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Similaire à The UN Haiti Cholera Settlement Fund Strategic Plan
Similaire à The UN Haiti Cholera Settlement Fund Strategic Plan (20)
The UN Haiti Cholera Settlement Fund Strategic Plan
- 1. Haiti in the Time of Cholera: The UN Haiti Cholera Settlement Fund Thu Do Sam Teicher Lexy Adams Jimmy Murphy Fabian Fernandez Yale Global Health Case Competition 15 February 2014
- 2. The Earthquake Over 200,000 Dead 2
- 3. The Epidemic: Cholera 7,436 Dead >600,000 Cases 3
- 5. Petitioner’s Requests Compensation Improved sanitation conditions 5 Water quality & access Access to medical services
- 6. The UN Haiti Cholera Settlement Fund $3 Billion 6
- 7. Our Strategic Approach 1. Compensation 7 The UN Settlement 2. Fund Water & 3. Sanitation Essential Infrastructure Medical Care
- 8. Overall Timeline Short 2 years 8 Medium 5 years Long 10 years
- 9. Distribution of Funds 7% 20% 200 million 600 million 73% 2.2 billion 9 Compensation Sanitation/Water Improvement Health Medical Access Infrastructure
- 10. Our Strategic Approach 1. Compensation 10 The UN Settlement 2. Fund Water & 3. Sanitation Essential Infrastructure Medical Care
- 11. Direct Financial Compensation to Victims $190/pers on $760/p erson $22,800/p erson Cases (No Hospitalization): 247,937 people $52,238,030 Hospitalizations: 329,697 people $250,569,720 Deaths: 7,436 people $169,540,800 Annual per capita income: $760 *See Appendix for additional plans 11 Cases: 3 months Hospitalizations: 1 year Deaths: 30 years
- 12. Compensation: Building Upon Existing Resources “Abuse of aid funds is seen as one of the reasons why only about half of the $4.46 billion aid pledged after the quake has found its way into Haiti.” - Partners in Health (PIH) • Biometric Identification Registry in Place – 4 Million Currently Registered (Elections 2006) – 600 devices in use across Haiti • Fingerprinting and Iris Identification • Each station can enroll 150 people daily – $6 per person 12 10 Year Goal: Address all Cholera Claims
- 13. Action Plan Biometric ID Registration TV/Radio Announcement Retrieve Hospital Records 13 Individual Compensation Register Bank Account
- 14. Action Plan for Individual Compensation Short Long Market Compensation Rural Branches Built Subsidize Branch Building Process Claimants w/o Documentation Compensation Enrollment Period Finished Urban Centers: Compensation 14 Medium Rural Centers: Compensation Open biometric ID registration to all Haitians
- 15. Compensation Gantt Chart Activity Enrollment in biometric registry Roll out compensation 15 Short Term (2 year) Urban Medium Term (5 year) Rural Long Term (10 year)
- 16. Building a Biometric Registry Compensation Electronic Medical Records Elections Biometric Identification Bank Accounts MicroLoans 16 Conditional Cash Transfers Results Based Financing
- 17. Our Strategic Approach 1. Compensation 17 The UN Settlement 2. Fund Water & 3. Sanitation Essential Infrastructure Medical Care
- 18. Root Cause Analysis for Poor Infrastructure Fragmented governance Lack of human resources Physical environmental damage Political conflict Poor Infrastructure 18
- 19. Water & Sanitation Objectives • Community hygiene education • Capacity building of national and local leadership • Coordination of NGOs • Partner with Water.org to create demand-driven sustainability • Source treatment infrastructure and framework • Establish surveillance system 19 10 year goal: Reach indicators of LAC countries
- 20. Sanitation Investments Infrastructure and Technology Human and Technical Capital Education Sustainable Sanitation Services 20
- 21. Water Quality & Sanitation Gantt Chart 21
- 22. Infrastructure: Rural vs. Urban VS. 22 .
