Cholera Continues to Spread as Response and Surveillance Weaken
The latest data from the MSPP (Ministry of Health) shows that the number of cholera cases and resulting deaths continues to rise. As of August 2, there have been a total of 583,871 cases and 7,497 deaths reported since October 2010 and this almost certainly is an underestimate. While the number of cases this summer has not spiked as high as it did last year, there have still been 377 deaths and nearly 45,000 cases reported in just the last three months.
The cholera outbreak that has already claimed thousands of lives all over the country remains a major threat to public health. Cholera prevention and response should be a key priority for the Haitian Government.In their latest humanitarian bulletin, the UN Office for the Coordination of Humanitarian Affairs (OCHA) noted that, “national capacity to respond to potential outbreaks, especially during the rainy season, remains very weak. The country has only 468 beds for cholera admissions, with 233 of these already occupied. At the height of the epidemic in June 2011, 2500 beds were available.” Despite this, OCHA notes that “significant progress has been made especially in the surveillance and reporting of the epidemic as well as in the integration of cholera care in the national healthcare system.”
Despite OCHA’s positive assessment of strengthening the national health care system, as CCO Haiti pointed out, MSPP is still facing serious issues in their response to cholera. One reason why the Haitian government has had a hard time leading the response is that the international community largely bypassed the government in their provision of funding for cholera. The government of Haiti received only $4.9 million in funds for the cholera response, while the Red Cross alone received $6.1 million. While CCO Haiti calls for increased funding from donors, it is imperative that this money not simply be channeled to international NGOs, but through the MSPP. As the UN Special Envoy has noted, “aid is most effective at strengthening public institutions when it is channelled through them.”
While the short-term cholera response has reportedly diminished, the only long term solution to stemming cholera’s spread is through investment in water and sanitation infrastructure. This is a key demand of the 15,000 plus Haitians who filed a complaint with the United Nations seeking compensation. Three weeks ago 104 congressional Democrats made a similar demand of the United Nations in a letter to Susan Rice, the US ambassador to the UN.
Thus far, the UN has failed to accept responsibility and the 104 Members of Congress have yet to receive a reply from Ambassador Rice. In the meantime, little money has been dedicated to improving the water and sanitation infrastructure throughout Haiti. As CEPR Co-Director Mark Weisbrot writes today for McClatchy:
But controlling and putting an end to the epidemic is the least that the U.N. can do for Haiti, having caused this disaster. We know that it can be done, too - as it has in many other countries - by building the necessary infrastructure so that Haitians can have access to clean drinking water. The cost has been estimated at $800 million - or the amount that the U.N. spends on keeping its soldiers there for a year.Surveillance System
Tracking the evolution and spread of cholera is key to an efficient response. Health actors must know where to focus efforts and where to allocate resources. Nevertheless, there have been increasing complaints about the national surveillance system. There are often long delays in publishing information and often there are unexplained jumps in the number of cases and deaths. In May, Doctors Without Borders (MSF), one of the leading responders to the epidemic called the surveillance system “dysfunctional,” later adding that “the numbers are incomplete and unreliable.” In their statement, CCO Haiti adds:
Further efforts need to be made to improve the quality and reliability of data collection systems. Thorough evaluations are needed to identify and address the problems in the epidemiological surveillance system. According to MSPP, only 57.8 % of the 341 daily cholera reports were submitted by departments during the period from March 27 to April 26, 2012. This lack of accurate reporting seriously impacts the capacity to effectively respond.This trend appears to be continuing as the recent daily reports published by the MSPP are consistently missing data from numerous departments. Without a clear picture of what the disease is actually doing, responding to it will continue to be hampered.