Haiti is currently facing a resurgence of cholera, a highly infectious bacterial disease that causes severe diarrhea, dehydration, and death. The outbreak was detected in October 2022, after more than three years without reported cases, and quickly spread throughout the country. However, addressing the outbreak has been complicated by Haiti's ongoing complex humanitarian crisis, which has been fueled by gang violence, socio-political instability, insecurity, fuel shortages, and economic decline. These challenges have severely affected access to healthcare, water, food, and sanitation. To control the outbreak, PAHO/WHO Haiti provided technical, operational, and financial support to train and mobilize 1,200 Community Health Workers known as Agents de Santé Communautaire Polyvalents (ASCPs) to contain the outbreak in the West, Central, and Artibonite departments. Cases peaked in November with 13 672 suspected cases and 283 deaths reported between October and December 2022, but have since plateaued in the Ouest department, the initial epicenter. As cholera continues to spread across the other nine departments of Haiti, the ASCP approach is now being promoted nationwide as a cornerstone of cholera control.
Key WHO Contributions
Training Agent de Santé Communautaire Polyvalents (ASCPs)
Providing funding to deploy ACSPs in the most affected regions
Providing equipment and supplies to ASCPs for cholera prevention, risk communication, and surveillance activities in the community.
How did Haiti, with the support of the PAHO/WHO Secretariat, achieve this?
ASCPs are the backbone of Haiti's health system, providing vital care, education, and surveillance for their communities in the ongoing fight against cholera and other health threats. In collaboration with the Ministry of Public Health and Population (MSPP), PAHO/WHO Haiti supported Health Directorates in multiple departments by organizing training sessions for ASCPs. This involved adapting global guidelines to develop training materials, mobilizing facilitators and trainers, and providing funding to ensure that ASCPs were deployed in the most affected regions.
The ASCPs, embedded within their communities, carry out a multifaceted mission. They serve as the pillar of community response, particularly in areas of the Port-au-Prince metropolitan region where access has been impeded by recent urban violence. As community members themselves, ASCPs have fostered trust between health organizations and local populations, leading to more effective collaboration between health authorities and the general public in cholera prevention and treatment efforts.
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PAHO/WHO accompanying Haiti’s Ouest (West) Health Directorate (DSO) in training hundreds of ASCPs for deployment to the most affected communities in the Port-au-Prince metropolitan area.
Photo credit: PAHO/WHO Haiti.
ASCPs go door-to-door, educating communities on the risks and prevention measures against cholera to curb transmission. They promote proper hygiene practices, sanitation, and water treatment methods to minimize the spread of the disease and are trained to identify cholera symptoms and refer patients to the nearest cholera treatment centers. PAHO/WHO Haiti provided them with basic equipment, such as oral rehydration salts, water purification tablets, visibility gear, and information leaflets.
“The mobilization of the ASCP has resulted in outreach to more than 100,000 households, the detection of over 10 000 suspected cases of cholera and the referral of more than 5,000 patients to cholera treatment centers.”
Dr. Pedro Lopez Puig, Health Systems Strengthening Advisor, PAHO/WHO Haiti
A critical aspect of ASCPs' work is their involvement in surveillance and monitoring. They were trained by PAHO/WHO Haiti to register and report suspected cholera cases and deaths in the community using a paper registry and share the data over WhatsApp with health authorities to shape response strategies. This ongoing work enables the ministry to rapidly detect and respond to cholera, preventing further spread. ASCPs have also supported cholera vaccination campaigns, assisting with logistics, mobilizing communities, and administering vaccines to control disease transmission.
"I communicate about the importance of using treated water for drinking and cooking at home and encourage hand washing and food washing. When I find a person suffering from diarrhea, regardless of the severity of their symptoms, I refer him or her to a treatment point in the community in order to provide them with the necessary care”
- Esterline Dumézil, Agent de Santé Communautaire (ASCP) in Cité Soleil, Haiti
The dedication and hard work of ASCPs have been instrumental in mitigating the impact of cholera in Haiti's Ouest Department, leading to a decline in cases and deaths associated with the disease. However, with the majority of new cases now concentrated in other regions, particularly the Centre, the North-West, and Artibonite Departments, the dedication of ASCPs remains crucial.
The training and mobilization of these vital health workers has not only enabled a more effective response to the cholera outbreak but has also demonstrated the importance of investing in community-based health systems. By building trust and fostering collaboration between health authorities and local communities, ASCPs have become an essential component in the fight against cholera and other public health challenges in Haiti. The lessons learned from their work can serve as a blueprint for future initiatives aimed at combating infectious diseases and promoting public health in complex humanitarian crises.