- 25. Role of Women as Proponents of Hygiene 25
- 26. Surveillance is Key, But Also Challenging 26
- 27. Our Strategic Approach 1. Compensation 27 The UN Settlement 2. Fund Water & 3. Sanitation Essential Infrastructure Medical Care
- 28. Root Cause Analysis for Medical Access Lack of human resources Physical infrastructure Transportation 50% of Haitians have access to health services 28
- 29. Medical Access Gantt Chart Activity Grow CHW program Mobile clinic rollout Implement CO training Establish health center coalition COs deployed in the field Coordinate health committee Consolidate CHW training Reach 1 health professional per 1000 population 29 Transition coordination to regulation Short Term (2 year) Medium Term (5 year) Long Term (10 year)
- 30. Place a WHO/PAHO Facilities in Pétionville • Financed from existing WHO research budget • Credible apology and development aid for Haiti • Increases capacity in a critical area and spreads PAHO’s influence further south • Physical plant and administrative staff can be shared with existing UN agencies in the country—MINUSTAH, UNICEF, etc. 30
- 31. Our Strategic Approach 1. Compensation 31 The UN Settlement 2. Fund Water & 3. Sanitation Essential Infrastructure Medical Care
- 32. 32
- 33. The Memorial • $50,000 will be set aside to create a monument to honor the victims • It will be designed by a local artist, chosen by a popular vote. 33 Cholera Monument, Sheffield, U.K.
- 34. Our Vision In 10 years, we have a CHOLERA-FREE HAITI with access to CLEAN WATER, QUALITY SANITATION, and BASIC MEDICAL CARE 34
- 35. The future of Haiti must be linked to the respect of the rights of every single citizen. - Jean Bertrand-Aristide 35
- 36. United Nations Haiti Settlement Mesi anpil! 36
- 37. Appendix 37
- 38. TABLE OF CONTENTS • • • 38 Organizational Structure for • Stakeholders Compensation – Compensation Plan Options – Compensation Plan Details – Risks & Limitations of Biometric System – Indicators for Compensation Infrastructure – Alternative Strategies • – Plan of Action for the Elimination of Cholera – Sanitation Plan – MSH Capacity Building in Haiti – Expected Benefits 2015-2025 Medical Access – Alternative Solutions – Root Cause Analysis – GRAPH: Why We Need More Health Professionals – Costs of CHWs – Overall Costs – MAP: Mobile Clinic Coverage – MAP: Population density Detailed Infrastructure Gantt Chart – Short Term – Medium Term – Long Term
- 39. Organizational Structure for Stakeholders UN Haiti Cholera Settlement Fund (3Billion) Compensation Campaign Team (TV/Radio) Health Infrastructure Sanitation/Water Quality Compensation Water.org Smartmatic Biometric Registration National Hospitals and Clinics Ministry of Health Government Actors DINEPA (Water and Sanitation Ministry) Treatment Product Suppliers Community Leaders/Residents Women Operational Workers 39 Community Health Workers Establishing PAHO Center Global Health Action Hospital Albert Schweizer National Bank of Haiti Youth Other Health NGOs PIH/Zamni Lasante
- 40. Direct Compensation Plan Options Plan Cases (no hospitalization) Hospitalizations Deaths High 3 months 1 year 30 years Total $472,348,500 $52,238,030 Medium $250,569,720 $169,540,800 1 month 1 year 20 years $381,009,596 $17,412,676 Low $250,569,720 $113,027,200 No compensation 6 months 10 years $181,798,460 $125,284,860 $56,513,600 Based on annual per capita income of $760 40
- 41. Individual Compensation Details Cases (no hospitalization): 274937 Hospitalizations: 329697 Deaths: 7436 Total Compensation of Individuals : High: 3 months ($52,238,030); 1 year ($250,569,720); 30 years ($169,540,800) Total ($472,348,550.00) Medium: 1 month ($17,412,676.66); 1 year ($250,569,720); 20 years ($113,027,200) Total ($381,009,596.66) Low: No compensation; 6 months ($125,284,860); 10 years ($56,513,600) Total ($181,798,460.00) Avg. annual per capita income is $760 Payments will be Made in Installations (3 Months) Tiered System: Senior Citizens – Kids – Working Age Adults http://data.worldbank.org/indicator/NY.GNP.PCAP.CD/countries/HT-XJXM?display=graph 41
- 42. Risks & Limitations • Difficulty adapting to the local beliefs and culture of Haitians • Imperfect means of measuring true cholera cases for compensation; instead address all claims in some way • New Technology (Smartmatic) • Human resources can’t keep up with goals • Rural spread of the country – adapting the program, decentralization is necessary, champion local leadership • Match GNI: we must increase compensation if GNI increases • Fragmentation of governance – emphasize importance of education, local capacity/ownership 42
