team 9
TRANSCRIPT
Team 9Emily Briskin, Teresa Logue, Lindsey Hiebert,
Justin Mendoza, Karen Zhang, Hye Ryeong Cho (Juli)
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1http://soteriapublishinghouse.com/?p=45242http://www.digitaltrends.com/computing/un-declares-internet-access-a-human-right/3http://www.mapsofworld.com/flags/haiti-flag.html
NGO/Aid
GovernmentUN
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1Fung et al. 20132Aibana et al. 20133Ivers et al. 2012
Cholera
Treatment Center
Cholera
Treatment Center
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1InterAction Haiti Aid Map, 2013 http://haiti.ngoaidmap.org/
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1Fung et al., 2013
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Housing, employment, health
Education, skills building, IDs,community health worker training
Internally Displaced Persons training program
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Monitor, Evaluate, and Adjust
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Vaccine delivery
Finite funds
Limited infrastructure
Coordinating various stakeholders
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The global burden of cholera Mohammad Ali, Anna Lena Lopez, Young Ae
You, Young Eun Kim, Binod Sah, Brian Maskery & John Clemens
Volume 90, Number 3, March 2012, 209-218A
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Development Gateway announced the AMP to Haiti in November
2012 Began with:
◦ Geocoding the activities of several donors in Haiti (USAID, World Bank, IADB, Canada, EU, etc.)◦ Enabled an analysis of aid flows in each sector◦ Trainings of staff and donors
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Goals:◦ Increase potable water
access to 85%◦ Increase assess to
improved sanitary and hygiene facilities to 90% of population
◦ Strengthen healthcare facilities to care for 80% of the population
◦ Increase solid waste collection to 90% in Port-Au-Prine and 80% in secondary cities
Short Term:◦ Emergency measures: ORT◦ Community health agents◦ Vaccinations
The annual cholera incidence rate in Haiti is reduced from 3% to 0.5%
80% of the population washes their hands after defecating and before eating
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Benefits Limitations
Synergistic effect Prevents transmission
of other diarrheal diseases◦ Leading cause of under 5
mortality Already endorsed in
National Plan for Eliminating Cholera
OCV not 100% effective
Time needed to build WASH infrastructure
Not enough OCV supplt to vaccinate entire Haitian population
Impact of target immunization campaigns not studied
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The Inter-agency Real-Time Evaluation of the Humanitarian Response to the Darfur Crisis◦ launched by the United Nations Emergency Relief
Coordinator◦ found that the 2004 crisis response in Darfur was
delayed and inadequate mainly due to the inability of aid agencies to mobilize and coordinate
Improve internal perceptions of aid◦ . A randomized study of 3,600 Ugandan citizens found
that nearly 80% of respondents reported that they had not directly benefited from aid, and nearly two-thirds of participants believed that more than half of aid dollars were not spent as intended. United Nations Office for the Coordination of Humanitarian Affairs.
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Need for:◦ Transparency
Preserve integrity of aid ◦ Reduce duplication of projects
Vertically and geographically ◦ Minimize cross-purposes
purposes that undermine the objectives of other projects
◦ Increase value of projects Prevent fragmentation of aid
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Double-edged sword of transparency◦ Privacy
Slow down provisioning process Monopolization of aid Group dynamic issues
◦ No one suddenly stepping up to the plate Donor fatigue from extra work burden Cumulative power gained by aid
organizations
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create permanent Haitian Development Authority to coordinate, set country-wide strategie
pool funding within existing Haitian gov budget mechanisms
regulate & provide oversight of NGOs align NGO projects to government priorities
and guidances
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Pan-American Health Association, 2013.http://new.paho.org/hq/images/Atlas_IHR/CholeraHispaniola/atlas.html34
The rate of new infections has decreased by 94 percent, from 11,985 cases in week 25 of 2011 to around 645 cases in week 25 of 2013.
