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Team 3

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  • Missing: where will base the operations?
  • Check numbers in the complaint for victims’ lawyers
  • Funding mechanism should incentivize partnerships between Haitian gov’t and not-for-profit & for-profit actors that transfer skills and capacity of gov’t
  • We endorse the plan and present innovations / supplements. EtcKEY THING: discussing the national plan and our endoresment and enhancement of it. For our innovations we should be saying things like “we propose …. “
  • Technicians are working alonside CHWs – be ready to differntiate.Technicians = leading campaigns and checking status of infrastructure. MENTION that DINEPA report is very recent! Show that we are up to date.
  • http://fritzphoto.com/blog/wp-content/uploads/2010/07/FritzLiedtke-Haiti10-358.jpgTraining for ppl work work in this??THINK THIS THROUGH a lot more!! “low interest loan to stimulate private sector”
  • DINEPA: National Directorate for Water Supply and SanitationMSPP: Ministry of Public Health and Population MTPTC: Ministry of Public Works, Transport and CommunicationMICT: Ministry of the Interior and Local CommunicationsNeed to strengthen Haitian government institutions to combat poverty impossible to improve longterm health without addressing public sector and widespread poverty Incentivize education for young peopleAttract talented young people to work in public sectorProvide job security to young professionals in public sector Empower nation by promoting local leadership Long-term effort to strengthen Haitian governmental capacity in all departments, as called for in multiple proposals (http://reliefweb.int/report/haiti/national-plan-elimination-cholera-haiti-2013-2022)· Widespread agreement that current efforts should focus on improving domestic infrastructure, ultimately weaning Haiti off of high dependence on foreign aid· Need to build qualified pool of people who are capable candidates for positions in governmental agencieso Currently do not have enough Haitians graduating with adequate training for employment in and improvement of local agencies
  • Urgency of current situation Expedited review of early proposals in heavily affected areasSustainability of responseDeceased burden of disease and cost of response over timeIncrease Haitian government support over time, but sustained response from international community is necessary
  • CDC reference on prophylaxis: http://www.cdc.gov/cholera/treatment/antibiotic-treatment.htmlPapers on prophylaxis:Weber JT, Mintz ED, Cañizares R, Semiglia A, Gomez I, Sempértegui R, Dávila A, Greene KD, Puhr ND, Cameron DN, Tenover FC, Barrett TJ, Bean NH, Ivey C, Tauxe RV, Blake PA. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood. Epidemiol Infect. 1994;112(1):1-11.Towner KJ, Pearson NJ, Mhalu FS, O'Grady F. Resistance to antimicrobial agents of Vibrio cholerae E1 Tor strains isolated during the fourth cholera epidemic in the United Republic of Tanzania. B World Health Organ. 1980;58(5):747-51.Vaccine source: http://www.dukoralcanada.com/dukoral-for-cholera
  • Should project costs for ScreeningVaccines $1.85 a dose, and two doses are needed over a few weeks' time to achieve 60 to 85 percent protectionProphylaxisSaniation
  • [fill in gaps, …]
  • http://www.stimson.org/spotlight/rebuilding-a-stronger-haiti/
  • MENTION TRAINING?! “Empower locals to provide healthcare” – as our bumper sticker here?! Hand washing after defecation and before food preparationProper use of chlorine Techs are doing education campaigns
  • Administer to vulnerable communities = use DINPEA and historical flooding pattersn** APPENDIX SLIDE = targeting strategy
  • Need to strengthen Haitian government institutions to combat poverty impossible to improve longterm health without addressing public sector and widespread poverty Incentivize education for young peopleAttract talented young people to work in public sectorProvide job security to young professionals in public sector Empower nation by promoting local leadership Long-term effort to strengthen Haitian governmental capacity in all departments, as called for in multiple proposals (http://reliefweb.int/report/haiti/national-plan-elimination-cholera-haiti-2013-2022)· Widespread agreement that current efforts should focus on improving domestic infrastructure, ultimately weaning Haiti off of high dependence on foreign aid· Need to build qualified pool of people who are capable candidates for positions in governmental agencieso Currently do not have enough Haitians graduating with adequate training for employment in and improvement of local agencies
  • APPENDIX PIH collaborating with training?Opportunities to travel abroad, study abroad, etc. Potential for foreign instructors to come teach courses, design curricula, etc.