- 43. Indicators of Compensation Short Medium 600 Workers Trained to Staff Biometric Machines Enrollment of 200,000 Individuals in Biometric Registry System 600 Workers Trained to Sift through Medical Records Exposure of Compensation Campaign Message to 10M Haitians Negotiated Construction of 60 Bank Branches in Underrepresented Areas 43 Long Set Up Infrastructure to Enroll 10M Haitians with Biometric IDs Finish Bank Branch Construction for 60 Branches Address 1,000 Claims in more Complicated Claims Procedure Address 80% of Compensation Claims in 5 Years
- 44. Alternative Water Quality Strategies Proposed: Aquatabs Improved Water Access & Quality Biosand filters 44 Solar power chlorination
- 45. Plan of Action for Elimination of Cholera MSPP NATIONAL PLAN FORTHE ELIMINATION OF CHOLERA IN HAITI 2013-2022 45
- 46. Sanitation Plan • Short-term – – – – • Baseline assessment of current conditions and practices Nation-wide workshops for stakeholders Development of accessible information system Distribution of sufficient chlorine tabs Medium-term – Rural technologies implemented – Education initiatives • National WASH campaign • Technical training (medical, engineering, additional relevant expertise) – Appropriate policy changes (national, municipal, and local levels) – Mobile medical and sanitation units deployable • Long-term – Urban infrastructure upgrades completed – Nationwide establishment of riparian buffers for water sources – State-of-the-art medical centers and services available nationwide 46
- 47. Management Sciences in Health (MSH) • Working in Haiti since 1980 • Strengthening the leadership and management skills of Haiti’s Ministry of Public Health and Population – Human resource management – Information systems – Performance based financing • 1,172 Health workers trained • 136 In country staff • 5 active projects 47
- 48. Expected Benefits 2015-2025 • • • • • • • • Reduction in cholera (>0.1%) Reduction in water-borne diseases Increased PAHO Commitment in Haiti Strengthening of Health Infrastructure Improved Health Outcomes Brain-Drain Reduction $500M in compensation in the hands of the Haitian people Skills training and jobs for Haitians in sanitation, education, health, and biometric registration. • Uniform National Biometric Registration • Fostering emotional healing after cholera epidemic 48
- 49. Alternative Solutions to Medical Access • Providing health professionals who remain or relocate to Haiti with ―hardship pay‖ from the fund to incentivize capacity increases • Direct investment in the Haitian health infrastructure by PAHO/WHO; placement of a lab in Pétionville • Investments in communication and transportation (ambulance, regular bus) technology to increase access to existing health infrastructure • Increase depth and quantity of CHW training 49
- 50. Root Cause Analysis of Medical Access • Only half of Haitians have access to health services • Barriers to Access – Physical Infrastructure • The 2010 earthquake further damaged Haiti’s few and poorly outfitted health centers. – Transportation • Over half of all Haitians live in rural areas, away from the primarily urban hospitals and with little access to good roads or vehicles. – Human Resources • Haiti has only 3 doctors and 1 nurse per 10,000 citizens, leading to major understaffing. The WHO target is 23 health professionals per 10,000 persons.1 This is due to both a lack of staffing and a high level of ―brain drain.‖2 50 1http://www.who.int/whosis/en/index.html 2https://www.jallc.nato.int/newsmedia/docs/haiti_case_study.pdf
- 51. Why we need more health professionals 51 http://www.who.int/hrh/documents/reassessing_relationship.pdf
- 52. Costs of CHWs • Starting package (phone, solar charger, data plan, backpack)=$200, $272 yearly via Digicel Haiti • Training=$6 per pupil, given 50 hours and 300 students • Salary=$760 per year (based on average in country) • Total: $206, then $1032 per year per worker 52