UN Cholera Factsheet: http://www.un.org/News/dh/infocus/haiti/Haiti%20Cholera%20Factsheet%20July2013.pdf
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Price of Vaccine is $1.85 per dose, 2 doses needed, gives 67% efficacy for about 3 years.
http://www.who.int/immunization/sage/SAGE_April_2011_cholera_investment_case.pdf
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2 Barzilay, et. al. (2013, February 14). Cholera Surveillance during the Haiti Epidemic – The First 2 Years. The New England Journal
of Medicine. 37
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“Community-based studies in North Jakarta and Kolkata found that cholera cases cost between US$28 and US$206, depending on hospitalization. Patients' cost of illness as a percentage of average monthly income were 21% and 65% for hospitalized cases in Kolkata and North Jakarta, respectively.”
http://www.ncbi.nlm.nih.gov/pubmed/21554781
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-Model of most effective combinations of WASH and OCV- yay!-“The rate of intervention coverage extension had the largest effect on cases of cholera averte
d” -”If in this scenario, effective OCV coverage were allowed to reach 50% at year 5, and then decr
ease at a constant rate to 5% at year 20, an additional 23,933 (95,519 cases) would be averted (Table 5).”
“Over the next two decades, scalable WASH interventions could avert 57,949–78,567 cholera cases, OCV could avert 38,569–77,636 cases, and interventions that combined WASH and OCV could avert 71,586–88,974 cases. Rate of implementation is the most influential variable, and combined approaches maximized the effect.”
Fung and Fitter et. al http://www.ncbi.nlm.nih.gov/pubmed/24106189
Murray Model Shows that in refugee camps cost-effective methods would be to use Treatment instead of Vaccine.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2305758/pdf/bullwho00004-0026.pdf
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-67% efficacy for 5 years-Does not require a buffer and thus much
simpler to administer in refugee and post-disaster situations
http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(13)70273-1/abstract
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Aibana et al. 2013
“Cholera vaccination campaign contributes to improved knowledge regarding cholera and improved practice relevant to waterborne disease in rural Haiti.”
-Oral cholera vaccination campaigns have been associated with increased awareness and hand washing/ water treating in Haiti. OCV can be paired with education and have increased benefits.
http://www.ncbi.nlm.nih.gov/pubmed/24278498
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Ivers et al. 2012:-OCV rollout has benefits to infrastructure: “The capacity of the health system in the region
is being reinforced by the cholera vaccination programme through the promotion of the national childhood immunisation campaign; community health workers have been trained to better prevent and, failing that, refer cases; cold chain capacity has been expanded; and a new vaccine has been delivered through the public sector vaccination programme.”
http://www.sciencedirect.com/science/article/pii/S0140673612608320
The WASH infrastructure provides a long-term, sustainable solution for prevention of cholera.12 Evidence from Europe and North America over the past two centuries, and more recently from Latin America, demonstrate that as water and sanitation coverage improves, the risk of epidemic or endemic cholera transmission is greatly reduced.12,14,15 WASH also prevents the transmission of many other diarrheal diseases, which in Haiti, as in many developing countries, is a leading killer of children less than five years of age.32,33 The overall benefit of expanding WASH coverage extends far beyond its effect on cholera alone.
http://www.ajtmh.org/content/89/4/633.long#T3
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The OCVs should help reduce the burden of cholera while WASH coverage is expanded, given the considerable amount of time required to improve WASH infrastructure (e.g., piped water and sewers). However, an OCV program should not be considered as a long-term alternative substitute for WASH. Implementation of OCVs will present its own challenges. Currently available OCVs are not 100% efficacious, induced immunity wanes over time thereby requiring periodic booster dosing, and today's globally available OCV supply is not sufficient to vaccinate the entire Haitian population with the required two-dose regimen. In addition, evidence from the routine childhood expanded program for immunizations and recent nationwide vaccine campaigns in Haiti has demonstrated varying ranges of coverage.34–37
http://www.ajtmh.org/content/89/4/633.long#T3
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“For every $1 U.S. dollar invested, an estimated $5–46 U.S. dollars in economic benefits results, depending on the particular WASH intervention.34 Haiti's National Plan to eliminate cholera provides an outline of how such health and economic benefits might be achieved: investment, coordination, and capacity building.”
http://www.ajtmh.org/content/89/4/665.long
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Hill and Baldwin et. al
Vermicomposting toilets, an alternative to latrine style microbial composting toilets, prove far superior in mass reduction, pathogen destruction, compost quality, and operational cost.http://www.ncbi.nlm.nih.gov/pubmed/22658870
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“Oral rehydration, intravenous rehydration and antibiotic therapy were given to 99.5%, 85% and 97.77% of patients, respectively. Only one hospital death was noted. The low case fatality rate was mainly due to the following factors: the high quality of care provided in a center with qualified personnel and available and free of charge treatment kits, protocols based on massive rehydration and appropriate hygiene measures, and patient compliance with the treatment plan. The response was also characterized by good coordination, wide mass and local health promotion, and selective antibiotic prophylaxis, which contributed significantly to reducing the spread of the infection.”
http://www.ncbi.nlm.nih.gov/pubmed/22177702
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- “The factors responsible for rapid spread in Haiti include: long-standing water and sanitary inadequacies in Haiti; the further disruptions to water and sanitary systems imposed by the earthquake; above average rainfall; high water and ambient temperatures; and insufficient capacity of the government infrastructure to respond to the crisis.”
