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NTD SUCCESS STORY: HAITI
Location:
Caribbean
Population:
10 million
First Lady of Haiti, Mrs. Sophia Martelly, stands by as a schoolgirl receives a dose of medicine to prevent NTDs
as part of a mass drug administration in St. Louis-du-Sud. Photo: Christopher Glass/IMA World Health
Endemic NTDs:
(trichuriasis)
Whipworm
Hookworm
Roundworm (ascariasis)
Lymphatic filariasis (elephantiasis)
The challenge:
The poorest country in the Western hemisphere, with the highest infant mortality and lowest life
expectancy, Haiti is a country with many challenges. Nearly the entire population is at risk of contracting the NTD lymphatic filariasis (LF), a mosquito-borne disease. Caused by thread-like parasitic
filarial worms that live in the lymphatic system, LF causes extreme swelling of the extremities (a
condition known as elephantiasis) and genitals (a condition known as hydrocele). The high prevalence of NTDs in Haiti persists, in large part, because of poor access to water and sanitation. About
nine out of ten Haitians in rural areas do not have access to clean, safe water, and almost half lack
access to adequate sanitation facilities. These circumstances were compounded in the wake of the
2010 earthquake that killed at least 200,000 people and destroyed much of the nation’s infrastructure. Despite these challenges, Haiti is making incredible progress against NTDs and expanding its
national NTD control program in an effort to eliminate LF.
The approach:
Under the leadership of the Haitian government, a range of partners have assisted with the annual
distribution of drugs to help prevent the spread of four NTDs: LF, whipworm, hookworm and roundworm. A critical aspect of the success of these efforts has been the training of more than 30,000
local community leaders to organize, promote, and carry out mass drug administration (MDA) campaigns, distributing medicine to everyone in at-risk communities. Until the 2010 earthquake, Haiti’s
Neglected Tropical Disease Control Program conducted MDAs only in the areas of the country where
LF was most prevalent. The crowded capital city of Port-au-Prince, with relatively low levels of LF
infection, was thought to be too difficult a setting to carry out MDA. But after two million people
were left homeless in the aftermath of the earthquake and internal migration threatened to redistribute the disease, the goal of MDA became national treatment coverage – with the aim of eliminating
the disease from Haiti altogether.
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Key successes:
By late 2011, at least one round of MDA had been conducted in all endemic areas of Haiti except the
capital, Port-au-Prince. From November 2011–February 2012, an MDA was conducted for the first
time in the crowded metropolitan area. More than 80% of the population has now been reached by
MDA, a tremendous accomplishment in a country facing many health and development challenges.
In May of 2014, the U.S. Agency for International Development, a major partner of the Haitian
government’s NTD program, delivered its one billionth treatment worldwide at a ceremony in SaintLouis-du-Sud, Haiti, a testament to the country’s commitment and progress in the fight against
NTDs. Haiti is also an example of an integrated approach to combating NTDs, having successfully
integrated its LF and soil-transmitted helminth (STH) control programs, which previously operated
in separate units at the Ministry of Health. The country is also scaling up efforts to fortify table salt
with medicine to prevent LF, an approach that has helped countries like China eliminate the disease,
and to address the needs of Haitians already incapacitated by elephantiasis and hydrocele as a
result of LF infection.
The road ahead: Haiti is one of just four countries in the Americas where lymphatic filariasis remains endemic, accounting for 80% of people at risk of the disease in the region. If the country can succeed in their
effort to eliminate LF by 2020, it would be a major step in the global effort to end the disease. As
Dr. Patrick Lammie, an immunologist with the Centers for Disease Control and Prevention, put it, “If
a country like Haiti, with all of the challenges that they’ve faced over the last few years, is able to
achieve full national coverage, I think that is as an important example for other countries, which are
struggling to scale up their programs as well.”
Partners in
progress:
The Haitian Ministry of Health has been combating NTDs in Haiti for years. Many agencies and
organizations, including the Pan American Health Organization, the Inter-American Development
Bank, the U.S. Centers for Disease Control, the U.S. Agency for International Development, the University of Notre Dame Haiti Program, IMA World Health, and CBM have partnered with the Ministry
of Health to provide technical assistance and implement a program to combat NTDs since 2000.
IN THE NEWS:
• Washington Post: Haiti takes on dreaded disease
elephantiasis one mouth at a time
• NPR: Haiti Moves A Step Closer Toward Eradicating
Elephantiasis
• CNN: 5 years on, hope for Haiti
LEARN MORE:
• MMWR: Mass Drug Administration for the Elimination
of Lymphatic Filariasis — Port-au-Prince, Haiti,
2011–2012
• USAID: Haiti’s NTD Program Overview
• PLOS: Haiti National Program for the Elimination of
Lymphatic Filariasis—A Model of Success in the Face
of Adversity
Young girls from the École Saint Patrick in St. Louis-du-Sud,
Haiti, line up at a ceremony to celebrate USAID’s delivery
of the one billionth NTD treatment in May of 2014. Photo:
Christopher Glass/IMA World Health
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