- 53. Overall Costs of Medical Access • To run the 10 mobile clinics, we will need a $2,061,800 outlay for physical resources and initially training followed by $309,600 to support a staff of 300 CHWs. We will fund operations for 10 years, leading to a total cost of $5,157,800. • For Clinical Officer training programs, to achieve an increase of 50% on current capacity we would need to invest $20,356,250. This includes a generous cushion for localizing the existing program in Burkina Faso (leverage Francophonie connection). • $50,485,950 will be allocated to fund the harmonization of the existing NGO health system under the MOH through regular meetings, EMR roll-out, and technology transfer. 53
- 54. MAP: PIH/ZL Mobile Clinic Coverage 54
- 55. MAP: Population density of Haiti 55
- 56. Average Water Access in LAC Improved water source: National 64% Urban 77% Rural 48% 56
- 57. Water and Sanitation Budget I 57
- 58. Water and Sanitation Budget II 58
- 59. Water and Sanitation Budget III 59
- 60. Water and Sanitation Budget IV 60
- 61. Water and Sanitation Budget V 61
- 62. Infrastructure Gantt Chart – Short Term Activity Rural technology implementation Start Water.org campaign Grow CHW program Implement CO training Establish health center coalition Education Capacity training 62 Surveillance Short Term (2 year)
- 63. Infrastructure Gantt Chart – Medium Term Activity Activity Mobile units deployed Respond to Water.org solicitations COs deployed in the field Coordinate health committee Education Capacity training Surveillance 63 Medium Term (5 year)
- 64. Infrastructure Gantt Chart – Long Term Activity Activity Follow 10-year DINEPA plan with Water.org assistance Upgrades to source treatment facilities Reach 1 health professional per 1000 population Coordination to Regulation Education Capacity training 64 Surveillance Long Term (10 year)
Notes de l'éditeur
- CNNTuesday Jan 12, 20107.0 magnitude earthquake – epicenter 25k west of PAP10 million population - 200,000 dead – 3 mill affectedThousands of NGOs, billions of dollarsLives saved in immediate aftermath but little lasting impact
- dadychery
- 35,000 cases and 300 deaths just in Jan-Aug 2013 (.9%) fatality
- Victims in partnership with Boston law firm
- This slide should be a combination of all “overview” slides for the pillars. Same format
- This slide should be a combination of all “overview” slides for the pillars. Same format
- Faced the difficulty: how do you compensate for the health or life of an individual, the cost of a life is immeasurable. Still compensation is essential to addressing the past and moving towards reconciliation. To this end we’ve dedicated 500M of our budget towards the compensation of individual victims. For those who were hospitalized for Cholera, we are distributing $760 annual per capita income. For those who have passed away we are distributing around $22,800, which is compensation for about 30 years of work based on that same annual per capita income. In our appendix we’ve included a more complicated tiered system for compensating the death of a loved one or family member (based on High, Medium, Low Budget Allowances) (based on economic dependence upon that loved one elderly<child<working adult); For those without record of incident claiming cWe saw this compensation scheme not only as an apology to those affected by the cholera epidemic, but also as an opportunity to revitalize the economic base of the country and ensure thtat
- 600 Smartmatic Registration Devices Across Haiti, 2013 SmartCard Enrollmenthttp://www.usaid.gov/results-data/success-stories/biometric-technology-improves-financial-servicesAre unique to every individualCannot be misplaced or forgotten Difficult to fake or stealDo not require literacyCan help to create an auditable trail for transactionsIncrease anonymity when used in place of personal details (names, addresses, etc.)
- Initial Focus on Port au Prince, Ouest, Nord-Ouest ProvincesParse words for edit
- THIS SLIDE IS A ONE SENTENCE SUMMARYAre unique to every individualCannot be misplaced or forgotten Difficult to fake or stealDo not require literacyCan help to create an auditable trail for transactionsIncrease anonymity when used in place of personal details (names, addresses, etc.)
- The second component of our strategy is water quality and sanitation infrastructure. Water and sanitation have long been an in issue, even before the 2010 earthquake. Our strategy will address acute as well as long term needs.