Etienne 2013
http://www.ncbi.nlm.nih.gov/pubmed/24106186
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-“As a result of the 2011 earthquake in Haiti, almost 280,000 internally displaced people (IDPs) remain in camps and another 200,000 are living with host families or in informal settlements. Many of the IDPs in these informal settlements have been forcibly evicted from camps. This situation is likely to continue in 2014, while the precarious conditions in the existing IDP camps are bound to pose significant protection risks, particularly sexual and gender-based violence (SGBV).”
-as many as 2 million Haitians lack documentation (personal ID papers) and are at risk of becoming stateless upon leaving Haiti
UNHCR http://www.unhcr.org/cgi-bin/texis/vtx/page?page=49e491766
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The ten-year cholera eradication plan also envisions a strengthening of the public health sector and of the coordination between NGOs and the government. To this end, the government plans to “integrate their support into the national health system.” Through investments in training, capacity building and by channeling funds through the domestic institutions in charge of each sector, the plan aims to create a stronger public sector overall. This could be especially significant given that aid for the cholera response (and for the overall relief and reconstruction effort) has largely bypassed the Haitian government. According to data from the U.N. Special Envoy, only 2.5 percent of humanitarian spending for cholera went through the Haitian government. As noted in the plan, the “lack of investment coming directly from the country’s fiscal budget represents a threat to the stability of the” water and sanitation sector.
http://www.cepr.net/index.php/blogs/relief-and-reconstruction-watch/cholera-eradication-plan-announced-but-funding-still-in-question
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AMP software works by replacing the Ethiopian government’s cumbersome collection of faxes,
spreadsheets and emails with a virtual workspace where the government, its donors and its agents in the field can share
information on aid flows and the activities they support – from planning through implementation,
to monitoring and reporting. With simple, web-based technology, AMP also establishes a
process for standardizing the data that is loaded into the system and retrieved from it.
The consolidated information is managed by the government, enabling detailed analysis
and reporting, as well as scenario-building, scheduling and knowledge management.
http://unpan1.un.org/intradoc/groups/public/documents/other/unpan022092.pdf
http://www.undp.org/content/nepal/en/home/operations/projects/democratic_governance/dceamc/
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Use digicel, Haitel, and Comcel to host a program like M-Pesa. http://www.un.org/africarenewal/magazine/december-2011/dialing-cash-mobile-
transfers-expand-banking
6.095 million people currently use Mobile Phones This would be expanded by the families of those affected by the outbreak. Source: CIA World Factbook, 2014
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• Responding to a request from the UN Special Envoy to Haiti, the Development Gateway has partnered with other organizations to build a system to help with Hatian reconstruction. The joint system, which partially adapts Aid Management Platform technology, will track damage reports and donor funding as well as pledges to Hait
• Development Gateway announced extending the AMP to Haiti in November 2012
• They began with: o Geocoding the activities of several
donors in Haiti (USAID, World Bank, IADB, Canada, EU, etc.), enabling an analysis of where aid is flowing within Haiti alongside needs in each sector
o Training government staff and donors on the Aid Management Platform
http://www.developmentgateway.org/news/development-gateway-extends-support-haiti
Regional Scale
Amount (USD)
Severe 4000
High 3500
Moderate 3000
Low 2500
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Regional Scale Cutoff 1 (Wk 25 2011)
Cutoff 2 (Wk 25 2013)
Severe 1700 1200
High 1200 700
Moderate 900 400
Low 700 200
Death
Illness
The U.N. historically has addressed the scope of its liability in peacekeeping operations through Status of Forces Agreements (SOFAs) signed with host countries.
The Haitian government signed such an agreement with MINUSTAH in 2004. In this SOFA, the U.N. explicitly promises to create a standing commission to review third party claims of a private law character.
-Yale Global Health Justice Partnership
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