Dying in a closing Cholera Treatment Centre.The Secretary General’s Cholera elimination Plan
How and why it is already unravelling
Just over three months ago, on December 11, the UN Secretary General launched in this building a $2.27bn, 10-year plan for the elimination of cholera from the island of Hispaniola. As the title suggests, the plan, even though it would be more than ten weeks before we saw it in any detail, was ambitious and aspirational.
We in HAWG welcomed then, and endorse now, that initiative as the most crucial step yet in recognizing the scale of the problem in Haiti and the comprehensive, integrated, coordinated way in which cholera has to be not only treated but fought to be eradicated.
Drawn up by a coalition of partners led by the Pan-American Health Organisation (PAHO), the Centre for Disease Control (CDC), UNICEF, and the Haitian government in the form of its Ministry of Public Health and Population (MSPP) and its water and sanitation utility DINEPA, the plan draws on real expertise and experience, in Haiti and elsewhere.
The Plan, published two weeks ago, has three phases.
The first phase focuses on short-term objectives to end 2014 with the emphasis on treatment, mitigation and education.
The second and third phases to 2017 and 2022 respectively focus on building the infrastructure and capacity to get Haiti to a water and sanitation access level comparable to the rest of the region. That is a measure of the scale of the task in both time and resource needed to meet the scale of the ambition.
Just to achieve this aim – comparable access — the proportion of the Haitian population with access to adequate sanitation will have to rise from 17% to 80%. Yes, we are dealing with one of the most water/sanitation-deprived nations on earth – a perfect incubator for the vibrio cholerae pathogen.
The missing link is the inevitable – money. To use a UN Secretariat term this is an “unfunded mandate.” In his announcement on December 11, the Secretary General said that donors had pledged $215m to which the UN would add $23.5m, meaning that little more than 10% of the total cost of the plan was, at that stage, even pledged. Ominously, there has been no additional money pledged in the fourteen weeks since.
Note pledged, not delivered or disbursed. There is little reason for much optimism even for the 10% that appears secured. Analysis by the UN Special Envoy’s office shows that none of the money included in that total was actually new, all of it had been pledged previously, nearly all of it as long ago as the spring of 2010 in the wake of the Haitian earthquake.
At the time of Secretary General’s announcement more than three months ago, we in HAWG thought the financing problem applied to Phases Two and Three of the plan. With the plan’s publication, costing Phase One to end 2014 at $486m, we know now that the implementation of even first phase is uncertain.
Over the past three months, NGOs and other funders have revealed the scale of cuts or even the full elimination of their cholera treatment and mitigation spending in Haiti, making the $486m needed for Phase One a serious underestimate.
There is a public perception that the cholera emergency is over in Haiti because the death toll has fallen. It’s a belief which flies in the face of all the evidence. The death toll is actually rising again – and rising very steeply.
In his report to the Security Council of March 8, a report you will be debating next week, the Secretary General noted and I quote “since mid-November 2012, however, more cases and fatalities are being reported than during the same period in 2011.”
How many more? Well in the first seven weeks of 2013, 115 Haitians died of cholera compared to 15 in the same period in 2012. Yes, nearly seven times more. And that is during the dry season. What Haitians have sardonically come to call the “dying season” – the rainy season – is about to start in Haiti.
The disease is re-establishing its hold in Haiti, not least because the pressure applied to it in 2011 and the first half of 2012 has been relaxed. As the Secretary General also notes in his most recent report, in June 2011 there were 248 cholera treatment centers in Haiti, by November 2012 there were just 159. The UN’s Haiti cholera fund appeal for $32m ended 2012 less than one-third fully funded.
The UN has spent some $118m on prevention and treatment of cholera in Haiti without which thousands more Haitians would be dead. What I am about to say should not in any way decry or discredit the often superhuman efforts of UN personnel on the ground or those of the NGOs and CSOs they fund. I have witnessed those efforts myself.
But the fact is that speaking to donors of all stripes and shades there are reasons beyond the usual donor fatigue or what is sometimes ambiguously referred to as “the Haiti factor” that the UN is finding it difficult to raise funds to combat cholera in Haiti. In is, in one word, a lack of credibility.
While the UN promotes “behavior change” amongst Haitians or their government to fight the disease, and fails to change its own behavior by updating and rationalizing its medical protocols to prevent this happening again, the charge of hypocrisy and double standards will not go away.
Why should donors fund an agency that cannot get its own house in order on this issue, however laudable or humanitarian its objectives?
While the UN tells Haitians to wash their hands, but fails to come clean itself, the UN and we who want to support and advocate for it’s efforts in treating and eliminating cholera in Haiti will be as weakened and enfeebled as the more than 650,000 who have been sickened and the 8059 Haitians who have died to date.
Let me conclude by saying that we and the water and sanitation experts we have consulted have some reservations about this plan.
Will it focus sufficiently on those who most need better water and sanitation in Haiti – the poorest, those who have to defecate in the open air and drink untreated water?
Will the right to water and sanitation at an affordable, accessible, accountable price, rather than a right to excessive profits by the companies who dominate water and sanitation in Haiti, permeate its implementation?
Will vibrant civil society organizations like Haiti’s numerous water committees whose agreement and co-operation is essential to real cholera mitigation and elimination efforts be fully consulted and incorporated into the execution and implementation of this Plan?
Will the implantation and execution of the Plan follow the UN’s own best practice guidelines with the rights-based approach to water and sanitation that the UN now advocates?
These questions are central. But we cannot discuss, debate or even dissent over something that does not happen. First we have get to a point where we can implement something – if only the saving of lives under real threat from what is still, today, the world’s most potent epidemic.
We need your help and you need our help and above all Haitians need everyone’s help to make that happen. Cholera has killed, is killing and will kill many more in Haiti. Real funding, for a real plan from a real credible UN is essential for all of us. Now.