  • http://www.un.org/esa/devaccount/projects/2010/10-11X.html – South Africa (SOUTH AFRICA)http://www.imf.org/external/np/exr/ib/2002/031402.htmhttp://hdr.undp.org/en/content/building-capacity-attainment-millennium-development-goals-gambiahttp://www.governing.com/events/webinars/Recruiting-And-Retaining-Young-Talent.html (NEW MEXICO)
  • http://www.thenation.com/article/170929/ngo-republic-haiti
  • OXFAM 2012 Guidelines
  • Transcript

    • 1. Strategic Plan for the UN Haiti Cholera Settlement Fund Restoring Justice and Building Capacity Development Consulting Group Alexander Bazazi Adam Beckman Amara Frumkin Oren Kanner Celso Perez Robert Thompson
    • 2. Problem of Cholera in Haiti Past Present Future Handling claims for harm caused by cholera outbreak Mitigating cholera transmission and treating current cases Strengthen Haitian institutions and UN policy to prevent future harm Solutions must address injustices across time.
    • 3. Framework for a Solution Claims process ($.7B) United Nations guidelines Empowering Haitians and building accountable institutions Cholera elimination plan ($2.3B) Our three pillars empower Haitians and build accountable national and international institutions.
    • 4. Claims Overview Goals Structure of the Commission Categories of Claims Claims Process Challenges and Opportunities
    • 5. Goals of the Claims Process Resource constraints International law and practices Sensitivity to needs of Haitians Cooperation among key actors Acknowledge harm done Redress wrong Promote rule of law Claims process acknowledges the harm done, redresses the wrong done, and promotes rule of law, human rights, and institutional legitimacy.
    • 6. Structure of the Commission Government of Haiti Independent Auditors UN SG/UN Commissioner Haitian Claims Commission Haitian Appointees (3) Joint Appointees (3) UN Appointees (3) Individual Claims Executive Secretary Compensation Fund Secretariat (local staff to the extent possible) Collective Claims The commission structure blends the vision of the SOFA and past claims commissions to build an efficient and accountable mechanism.
    • 7. Categories of Claims Types of Claims • Category A • Death claims • $4000/person ($30M) • Category B • Injury claims • $725/person ($470M) • Category C • Communal claims • Stop-gap fund ($110 M) Administrative process • Advantages: • Less contentious process • Greater efficiency (time) • Cost savings • Disadvantages: • No individualized determination of harm (claims A and B) • Lower evidentiary standards Claims are structured into a streamlined, administrative process.
    • 8. Claims Process: A and B End date for receiving claims Limit of UN liability Notification and call for claims Submit claims form with evidence Determination by the commission Notification of decision 6-18 months 8-10 years A and B claims are handled through the same administrative process. Award
    • 9. Claims Process: C Determination of “most affected” communities Notification and call for claims Identification of groups speaking on behalf of the community Determination by the commission Notification of decision 8-10 years C claims are handled through an individualized determination process. Award
    • 10. Challenges and Opportunities Preparing individual claims • Dedicated commission staff • Contingency fees Evidence for individual claims • Low evidentiary burden • Cooperation with victims’ lawyers Communal claims • Identifying representatives for the community • Oversight of the spending Legitimacy • Transparent process and reporting • Feedback from the communities Gathering claims, evaluating evidence, administering communal claims, and ensuring legitimacy will be the main challenges of the claims process.
    • 11. Framework for a Solution Claims process United Nations guidelines Empowering Haitians and building institutions Cholera elimination plan Our three pillars empower Haitians and build accountable national and international institutions.
    • 12. Partnerships for strong response & capacity building Foreign aid bypasses public sector, hindering improvement Need for increased partnerships between government and NGOs/private sector Haitian government alone lacks capacity to eliminate cholera Solicit proposals from all sectors. Evaluate potential for efficacy and capacitybuilding.
