Haiti: sustaining the humanitarian health response
Since the beginning of December, the response has focused on keeping the supply chain operational and developing contingency plans for new emergencies. WHO/PAHO, the Cuban Medical Mission and the US Centers for Disease Control (CDC), in support to the Ministry of Health and Population (MSPP), have developed a plan dedicated to surveillance, alert and response and departmental coordination which will lead to a more efficient response in situations where security is volatile.
Insecurity has had an impact on the delivery of care: some cholera patients have been afraid to seek help at health centres while the proper removal, transportation and disposal of human waste has some times been a challenge. Nevertheless, most cholera treatments centres (CTCs), cholera treatments units (CTUs) and oral rehydration posts (ORPs) have remained operational and supplies have reached the areas of greatest need. The MSSP reports that 63 CTCs and 123 CTUs were operational in December. The scaling-up of ORPs, which are based at community level, is considered a priority.
As of 13 December, the cumulative number of cholera cases and deaths was 112 330 and 2478 respectively. The overall fatality rate remains at 2.2%. According to the MSSP, 56 435 patients had been hospitalized by that date.
The alert and response system set up by WHO/PAHO in coordination with the MSPP and other health partners collects data from field epidemiologists, sanitary and logistics engineers as well as other sources, promptly investigates reports of sudden rise in numbers of cases (hot spots) and deaths, and monitors the availability of medicines and supplies, security problems and coordination. It also serves as an early warning system. The system is now officially in the hands of the MSSP which will facilitate information gathering and enable a quicker and more efficient response to needs.
Health Cluster members continue to meet under the coordination of WHO/PAHO. The meetings allow partners to examine important logistical questions, such as expediting the clearance of medicines and supplies at customs, registering NGOs and deploying human resources. WHO/PAHO also holds the technical secretariat of the Inter-Cluster, which comprises the coordinators of the Logistics, Water Sanitation and Hygiene (WASH), Education, Health and Communication Clusters and provides a forum to discuss priority inter-cluster issues and to coordinate effective actions.
With the relative improved security since 14 December – which may be temporary – some response activities were normalized.
The MSPP has outlined a strategy to fight cholera based two main objectives:
- Saving lives by diminishing the lethality rate in CTUs and CTCs;
- Preventing the spread of the disease by diminishing contagion at community level, through social mobilization, health promotion and the deployment of ORPs.
These objectives should be attained by focusing on community level, on primary health care level and on secondary and tertiary level.
To effectively implement this strategy in the next six months, there are still important gaps to fill. Among them, there are some 5000 ORP still needed to be deployed.
Large number of local and international NGOs have resumed their visits to PROMESS, the MSSP warehouse managed by WHO/PAHO, to collect cholera medicines and other supplies, including beds, which are now manufactured on the PROMESS premises. Since the beginning of the epidemic, PROMESS has distributed enough medicines to treat 71 261 mild cholera cases and 33 672 severe cases. Current stocks include enough medicines for 49 685 mild cases and for 5858 severe cases. Additional supplies arrive continuously.
In the last few days, WHO/PAHO, the WFP and their partners have delivered 18 tons of additional supplies to Gonaives and Jacmel and 3 tons to Cap-Haïtien and Jeremie. The distribution of supplies is based partly on a countrywide distribution plan set up by health partners and the MSSP based on information from the alert system, and partly on the need to preposition strategically medicines and supplies throughout all 10 departments. A further 60 tons of supplies have been positioned by 23 December.
In addition to health, WHO/PAHO is helping to improve the management of supplies related to water, sanitation, and hygiene. A series of training workshops was organized for WASH Cluster leaders on the use of the WHO/PAHO Logistics Supplies System LSS/SUMA, which is operational at DINEPA (Direction nationale de l’eau potable et de l’assainissement). A second phase will include the training of all NGOs receiving and managing WASH supplies in the country.
In the last couple of weeks, WHO/PAHO has received US$ 5.8 million from Andorra, Canada, Finland, Italy, Spain, the Autonomous Community of Andalusia, and the United States of America. Several other countries and agencies have made pledges.