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Strategic Assessment of Reproductive Health in the Dominican Republic

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Strategic Assessment of Reproductive Health in the Dominican Republic United States Agency for International Development (USAID) Secretaria de Salud Pública y Asistencia Social (SESPAS) Population Council Strategic Assessment of Reproductive Health in the Dominican Republic Prepared by Suellen Miller, PhD, CNM, Population Council Argelia Tejada, PhD, Consultant to the Population Council with Dr. Patricio Murgueytio, REDSALUD and Juan Díaz, MD Rasha Dabash, MPH Pamela Putney, MPH, CNM Sandra Bjegovic Gladys Caraballo Santo Domingo, Dominican Republic February 15, 2002 One Dag Hammarskjold Plaza New York, NY 10017 telephone: 212-339-0500 fax: 212-755-6052 e-mail: [email protected] www.popcouncil.org The Population Council is an international, nonprofit, nongovernmental organization that seeks to improve the well-being and reproductive health of current and future generations around the world and to help achieve a humane, equitable, and sustainable balance between people and resources. The Council conducts biomedical, social science, and public health research and helps build research capacities in developing countries. Established in 1952, the Council is governed by an international board of trustees. Its New York headquarters supports a global network of regional and country offices. This publication was made possible by the Office of Population of the United States Agency for International Development (USAID) under the terms of Cooperative Agreement number HRN-A-00-99- 00010. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of USAID. © 2002 by The Population Council, Inc. PARTICIPANTS Investigation team (Defined strategic questions, developed tools, collected data, and synthesized results) Ámbar team: National District and Region IV Supervisors: Pamela Putney, MPH, CNM and Mélida Núñez, EngenderHealth, RN Suellen Miller, PhD, CNM (in National District) Nancy Vásquez, Clinical Psychologist, IDSS Gladys Caraballo, Social Worker, Consultant Wilme Vargas, Rural Development, Consultant Larimar team: National District and Region III Supervisor: Argelia Tejada, PhD, Sociologist Sonia Brito, MD, OB/GYN, Plan de Lucha contra la Pobreza Ana Julia Hernández, Clinical Psychologist, SESPAS Leda Herasme, Health Educator, SEE Héctor Rodríguez, Social Worker, ONE Technical Advisory Group Dr. Milton Cordero, PRIME Ms. Ann Lion Coleman, PRIME Dr. Ramón Portes, ADOPLAFAM Dr. José Figueroa, EngenderHealth Dr. Patricio Murgueytio, REDSALUD Dr. Jenny García, Colectiva Mujer y Salud Dr. Maria Artola Faget, FCI Dr. Guillermo de La Rosa, INSALUD Dr. David Losk, USAID/Salud y Población Ms. Elba Mercado, USAID/Salud y Población iii Table of Contents Acknowledgments....................................................................................................... v Acronyms ..................................................................................................................vii Executive Summary .................................................................................................... 1 1: Strategic Assessment of Reproductive Health in the Dominican Republic ............... 5 2: Maternal Health .................................................................................................... 14 3: Family Planning .................................................................................................... 34 4: Adolescent Reproductive Health ........................................................................... 50 5: Conclusions .......................................................................................................... 63 References ................................................................................................................ 64 Appendix A............................................................................................................... 67 Appendix B............................................................................................................... 69 Appendix C............................................................................................................... 70 Appendix D............................................................................................................... 85 Appendix E............................................................................................................... 87 Appendix F ............................................................................................................... 96 Appendix G............................................................................................................. 101 Appendix H............................................................................................................. 108 iv Acknowledgments This Strategic Assessment report and background paper were produced with the support of many institutions and individuals. At SESPAS we thank Drs. José Rodriguez Soldevilla, Victor Calderon, and Manuel Tejada. From the inception of this project they provided total access to SESPAS’s institutions, participated fully in the orientation and dissemination workshops, provided a team member (Ms. Ana Julia Hernandez), and supported our findings. Likewise we thank the director of IDSS, William Jana, and Dr. Clavel Sanchez for facilitating our access to the IDSS institutions and permitting the participation of Ms. Nancy Vásquez on the data collection team. Most importantly, both IDSS and SESPAS have supported the recommendations the assessment team has made for improving the quality of care in the sexual and reproductive health programs and services of the public sector. Among the international organizations and nongovernmental organizations who participated as stakeholders in this assessment, we give particular thanks to Ms. Magaly Caram of PROFAMILIA, who allowed us to observe the PROFAMILIA clinics. We also thank PROFAMILIA and Dr. Frank Caceras for his invaluable participation and consultation. Likewise we thank EngenderHealth for allowing Ms. Mélida Núñez to join our team and allowing Dr. José Figueroa to participate as part of our technical advisory group. Special thanks also to PRIME for providing us with the technical advisory group participation of Ms. Ann Lion Coleman and Dr. Milton Cordero. PRIME also provided an office space for the team while we were preparing the background document for the study and lent us many background documents. Dr. Ramón Portes of ADOPLAFAM deserves special thanks for his work on the technical advisory group and for the donation of the training facility in which the team met during the data collection phase. Dr. Patricio Murgueytio of REDSALUD provided incredible support by informing us about the new social security and health laws and writing the first draft of the section of the report on health-sector reform. All of the participating international organizations and NGOs listed in our participants’ list were active in all aspects of our work, and we thank them for making this work possible. Thanks also to Ms. Yanni Almazar, of the Universidad Catolica Nordestana, for helping us form the focus group in Region III. During our visits to the different health centers of IDSS, PROFAMILIA, and SESPAS, we were treated well by all directors, administrators, and service providers. We give special thanks to the directors who not only gave us interviews and access to their facilities, but who also provided access to statistics and records. Immeasurable thanks to the adults and adolescent clients who participated in the focus groups and individual interviews, and to those women who allowed us to observe them during surgeries, while they were in labor, and during the births of their infants. It is to them that we dedicate our ongoing work. Ms. Elba Mercado and Dr. David Losk of USAID deserve thanks for their ongoing support of this work and making this report possible. Ms. Mercado personally interviewed many of the decisionmakers and leaders among the stakeholders and was invaluable in translating and back translating between English and Spanish. Dr. Losk was a constant source of support and hard work. Both were available at any time during all the phases of preparation, instrument development, implementation, meetings, and report writing. To all stakeholders and team members, the team who prepared this report and the assessment team feel that we have functioned as your tape recorders and writing implements for documenting the v reproductive health situation in the Dominican Republic. We sincerely hope that this report reflects your findings and analysis. This report would not exist today had it not been for the incredible efforts of Ms. Norma Paredes, who translated both the background paper and the first English draft of the report into Spanish. vi Acronyms ADOPLAFAM Dominican Family Planning Association (Asociación Dominicana de Planificación Familiar) AGI Alan Guttmacher Institute AIDS Acquired immune deficiency syndrome ALIRH Latin American Association of Human Reproduction Investigators (Asociación Latinoamericana de Investigaciones Reproducción Humana) CEA State Sugar Advisory (Consejo Estatal de Azúcar) CERSS Executive Commission for Health Sector Reform (Comisión Ejecutiva para la Reforma del Sector Salud) CPR Contraceptive prevalence rate CYP Couple-years of protection DHS Demographic and Health Survey DR Dominican Republic ECC Expanding Contraceptive Choice program FP Family planning GDP Gross domestic product GODR Government of the Dominican Republic HIV Human immunodeficiency virus IDDI Dominican Institute for Integrated Development (Instituto
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