Haiti / Zanmi Lasante

Zanmi Lasante (“Partners In Health” in Haitian Kreyol) is PIH’s flagship project – the oldest, largest, most ambitious, and most replicated. The small community clinic that first started treating patients in the village of Cange in 1985, has grown into the Zanmi Lasante (ZL) Sociomedical Complex, featuring a 104-bed, full-service hospital with two operating rooms, adult and pediatric inpatient wards, an infectious disease center (the Thomas J. White Center), an outpatient clinic, a women’s health clinic (Proje Sante Fanm), ophthalmology and general medicine clinics, a laboratory, a pharmaceutical warehouse, a Red Cross blood bank, radiographic services, and a dozen schools. ZL has also expanded its operations to eight other sites across Haiti’s Central Plateau and beyond. Today, ZL ranks as one of the largest nongovernmental health care providers in Haiti – and the only provider of comprehensive primary care, regardless of ability to pay, for more than half a million impoverished people living in the mountainous Central Plateau.

Our community-based model has proven successful in delivering effective care both for common conditions like diarrhea, pneumonia, and childbirth that often prove fatal for Haiti’s poor and malnourished, and for complex diseases like HIV and tuberculosis. A key to this success and to the PIH model of care pioneered in Haiti has been training and hiring thousands of accompagnateurs (community health workers) to prevent illness, monitor medical and socioeconomic needs, and deliver quality health care to people living with chronic diseases such as HIV and tuberculosis.

In each of our expansion sites, we have partnered with other nongovernmental organizations and the Haitian Ministry of Health to rebuild or refurbish existing clinics and hospitals, introduce essential drugs to the formulary, establish laboratories, train and pay community heath workers, and complement Ministry of Health personnel with PIH-trained staff. Clinics that previously stood empty now register hundreds of patients each day across our nine sites—Cange, Boucan Carré, Hinche, Thomonde, Belladère, Lascahobas, and Cerca La Source in the Central Plateau plus two recent additions in the Artibonite region, Petite Rivière and Saint Marc. In 2005, ZL recorded more than 1.1 million patient visits at our clinical sites, not including well over a million more home visits by community health workers.

In 1998, Zanmi Lasante launched the world’s first program to provide free, comprehensive HIV care and treatment in an impoverished setting. Two years later, with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, this pilot effort was expanded across central Haiti and became known as the HIV Equity Initiative. The initiative is now a global model for the delivery of community-based treatment for complex diseases within the context of comprehensive primary care. In November 2003, a lengthy article in the New York Times, datelined from Cange, stated, “No program to treat people in the poorest countries has more intrigued experts than the one started in Haiti by Partners In Health.”

In the course of expanding our care of HIV-positive patients and their families, we have also significantly increased our ability to identify and treat patients with other diseases.

Women’s health has always been a strong focus of ZL’s outreach activities, and is one of the four essential components of the HIV Equity Initiative. One of ZL’s first projects was a women’s clinic, Proje Sante Fanm, which offers family planning, pre- and post-natal care, assisted deliveries and caesarean sections, vaccination of women and children, and screening and treatment of HIV, other sexually transmitted infections and cervical cancer. In 2005, Proje Sante Fanm provided clinical services to 40,000 women and served hundreds of thousands more through outreach in the countryside.

ZL has also been an incubator for other innovative programs, such as its Program on Social and Economic Rights (POSER). PIH has long championed the need for social as well as medical support for our patients. POSER addresses the social inequalities that put our patients at increased risk of disease by providing nutritional support, building houses, paying for school fees and installing well caps or filtering systems to ensure access to clean drinking water.