Introducing a Maternal Child Health Handbook in the Province of Dajabon, Dominican Republic: Prospects and Issues from the Perspectives of Sustainability and Replicability / 国際保健医療

ABSTRACT

<b>Introduction</b><br>In the Caribbean country of the Dominican Republic, specifically in the northwestern Province of Dajabón bordering Haiti, a Maternal and Child Health (MCH) handbook, “History of My Health” was introduced through the technical cooperation of the Inter-American Development Bank's Japan Program with the leadership of the Provincial Office of the Secretary of Health. This report describes the implementation process and results, examines the project's sustainability and replicablility, and shares good practices and lessons learned.<br><b>Activities</b><br>The implementation of the project can be divided into three phases first, development of a Dominican version of MCH handbook, local awareness raising, capacity building of health personnel, and the establishment of monitoring system were areas of high priority; the second phase centered around the improvement of MCH handbook with participatory approach and the continuation of the capacity building of health personnel; and the last phase focused on the sustainability through local management-precisely securing recurrent costs of the project.<br><b>Results</b><br>The evaluation and regular monitoring visits revealed positive results: as for pregnant women, the handbooks were well accepted for their friendliness, simplicity, durability and mobility, and the rate of their receiving antenatal and postpartum cares at designated clinics or hospitals increased; as for newborns and children, the immunization coverage improved while common problems such as diarrhea decreased; and as for health personnel, the handbook helped clarify the division of work and enhanced their sense of responsibility, communication, and continuity and integration of service. Currently, 359 trained health personnel use MCH handbook in all of the 22 health establishments in the Province, covering around 98% of the target population.<br><b>Conclusions</b><br>To achieve self-sustainability, this pilot project suggests that the use of MCH handbook needs to be institutionalized through the bottom-up approach and to integrate into the existing rural and national health care system through the top-down approach.