INTERVIEW: Amid progress in fighting cholera, UN official urges support to health-care system

While the incidence of cholera in Haiti has decreased by 90 per cent since an outbreak that began shortly after the devastating earthquake of 2010, more investment is needed in the country’s health-care system to fully eliminate the disease and address the country’s other health challenges, a top United Nations official today said.

“A lot of progress has been made in terms of controlling the disease,” said Marc Vincent, UN Children’s Fund (UNICEF) Representative for Haiti, in an interview with UN News Services. “But a lot more work needs to be done to eliminate it.”

“We’ve come a long way, but obviously we need a lot more investment, and it’s going to take more time to ensure that all Haitians – particularly Haitian children – have access to clean water and good sanitation facilities,” he continued, citing the need for “a huge and massive investment in the health-care system.”

Mr. Vincent noted that between $3.5 million and $4 million per year is needed to maintain the rapid response mechanism in Haiti, which consists of some 50 teams that are dispatched to every reported cholera case in the country. The teams help to sanitize the affected household, as well as work with family members to provide oral rehydration treatment and explain what needs to be done to avoid future transmission.

The representative highlighted that of the amount required for the response teams, $2 million is needed for the rest of this year, in order to ensure that the teams are in place during the critical rainy season at the end of the year. The response teams also help with issues such as Zika and other infectious diseases.

“With that mechanism, we’ve been able to bring down the number of people affected by cholera from a high of 350,000 in 2011 to just over 36,000 last year. So this rapid response mechanism really helps to control the disease,” he emphasized.

Indeed, as a result of efforts spearheaded by the UN and the Government of Haiti, by the first semester of 2014, the number of cholera cases had been reduced by 75 per cent and stood at 12,000. However, according to the World Health Organization (WHO), as of April this year, the number of cases stood at 24,108, including 378 deaths.

Underscoring that it is necessary to tackle all waterborne diseases – which are the second cause of infant mortality in Haiti – Mr. Vincent said that UNICEF and partners have been working on establishing cholera treatment centres in isolated areas throughout Haiti, while at the same time working with the Government to improve the country’s overall health-care system.

The UN Stabilization Mission in Haiti (MINUSTAH) has partnered with Haitian Agencies to combat cholera by providing clean water. UN Photo/Logan Abassi

“Cholera treatment and the epidemic reflect the need to invest much more in the health-care system. It’s a lot like Ebola – you’ve seen the same number of people die from cholera since the beginning of the epidemic in Haiti as we saw in Ebola – but we need a huge and massive investment in the health-care system to really address the challenges that we face,” he said.

In addition to the efforts of the response teams to control the disease, UNICEF has also been working to increase access to clean water and sanitation facilities, as well as working with populations to reduce open defaecation, particularly in communes where cholera is known to be most persistent.

Through a campaign launched in late 2014 by the UN and the Prime Minister of Haiti, Mr. Vincent noted that a total of 31 communities have become open defaecation free, resulting in about 20,000 people making the transition.

Another challenge is reducing contamination to cholera in urban areas throughout Haiti, which include marketplaces and transportation hubs that become the centre from which the disease spreads to other parts of the country.

“What we would really like to do is invest in reducing the contamination in those areas, ensuring awareness as people transition through those areas, but also repairing the water systems in these urban areas to prevent further transmission,” Mr. Vincent said.

The representative estimates that about $5 million is needed in those urban areas between now and the end of next year in order to map out weaknesses in the water systems.

Noting that 100,000 children suffer from suspected cholera, and more than 750 have died from cholera since the beginning of the epidemic in Haiti, Mr. Vincent said that UNICEF has calculated that 28,000 school days have been lost since the beginning of the outbreak.

“In addition to the mortality figures, which are way too high already, there are also much greater impacts in terms of the families and the communities,” he said, adding that there is also a huge impact on both a family’s ability to survive in the absence of a parent or loss of a parent, as well as psychological impacts on children.

In total, up to May this year, an estimated 780,000 number of cases have been reported with just over 9,000 deaths, according to Mr. Vincent.

The longer sanitation campaign requests $310 million ($228 million for water sanitation and hygiene, and $82 million for health) over a five year period to reach 3.5 million people in rural areas and is being implemented by the Haitian Government (through the National Directorate of Water Supply and Sanitation or DINEPA) with the support of the UN family and partners.

As of June 2016, $67 million has been mobilized to implement projects reaching 400,000 beneficiaries – $22 million as part of the $59 million mobilized by the UN family, and $50 million provided by the World Bank. In terms of funding, there is still a gap of $243 million, and support from donors and partners is crucial.