March 7, 2013 Liz Borkowski, MPH 0Comment

Haiti’s cholera epidemic began in October 2010, as the country was still reeling from the devastation of the January 2010 earthquake. The epidemic has now claimed nearly 8,000 lives, and although transmission has slowed, more than 1,500 new cases are still reported each week. Evidence suggests the cholera bacteria arrived in Haiti via UN peacekeepers from Nepal and spread because of an inadequate sanitation system in peacekeeper housing. Last month, however, the UN responded to a compensation lawsuit by invoking immunity under section 29 of the Convention on the Privileges and Immunities of the UN.

Now, Haiti has released a National Plan for the Elimination of Cholera (PDF), and the Pan American Health Organization/World Health Organization (PAHO/WHO) is calling on the international community to contribute to the effort, which will cost $2.2 billion. PAHO/WHO has pledged $500,000 “to install water and sanitation connections in primary health care facilities, strengthen care for cholera patients, and promote oral rehydration at the community level.” (Diarrhea can produce fatal dehydration, so reyhydration is the primary treatment for cholera.)

Cholera was able to spread quickly across Haiti because many of its residents lack access to improved drinking water sources and sanitation. (“Improved” drinking water sources include things like protected dug wells and protected springs as well as piped water, and “improved” sanitation includes some kinds of latrines as well as toilets.) PAHO notes that even before the earthquake, only 17% of residents could use improved sanitation, and 63% had access to improved water sources. When cholera victims’ feces can contaminate waterways people use for drinking water, the disease can spread quickly.

Haiti’s 10-year plan has four areas for action:

  • Water and sanitation: Objectives include ensuring access to potable water for 85% of the population and access to improved sanitation facilities to 95% of the population.
  • Epidemiologic surveillance: Objectives include strengthening epidemiological and laboratory surveillance and responding to outbreaks. Geospatial and epidemiologic surveillance data will guide the distribution of the oral cholera vaccine.
  • Health promotion for behavior change: Objectives include ensuring that 75% of the general population knows about prevention measures for cholera and other diarrheal diseases.
  • Care of infected persons in health institutions: Objectives include increasing the percentage of the population with access to primary care to 80% — up from 46%. Each of Haiti’s 565 communal sections will have an oral rehydration station staffed by a community health worker.

If Haiti, with support from the international community, can achieve these objectives, the public health results will extend far beyond cholera prevention. Water and sanitation infrastructure can reduce the transmission of other waterborne diseases, and can help girls stay in school. A strong surveillance system can help officials detect and respond to outbreaks of other diseases before they engulf the entire country. And a stronger primary healthcare system can help the country’s entire population live healthier lives. If Haiti carries out its 10-year plan, residents will reap the benefits on a day-to-day basis as well as when the next natural disaster or epidemic hits.

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