The door-to-door battle for health equity in Honduras

María Dominga Pineda and her daughter Alison Fabiola at their home in Tambla Lempira, Honduras

Tambla Lempira –Honduras- (November. 2016). Marta Leticia Cartagena is 31 years old and lives in Tambla Lempira, a municipality located in one of the poorest regions of Honduras, very closet o the border with El Salvador. Marta has been working for four years as a promoter at the health center of this locality. She has drawn a map of the town’s houses on the wall of her office. There is an annotation for each house, based on each neighbor’s health needs: “pregnant woman”, “child under 36 months of age”, “woman who has just given birth”. The houses posing a greater health risk are painted red. She knows each one of her 3,100 neighbors. And she knows precisely what their needs are.

Miriam Janete Martínez is 29 years old and has three children. She, alone, is in charge of taking care of her children and of “making sure that they do not lack food”. Every day she walks to her mother’s house to prepare tortillas with an old stone mill. Her house is one of those that Marta, the health promoter, has marked in red. Periodically, she visits them to verify that the youngest ones are taking their dose of micronutrients and that their health needs are covered. Miriam Janete ensures that she never forgets to give the micronutrients to the children. “It is very important for the nutrition of my children and I always put them in their meals. They take them without any problems”, she explains. “Likewise, the promoters weigh and measure the children and remind us of how important it is to keep the house clean and that the children wash their hands”.

Day after day, Marta, along with another friend, walk to those houses where they suspect that some child or some woman in child-bearing age may be at risk of encountering a gap in access to health services. “We make sure that everybody is alright, that they have a healthy lifestyle and that they meet the hygiene and cleanliness standards”, explains Marta Leticia Cartagena, who displays her satisfaction for the results of the work carried out in the past three years. “We no longer have maternal or child deaths in this municipality. Before, it was normal that some woman would die every year during delivery. For the past three years this is no longer normal. All deliveries are institutional and all women are taken care of. Likewise, we have also achieved zero cases of zika, dengue or chinchingulla”, acknowledges Marta with a broad smile.

One of the houses Marta visits frequently is where María Dominga Pineda, age 20, and her four month old daughter Alison Fabiola live. They live in a small adobe house surrounded by vegetation and cattle. “María is an exemplary mother”, explains the health promoter. “We detected that she was pregnant when she was four weeks into the pregnancy and, since then, she has attended to all her medical checkups and prepared her delivery beforehand and in a responsible manner. She even gave her baby a name when it was still in her little gut”, acknowledges Marta. María, in turn, thanks the work of the promoter. “Ever since I became pregnant she taught me what were the signs of danger, they helped me to prepare for delivery …, now they monitor that the baby complies with her vaccines and they are already explaining to me how I have to give her the micronutrients when the baby is six months old. Additionally, they advise me to plan and not have another child so close to this one”, adds María Dominga.

The battle to reduce health inequities in Honduras is bit by bit and, more specifically, door to door. The health promoter teams, such as the one Marta is part of, visit day after day the homes of the municipalities where the poorest 20% of the country live to ensure their access to quality health for children and women in child bearing age. They know, treat and worry about the local population as if they were their own families. They are part of the plan elaborated by the Salud Mesoamérica Initiative to eliminate gaps in access to health of the poorest population of Honduras. The work of these volunteers during the past three years has allowed the poorest of this country to significantly improve access to health services.

In 2013, only 0.1% of the children ages 6 to 23 months received micronutrients in a regular manner. Three years later, this figure has risen to 15%. In 2013, only 18.7% of the poorest women of Honduras received quality care before delivery. 36 months later, this figure has increased up to 65.6%. In 2013, obstetric complications cared for in accordance with quality standards was barely 11%. Three years later, this figure has risen to 67.9%.

The first operation of the Salud Mesoamérica Initiative began on July 2012 and ended on July 23, 2014, after an investment of 8 million Dollars. In this first operation, the Government of Honduras met the established goals and was able to collect the performance tranche, which meant two million Dollars. The second operation began in Honduras in 2016 with a 7 million Dollar investment. It is foreseen that the project will extend up to May 2018.