The Centers for Development and Health

Les Centres pour la Development et la Santé (CDS)

CDS provides the population it serves with one of the most comprehensive health and social service programs in the developing world. Statistics detailing certain health achievements by CDS are set forth below:

In Cite Soleil, improvements were even more dramatic, with infant mortality cut in half, neonatal tetanus, once the number 1 killer in the slum, virtually eliminated; vaccination coverage going from 43% to nearly 90% (3 times the national average), ORT used by 80% of the mothers (6 times the national average), and family planning coverage three times the national average.

CDS published research in such journals as The New England Journal of Medicine, Pediatrics, and JAMA and its presentations at international scientific conferences has brought significant advances in knowledge and health practices to public health officials around the world. CDS collaborated on this research with schools of public health at Johns Hopkins, Harvard, Tulane and Columbia universities. In one study, CDS and Johns Hopkins examined the optimal age for measles immunization. The study led the WHO to lower its recommended age for administering the measles vaccines. CDS officials diagnosed the epidemic of meningococcemia in Haiti. A sample of published studies are listed below:

• • Tuberculosis therapy with and without HIV infection (Johns Hopkins).
• • Transmission of HIV-1 infections from mothers to infants, impact on childhood mortality and malnutrition (Johns Hopkins).
• • Study of anemia in children (Tulane University).
• • Study of childhood intestinal parasites (Tulane University).
• • Study of the role of traditional birth attendants (PRICOR).
• • Study of alternative methods of providing family planning services (USAID - Columbia)
• • Study on the treatment of genital infections during pregnancy and their effect on birth weight (Harvard University).
• • Protective effect of measles vaccination (Johns Hopkins)
• • Response to measles vaccine in Haitian infants 6 to 12 months old (Johns Hopkins)

More importantly, many of the health practices introduced by Cite Soleil are now an accepted standard of care for developing nations. But in the 1970s and 1980s when the model was developed, hardly anyone was using these measures. Fewer still had the administrative capacity to use them well, on a sustainable basis, in extreme poverty. Observed home dispensation of short-term TB treatment was almost entirely novel. The elaborate CDS documentation system and extensive use of CHWs is today broadly accepted, but when the Cite Soleil model was developed, CDS was at the forefront of community medicine. Through a practical demonstration, CDS had a key role in advancing many other innovations or concepts that are now widely accepted by health professionals around the world:

• • The focus on women and, in particular, mothers in community health care;
• • Empowering and listening to local community members, including the CHWs, the traditional midwives and the local religious leaders;
• • Using local community members to address sensitive topics like family planning, AIDS and other STDs;
• • Prioritizing health education, which created demand for preventive health;
• • Promoting the use of Vitamin A supplements for children.
• • Collaborating with the government to help strengthen the knowledge base and administrative capacity of the Ministry of Health, the institution that, for better or worse, ultimately will have a significant influence on the health status of all citizens;
• • On health administration, creating a public health school, training indigenous health professionals, and promoting from within to create a core of dedicated, competent professionals;
• • Relentless attention to financial management, ¹ constantly refining the CDS model to obtain greater efficiencies and ultimately producing a system that provides excellent preventive and curative care at a cost of $8 per person annually.

All of this was accomplished under desperate political and economic conditions. Overall, it would be difficult to find an organization that had done more good, for more people, over a longer stretch of time, under worse conditions.