Health Alliance International

HAI Teams in Côte d’Ivoire Continue Work Despite Ongoing Political Turmoil

Posted: Jan 24, 2011 · Posted by: Health Alliance International

The political situation in Côte d'Ivoire remains tense as the incumbent president Laurent Gbagbo refuses to step down in favor of his challenger, Alassane Ouattara, whom international governments and agencies recognize as the winner of the November 28, 2010 elections.

UN peacekeeping troops are being increased to 11,000 (Photo: IRIN)

The number of UN peacekeeping troops in the country is increasing by 2,000, to 11,000 total, reports AllAfrica.com. This is in response to the growing unrest, amid reports that supporters of both Gbagbo and Ouattara are amassing armed forces or militias and making threats against ethnic groups of the opposite side. At least 260 people are estimated to have been killed and more than 50,000 have fled the country. The United States, the European Union, and the World Bank have all imposed sanctions on the country, including cutting off financial resources to Gbagbo's government in hopes of avoiding military action to remove him from power. Nevertheless, Gbagbo is still accessing enough funds to continue paying salaries to the military and civil servants, although people both inside and outside of the country wonder how much longer this will continue. While there are reports that Gbagbo has proposed a power-sharing arrangement, many political leaders oppose this idea as setting a bad precedent for future elections in the region. 

Amidst this turmoil, our staff in Côte d'Ivoire are moving ahead wherever possible to ensure critical health services are being delivered.

Here are excerpts from a report provided by our office in Bouaké to PEPFAR on how our team is working during this time:

Following the sudden deterioration of the political situation in December 2010, the level of functioning of our activities dropped to about 50% due to the following reasons:

1. Unavailability of health care providers at the health facilities and the district and regional management teams who went to cast their votes at their various regions of origin and never returned before the outbreak of the crisis.
2. Health providers that are still present at the region of activity, are usually absent from their duty post because of fear of being attacked by the angry population and also because of their intention to respect the civil disobedience call.
3. Poor utilization of services by health facilities by the population themselves due to difficulty in transportation (breakdown of all commercial transport system at the onset and during the crisis) and also fear of the population to leave their homes due to insecurity.

Despite this difficult situation, our technical staff who are all based in our various regions of intervention (Bouaké, Korhogo and Bondoukou) have been making regular visits to most health facilities, resolving critical and urgent situation at the health facilities, coordinating logistic supplies, sometimes technically substituting health care providers if need be to resolve patients' emergencies, and encouraging those providers available to resume work and make their presence in their offices to provide skeletal or minimum services to the very sick who have made extra effort to get themselves to the health facilities.

One factor that has really contributed to our ability to continue most of the services we provide despite the tense socio-political climate is the fact that our organization is well known by the population (we live and work with them) as a health care organization supporting the district health services with our offices located at the district and regional health services. So our team can carefully circulate in our regions of intervention when the situation is not too tense to support services at health facilities and also provide logistics.

Some of the principal areas we have supported despite the breakdown of the system include:

1. Drug supplies and distribution

Some district pharmacies did not receive needed drug supplies in October or November, and then did not receive supplies in December following the elections either. Health facilities in these districts were already experiencing drug outrages. We had to work with the district pharmacists and the National Public Health Pharmacy to look for an alternative delivery pathway. When the national pharmacy could not get the supplies through, we coordinated transport of these supplies in our vehicles which could carefully make their way through despite the road blocks.

2. Patient monitoring and follow-up

At the onset of the crisis, health facilities had to prioritize follow-up of patients, particularly targeting patients on antiretroviral treatment at health facilities where health staff are now absent. Our technical staff composed of physicians and midwives occasionally substitute for the health facility provider to address critical and urgent patients' medical conditions.

We also have a pool of roving Ministry of Health (MOH) physicians for whom we provide logistical support (especially transport) to coordinate their assistance to health facilities with deficient or absent staff. We have a pools of subcontracted local NGOs made up mostly of people living with HIV/AIDS which provide peer counselors stationed at the various health facilities. They help in patient tracking (home visits, tracking of consultation, laboratory analysis and drug refill) and organizing support group meetings to provide psychosocial support. This has still been very active and working well despite the socio-political situation and it gives us the occasion to have an overall visibility on patients' follow-up.

3. Laboratory support

With the breakdown of the normal system of functioning and financing during this crisis, the laboratory at the CHR Bondoukou which is the reference laboratory for the region and funded by Global Fund, shut its doors due to stock out of supplies. The PSP [National Public Health Pharmacy] also does not have these supplies and is expecting delivery only in January 2011. This is the sole laboratory supporting HAI sites in Bondoukou.

We had to create an alternate path way to assemble and channel blood samples for CD4 and other complementary laboratory analysis to Bouna (176km from Bondoukou) twice a week from all health facilities in Bondoukou district.

In January, there has been slight improvement of the situation and our work has returned to approximately 75% of original capacity. This has been influenced by return of some health providers, some district and regional management staff and improved frequency of utilization of services by the population. This gradual return to normalcy has been very irregular with some good days and some bad ones.

We will continue with updates from the field while this situation continues.