During my recent trip to Honduras, I saw some of the small yet impactful changes being made as a result of the social audits that Honduran grassroots groups and NGOs are conducting to improve services in rural health clinics. The social audits are part of MCC’s $15.6 million Threshold Program in Honduras which seeks to help the government become more efficient and transparent. The centers and organizations I spoke with were implementing a program developed by Trocaire, an international faith-based NGO and MCA-Honduras grant recipient that is working throughout the country.
Residents demand increased capacity
The first town I visited was in Copán, a rural region of the country with winding roads and picturesque views of Honduras’ abundant green hills. In San Nicolás, Copán, an organization called Regional Western Space for Honduras (Espacio Regional de Occidente Honduras, EROC) trained women’s networks to audit the quality of care at their local health centers. The audit yielded several results that surprised community members. They learned that almost 60% of women treated at the health center did not know what illness they had or what kind of medication they were prescribed, even though the sharing of this information is required under the new public health model.
Most significantly, the audit identified the need for an additional doctor in the area. Before the audit, San Nicolás residents had to share one doctor who would ferry between multiple health units. By capitalizing on strong ties to the local government and members of the community as well as a lengthy public awareness campaign on the purpose of the social audit, the women’s network conducting the audit presented their results to the mayor’s office and, working with their local mancomunidad, or municipal association, secured funding for an additional doctor. Carlos Chinchilla, director of EROC, told me that “if the population hadn’t demanded it, things would have continued as before.”
Clinics get organized to reduce patients’ confusion
Following my visit to San Nicolás, I traveled to Choluteca, an area in southern Honduras with flatter and hotter surroundings, and a mere three-hour drive from the capital. There I met Ada Luz Ramirez, the young and enthusiastic head of the team that audited the health units in the municipality of Orocuina. Along with volunteers from the Association of Women Defenders of Life (Asociacion de Mujeres Defensores de Vida, AMDV), we visited a newly reorganized health unit that now had a walled off area for immunizations. Areas specifically designated for different types of care, along with new signage, have brought order to the center and decreased confusion among patients.
Like EROC in Copán, AMDV in Choluteca also utilized their strong relationships with the mayor’s office and the community to enact several changes in the way patients are received and treated at these health units. Nurses Rosa del Carmen Aguilar and Ada Yamilet Rodezno, who now wear name tags so patients can more easily identify them at the health centers (the result of another audit finding), explained to me that she and her colleagues are now empowered to hold doctors in the health units accountable for ensuring every patient that arrives within prescribed hours receives treatment. Before the audit, doctors could choose when they would stop seeing patients for the day. AMDV is also working with the mayor’s office to secure funds for additional staff for these centers as a result of the findings of the audit.
Patients gain confidence in clinics
Finally, I spoke with Luz Estela Sanchez, a resident of Orocuina who has been a patient for the last three years at one of the health units we visited and now volunteers there to help build awareness of the improved health services among the community. Luz told me that the quality of service at her local clinic has improved markedly. “Before, the staff did not bother to inform patients about their diagnosis or what kind of medicine they were getting. Now they get regular chats from the staff, doctors and nurses about what they have and how they can prevent it or treat it.”
Social audits are a small component of MCC’s program in Honduras, but these audits are improving the quality of care in historically neglected areas of the country. At the same time, the audits are empowering women in Honduras to lead the charge to hold their government accountable for the quality of services it delivers to its people, and ensuring rural communities have access to the essential healthcare services they need. My trip was a great chance to get an up-close look at how MCC’s support for Honduran efforts to empower women and ensure government accountability are reaping benefits.