Eliminating Cholera from Haiti by 2024

Presentation prepared for the U.N. Haiti Cholera Settlement Fund

International Developoment Group’s Emergency Task ForceAbi Olvera, Akarsh Sharma, Katherine Rich, Theresa Bailey and

Sohini Sircar

• Cholera Outbreak in Haiti:

• Following 2010 earthquake, UN affiliated forces stationed in nation let untreated sewage from their camp leak into a tributary and pollute surrounding water sources

• Cholera has spread to other countries including Haiti, the United States, the Dominican Republic and Cuba

Background

Problem

Cholera in Haiti

People have died

People are sick & dying

People will

continue to get sick

Problem ComponentsPeople have died due to

cholera•UN image in the international community

•Families have lost income earners

People are sick and dying

•Highly infectious

•6% of people in Haiti have had cholera

•1.2% case-fatality•Lack of knowledge, resources, and infrastructure fuel this process

People will continue to get

sick•Scarce clean water sources for drinking water, sanitation, and hygiene

•Cholera spreads with each new case

Mission: We seek to eliminate cholera as a cause of death in Haiti and prevent the possibility of the reoccurrence of an outbreak within 10 years.

ObjectivePeople have died due to

cholera

People are sick and dying

People will continue to get

sick

Strategic Approach

People have died

•UN Settlement Fund Claims Committee

•UN Peacekeeping Operation health protocols

People are dying

•Clean water•ORS•IV•Antibiotics

People will continue to get

sick•Education•Supplies•Infrastructure•Regional incentives

StrategyPeople have

died

Claims committee

UN Peacekeeping protocols

$40 million allotted

Formula Driven:

Proof of Death + Number of Dependents + Age + Economic Loss

Ex. Father of five, aged 28: $3,000 - $4,000

8,000 have died so far

Claims Committee

Health screening and immunization of peacekeepers prior to deployment by troop-contributing country

After deployment, chief administration office responsible for exams

Cross check by setting up an internal committee to investigate the UN officials

Determine waste disposal protocol on a country-by-country basis

UN Peacekeeping Health Protocols

People are sick and

dying

ORS Clean water IV antibiotics

reduce case–fatality rates to <1%

Treatment strategies

Clean WaterFilteredBoiled

Salt & sugar solutionsIV fluids and kits

Low-tech, Low-cost Solutions

Strategy

People will continue to

get sick

Education Supplies Infrastructure

Regional Incentives

Curriculum:Cholera: Signs & SymptomsWater purificationWaste treatmentHygiene: hand washing & food preparationORS administration

Education

FuelClean water containersSoapFiltersORS packetsVaccines

Supplies

Public campaignsCommunity health workersCommunity-based education programsSchoolsDoor-to-door

Method of Distribution

Waste TreatmentUrban

UNEP: Collective disposal through small sewer systems including a primary treatment plant Sanitary sewer system by gravity or under pressure optimal.

UNEP: Private disposal system through individual holding tanks, cesspools, and septic tanks.

SOIL Toilets in slumsRural

Partners in Health $250,000 wastewater treatment systems installed in clusters of rural populations, scaled to size

SOIL toilets for dispersed clusters

Infrastructure

Healthcare systemCholera Treatment CentresIncrease access

Infrastructure

Pilot programs for optimal usage and PRUrbanRural

Randomized testing:Up-front cost of toilet on sliding scaleMonthly maintenance fee, reimbursement

SOIL Toilets

Partner Countries

Distribution of Budget

Infrastructure: 65% ($1.95 Billion)

Treatment and Education: 25%($750 Million)

Settlement Fund: 5% ($150 Million)Regional Incentives: 5% ($150 Million)

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

Timeline

Infrastructure: 65% ($1.95 Billion)

Treatment and Education: 25%($750 Million)

Settlement Fund: 5% ($150 Million)Regional Incentives: 5% ($150 Million)

Rollout Plan

People have died Animosity towards the UN may not be absolved by settling personal claims Relations with other nations may still be permanently affected by this incident

People are dying Plan does not include diagnostics Haiti’s health care infrastructure may prevent patients from obtaining treatment

People will continue to die: More countries affected then we can sustainably support Haiti may not be able to consistently generate enough electrical energy to

adequately maintain all sewage treatment facilities

Limitations

Sewage treatment plan is self-sustainingThe infrastructure of Haiti will undergo rapid expansion

The current proposal simultaneously improves the state of neighboring nations like the Dominican Republic

Engages the community in the solution Relatively low-cost, low technology solutions

Advantages

Our goal is to elminate cholera from Haiti through treatment, prevention and

development of long-term infrastructure.

Summary Slide

Additional slides

Problem8,300 have died due to

choleraCholera

outbreak in Haiti: people

are gettig sickInadequate water and

waste treatment & hygiene

Inadequate waste treatment by PKO

Haiti lacks infrastructure

• Haitians with cholera and at risk for cholera

• Haitian Government

• UN

• UN PKO

• WHO

• Partners in Health

• SOIL

• HAS

• DINEPA

Stakeholders

8,300 Haitians who died as a result of the cholera epidemic as well as some 650,000 more survivors of the illness.

$2,220,000 ORS (.11cents per packet, 20 packets per person, 1,000,000 ppl)

$10,000,000 vaccine/yr (1.85 per vaccine, vaccines for 1,000,000)

$9,600 (.04per 200mg tablet)

$920,000 (7 per IV Ringer Lactate solution kit) *really 840,000 but a bit

more added just in case

[120,000 hospitalization per year]

$1,222,300,800 Full sanitation system (cost of treatment system for all of the domestic water

$250,000 (300,000liters per day)

Hôpital Universitaire de Mirebalais (HUM) Mirebalais

Solutions

As of 30 November, 40 cholera treatment centres (CTCs) were operational (100 to 200 beds each) and 61 cholera treatment units (CTUs) were functional. Few oral rehydration centres (ORCs) have been established so far due to difficulties in implementing the response.

Cholera Treatment Centres

Deputy director of PAHO, and arm of UN thinks that vaccines for all newborns could be useful (60-70% effective and lasts 2 years)

So we would need about 3 vaccines per kid to get them out of the danger zone

Densely populated urban areas and rural places since little access to health care because vaccine is in short supply

Need about 46% vaccination coverage and Zindoga Mukandavire, David L. Smith & J. Glenn Morris Jr think it’s a good idea

Vaccine Distribution

Treatment

Education

Infrastructure

Investment in Haiti’s neighbor

Strategic Approach