- Most households in rural Artibonite do not have access to a potable water supply. Reaching the 2015 MDG for water and sanitation in Haiti would require 74% coverage for improved water sources and 63% for improved sanitation. Despite the influx of international technical assistance and support from multilateral lending agencies such as the International Development Bank IDB?, Haiti’s efforts to improve water supply and sanitation fact other challenges such as a history of political conflict, fragmented governance, a lack of human resources, and physical environmental damage. Political conflict has interrupted significant NGO efforts to implementing water projects. Fragmented governance as well as the lack of human resources has hindered the ability to manage large coordinated projects. And despite funding and intentions to invest in infrastructure, physical damage caused most recently by the earthquake and poor farming practices has exacerbated the situation.
- Our water and sanitation objectives aim to address needs across a 10 year time line with a focus on acute and long term needs. Above all, our objectives all serve to contribute to a sustainable framework. Community hygiene education as well as capacity building of national and local leaderships are intended to target behavioral changes that improve sanitation practices and the ability to manage large projects. Coordination of NGOs will serve to more efficiently and effectively allocate resources where they are appropriate. A partnership between Haiti’s DINEPA and a highly regarded water quality organization, Water.org will create demand driven sustainability.Source treatment infrastructure moves Haiti towards its long terms goal of sustainable and comprehensive coverage of access to potable waterAnd the establishment of a surveillance system ensures that continual monitoring will help Haiti respond to future water and sanitation needs.
- Our proposed investments in water and sanitation are divided into three categories: Infrastructure and technology, human and technical capital, and education. Prior experience has shown that without capacity building efforts, the benefits from investments in water ans sanitation infrastructure and hygiene education will not be sustain. The combination of these three areas are intended to ensure that investments are made in sustainable sanitation services.
- This gantt chart illustrates the action plan for improving water and sanitation across the proposed timeline. I want to call your attention to the short term actions. Firstly, in response to the acute need to disrupt cholera transmission, especially in the hard hit rural regions, we plan to implement appropriate rural tech and innovation such as DINEPA’s Potable Water and Sanitation Technicians for the Communes also known as TEPAC to coordinate WASH activities such as distribution of chlorination tablets. In addition, the immediate advertisement of the water.org partnership should be rolled out on radio stations to make people aware that they can solicit assistance in implementing water and sanitation projects. In the medium term, our strategy would then begin to respond to the solicitations from the water.org campaign. Having a demand driven structure greatly improves community ownership and tailoring to community needs to ensure sustainability of projects. In addition, the medium term actions would also include a scaling up of urban water treatment infrastructure. In the long term water.org would continue to provide assistance to help Haiti realize its 10 year national plan and move towards source treatment facilities rather than point of use treatment. I want to call your attention to the strategies that span the entire timeline such as education, capacity training, and surveillance. Education of the population and capacity building at the community healthworker, health facility, and government level are critical to success and sustainability of any of the above mentioned actions. These three strategies help to move DINEPA and Haiti’s government from a coordination role of NGO’s to a regulation role of the water and sanitation sector.
- What should be built? Population density mattersA water treatment center that is appropriate for Port-au-Prince may not be best option for the Artibonite Valley. As such, infrastructure investments should reflect local conditions, and rural infrastructure investments may include creation of new cisterns, latrines, rainwater catchments, chlorination systems, and development of riparian buffers near water sourcesCommunity leadership criticalPhoto credit: http://otundefined.tumblr.com/post/49018842359/community-can-we-build-some-tippy-tapsAnd https://il-elgin3.civicplus.com/index.aspx?NID=197
- General rule: new infrastructure investments are flawed if not done in tandem with considerations to long-term operations and maintenance, capacity of local/municipal services and leaders to deliver services and encourage effective behavior changes Current limiting factors besides infrastructure: inadequate institutional capacity and lack of technical expertise in WASH technologies and methodsCommunity-focus/leadershipBring better knowledge to communitiesEnable them to take greater ownership of their sanitation/hygieneLocal authorities need sufficient resources and technical capacity to support improvements EducationPhoto credit: http://www.worldwaterrelief.org/meet-our-in-country-team/Andhttp://enr.construction.com/buildings/haiti_reconstruction/2012/0206-seismic-training-efforts-help-haitians-help-themselves-.asp
- WASH- Hygiene education for children- multiplier effect as they take lessons home, and as they utilize best practices while collecting water. Children play a major role in collecting water in rural regions, along with women
- Women as champions for best practices in their role as leaders in communities. Additional capacity training for such leadersPhoto credit: http://www.cnn.com/2012/01/15/opinion/etienne-haiti/
- Surveillance has always been one of the most difficult challenges for long-term success.Rural Water and Sanitation Information System (SIASAR) (SIASAR) is an innovative platform de- signed to monitor the development and performance of rural water supply and sanitation (WSS) services. SIASAR automatically produces rankings and summary reports that detail the performance of communities, infrastructure systems, service providers, and technical assistance providers. SIASAR data analysis is an ideal method of surveillance b/c uses a portable/ easy to use technology. Technical expertise in your pocket. Create a mobile platform and automate technical expertise.Standardizes method for communicating indicators Mapping data, and since everything is location-based, can generate data based on indicators. This standardizes the information and baseline assessments for stakeholders. Information on need, redundancy, threats, and impact.
