Tiyatien Health: Justice in Health

Strategic Framework: 2009 – 2013

 

 

Mission & Vision

 

The mission of Tiyatien Health (TH) is to promote equity by advancing healthcare services and the fundamental rights of the poor. Through services, research, advocacy and training, we are working to improve access to HIV treatment, care and support; build models that deliver primary healthcare fairly and for all; and bolster social justice in rural Liberia – one of Africa’s poorest war-torn countries.

 

 

TH envisions a just global society – a necessary element of which is a world in which people share equity in survival.  For us, this means a world in which communities have eliminated separate, unequal standards of healthcare; political and economic structures are fair to the poor; and fundamental freedoms are enjoyed by all.    

 

 

Guiding Philosophy and Principles

 

We recognize that the health of the poor is inextricably linked to social and economic inequalities that promote vicious cycles of disease, poverty and violence.  By developing, implementing and advocating for comprehensive, community-based healthcare for the poor we aim to tackle these inequalities.  Our aim is to promote virtuous social cycles:

 

Direct delivery of healthcare services will be our chief priority.  We will seek and serve the poorest rural communities.  Our commitment to them will be assessed based on long-term engagement – measured over decades, not years.   Improved health outcomes among the poor will be the yardstick by which we judge our success. 

 

No person will be considered “untreatable” and no condition will be considered “too complex to treat.”  We will remain critical of prevailing paradigms – such as cost-effectiveness – in public health.  We will treat all patients with dignity and respect, caring for them as if they were members of our own families.  Care for complex, chronic illnesses such as HIV, depression and heart disease will be as aggressively pursued as treatment for acute conditions like malaria and obstetric emergencies.  

 

Building on a pillar of healthcare, we will listen to the poor retell their experiences – their struggles, their truths.  We will strive to learn about their competing survival needs.  Through home visits, narratives, and participatory methods we will collectively uncover the roots of their maladies. 

 

Working along side the poor, we will design and implement comprehensive, pro-poor models of healthcare.  Community health workers will feature at the forefront of our efforts.  They will receive fair compensation for their commitment to serve and accompany the destitute sick.  

 

Economic barriers to care will be abolished.  User fees will be eliminated and our interventions will address poverty and its associated maladies of malnutrition, limited transportation and illiteracy.

 

We will seek to demonstrate the effectiveness of our models through quantitative and qualitative research.  Employing participatory ethnographic, epidemiologic and operations research, we will compulsively document and disseminate the findings of our work in the scientific and popular literature. 

 

Effective healthcare models will be expanded through direct implementation as well as advocacy for similar programs and policies globally.

 

Healthcare is a human right and should be enshrined as a collective good.  The public sector is well positioned to deliver sustainable healthcare to the poorest populations.  We will work closely with the public health sector to adopt and disseminate effective models of care.

 

Health cannot be achieved without advancing other social and economic rights.  We will integrate our healthcare services with broader efforts to achieve social justice.  This will include building socio-medical centers engaged in promoting access to education, employment and agricultural assistance.

 

Context

 

Positioned along West Africa’s Atlantic coast, Liberia, by all customary indicators, is one of the world’s poorest nations.  Gross domestic product in 2005 averaged a mere $165 per capita, declining by 90% relative to pre-war figures – the worst national economic collapse since World War II.  Grinding poverty is compounded by generalized unemployment, leaving eight of every ten Liberians jobless.  And in the balance looms a suffocating external debt of $3.7 billion – over 25 times the amount available in Liberia’s coffers for spending on public services in 2006.   

 

Relics of violent disruption texture life in contemporary Liberia.  Bushes grow from the cracks of abandoned homes, burned during fighting that uprooted nearly a third of Liberia’s three million people.  Empty, roofless, skeleton-like structures once lodging schools and clinics serve as reminders of the systematic looting that fueled the war. 

 

Southeastern Liberia is the poorest region of one of Africa’s poorest nations and has been severely affected by decades of war and poverty. Grand Gedeh County, where Tiyatien currently focuses its attention, is home to over 100,000 subsistence farmers and hunters, nearly 90% of whom were displaced during Liberia’s decades-long civil wars. These people can expect to live only a mere 42 years, often embattled by harsh living conditions. Nearly a quarter of Liberia’s children die before they turn five. Death during childbirth is also rampant, signaled by the harrowing figure that about one in twenty women can expect to die in childbirth. Interrupted disease control efforts have bred West Africa’s largest HIV epidemic here, with 9% of mothers infected. Amidst such despair, these southeastern communities are forced to deal with the reality of being served by only one doctor for more than 100,000 people.

 

 

Gaps

 

TH recognizes several challenges must be overcome by many actors – indeed, a broad-based movement – to achieve its vision of a just global society.  These gaps include the obvious needs for increased funds for research on diseases afflicting the poor and improved mechanisms to expand access to resultant technologies and knowledge.  However, other institutions may be better placed to address these research and access challenges. 

