Haitian/PAHO Plan to Eradicate Cholera, 2013

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Little needs to be written about the developmental roadblocks and reversals experienced in the small, battered, yet beautiful country of Haiti. On a foundation of minimal established public service, the country experienced a devastating earthquake, followed in 10 months by an ongoing epidemic of Cholera. Over 650,000 people have experienced acute illness which required intravenous or less commonly, oral fluids, and ~ 10,000 died. The rate of Cholera, as a result of amazing international efforts, has dropped from (12/2010) ~ 20,000 cases weekly to 1,500 cases weekly at present, but the fundamental problem, that only17% of urban residents (PAHO report; 02/27/2013) have access to sanitary means for waste removal remains!
The 2006 UN Development Program “Drilled down” if you will, on these 8 Millenium Development Goal’s focusing on the Global Water and Sanitation Crisis (as “core” to environmental sustainability (#7). This was reinforced last year by UN Secretary General Ban Ki-moon.
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In managing the repeated physical and sanitation crises (e.g., near-yearly typhoons or tropical storms) in the Philippines, WHO, USAID, CRS, and many others realized and implemented the Philippine Sanitation Alliance (PSA) in 2007. The work took incredible pre-project energy, with respect to stakeholder promotion and education, eventually of “over 5000 to cultivate services at a local level” (USAID PSA site). The result was an improved overall health, school attendance, ecosystem biodiversity, etc.
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PAHO Director, Dr Carissa Etienne announced on 02/27/2013 that the Organization has called upon the international community to support a $2.2 Billion project proposed by the Haitian government for cholera eradication. The projects keystone will be 12% devoted to excreta removal and 15% for capacity growth of DINEPA (Direction Nationale de l’Eau Potable et de l’Assainissement), the first time a legitimate Public Service vehicle existed to which funds for water and sanitation could be targeted!
Many in the international and Haitian community have expressed understandable doubt about going forward with a plan being administered by an unstable government on a foundation of poor public service and years of neglected promises. As with the Philippines and several sub-saharan countries, this requires intensive pre-implementation education and cultivating a demand for stakeholders. The answer would not be to have some sort of external “Supervising Organization”… that model has led, in the past, to increased bureaucracy and reduced efficiency.

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