Health authorities’ leadership reduces cholera deaths in Haiti
Authors: Mohamed Ag Ayoya, Ariel Higgins-Steele, Donatella Massai, Chantal Umutoni, Asako Saegusa, Jean-Claude Mubalama, Stephanie Kleschnitzki, Sandra Lattouf, Solofo Ramaroson, Françoise Gruloos-Ackermans
Journal: The Lancet (2012)

1·5 years after the first cases of cholera were reported in Haiti, 534 647 people have been infected and 7091 killed.1Ministry of Public Health and PopulationCase report.http://www.mspp.gouv.ht/site/downloads/Rapport%20journalier%20MSPP%20du%2010%20avril%202012.pdfDate: April 10, 2012Google Scholar We report on how the motivation and capacity of decentralised health authorities to lead the response and coordination of activities in one department were able to contain quickly a major cholera outbreak and reduce mortality. Cholera peaked in the northwest department in December, 2010. The capacity to respond to the epidemic was low and case fatality rates exceeded 20% in some areas. A major spike in cases occurred again in July, 2011; 1776 cases of cholera were identified and 1186 patients were admitted to hospital in Port-de-Paix, the major city of the department. The response to this second peak was swift. A joint effort led by the Ministry of Health and supported by the Inter-American Development Bank, UNICEF, WHO, and Médecins Sans Frontières France helped the two main hospitals of the city to scale up their bed capacity to 250 and 200 from 30 and 20, respectively. Additional health professionals and community health and sanitation agents (brigadiers) were hired and social mobilisation and home visits for early identification of cases were stepped up. Daily coordination meetings chaired by the department's director of health were held to identify needs and available resources for an adequate response, avoid duplication of efforts and activities among partners, and maximise the quality of services. As a result, the number of cases was reduced in 6 days and a low case-fatality rate of 0·8% was noted. Interviews with 11 key informants revealed several success factors including: strong coordination of partners by the department health authorities; a robust and functional community-based cholera surveillance system; clarification, adaptation, and widespread dissemination of treatment protocols including management of dehydration in severely malnourished children; increased awareness of prevention and early case detection of illness in urban and rural communities; installation of new oral rehydration points and cholera treatment units; availability of medicines (including antibiotics and zinc) and supplies; availability of sufficient funds to the department health authorities that could be disbursed immediately without any decision at the central level; a functioning patient transfer system; quick chlorination of water sources; community education campaigns for systematic handwashing with soap; and information on how to get quickly to treatment facilities. Tackling the cholera epidemic in Haiti effectively requires an accompaniment strategy and a commitment that strengthens local health authorities' capacity and leadership. Until the Government of Haiti is able to ensure this throughout the country, the international community must not withdraw from providing the needed resources and technical support that would make it happen. We declare that we have no conflicts of interest.