- This slide should be a combination of all “overview” slides for the pillars. Same format
- Only half of Haitians have access to health servicesBarriers to AccessPhysical InfrastructureThe 2010 earthquake further damaged Haiti’s few and poorly outfitted health centers. TransportationOver half of all Haitians live in rural areas, away from the primarily urban hospitals and with little access to good roads or vehicles.Human ResourcesHaiti has only 3 doctors and 1 nurse per 10,000 citizens, leading to major understaffing. The WHO target is 23 health professionals per 10,000 persons.1 This is due to both a lack of staffing and a high level of “brain drain.”23 doctors and 1 nurse per 10 000 Haitians, far less than the World Health Organization's target of 23 health professionals per 10 000 persons.2Human resources in the health sector are severely limited with fewer than 0.25 doctors per 1000 Haitians and more than 80% of its health workers migrating to other countries within two years after training. https://www.jallc.nato.int/newsmedia/docs/haiti_case_study.pdf
- WHO CO:Dr Jean-Luc PonceletMOH: Florence Duperval GuillaumeStrategic Partners--mobile clinics: PIH and ZanmiLasante, Costs: Operations $15,000; Shipping prototype $20,000; Unit production $200,000-http://cchaiti.org/medical/Coalition—cheap to free. Just get communication? Ugh probably not monthly conference. Teleconference?CHW partnerships—Hospital Albert Schweizer, Global Health Action, PIH
- This slide should be a combination of all “overview” slides for the pillars. Same format
- Description or title: Cholera Monument, Sheffield. Date: 2006-04-27 Source: Own work Author: Gregory Deryckère Permission: Attribution-ShareAlike 2.5http://en.wikipedia.org/wiki/File:Cholera_Monument_27-04-06.jpg
- Former president
- apogeephoto
- National Radio and Television Campaign to Inform Individuals of 3-Year Compensation ProgramCommunity Involvement through CHWBank Subsidies to Establish Branches in Rural Areas - Building InfrastructureBring Hospital Claims of Hospitalization or Death to the BankRegistration for Biometric IDCompensation through Bank Account Connected with Biometric IDOctober 2010-2012 Ministry of Public Health and Population604,634 Claims of Cholera7,436 Deaths
- 1. especially in rural areas.
- 3 doctors and 1 nurse per 10 000 Haitians, far less than the World Health Organization's target of 23 health professionals per 10 000 persons.2Human resources in the health sector are severely limited with fewer than 0.25 doctors per 1000 Haitians and more than 80% of its health workers migrating to other countries within two years after training. https://www.jallc.nato.int/newsmedia/docs/haiti_case_study.pdf
- http://www.who.int/bulletin/volumes/91/4/12-109660.pdf great cost breakdown Coshttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584281/Medical assistant=2+1 2 year bridge->Clinical officer=3+1== 5,000 to train, step up from CHW pay by $100?Cost at least 50% less to train than a doctorhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2657565/
- 10 mobile clinics
- This map shows the average water access in the Latin American and Caribean region. As you can see, the overwhelming majority of nations is on track to achieve the MDG goal and had rates of greater than 95% or was within 5% of meeting the goal. Haiti, highlighted in green was making progress but it was insufficient. The 2010 earthquake exacerbated the situation and Haiti now only has 64% of their population with access to improved water source. The urban rural divide is 78 and 48 respectively according to the WHO/UNICEF joint monitoring program