MCH Student:

Shelby Panttaja

Date of Defense:

October 5, 2018

Abstract:

Introduction

The Dominican Republic is home to approximately 230 State-owned bateyes, that once formed the economic backbone of the small Caribbean nation¹. The bateyes are segregated rural communities established by the Dominican Republic government, which were originally built to house Haitian migrant sugarcane cutters. Estimates of the population living and working on these bateyes vary greatly, from 200,000 to over 1 million, and accounting for anywhere between 7-12% of the total population of the Dominican Republic².  Despite the significant amount of sugarcane once produced by these communities and their contributions to the Dominican economy, those living on bateys suffer immensely from economic isolation, extreme poverty, and food insecurity, when compared to their counterparts. One indicator of this heightened poverty and lack of government support is in the rates of food insecurity, in which childhood malnutrition rates are three times that those outside of the bateyes³.  Food insecurity is of particular concern in the Dominican Republic because it exacerbates vitamin A deficiency, which is a leading cause of preventable childhood illnesses and death. In order to relieve some of the burden of micro-nutrient deficiencies and food insecurity on the women and children of the Dominican Republic, agricultural micro-grants are granted in conjunction with multivitamins and vitamin A, which are provided by Batey Relief Alliance (BRA)⁴.

Experience

This Field Experience was facilitated through a five-year Strategic Plan, in which a comprehensive Women’s Empowerment Initiative aims to provide 5,000 women with the tools needed to escape poverty, become self-sufficient and develop their community, and seek higher levels of education⁴. Batey Relief Alliance feels that the tools need to escape poverty and empower women include providing skills training on livestock rearing and stainable gardening, as well as nutrition, multivitamins, and health care. My role in this organization involved evaluating their current Women Empowerment Initiative, through a series of ecological and logic models, literature reviews, clinical observations, and home visits. This was all done to create an evaluation and data collection tool for BRA to use for the remaining 5 years of the Strategic Plan.

A literature review determined that while micro-grant projects are commonplace in international settings, rarely do they focus on women and their empowerment through nutrition and food security. To evaluate nutrition and food security, we focused on the Household Hunger Index, and utilized two different screening tools one of which has a 97% sensitivity⁴. The evaluation tool also drew indicators from the Safe Sex Behavior Questionnaire and the United Nations Sustainable Development Goals. Our survey utilized the Likert Scale, Yes/No questions, and nutritional screening tools. It was intentional to use close-ended questions, as this helped keep the time required to complete the survey manageable, assisted in the ease of data collection, and decreased the burden on community health workers, who are the primary data collectors. During my last week with BRA, I presented our deliverable to BRA’s Executive Board of Directors, Vice President, and to the President/Chief Executive Officer. The Board and Executive Officers determined that the tool was satisfactory for the Women Empowerment Initiative, and voted to implement the tool during the next round of micro-grant dissemination.

Organization

Batey Relief Alliance (BRA) is a non-profit international humanitarian aid entity, which unites grassroots groups, faith-based organizations, government agencies, and the international community in partnerships to help create a safe environment for children and their families who are affected by extreme poverty, disease, and hunger in the Caribbean⁵. The projects of BRA provide services to more than 60,000 thousand people each year, including primary health care, maternal and child health services, and HIV / AIDS prevention and treatment⁵. In addition to these efforts, BRA serves another 100,000 people through donations of medicines, medical supplies and equipment to partner organizations working in other sectors of the country⁶.

Results

The evaluation tool created has four distinct sections: Decision-Making, Nutrition and Hunger, Security of Household, and Sexual Health. This evaluation tool was used for primary data collection, in which future rounds of data collection is planned, in order to better analyze BRA’s Women’s Empowerment Initiative and track changes in responses from beneficiaries. Our initial surveys provided the following information:

The Decision-Making section data collection found that 40% of women surveyed strongly agreed that their partner considers their financial contribution to be as important as theirs, and 50% of women surveyed strongly agree that they are an important part of the economy of their communities. The Nutrition and Hunger section found that 75% of women surveyed have food insecurity, 65% of women surveyed are experiencing moderate to severe hunger, as evidenced by the Household Hunger Index, and 70% of women surveyed consume only 0-3 vegetables per week. Our final section, Sexual Health found that 30% of women surveyed agree that they insist that their sexual partner uses a condom. This data will need to be continuously collected to assess trends in women empowerment, as the initiative continues to remain in the community for more time. We are aware there may have been response bias, due to the sensitive nature of of the questions.

Lessons Learned

My experience in the Dominican Republic has had a substantial effect on my academic and professional goals, particularly in evaluating humanitarian aspects of public health work abroad. During my time with Batey Relief Alliance, I was not only able to conduct an evaluation project, but also participate in home visits and clinic observations, which proved to be challenging. Visiting the homes of our participants was challenging as I witnessed extreme poverty, severe health inequalities, and immense food insecurity and hunger. Overall, the experience has made me a more competent and compassionate public health professional, as well as a more empathetic and socially conscious individual.

Recommendations

Our immediate recommendations included improving the training of community health workers and office assistants on data collection methods, education on appropriate question prompting, and organizing a consistent evaluation schedule. Short-term goals are to increase measuring the economic impact of the women empowerment program, by measuring how women use the agricultural inputs and how purchasing choices may change, particular in their food diversity. Long-term goals are to increase interest on mental health and sexual health indicators, services, and implementation of breast-feeding peer support groups.

Conclusion

Batey Relief Alliance has the tools necessary to make a significant impact on women’s empowerment in the Dominican Republic bateys. This evaluation project’s purpose was to provide data for later analysis on the effectiveness of the program, provide recommendations for clinical and community programming, and to obtain information on BRA’s agricultural and micro-grants beneficiaries. In its inaugural year of the Strategic Plan, we aimed to support BRA’s efforts and contribute to health of women and children in the under served communities of Monte Plata, Dominican Republic.

 References

1. Wright, P. (n.d.). The Origin of the Dominican Batey. Retrieved September 16, 2018, from https://cotni.org/news/dominican-republic/2007/11/14/origin-dominican-batey
2. Estimates of the population living and working on these bateyes vary greatly, ranging from 200,000 to over 1 million, and accounting for anywhere between 7-12% of the total population of the Dominican Republic.
3. IMPROVING HUMAN SECURITY IN THE BATEYES OF THE DOMINICAN REPUBLIC. FIRST YEAR PROGRESS REPORT [PDF]. (2013, December 31). UNICEF.
4. Maxwell, Daniel, Jennifer Coates, and Bapu Vaitla (2013). How Do Different Indicators of Household Food Security Compare? Empirical Evidence from Tigray. Feinstein International Center, Tufts University: Medford, USA.
5. Batey Relief Alliance – “…One of the best NGOs in developing countries.” – US Department of Agriculture, 2013. (n.d.). Retrieved September 16, 2018, from http://bateyrelief.org/
6. Batey Relief Alliance: 2012-2013 Annual Report [PDF]. (2104). Santo Domingo: Batey Relief Alliance.