1. Team 9
Emily Briskin, Teresa Logue, Lindsey Hiebert,
Justin Mendoza, Karen Zhang, Hye Ryeong Cho (Juli)

2. 2

3. 3

4. 4

5. 5

6. NGO/Aid
1
UN
Government
2
3
http://soteriapublishinghouse.com/?p=4524
http://www.digitaltrends.com/computing/un-declares-internet-access-a-human-right/
3
http://www.mapsofworld.com/flags/haiti-flag.html
1
2
6

7. 7

8. Fung et al. 2013
Aibana et al. 2013
3
Ivers et al. 2012
1
2
8

9. Cholera
1
Treatment
Center
Cholera
Treatment
Center
InterAction Haiti Aid Map,
2013
http://haiti.ngoaidmap.org/
1
9

10. 1
Fung et al., 2013
1
10

11. 11

12. 12

13. Internally Displaced Persons
training program
Education, skills building, IDs,
community health worker training
Housing, employment, health
13

14. 14

15. 15

16. Low Estimation
Moderate Estimation
High Estimation
Compensation
Infection
Fatality
Period 1
513,340,300
Period 2
266,194,800
Compensation
coverage
779,535,100
23,348,000
Subtotal
802,883,100
WASH+Vaccine
OCV
WASH+
Treatment+Prevention
9,775,207
593,636,040
Extraneous
300,000,000
Subtotal
893,636,040
ID
People w/o ID
cost per person
2,000,000
2
Subtotal
4,000,000
ORS
applicable
Unit cost
population
0.5
1600000
Subtotal
800,000
Mobile Banking
Subtotal
200,000,000
Refugee Program
Subtotal
240,000,000
GSI
Subtotal
100,000,000
TOTAL
2,241,319,140
Infection
Fatality
513,340,300
266,194,800
779,535,100
OCV
Infection
Fatality
692,986,800
411,231,800
23,348,000 1,104,218,600
31,520,000
802,883,100
1,135,738,600
WASH+
OCV
WASH+
9,775,207
989,393,400
9,775,207
989,393,400
300,000,000
300,000,000
1,289,393,400
1,289,393,400
People w/o ID
cost / person
People w/o ID cost / person
2,000,000
2
2,000,000
2
4,000,000
4,000,000
Unit cost
applicable
population
Unit cost
1
1600000
1,600,000
applicable
population
1
1600000
1,600,000
200,000,000
200,000,000
240,000,000
240,000,000
100,000,000
2,637,876,500
100,000,000
2,970,732,000
16

17. 17

18. Monitor, Evaluate, and Adjust
18

19. 
Vaccine delivery

Finite funds

Limited infrastructure

Coordinating various stakeholders
19

20. 20

21. 21

22. 22

23. 23

24. 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

24

25. 25

26. 
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
26

27. 
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-AuPrine 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
27

28. 
Synergistic effect


Prevents transmission of
other diarrheal diseases

◦ Leading cause of under 5
mortality


Already endorsed in
National Plan for
Eliminating Cholera
Benefits

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
Limitations
28

29. 
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.
29

30. 
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
30

31. 
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

31

32. 32

33. 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

33

34. Pan-American Health Association, 2013.
http://new.paho.org/hq/images/Atlas_IHR/CholeraHispaniola/atlas.html
34

35. 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
35

36. 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

36

37. Barzilay, et. al. (2013, February 14).
Cholera Surveillance during the Haiti
Epidemic – The First 2 Years. The
New England Journal of Medicine.37
2

38. “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
38

39. -Model of most effective combinations of WASH and OCV- yay!
-“The rate of intervention coverage extension had the largest effect on cases of
cholera averted”
-”If in this scenario, effective OCV coverage were allowed to reach 50% at year 5, and
then decrease 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
39

40. 40

41. 41

42. -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)702731/abstract
42

43. 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
43

44. 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
44

45. 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
45

46. “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
46

47. 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
47

48. “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
48

49. - “The factors responsible for rapid spread in Haiti include: longstanding 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
49

50. -“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
50

51. 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/choleraeradication-plan-announced-but-funding-still-in-question
51

52. 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/d
ceamc/
52

53. Use digicel, Haitel, and Comcel to host a program like M-Pesa.
http://www.un.org/africarenewal/magazine/december-2011/dialing-cash-mobile-transfersexpand-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
53

54. •
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/developm
ent-gateway-extends-support-haiti
54

55. Death
Amount (USD)
High
3500
Moderate
Illness
Regional
Scale
Severe
3000
Low
2500
Regional Scale
4000
Severe
Cutoff 1 (Wk 25
2011)
1700
Cutoff 2 (Wk 25
2013)
1200
High
1200
700
Moderate
900
400
Low
700
200
55

56. 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
56