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Phase II Cholera Epidemic Management Initiative In Haiti

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Kathy Gilbeaux
Joined: 2010-11-10

Phase II Cholera Epidemic Management Initiative In Haiti


Michael D. McDonald, Dr.P.H.

Health Initiatives Foundation, Inc.


Within the One Team Against Cholera initiative, there is a movement toward a Phase II Cholera Epidemic Management Initiative in Haiti.  This Phase II initiative engages a systematic reprogramming of the bulk of cholera-related resources to accountable, outcomes-oriented, community-based cholera epidemic management in Haiti’s communities, most at risk of cholera outbreaks.  The Haiti Race to Resilience public / private consortium, with its Haiti Medical and Public Health Information Sharing Environment is being used as an integrative management and governance system to link over 1,500 representatives of organizations and social networks throughout Haiti focused on health and human security to stop the threat of cholera.

The Phase II Cholera Epidemic Management Initiative uses a fifth generation integrative management and governance approach, which differs significantly from the highly hierarchical command and control approaches during the first three waves of the epidemic (Phase I).  In contrast to the chaotic and incomplete epidemic surveillance and responses, which have led to poor cholera outcomes since the initial cholera outbreaks in October of 2010, the Phase II management and governance is architected to stimulate targeted, sustainable development from within Haitian communities addressing gaps in epidemic management.  It focuses on converging many different organizations and communities into a unity of effort.

Unlike the first three waves of the epidemic in which only a small portion of the funds raised reached the communities affected and at risk from cholera, the majority of the Phase II moneys are being committed directly to Haitian-run community-centric interventions with superior situational awareness through the Haiti Medical and Public Health Information Sharing Environments (Haiti MPHISE). 


The Haiti MPHISE, combined with the associated Haiti Big Data Value Chain project, provides unprecedented high levels of transparency regarding resource flow focused on improving health status associated with cholera and water-borne disease. 

Addressing Mission Critical Gaps Nation-wide

A highly pathogenic form of 01 Ogawa strain of cholera, exploded into an epidemic in Haiti during the fall of 2010.  Haiti, following its devastating earthquake on January 12, 2010, was not prepared.  All sixteen mission critical functions essential to dramatically reducing the threat of cholera in Haitian communities must be addressed.  To take the top off of Haiti's cholera epidemic, efforts are now being planned in over 750 Health Capacity Zones in Haiti to save thousands of lives, reducing hundreds of thousands of cases, diminishing the high burden of illness, and dramatically cutting the number of infections resulting from cholera.  

Below is a list of the 16 mission critical functions, that when systematically addressed through the Phase II activities in Health Capacity Zones (HCZs) will eliminate the threat of cholera from those communities within the HCZs:

1) Community Health Worker and CERT Cholera Training, Job Recruitment, and Deployment 

2) Medical Team Recruitment and Deployment within Viable Cholera Treatment Facilities

3) Medical Data and Information Management

4) Rehydration and ORS Distribution

5) Environmental Testing and Control

6) Management of Water Quality

7) Presence and Maintenance of Sanitation Systems

8) Communication

9) Logistics, Supply Chain Management, Operations, and Security

10) Rapid Response Teams

11) Task Server and Project Management Systems

12) Health Education

13) Shelter

14) Body Removal

15) Immunization and Containment

16) Food Security   

Eliminating the Threat of Cholera Throughout Hispaniola & Beyond

There is evidence that Vibrio cholerae (the bacteria causing cholera) is now becoming endemic throughout Haiti.  Two waves of cholera are expected each year for many years going forward, unless definitive Phase II epidemic management is engaged throughout Hispaniola.  That said, in the vast majority of situations, Health Capacity Zones addressing all gaps within the above 16 mission critical functions, will no longer have deaths or severe cases.  The high burden of illness and infections due to cholera, or disease from 25 other water-borne illnesses now plaguing Haitians and their communities can be largely eliminated. 

With over 7,000 Haitians already dead, and hundreds of thousands more having experienced a high burden of illness due to cholera already, a fully engaged Phase II Cholera Epidemic Management Initiative must now be systematically implemented throughout Haiti. By fully engaging these mission critical functions using local value chains, Haitian health and human security will be substantially enhanced far beyond the concerns of cholera, while stopping this highly infectious and lethal 01 Ogawa pandemic strain of cholera from spreading further in the Americas.  In addition, addressing many of the functions at the community level will provide jobs locally and build the foundations for a resilient and sustainable community-based economy – assisting recovery and resilient development.

The Haiti Phase II Cholera Epidemic Management Initiative (working under the 501C3 nonprofit organization, Health Initiative Foundation, Inc.) is now working closely with the U.S. Congress, the Martelly Administration, and a myriad of Haitian, U.S. and international organizations, government agencies, and NGOs to scale up the Phase II efforts in Haiti and the Dominican Republic to defeat this epidemic as quickly as possible.  The Phase II initiative has been presented to President Fernandez of the Dominican Republic in the spirit of the One Team Against Cholera in all of Hispaniola.  Once the Phase II efforts are fully engaged in Haiti, additional efforts will be made to link Hispaniola-wide efforts with the Dominican Republic, through a two-country process already underway.


Scaling Up the Phase II Effort

The Phase II, Stage I team members are now combating the fourth wave of the cholera epidemic.  Significant resources must be immediately engaged to respond with more robust fourth wave interventions, and prepare for the fifth wave of the epidemic in fall.  Donors have verbally agreed to commit emergency response, education, infrastructure, medical supplies, and planning in the range of $5 million to $15 million during the fourth wave of the epidemic.  It is proposed that the Phase II initiative will be further expanded by re-programming $60 million of the overall moneys now raised to fund the upcoming cholera management in the fifth wave of the epidemic during fall 2012. 

The $60 million reprogrammed for Phase II, Stage II is a small amount of the hundreds of millions of dollars raised and not yet spent by the U.N., U.S. government agencies, and the large NGOs specifically for improving health and human security in Haiti.  In terms of sustainable security and improving the resilience of the Haitian people, their communities, and the Haitian society as a whole, there is no better investment right now to improve the future of Haiti than stopping cholera and other water-borne diseases.  Cholera-free communities that are also eliminating 25 water-borne illnesses through the Phase II cholera effort are an essential foundation to attract investment and fully catalyze Haitian recovery and long-term resilience.

As the Phase II Cholera Epidemic Management Initiative is taking the top off of the cholera epidemic in Haiti nation-wide, a new day will have finally arrived for the advancement of the Haitian people.  The Phase II Cholera Epidemic Management Initiative is being expanded to six Health Capacity Zones in six departments during Phase II, Stage 1 (during the fourth wave of the epidemic this spring 2012).  Current plans are to expand Phase II, Stage II efforts to 260 Health Capacity Zones during fall of 2012 in all departments and communes by the end of the year. 

Phase II, Stage III efforts will engage 760 Health Capacity Zones during 2013, with detailed assessment of all mission critical functions.  These Phase II, Stage III efforts will engage community-based efforts to resolve mission critical gaps throughout Haiti. This nation-wide network of Health Capacity Zones will represent an unprecedented advancement from dependency-based aid to Haitian development based in sustainability and resilience.

For more information, contact:


            Dr. Michael D. McDonald

            Phase II Coordinator