The Case for Comprehensive: Dominican Republic

During a trip to the Dominican Republic, CHANGE discovered that the contrast between the quality and breadth of care offered by nongovernmental organizations as compared with the public health care system is striking.

Promising Practices: Nongovernmental Organizations

PROFAMILIA 

International Planned Parenthood Federation member association PROFAMILIA is seen as a leading sexual and reproductive health care provider in the country and a leader in defending women. In one hospital, seven clinics, one mobile clinic, and 26 community distribution outlets, Profamilia provides the full range of reproductive health care – family planning, maternal health, and HIV/AIDS and other STI services. They also incorporate youth-friendly outreach and programming.   

Unlike other health providers, Profamilia incorporates attention to gender based violence in all  levels of service with professional counseling on gender-based violence (GBV) from a rights-based approach. They also have a model maternity hospital in Santiago that is open 24 hours a day and serves 1,000 birthing women per year. To combat stigma for HIV+ clients, their clinics do not physically separate HIV services from other sexual and reproductive health services.  All users use the same entrance, lobby and lab services, regardless of the reason for seeking care. It is important to note that while this inclusive approach has been successful for Profamilia, it may not work in all settings.  

Colectiva Mujer y Salud  

The feminist NGO Colectiva Mujer y Salud (Women’s Health Collective) has a strong community presence from years of outreach and education, and  opened the Monte Plata health center in March 2008. This center offers family planning, antenatal care, voluntary counseling and testing, antiretrovirals, sexual education for ages 10 and up, and community outreach that includes gender violence screening and focuses on women’s rights and gender equity. They base service selection on women’s needs as identified by women in the community.   Although the Ministry of Health provides no female condoms, Colectiva is working to train Ministry of Health personnel on their use and is working in communities to raise awareness about female condoms. However, low supplies of female condoms have been a consistent challenge to fully execute the program. 

Limitations in the Public Health System 

Public health services offer far less than their NGO counterparts. The only forms of contraception offered by public health outlets are birth control pills, IUDs, condoms, Depo Provera, and sterilization.  

The public sector also suffers from a  lack of integration  between services. In a study exploring provision of family planning to postpartum women, the authors note that while 97 percent of women entering the hospital for labor had indicated interest in using family planning postpartum, only 12 percent received a method before leaving the hospital. For postabortion care clients, the situation was even worse: only 12 percent even received counseling on family planning, and just nine percent received a method before leaving.

In contrast to Profamilia’s approach, the public health system provides care to those living with HIV and AIDS through separate clinics – sometimes attached to hospitals although with separate entrances – called “Integrated Attention Units” (UAIs). However, despite their name, UAIs and hospitals have no referral system between them. Moreover, UAIs have no gynecologists on staff and provide no services for contraception or GBV (Galvan 2008). They do not have any youth-friendly counselors or other staff and they have little outreach to communities.

For the complete case study, see The Case for Comprehensive: Dominican Republic, CHANGE