USAID-Funded Neglected Tropical Diseases Program Exceeding Goals in Haiti

Beyond Disease Control, Initiative Seen as Key to Broader Health and Development Objectives Full National Coverage Targeted by 2011

Port-Au-Prince, Haiti - More than 70 percent of Haiti's population is at risk for Lymphatic Filariasis (LF)[1], a Neglected Tropical Disease (NTD) that can cause extreme suffering, disability and isolation. But IMA World Health and its partners are ramping up efforts to control and eliminate NTDs across the developing nation.

LF, more commonly known as "elephantiasis," and Soil-Transmitted Helminthes (STHs), intestinal worms found mostly in children, are the two NTDs of greatest concern in Haiti. Testing by the Haitian government in 1999 indicated that 37 percent of the Haitian population is infected with LF, and testing in 2002 revealed that up to 75 percent of school-age children are infected with STHs.

Through the U.S. Agency for International Development (USAID)-funded NTD Program, nearly 750,000 Haitians were treated in May 2009 alone. Under the program this year, more Haitians than ever — an estimated 3.6 million people across five Departments — will receive treatment for LF and STHs.

IMA World Health President Paul Derstine traveled to rural Haiti last month to observe the program's first round of medicine distributions of 2009. "We have seen unprecedented turnout rates at medicine distribution posts and schools across the nation," Derstine said. "The program is exceeding even the most optimistic expectations, putting us in a strong position to rapidly accelerate our prevention and treatment efforts." The next round of distributions is slated for October 2009.

According to the World Health Organization (WHO), "over 1 billion people – one sixth of the world's population – suffer from one or more NTDs." These diseases include a range of 14 mostly parasitic illnesses that are virtually unheard of in the developed world but which thrive in tropical heat and humidity.

NTDs are increasingly viewed as a major obstacle to broader global health and economic development goals. They are strongly linked to factors such as unsafe water and poor sanitation, which are common problems in the developing world. Because NTDs can carry with them long-term debilitating physical and social consequences, they have an enormous impact on individuals' and families' ability to make a living.

The scope and urgency of the global NTD problem has propelled the issue to the national stage. President Obama's proposed Global Health Initiative specifically cites the importance of NTD prevention and treatment, calling for $63 billion over five years to address a number of pressing global health concerns, including NTDs.

A key feature of the USAID-funded program in Haiti — and one widely credited for its success — is local "ownership." From making sure that medicines arrive at distribution posts to publicizing the program in local communities, Haitians ultimately run the program at the ground level. "Our goal is to support local management of health care services," Derstine explained. He added that while IMA World Health helps to coordinate medicine distributions, it has no need to actually touch the medicines because so much of the work is done by Haitians.

Another hallmark of the program is education and training for community organizers, designed to help counter social stigmas associated with NTDs that can serve as an obstacle to treatment. Often those with elephantiasis or other outcomes of NTDs remain virtually unseen, especially in rural areas. "The NTD program in Haiti provides strong evidence that community education and training, along with local stakeholder involvement at every stage of the process, is vital to long term success and sustainability," Derstine said.

IMA World Health's Country Representative, Dr. Abdel Direny, works from the organization's field office in Port-au-Prince to support Haitian Ministries of Health and Education officials who coordinate the work of community organizers and volunteers on the ground — an especially important task in a nation where so many people live in remote areas. "The NTD program in Haiti is faced with major logistical obstacles," Direny said. "But we are overcoming these challenges."

Jose Mirar, trained as a health promoter, is one of hundreds of community leaders helping to coordinate medicine distributions at the grassroots level. "Heaven has brought us this help," he said. "We wouldn't have known NTDs even existed without this program." In all, nearly 3,900 volunteer community leaders, promoters and medicine distributors will help drive the USAID-funded program in 2009.

WHO also notes that NTDs "express this link between health and development in an explicit, almost visual way." Mirar confirmed that the program is having a ripple effect resulting in other social and economic benefits that support broader global health and development goals. He told

IMA that he has seen an increase in public awareness of issues related to hygiene and environmental cleanliness, which have a direct impact not just on NTDs but on a range of other health problems in Haiti, such as malaria.

The overall Haiti NTD Control Program is led by the nation's Ministry of Public Health and Population and Ministry of Education and is funded by two donors: USAID, through RTI International, and the Bill & Melinda Gates Foundation, through the University of Notre Dame.

The USAID-funded initiative is being implemented with the support of a consortium of organizations working with the Haitian government to expand the program to achieve full national coverage by 2011. IMA World Health leads the consortium, which also includes the U.S. Centers for Disease Control and Prevention, the Pan American Health Organization, the University of Notre Dame and St. Croix Hospital in Port-au-Prince.

"The possibility of LF elimination in Haiti has become a reality," said Mary Linehan, Operations Director, NTD Control Program, RTI International. "The NTD Control Program is very pleased to be part of the partnership supporting the government of Haiti in achieving this important public health goal. IMA and its partners are making a critical contribution to the improvement of the lives of the Haitian people."