdaile

An old Honduran saying goes: “No two pregnancies or childbirths are ever the same.” This is especially true for Marta Lidia Castro, a 28-year-old mother of two whose first child was born in Santa Rosa’s Regional Hospital, about a day’s walk from her home. Her second child was delivered only a few miles away from her house, in the Santa Rita Clinic. “My experience at the clinic was much better than at the hospital,” said Castro. “The clinic is always open and has a doctor. At the hospital, I delivered pretty much by myself.

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”She is one of 42,000 people in Copán, Honduras, who use the locally managed health care system. In Honduras, public health care is financed and managed by the central government in the capital Tegucigalpa. However, the cen¬trally run system is inefficient, lacks medicine, needs supplies, and closes frequently when the hospital workers are on strike.

For the past five years, USAID has helped local governments in Copán take over the management of area health care systems through a process called decentralization, which transfers health care management responsibilities and resources from the central govern¬ment to the local government. The central government continues to finance health care services, while local governments implement and manage them. Leonidas Aleman is the administrative director for a group of municipalities in the department of Copán. He says the decentraliza¬tion has resulted in fewer deaths of women during pregnancy and childbirth. “The changes in health in our communities are impressive,” says Aleman. “We went from having 12 mothers dying from pregnancy and delivery complications every year, to none. The number of women who deliver at a clinic as opposed to at home has gone up from 57 percent to 95 percent.

” Health care costs the community less, too. “We do more with less money. Our clinics provide services to three times as many women, and our overall costs are lower,” Aleman adds. Local governments also save money by using more efficient pro¬cesses for buying medicines and supplies and for contracting doctors and nurses. The savings allow local governments to expand services. For example, in the last four years, local governments opened 10 additional community health centers and one new clinic specializing in maternal and child care. Five more health centers are scheduled to open this year.

Unlike the centrally run health care system, the locally run system focuses on prevention. “Our social workers also help communities acquire clean water and sanitation systems. We cannot expect people to have healthier lifestyles if we don’t provide the means for them to do so,” says Kenya Lopez, local government project coordinator. Local governments also help to provide communities with water tanks and improve household stoves that reduce smoke contamination in the home.

Decentralization also strengthens community involvement. “Under the old system, there was a nurse assigned to a clinic that was closed for seven years,” says Anardo Napoleon, the mayor of the municipality of Cabañas, about 45 minutes from Copán Ruinas. “All that time, the nurse continued to receive pay, and her absence was excused as sick leave. No matter how much we complained, authorities in Tegucigalpa did nothing about it.” Napoleon said the clinic has re-opened and it has medicine in stock, a doctor, two full-time nurses, and three social workers. It also remained open despite the fact that the centrally run clinics have been on strike several times.

For more information on USAIDs work in Honduras please visit: USAID to Honduras

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