 

TH’s strength as a community-based, social justice organization better suits it to address a third critical challenge in settings of extreme poverty – gaps in healthcare implementation.  TH’s service, research, policy and training programs seek to address the following critical barriers to effective healthcare delivery in resource-poor settings:

 

• Global policies and programs are not judged based on their impact on equity in health.

 

• Public goods, including health services, for the poor have been severely weakened. 

 

• Voices of the poorest factor marginally, if it all, in shaping global policies. 

 

• Healthcare delivery models that fairly serve the poor have been insufficiently explored, scaled and sustained.

 

• Separate, unequal standards in healthcare prevail between rich and poor.  

 

• Few healthcare initiatives pragmatically and aggressively tackle the social determinants of health. 

 

 

 

Strategic Directions: 2009 - 2013

 

“Should medicine ever fulfil its great ends, it must enter into the larger political and social life of our time; it must indicate the barriers which obstruct the normal completion of the life-cycle and remove them. Should this ever come to pass, medicine…will become the common good of all.”

 

- Rudolph Virchow, 19^th Century physician, anthropologist, statesman

 

TH’s five strategic directions directly target the implementation gaps described above.  These strategic directions are in line with key policy imperatives of the Government of Liberia, including the Poverty Reduction Strategy and the Ministry of Health’s National Health Plan.  Most importantly, they were developed through an authentically inclusive process.  Rural Liberian subsistence farmers and hunters, people with HIV, their family members, residents of poor communities, community health workers and TH staff developed these directions in multiple community forums, culminating in a strategy retreat in Zwedru, Liberia in November 2008.

 

 

SD1: Eliminate inequalities in health. 

 

TH’s strategy to eliminate inequalities in health involves expanding access to and improving the quality of health services in southeastern Liberia.  TH will build comprehensive prevention, treatment and care services for diseases not currently addressed in rural Liberia.  Through 2008, TH has already successfully treated cancers, heart failure, and HIV, where treatment for these conditions was previously absent or minimal.  HIV, tuberculosis and chronic diseases, including mental health disorders, will remain of priority focus from 2009 - 2013.  In partnership with MoH, TH seeks to decentralize and integrate its innovative work through its HIV Equity Initiative and Chronic Care Clinic to other primary health centers in southeastern Liberia.  Impact will be measured based by population-based reductions in morbidity and mortality from HIV, tuberculosis and chronic diseases such as depression, hypertension, and heart failure. 

 

TH will also strengthen the quality of care delivered under the Liberian Basic Package of Health Services (BPHS), the Ministry of Health’s key policy mandate.  In collaboration with MoH, TH will work to strengthen maternal, newborn and child healthcare services at public centers in southeastern Liberia.  Impact will be measured by population-based reductions in childhood and maternal mortality. 

 

 

SD2: Strengthen health systems through the public sector.

 

To realize health as a human right TH’s health services will continue to delivered in genuine partnership with the Liberian Government.  The public sector is well positioned to deliver sustainable healthcare to the poorest populations.  TH will work within the public sector from 2009-2013 to strengthen health systems and performance.  TH will renovate and rebuild physical infrastructure at public facilities in Grand Gedeh and River Gee Counties.  TH will recruit health personnel, including physicians, physician assistants, nurses and community health workers to MoH facilities.  Compensation will be strengthened for workers at public facilities in line with policies of the MoH. 

 

Furthermore, TH will research innovative and more equitable models for delivering primary health services within the public sector.  Recently published studies from TH/MoH on HIV, depression and post-traumatic disorder have already shaped MoH policy and programming. From 2009 – 2013, TH will carry out operations research to improve care delivery for BPHS priorities, including HIV, tuberculosis, mental health and maternal mortality. 

 

 

SD3: Leverage healthcare as a force for social justice.

 

As documented by the WHO Commission on Social Determinants of Health, TH acknowledges health is adversely affected by social and economic barriers.  From 2009 – 2013, TH will continue to work to remove these barriers.  TH will continue to link and leverage healthcare programs to broader efforts to strengthen social and economic rights, including the rights to food, housing, education and jobs.  TH will strengthen its current work on agriculture, economic aid, small business enterprise development, and housing.  Employment and training opportunities, including community health worker appointments, will continue to be expanded for the poorest of the poor. 

 

 

SD4: Build durable mechanisms to secure the rights of the poor.

 

As part of its evidence-based advocacy strategy, TH will promote institutions, policies, and funding that enhances the rights of the poor.  From 2009-2013, TH will continue to offer major policy input to the National AIDS and Tuberculosis Control Programs, GFATM proposal development, the National Mental Health Policy Committee, and the National Health Reform process, with focus on the Basic Package of Health Services.  Through its US-based team, TH will continue to advocate for equitable health and social services in globally prominent forums including widely read academic journals, such as the Lancet and the Journal of the American Medical Association, and venues such as Harvard University, the World Health Organization and the International AIDS Society.