    • 13. Capacity-building cholera elimination plan Cholera treatment, prevention, & surveillance ($.3B) Water supply & wastewater management ($1.4B) Solid waste management ($.4B) Haiti Corps. Leadership Training ($.2B)
    • 14. Intervention Oversight Oversight UN Executive Commission Recommendation and assessment Strategic Committee Technical Committee Working Groups Treatment & prevention Water supply & waste management Solid waste management
    • 15. Cholera treatment, prevention, & surveillance Haitian Government NGOs Future Directions • Lacks capacity to respond to cholera epidemic • Demonstrated effective programs critical to cholera response • Increased partnerships between NGOs and Ministry of Public Health
    • 16. Cholera treatment, prevention, & surveillance Funding Priorities: Community-Based Responses Active Surveillance Vaccination 20,000 Community Health Workers Education Case Management
    • 17. Water supply & wastewater management Haitian Government NGOs Future Directions • DINEPA demonstrates strong institutional capacity • Smaller role in long-term response • Increased funding directly to DINEPA
    • 18. Water supply & wastewater management Funding Priorities: Decentralization of water management. Potable water Wastewater management Rural Disinfecting water Community Water Supply & Sanitation Technicians Infrastructure Target based on DINEPA Infrastructure Inventory Latrine location & set up Urban Sewage collection & treatment Community Led Total Sanitation (CLTS)
    • 19. Solid waste management Haitian Government NGOs Future Directions • Lacks capacity to meet societal needs • Limited, small-scale interventions • Stimulate private sector investment • Consider long-term public-private partnerships
    • 20. Solid Waste Management Funding Priorities: Urban areas Proper disposal of medical waste Seed grants for local reuse businesses Engage private sector
    • 21. Haiti Corps Leadership Training Initiative Steering Committee includes Haitian leaders and settlement fund appointee Haiti Now Intensive training for current government employees and leaders Future Corps Placement in DINEPA, MSPP, MTPTC, and MICT Comprehensive training for future government employees and leaders Haiti Corps will focus on placements in agencies related to sanitation and health.
    • 22. Mitigating Potential Challenges Urgency of current situation Sustainability of plan • Expedited review of early proposals in heavily affected areas • Plan will become less necessary over time • Simultaneous increase in domestic capacity Managing rapid • Train national employees in management and strategy workforce increase Collaboration between NGOs and • Financial incentives encourage partnership Gov’t
    • 23. Framework for a Solution Claims process United Nations guidelines Empowering Haitians and building institutions Cholera elimination plan Our three pillars empower Haitians and build accountable national and international institutions.
    • 24. UN Guidelines for Future Peacekeeping Operations ✗Screening • Ineffective • Asymptomatic peacekeepers ✗Antibiotic Prophylaxis • Ineffective, not recommended ✗Vaccination ✔Sanitation • 2-3 week lead time • Temporary protection • Effective way of controlling • Requires case-by-case oversight Sanitation is the only reliable method for preventing future outbreaks.
    • 25. UN Guidelines – Sanitation Sphere Guidelines • Hygiene promotion • Proper drainage / disposal • Chlorinate black water Oversight • In-country UN health officers • Sanitation auditing of UN facilities Peacekeeping camps must be held to appropriate sanitation standards with appropriate accountability.
    • 26. Conclusion Claims process United Nations Guidelines Empowering Haitians and building accountable institutions Cholera elimination plan Our three pillars empower Haitians and build accountable national and international institutions.
    • 27. Summary and Outcomes ✔ Just and efficient compensation • Acknowledges harm and promotes rule of law ✔ Effective distribution of funds to eliminate cholera • Incentivize partnerships that build capacity, transfer skills ✔ Reduce risk of future harm • Change standards and oversight of future UN operations ✔ Increased capacity of Haitian institutions • Haiti Corps leadership training ✔ Community empowerment • Haitian participation in the claims process and health interventions Equitable and effective community-based response to redress past harms, improve health, and prevent future catastrophes.
    • 28. Thank you!
    • 29. References Barzilay EJ, et al. Cholera Surveillance during the Haiti Epidemic – The First 2 Years. N Engl J Med 2013;368:599-609. Available at: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1204927. Centers for Disease Control and Prevention. Cholera- Antibiotic Treatment. http://www.cdc.gov/cholera/treatment/antibiotic-treatment.html CIA World Factbook. Haiti. Available at: https://www.cia.gov/library/publications/the-worldfactbook/geos/ha.html. Epidemic cholera in Ecuador: multidrug-resistance and transmission by water and seafood. Epidemiol Infect. 1994;112(1):1-11. International Monetary Fund. The role of capacity-building in poverty reduction. March 2002. http://www.imf.org/external/np/exr/ib/2002/031402.htm Klarreich, K and Polman, L. The Nation. The NGO Republic of Haiti, November 19, 2012. http://www.thenation.com/article/170929/ngo-republic-haiti National Plan for the Elimination of Cholera in Haiti, 2013-2022.
    • 30. References, cont’d. Gladstone, Rick. “Rights Advocates Suing U.N. Over the Spread of Cholera in Haiti.” New York Times. 8 October 2013. Available at: http://www.nytimes.com/2013/10/09/world/americas/rights-advocates-suing- un-over-the-spread-of-cholera-in-haiti.html. Global Humanitarian Assistance. Haiti. Available at: http://www.globalhumanitarianassistance.org/countryprofile/haiti. Organisation for Economic Co-operation and Economic Development. Available at: http://stats.oecd.org/Index.aspx?DatasetCode=TABLE2A San Diego State University VizCenter. Haiti Cholera Hospitalizations by Department with Hospital and Clinic Locations. Available at: http://vizcenter.sdsu.edu/wp-content/uploads/2010/12/haiti-hospitalizations- 121410-930.png. Towner KJ, Pearson NJ, Mhalu FS, O'Grady F. Resistance to antimicrobial agents of Vibrio cholerae E1 Tor strains isolated during the fourth cholera epidemic in the United Republic of Tanzania. B World Health Organ. 1980;58(5):747-51. Transnational Development Clinic, Global Health Justice Partnership, and Association Haitïenne de Droit de L’Environnment. Peacekeeping without Accountability: the United Nations’ Responsibility for the Haitian Cholera Epidemic. 2013. Available at: http://www.law.yale.edu/documents/pdf/Clinics/Haiti_TDC_Final_Report.pdf. UNDP. Rebuilding Haiti. 2013. Available at: http://www.undp.org/content/undp/en/home/ourwork/crisispreventionandrecovery/projects_initiatives/cris is_in_haiti/. Weber JT, Mintz ED, Cañizares R, Semiglia A, Gomez I, Sempértegui R, Dávila A, Greene KD, Puhr ND, Cameron DN, Tenover FC, Barrett TJ, Bean NH, Ivey C, Tauxe RV, Blake PA. World Bank. Haiti. Available at: http://www.worldbank.org/en/country/haiti. World Health Organization. Haiti. Available at: http://www.who.int/countries/hti/en/index.html.
    • 31. Appendices
    • 32. Problem of Cholera in Haiti Past harm to individuals and communities Disempowerment and lack of accountability Lack of prospective measures to prevent future harms Cholera has created a situation of injustice and disease. Persistent ongoing disease burden
    • 33. Legal basis for claims Article 105 Section 29 ¶7 ¶55 • United Nations Charter • Convention on the General Privileges and Immunities of the United Nations • MINUSTAH 2004 Mandate • Status of Forces Agreement The legal claims process is based on obligations under international law.
    • 34. Claims reporting process Government of Haiti UN Secretary General Haitian Claims Commission Independent Auditors Executive Commissioner
    • 35. Category C claims “Most affected communities” determination Definition of community Parameters for “most affected” Agency problem Oversight Who speaks on behalf of the community How will the money be spent Do they have a legitimate mandate How can the community hold the representative accountable
    • 36. “Most affected” communities Department Capital L'Artibonite Gonaïves Centre Population Number of Cases % by cases 1,571,020 125,181 7.97% Hinche 678,626 70,898 10.45% Grand-Anse Jérémie 425,878 25,839 6.07% Nippes Miragoâne 311,497 8775 2.82% Nord Cap-Haïtien 970,495 66,323 6.83% Nord-Est Fort-Liberté 358,277 30,766 8.59% Nord-Ouest Port-de-Paix 662,777 34,002 5.13% L'Ouest Port-au-Prince 3,664,620 161,983 4.42% Sud Les Cayes 704,760 33,354 4.73% Sud-Est Jacmel 575,293 11,225 1.95% 9,923,243 568,346 5.73% Total
    • 37. Claims Budget Number of claims Award or cost per claim ($) Estimated total ($ in millions) $500 Total A and B Awards Category A 8300 $4,000 $30 Category B 650,000 $725 $470 $110 C Communal Fund Cost A and B Claims Cost C Claims 658300 $140 $89.8 1000 $200 $0.2 TOTAL $700
    • 38. A and B claims budget A and B Awards Claims Amount per claim Estimated awards in USD Category A 8300 $4,000 $33,200,000 Category B 650,000 $725 $471,250,000 Total A and B Awards 658300 Processing A and B Claims UNCC claims resolved UNCC total cost 2,686,131 $362,600,000.00 UNCC cost per claim $134.99 Claims in Haiti 658300 Cost A and B Claims $88,863,715.14 $504,450,000
    • 39. C claims budget C Compensation Fund C Compensation Fund $106,525,540.60 Cost of processing C claims Estimated markup 20% Cost of processing C claim $161.99 Average size of community 10000 Number of communities Total cost processing C claims 992 $160,744.26
    • 40. Estimated comparative costs of sanitation Cost/unit ($) Vaccine Units People Cost/Month $1.85 2 11857.5 $43,872.75 $4.00 1 11857.5 $47,430.00 $19.00 1 11857.5 $225,292.50 $0.02 3 11857.5 $711.45 $0.16 4 11857.5 $7,588.80 Testing Stool culture RDT Prophylaxis Doxycycline (100mg) Azithromycin (250mg) Turnover/month DPKO personnel 10% 118,575
    • 41. Estimated comparative costs of sanitation Wage/month Units People Cost/month Sanitation Sanitation officer Wage/year Months/year No. Employees $3,333.33 $40,000.00 12 5 1 5 $16,666.67
    • 42. Bibliography – Claims • Status of Forces Agreement (2004) • UN Charter (1945) • General Convention (1946) • MINUSTAH Mandate (2004) • UN Secretary General Report S/22559 (1991) • Center for Civilians in Conflict, Monetary Payments for Civilian Harm in International and National Practice (2013) • Howard M. Holtzmann et al., International Mass Claims Processes (2008)
    • 43. Bibliography – Guidelines • Sphere Handbook (2011) • Oxfam, Cholera Outbreak Guidelines (2012) • CDC, Recommendations for the Use of Antibiotics for the Treatment of Cholera (2013) • CDC, Prevention and Control Measures (2013)
    • 44. Cholera treatment, prevention & surveillance 20,000 Community Health Workers
    • 45. Cholera treatment, prevention & surveillance Active Surveillance Vaccination 20,000 Community Health Workers Education Case Management
    • 46. Cholera treatment, prevention & surveillance Active Surveillance Vaccination 20,000 Community Health Workers Education Case Management
    • 47. Real-time SMS surveillance and rapid response CHW Active surveillance SMS Case Reporting Data Monitoring (Ministry of Public Health) Rapid response Technology used to establish national public health information network.
    • 48. Cholera treatment, prevention & surveillance Active Surveillance Vaccination 20,000 Community Health Workers Education • Assessment of severity • Treatment or referral to health facility Case Management
    • 49. Cholera treatment & prevention Active Surveillance Vaccination 20,000 Community Health Workers Case Management • • Household water safety • Proper use of chlorine Education • Hand washing after defecation and before food preparation Educate traditional healers
    • 50. Cholera treatment, prevention & surveillance Active Surveillance Vaccination • Target high-risk communities • Geospatial analysis 20,000 Community Health Workers Education Case Management
    • 51. Budget for health intervention Short term (2014-15) Medium term (2016-2018) Long term (20192024) TOTAL Total Claims Expense 700,000,000 HEALTH RESPONSE (ENDORSED NATIONAL PLAN & INNOVATIONS) DINEPA 575,000,000 168,612,500 824,612,500 59,600,000 181,400,000 226,750,000 467,750,000 Institutional strengthening DINEPA 74,000,000 146,000,000 65,000,000 285,000,000 1,000,000 1,500,000 500,000 3,000,000 140,000,000 230,000,000 33,425,903 403,425,903 Health care services (incl. CHWs) 35,030,000 18,480,000 29,600,000 83,110,000 Inputs/Essential medicines 63,660,000 24,435,000 6,425,000 94,520,000 Micronutrient deficiencies 9,340,000 6,750,000 420,000 16,510,000 13,000,000 3,240,003 2,340,003 18,580,006 Quality of information 2,100,000 2,200,000 1,000,000 5,300,000 Research capacity 3,300,000 15,001,000 2,000,000 20,301,000 Hygiene practices 3,580,000 1,420,000 1,900,000 6,900,000 Institutional stregnthening 8,010,000 10,450,000 17,250,000 35,710,000 Food hygiene 1,240,000 860,000 800,000 2,900,000 Hospital Hygiene 4,160,000 2,280,000 2,390,000 8,830,000 Support staff for comissioner 390,000 390,000 390,000 390,000 AyitiCorps Ministory of Public Health 81,000,000 Wastewater and excreta treatment Ministory Public Works/LC/T Water supply 958,309 1,908,392 102,934 2,969,635 500,368,309 1,221,314,395 558,906,340 TOTAL PLAN COST 2,300,000,000 Institutional strengthening of solid waste and management Waste Collection and treatment (incl. technicians) SMS Total Plan Expense 3,000,000,000
    • 52. Haiti Now Identify leaders and top-level employees in MSPP, DINEPA, MTPTC, MICT • Focus on agencies aiming for increased autonomy Train employees in strategy and management • Short-term trainings provided by local leaders and outside partners Monitor outcomes in public sector • Increase funding based on demonstrated capacity Haiti Now addresses immediate needs in the Haitian public sector.
    • 53. Future Corps Recruit Future Leaders in Secondary Schools Train for Work in Public Sector Employ in Government Agencies Focus on gender equity and geographical diversity Strengthen domestic institutions Improve management of health and development Haiti Future will strengthen long-term domestic capacity through comprehensive leadership training.
    • 54. Step 1: Recruit Step 2: Advertise in schools and communities. Pay participants families. Provide summer programs. Train Match students based on interest and skills. Duration dependent on job. Place at low-level in government agency. Step 3: Employ Provide mentoring in early years. Promotion dependent on performance. Future Corps incentivizes talented students to pursue public sector careers.
    • 55. Future Corps: Program Details and Logistics Stage 1: Recruitment -Program advertised in schools and communities -Secondary school tuition covered for students who enroll, stipend provided to family -Short-term, cost-free summer program during secondary school provides exposure to public sector jobs -Attempt to recruit 10 students per geographic department; 50/50 male/female enrollees Stage 2: Training -Student applies for training program based on interest -Student matched in training program based on application and skillset -Student completes appropriate training program and receives living stipend -Mixture of academic coursework and practical internships -Training programs made available based on projected societal needs: initial focus on healthcare and sanitation -Potential for collaboration with international universities and organizations Stage 3: Employment -Upon successful completion of training, graduate placed in appropriate agency -Graduate starts in low-level position -Job and benefits guaranteed for pre-determined number of years (contingent upon performance) -Continued professional development opportunities and mentoring provided -Financial penalty if contract is breached
    • 56. Future Corps: Program Details and Logistics Oversight • Creation of Haiti Corps Planning Committee with representatives from Haitian Government and Appointee from Settlement Fund • Students based at University of Haiti Evidence • United Nations recognizes institutional capacity building as key to poverty reduction • Incentive-based training programs work on small and large scales Finance • 100 students recruited annually • Funding provided for first 10 years of program • Funds cover administration, implementation and student costs
    • 57. Future Corps: Investing in a Cycle of Empowerment Recruit Young Haitians Empowering individuals and institutions Opportunity for promotion and leadership Provide Training for Public Sector Placement in government agency job
    • 58. Haiti Corps Budget Future Corps 5000 per Future Corps student (1000 students over 10 years) $50,000,000 5000 per graduate for early professional development $50,000,000 Haiti Now 1000 per student (2000 total) 20,000,000 Implementation Establishment of steering committee 20,000 Collection of curriculum and visiting collaborators 20,000 Establishment of physical space 40,000 Total cost Haiti Corps USD$200,000,000
    • 59. UN Guidelines – Epidemic Control Response Response Coordination Initial investigation Task force committees Intervention National and field Community engagement Government and non-profit Monitoring

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