Photos courtesy of CDC Foundation
In January 2010, Haiti suffered a devastating earthquake that killed thousands of people, left millions homeless, and significantly damaged the country’s already fragile infrastructure, including its health system. In this guest blog post, Dr. John Vertefeuille, country director for CDC Haiti, discusses how he is cautiously optimistic about improvements in Haiti’s public health since the earthquake. (This post is an abbreviated version of Dr. Vertefeuille and colleagues’ commentary published in The Lancet on January 15, 2013.)
Be sure to also check out CDC Director Dr. Tom Frieden’s latest Director’s Briefing video on Haiti, which highlights how CDC, CDC Foundation, and other critical partners are helping Haiti recover and build back better. New office space for Haiti’s Minister of Health and the Ministry’s surveillance, epidemiology, and laboratory staff are allowing critical public health work to continue, protecting people in Haiti and abroad from health threats. After all, diseases know no borders.
The words of Dr. Vertefeuille:
For many decades, Haiti has had poor health service statistics and some of the highest rates of disease in the Americas. Before 2010, only 17% of Haitians had access to adequate sanitation, measles vaccine coverage was just 47%, HIV prevalence was 1.9%, and the parasitic disease lymphatic filariasis affected 7% of the population.
On Jan 12, 2010, a 7.0 magnitude earthquake struck Haiti, resulting in more than 200,000 deaths, destruction of infrastructure, and further weakening of an already fragile health system. Although no one doubted the resilience of the Haitian people, both international and domestic public health organizations recognized the vulnerability that this national disaster had created. International aid arrived quickly after the earthquake to provide for basic needs, but there was a growing feeling that the disaster should prompt the transformation of Haiti’s health system.
However, the Haitian Government had only just begun efforts to coordinate this process and to define medium-term goals when the inadvertent introduction of Vibrio cholerae in October 2010 resulted in the worst cholera epidemic experienced by a single country in more than a century.
As the Haitian health system began to recover from the cholera epidemic, the Ministry of Public Health and Population (MSPP) started to look beyond emergency responses and towards improvement of longer-term health care for the population. In a collaborative process led by MSPP, CDC and other organizations identified public health goals that support national health priorities to improve health service delivery and disease outcomes in the years ahead.
At the three-year anniversary of the earthquake, Haiti is starting to show that its health services have expanded far beyond those in place before the earthquake occurred:
- HIV: HIV testing of pregnant women has increased by 55%. The proportion of HIV-infected pregnant women given antiretroviral drugs increased from 54% to 83% during the same two-year period. Access to highly active antiretroviral therapy for HIV rose from 35% of nationally eligible patients receiving the treatment in July 2009 to 69% in September 2012.
- Cholera: In 2012, the National Directorate for Drinking Water and Sanitation trained and deployed 258 water technicians to test municipal water sources and provide education about sanitation in all 140 administrative communes of Haiti. A coalition for the elimination of epidemic cholera transmission through investments in water and sanitation infrastructure, good clinical services, and targeted use of the oral cholera vaccine is recruiting international partners.
- Vaccine-Preventable Deaths: From April to June 2012, a national vaccination campaign successfully targeted more than 2.5 million children younger than 10 years of age with measles-rubella and oral polio vaccines. A follow-up MSPP and CDC vaccine coverage survey showed that 91% of nearly 10,000 children sampled were vaccinated against measles-rubella.
- Parasitic Diseases: In November 2011, MSPP first targeted Port-au-Prince with mass drug administration for lymphatic filariasis; 2.3 million residents received the drugs, which increased national coverage to 90%. This number represents a substantial increase compared with 2009, when coverage was 35%. Annual national campaigns are planned to support elimination of lymphatic filariasis from Haiti.
These interventions represent an expansion of public health services and reductions in disease in Haiti during the past three years. We believe that further gains can be achieved in each of these domains, as well as in other areas such as tuberculosis control, emergency obstetrics care, malaria elimination, and under-five mortality. However, the need for expanded public health services persists, and MSPP and its partners need to refine their priorities to ensure that maximum effectiveness is achieved as external post-earthquake resources continue to decrease.
MSPP leaders have shown good foresight in working with partners to look beyond disasters and initiate long-term strategic plans. If these early successes are extended and sustained, significant public health achievement could warrant emphasis as one area of accomplishment in post-earthquake Haiti, with lessons for other post-disaster settings.