Global Health: Health in Haiti

On Jan 12, 2010, a 7.0 magnitude earthquake struck the Caribbean nation Haiti. Its immense power left 1.3 million people homeless, and an estimated death toll of 220,000. With an estimated 70 % of the population living on less than two dollars a day, the nation has solely relied on international aid in the attempt to rebuild their country(DEC, 2011). As of last month, over 7.5 billion in aid had been donated but this amount is nowhere near what has been promised by the international community (Sontag, 2012). Despite this sum of money and being in the United States’ back yard, the people of Haiti are still suffering from extreme poverty, unacceptable living conditions and little access to health services. Each member of group 12 has taken it upon themselves to connect Haiti’s current predicament to one of the many key concepts that has been presented to us during the past 10 weeks. As you will soon see from the information provided, the world has failed in its response to the Haitian earthquake and conditions seem to only be getting worse.

Role of community health workers:

        Years after their catastrophic earthquake, Haiti still faces several diverse economic, environmental, and health issues. UNICEF, Haiti's long-term development partner, moved up its interventions to meet the critical needs of Haiti’s children in health, water and sanitation, education, and protection. Improving Haiti’s water and sanitation structure is critical to achieve large health improvements and reduce the incidence of several diseases.
        For many people in rural Haiti, roads which were destroyed during the 2010 earthquake have yet to be repaired. The closest health clinic could be an eight to ten hour walk, often through treacherous mountain terrain. This makes the presence of community health workers (CHW’s) so important to rural Haitians. CHW’s are some Haitians only source of readily accessible or affordable health care and treatments. Trained CHW’s provide vital health services in their remote, rural communities by preventing and treating disease, illness, and malnutrition. Global Health Action, in coordination with other major NGO’s like the USAID, CDC, and Partners in Health, have been training community health workers in Haiti since 1982. These workers are estimated to treat or care for 80% of all illnesses and diseases in their communities without the need for any outside medical care.
        CHW’s are usually selected or recommended by members of the community to which they belong. Generally, they receive eight weeks of training in basic healthcare and health promotion that covers sanitation, nutrition, diarrhea, tuberculosis, malaria, HIV/AIDS, medications, immunizations, family planning, first aid, and record keeping. During the weeks of training, participants work at home to practice their newly learned skills. By graduation each CHW receives an initial stock of medical supplies, some medications, and a reference list to refer back to if needed. When the workers return to restock their bags, they receive continuing education from the local staff working with NGO’s such as the Global Health Action Group. With the increasing incidence of cholera, follow-up evaluations are one of the most important parts of the program to which the CHW’s must commit. More than 1,200 CHW’s from different regions of Haiti have successfully graduated from the training program and are currently serving in the most remote communities. The success of Haiti's CHW program has provided an economic boost by educating local residents and placing them in their own communities.

Aid disbursement:

         Haiti’s cholera outbreak requires special attention from the Haitian government and the global community. In December of 2012, the United Nations launched a multi-billion dollar effort to eradicate cholera in Haiti. The aim was to supply up to $2.2 billion dollars of newly generated monetary aid into Haiti over the next 10 years to specifically treat this re-emerging disease. The United Nations has been criticized for its apparent involvement in the initial outbreak and spread of cholera. At present, the criticism extends to the lack of new money the organization has pledged for the cholera eradication effort. It is reported that the United Nations plans to contribute a mere $23.5 million of the initially planned $2.2 billion in monetary aid over the next ten years.
        The fund set up by the United Nations to eradicate cholera will be receiving both unilateral and bilateral aid from many countries and organizations. Both Spain and Japan have pledged to step in and donate to the Haitian cholera fund. The World Bank and Inter-American Development Bank have also offered their hand in support of the fund. In total, the U.N. will receive $215 million dollars from countries and organizations. The first two years of the U.N. plan call for an investment of almost $500 million, which will be spent on providing a safe potable water supply, toilets, latrines, and increased healthcare. Unfortunately, it seems as though the money has not provided substantial improvements.
        To date, the United Nations has spent $118 million dollars in addressing the cholera outbreak. Of the $118 million spent in Haiti, only about 3% went to the Haitian government, while 24% went to the U.N. and its agencies. More time, money, and effort in strengthening Haitian institutions will be needed for the country to better deal with issues such as disease outbreak. Haiti’s future success depends on the funds pledged for the cholera eradication initiative being collected and used for their intended purpose.

Sustainability:

In order to create a healthy and stable environment for Haiti’s future, sustainability must be a main focus. Haiti’s efforts to rebuild have been restricted by a lack of resources, some of which they never had and some that were swept away by Hurricane Isaac in 2012. Many organizations and partnerships are working towards the common goal of a sustainable Haiti by the year 2040. At the moment, Haiti is a main focus of international aid. However, as money runs out and countries withdraw their aid, Haiti will need a sustainable infrastructure to survive and thrive. Many of the reconstruction projects in Haiti have short term development and marketing goals but lack the foresight of creating a sustainable Haiti. Another issue is a lack of equal geographic disbursement of redevelopment projects, which often focus solely on population centers. This leaves rural areas without any energy or waste management infrastructure. While the ideas and intentions of Haitian aid groups are good, many of these issues are not unique to Haiti. Some of Haiti’s issues have already been solved in other developing countries and these solutions may be effective if brought to Haiti.

Corruption

An estimated $7.5 billion of relief aid has been given to Haiti by international assistance. Unfortunately, a large number of people remain homeless and many of the homes destroyed by the earthquake remain mounds of rubble. The question must be asked; where did the aid money go? Haiti was declared the most corrupt country in the world in 2006 by Transparency International, a non-profit group that monitors corruption. In subsequent years, Haiti has remained near the top of the list of the world’s most corrupt countries, as ranked by Transparency International’s annual Corruption Perceptions Index. The source of Haiti’s corruption is suspected to be the greed of government and a few private organizations. These entities have likely played a significant role in the disappearance of aid money without substantial change in the way people are living. Unfortunately, for Haiti’s needy citizens, this has caused aid groups to exercise caution in monetary aid disbursement.

For those of you who fancy themselves visual learners and want to spend a bit more time on the topic, below are links to two different short videos for your viewing pleasure. The first video profiles the United Nations security council’s members assessment of the rebuilding efforts. The second video comes from the BBC and shows the deadly effects of cholera. I must warn you this video is not very pleasant but does a good job at showing the true Haitian experience.

1. http://www.youtube.com/watch?v=H70Tvu4abmA

2. http://www.bbc.co.uk/news/world-latin-america-11800523

Group 12: