Team 2

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Team 2

  1. 1. Reparative and sustainable investment in Haiti’s future FRESH CONSULTING, INC. (TEAM 2) February 15, 2014 Stuart Craig, Brian Dunican, Nicole Patterson, Maury Raycroft, Jason Suway
  2. 2. AGENDA • Overview of the situation • Desired outcomes • Recommendations • Questions
  3. 3. BACKGROUND January, 2010 •Earthquake responsible for ~72,000 Haitian deaths •“Without their help, it would be impossible for us to cope with the situation” -President Preval •43 international teams (1,700 people) carried out 90 rescues and provided 2M liters of water and 17M meals per day. October, 2010 • Cholera outbreak responsible for 650,000 illnesses and 8,300 deaths to date • UN aid workers are implicated in the introduction of cholera • Healthcare expenditures increased by $395M to treat cholera patients in Haiti Problem Statement: How should the UN divide and prioritize $3B in international support to address the epidemic and build a stronger Haiti?
  4. 4. DESIRED OUTCOMES Introduction Stop Cholera Repair Damages Invest & Build Conclusion Objectives Stop Cholera • • Prevent spread Treat infected Repair Damages • • Compensate families Reimburse care Invest & Build • • • Produce clean water Expand health infrastructure Facilitate innovation Engage Haitian resources to ensure long-term sustainability of UN intervention
  5. 5. RECOMMENDATION: INDIVIDUAL COMPENSATION Stop Cholera Legacy Fund Repair Damages Millions Introduction $500 Invest & Build Conclusion Projected Fund Valuation—2014 USD $400 Total after payments Interest earned $300 Value of Statistical Life: $84,000 Annual Payment: $2,800 (120* GDP/capita) ($84,000 / 30yr) $200 $100 $0 0 5 10 15 Year Saves $388M versus immediate dispersal 20 25 30
  6. 6. RECOMMENDATION: INDIVIDUAL COMPENSATION Stop Cholera Legacy Fund Repair Damages Millions Introduction $500 Invest & Build Conclusion Projected Fund Valuation—2014 USD $400 Total after payments Interest earned $300 Value of Statistical Life: $84,000 Annual Payment: $2,800 (120* GDP/capita) ($84,000 / 30yr) $200 $100 $0 0 5 10 15 Year Saves $388M versus immediate dispersal 20 25 30
  7. 7. RECOMMENDATION: INDIVIDUAL COMPENSATION Stop Cholera Legacy Fund Repair Damages Millions Introduction $500 Invest & Build Conclusion Projected Fund Valuation—2014 USD $400 Total after payments Interest earned $300 Value of Statistical Life: $84,000 Annual Payment: $2,800 (120* GDP/capita) ($84,000 / 30yr) $200 $100 $0 0 5 10 15 Year Saves $388M versus immediate dispersal 20 25 30
  8. 8. RECOMMENDATION: INDIVIDUAL COMPENSATION Stop Cholera Legacy Fund Repair Damages Millions Introduction $500 Invest & Build Conclusion Projected Fund Valuation—2014 USD $400 Total after payments Interest earned $300 Value of Statistical Life: $84,000 Annual Payment: $2,800 (120* GDP/capita) ($84,000 / 30yr) $200 $100 $0 0 5 10 15 Year Saves $388M versus immediate dispersal 20 25 30
  9. 9. RECOMMENDATION: SANITATION INITIATIVE Introduction Stop Cholera Repair Damages Invest & Build Conclusion Water Sanitation is crucial to Haitian health 88% of diarrheal disease is attributed to unsafe water supply and inadequate sanitation Child mortality is 30% higher without access to improved sanitation $9 for $1 USD spent Testing & Evaluation Clean Water Source Filtration System Investment results in economic benefit: Improved Water Sanitation Distribution Management & Maintenance
  10. 10. RECOMMENDATION: SANITATION INITIATIVE Introduction Stop Cholera Repair Damages Invest & Build Conclusion Stage 1: World Bank Sanitation Initiative receives 100M per year for 5 years • Established program will capability for immediate action $1.3B Investment 20 = 15 6.5M people with improved access to sanitation Distribution of Funding in Stage 2 $40 $30 $ / NGO 10 $20 # NGOs + 5 $10 20,448 avoided childhood deaths/year 0 $0 2014 2016 2018 2020 2022 Millions Stage 2: Allocate remaining 800M to NGOs dedicated to water access and sanitation • Evaluations of NGO performance with reallocation of funds • Number of NGOs receiving funds will decrease over 10 year period
  11. 11. RECOMMENDATION: EDUCATION & PUBLIC RELATIONS Introduction Stop Cholera Repair Damages Invest & Build Train local community workers Promotion of claims process via newspaper, radio, etc. Community Awareness Press releases from Haitian government regarding UN settlement Public health education through NGOs Conclusion
  12. 12. RECOMMENDATION: CLINICAL REIMBURSEMENT Introduction Stop Cholera Repair Damages Invest & Build Conclusion Cost $395M Reimburse • 1.69% increase in healthcare share of GDP since outbreak • Reimburse Ministry of Health for ’11-’13 to allocate funds to hospitals, clinics, government based on inferred cost $10M Prevent • Children are more susceptible to contracting cholera than adults (6.6% vs 6.0% of demographic) • Provide oral vaccinations for all children under 5 years old $171M Treat • Haiti lacks sufficient healthcare resources when compared to other comparable developing countries, • Construct largest teaching hospital to train doctors over next 30 years, and cover cost of projected cases of cholera $576M
  13. 13. RECOMMENDATION: CLINICAL REIMBURSEMENT Introduction Stop Cholera Repair Damages Invest & Build Conclusion Cost Reimburse • 1.69% increase in healthcare share of GDP since outbreak • Reimburse Ministry of Health for ’11-’13 to allocate funds to hospitals, clinics, government based on inferred cost $395M Cholera Outbreak Prevent • Children are more susceptible to contracting cholera than GDP adults (6.6% vs 6.0% of demographic) UN Healthcare Exp • Provide oral vaccinations for all children under 5 years old Haiti Healthcare Exp 124 132 9,000 $10M 139 8,000 7,000 6,000 • Haiti lacks sufficient healthcare resources when compared to other comparable developing countries, 460 455 • Construct largest teaching hospital 418 train doctors over 491 to 351 next 30 years, and cover cost of projected cases of cholera 324 Treat 5,000 4,000 517 205 $171M 3,000 2,000 278 150 GDP (In $ millions) Healthcare Exp (In $ millions) 700 650 600 550 500 450 400 350 300 250 200 150 100 50 0 183 1,000 $576M 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
  14. 14. RECOMMENDATION: CLINICAL REIMBURSEMENT Introduction Stop Cholera Repair Damages Invest & Build Conclusion Cost $395M Reimburse • 1.69% increase in healthcare share of GDP since outbreak • Reimburse Ministry of Health for ’11-’13 to allocate funds to hospitals, clinics, government based on inferred cost $10M Prevent • Children are more susceptible to contracting cholera than adults (6.6% vs 6.0% of demographic) • Provide oral vaccinations for all children under 5 years old $171M Treat • Haiti lacks sufficient healthcare resources when compared to other comparable developing countries, • Construct largest teaching hospital to train doctors over next 30 years, and cover cost of projected cases of cholera $576M
  15. 15. RECOMMENDATION: CLINICAL REIMBURSEMENT Introduction Stop Cholera Repair Damages Invest & Build Conclusion Cost $395M Reimburse • 1.69% increase in healthcare share of GDP since outbreak • Reimburse Ministry of Health for ’11-’13 to allocate funds to hospitals, clinics, government based on cost incurred $10M Prevent • Children are 10% more susceptible to contracting cholera than adults • Provide oral vaccinations for all children under 5 years old for 5 years $171M Treat • Haiti lacks sufficient healthcare resources when compared to other comparable developing countries, • Construct largest teaching hospital to train doctors over next 30 years, and cover cost of projected cases of cholera $576M
  16. 16. Introduction Stop Cholera Repair Damages Invest & Build Conclusion Cost $395M Reimburse • 1.69% increase in healthcare share of GDP since outbreak • Reimburse Ministry of Health for ’11-’13 to allocate funds to hospitals, clinics, government based on cost incurred $10M Prevent • Children are 10% more susceptible to contracting cholera than adults • Provide oral vaccinations for all children under 5 years old for 5 years Treat • Haiti’s healthcare resources are limited • Train 200 doctors/year over the next 30 years • Cover cost of future incidences of cholera $171M $576M TRAIN RECOMMENDATION: CLINICAL REIMBURSEMENT
  17. 17. INNOVATION FUND Introduction Stop Cholera Repair Damages Invest & Build Conclusion Call for applications from for-profit and nonprofit organizations for UN funding Project Criteria Purpose • • Provide funding for innovative development Competition between organizations for cost effective solutions • • • • • Inclusive of Haitians Feasible and Sustainable • Addresses an unmet • need Economic impact Outcomes Improved quality of life for the people of Haiti Economic growth Job creation
  18. 18. INVESTMENT ALLOCATION Introduction Stop Cholera Repair Damages Total Cost Sanitation $1,300 M Clinical $576 M Individual Compensation $452 M Innovation Fund $300 M 10% $50 M Overhead Total Cost: Conclusion % ALLOCATION $322 M Education & PR Invest & Build 2% 11% 43% 19% $3,000 M 15%
  19. 19. GUIDELINES TO REDUCE LIABILITY AND IMPROVE UN INTERVENTION Introduction Stop Cholera Repair Damages Invest & Build Conclusion Challenge 1: Coordinating entry and action in a sovereign state Clarify UN rights and autonomy to act Form an effective intergovernment task force Incorporate grand strategy to understand the goals and visualize the end
  20. 20. GUIDELINES TO REDUCE LIABILITY AND IMPROVE UN INTERVENTION Introduction Stop Cholera Repair Damages Invest & Build Conclusion Challenge 1: Coordinating entry and action in a sovereign state Clarify UN rights and autonomy to act Form an effective intergovernment task force Incorporate grand strategy to understand the goals and visualize the end Challenge 2: Paving inroads for successful UN integration and operations Identify local resources Form districts (population, existing borders, or need) Comprehensive planning
  21. 21. GUIDELINES TO REDUCE LIABILITY AND IMPROVE UN INTERVENTION Introduction Stop Cholera Repair Damages Invest & Build Conclusion Challenge 1: Coordinating entry and action in a sovereign state Clarify UN rights and autonomy to act Form an effective intergovernment task force Incorporate grand strategy to understand the goals and visualize the end Challenge 2: Paving inroads for successful UN integration and operations Identify local resources Form districts (population, existing borders, or need) Comprehensive planning Challenge 3: Sensitizing to complex local culture and building local ownership Outreach to local reps to gain understanding and identify resources Local action committee formation Leverage existing technology, resources, an d accumulate data
  22. 22. GUIDELINES TO REDUCE LIABILITY AND IMPROVE UN INTERVENTION Introduction Stop Cholera Repair Damages Invest & Build Conclusion Challenge 1: Coordinating entry and action in a sovereign state Clarify UN rights and autonomy to act Form an effective intergovernment task force Incorporate grand strategy to understand the goals and visualize the end Challenge 2: Paving inroads for successful UN integration and operations Identify local resources Form districts (population, existing borders, or need) Comprehensive planning Challenge 3: Sensitizing to complex local culture and building local ownership Outreach to local reps to gain understanding and identify resources Local action committee formation Leverage existing technology, resources, an d accumulate data Challenge 4: Preventing introduction of contaminating disease/species Establish ISO standardization for UN health clearance Digitize health records Four eye principle to confirm personnel clearance
  23. 23. EXECUTIVE SUMMARY Introduction Reasons Impact Risks Conclusion Use the $3B to enhance and build Repair UN reputation Improve sanitation and health Strengthen Haiti Next Steps Form Claims Commission Improve relationships with Haitian government and citizens Recruit bids
  24. 24. QUESTIONS?
  25. 25. RISKS, MITIGATION AND CONTINGENCY Introduction Stop Cholera Repair Damages Invest & Build Conclusion Risks Mitigation Contingency Misappropriated Funding Invest in pre-screening NGOs Require collateral from Haitian gov; stop support Haitian public dissatisfaction Boost initial PR spending; work closely with IJDH, gov, communities Wait longer, listen more, and collaborate more Another outbreak/disaster Improving sanitation and clinics are not cholera-specific Invest in robust systems and Haitian adaptability
  26. 26. REFERENCES • CNN Article: http://www.cnn.com/2010/WORLD/americas/01/19/haiti.earthquake/ • UN Civilian and Crisis Management (Independent study by Kaspersen and Sending) •Cost of Disease Calculator http://www.idcostcalc.org/index.html • WHO vaccination: http://www.npr.org/blogs/health/2012/08/17/159014069/who-calls-for-emergency-stockpile-of-choleravaccine • OMS/OPS, MSPP, WASH Cluster, Health Cluster: http://reliefweb.int/sites/reliefweb.int/files/resources/Cholera%20in%20Haiti%20An%20End%20in%20Sight%20Key%20facts% 20and%20figures%20as%20of%2017%20Dec%202013.pdf • World Health Organization. “Fact and figures: Water, sanitation and hygiene links to health.” Water Sanitation and Health. March 2004. Accessed on Feb. 10 2014. http://www.who.int/water_sanitation_health/publications/factsfigures04/en/ • Fink, G. and Gunther, I. “Water and sanitation to reduce child mortality: The impact and cost of water and sanitation infrastructure” Policy Research Working Papers. March 2011. Accessed on Feb. 10 2014. http://elibrary.worldbank.org/doi/book/10.1596/1813-9450-5618 • Gunther, et al. “The effect of water and sanitation on child health: evidence from the demographic and health surveys 19862007.” Oxford University Press. May 2011. Acessed on Feb. 10 2014. http://ije.oxfordjournals.org/content/early/2011/06/30/ije.dyr102 • BRAC “Attaining MDG Targets on Water and Sanitation in Bangladesh.” Brac’s Water, Sanitation, and Hygiene Programme. Jan. 2006. Accessed on Feb. 10 2014. http://brac.net/oldsite/downloads_files/WASH_Proposal.pdf • UN Water. “Sanitation is an investment with high economic returns.” 2008. Accessed on Feb. 10, 2014. http://esa.un.org/iys/docs/IYS%20Advocacy%20kit%20ENGLISH/Fact%20sheet%202.pdf • 120*gdp: http://www.bath.ac.uk/e-journals/jtep/pdf/Volume_34_Part_2_169-188.pdf • review of VSL studies: http://search.oecd.org/officialdocuments/displaydocumentpdf/?cote=ENV/EPOC/WPNEP(2010)9/FINAL&doclanguage=en
  27. 27. APPENDIX 1: LEGACY ANNUITIES • • • • • • • Pending lawsuit requests $100,000 per death and $50,000 per injury Cross-national review of contingent valuation studies suggests VSL is 120x GDP per capita • Haiti’s GDP per capita was 671-732 during 2010-2011 period • Yields a VSL of $84,000 per death Life lost is financial and emotional burden to the community and the nation Replacement of lost income maintains Haiti’s economic growth potential Recommendation: Disburse $84,000 via 30 year annuity to immediate relation Cover annuity cost from $452M pension-like fund, principle spent to $0 over 30 years • Assume 5% real rate of return (UN pension is 5.1% over 25 years) • Assume 10,000 claimants, all receive 30 years of compensation • Save $388M over immediate disbursal Regarding Injury • UN is not liable for Cholera cases • Each episode lasts 1-7 days $2 - $14 dollars lost wages • Administrative cost too high for direct payments
  28. 28. APPENDIX 2: COST OF SANITATION PROJECTS World Bank-Supported Initiative • Average $833 Million for 1 Community Sanitation Intervention • Project Includes: • Attainment of secure water source • Purification/Filtration System • Distribution Kiosks for some • Household Connections for some • Public water fountains • School latrines • Household latrines for some • Training of community water managers • Health promotion and education for community members
  29. 29. APPENDIX 3: SANITATION CALCULATIONS Deaths avoided by improved sanitation for the under-5’s Clean water improves under-5 mortality by 25 per 1000 (Pop under 5) x (25 deaths/1000)*(prop. Reached) = 1,245,000*0.025* (6,500,000/9,893,934) = 20,448 per year Population with improved sanitation *Based on World Bank model: reaches an estimated 50,000 for a $10M investment 1,300,000,000*(50,000/10,000,000) = 6,500,000 individuals NGO Payout Table Total Payout Year 75,000,000 75,000,000 75,000,000 150,000,000 150,000,000 150,000,000 156,250,000 156,250,000 156,250,000 156,250,000 Cum. Payout # NGOs 2014 75,000,000 2015 150,000,000 2016 225,000,000 2017 375,000,000 2018 525,000,000 2019 675,000,000 2020 831,250,000 2021 987,500,000 2022 1,143,750,000 2023 1,300,000,000 Avg. Per NGO 15 5,000,000 15 5,000,000 15 5,000,000 10 15,000,000 10 15,000,000 10 15,000,000 5 31,250,000 5 31,250,000 5 31,250,000 5 31,250,000
  30. 30. APPENDIX 4: SANITATION PROJECT OPTIONS Sanitation Technology Water Source Purification Distribution Disposal Testing • Surface water • Borehole • Deep tube well • Sedimentation • Chlorination • Biosand Filters • Ceramic Filters • Pressure Sand Filters • Piped Water Scheme • Distribution Kiosk • Public Fountain • Pit Latrine • Flush Toilet • Standing Shower • Pathogen test kits • Nitrate/Nitrite test strips • Chloride test strips
  31. 31. APPENDIX 5: PREVENTION COSTS Dept or PaP Total Population Total Male Population Total Female Population Total >=18 years old Total <18 years old ARTIBONITE 1,571,020 776,517 794,503 886,875 684,145 CENTRE 678,626 346,232 332,394 350,517 328,109 GRANDE ANSE 425,878 222,072 203,806 232,718 193,160 NIPPES 311,497 163,185 148,312 175,826 135,671 NORD 970,495 476,349 494,146 537,348 433,147 NORD EST 358,277 179,511 178,766 187,276 171,001 NORD OUEST 662,777 328,173 334,604 351,847 310,930 OUEST 1,187,833 590,019 597,814 680,890 506,943 PORT-AU-PRINCE 2,476,787 1,179,978 1,296,809 1,532,613 944,174 SUD 704,760 363,927 340,833 392,765 311,995 SUD-EST 575,293 286,550 288,743 309,590 265,703 Total 9,923,243 4,912,513 5,010,730 Size of Population/Age Population <5 years old New Borns for 5 years Total Population to be Vaccinated % Adoption Cost Per Dose Number of Doses Total Cost/Patient Total Cost to UN 5,638,265 4,284,978 $ 238,054.33 1,190,272 1,190,272 2,380,543 80% $2.73 2 $5.46 10,398,213 http://www.npr.org/blogs/health/2012/08/17/159014069/who-calls-for-emergency-stockpile-of-cholera-vaccine
  32. 32. APPENDIX 5: CHOLERA TREATMENT AND HOSPITAL Treatment of Projected Cases: Hospital Clinical Hospitalization Rate Average Cost Expected Cases/Month Total Cases over 5 years Total Cost Cost of Constructing & Supporting a Teaching Hospital: Assumptions: • $40M to construct new teaching hospital • $115M to fund 200 students for the next 30 years • $10,000 tuition/student/year • 5% interest in fund $ $ 50.68 9.96 54.5% $ 32.15 8484 509,040 $ 16,366,857.70
  33. 33. APPENDIX 6: CLINICAL INFRASTRUCTURE “The problem with healthcare in Haiti is that there is no system, no structure, no plan – at least, not one that has been implemented.” Inadequate Healthcare Facilities • Medical staff • Support Staff • Equipment and Treatment Indicators Indicators (per 1,000 people) • 0.25 Physicians • 0.8 Hospital Beds • 0.107 Nurses and Midwives Haiti Regional V% Under-five mortality rate (per 1,000 live births) 70 16 338% Adult mortality rate (per 1,000 population 258 160 61% Maternal mortality ratio (per 100,000 live births) 350 63 456% Life expectancy at birth (years) 63 76 -17% 46% of Haitian’s did not have access to healthcare before earthquake
  34. 34. APPENDIX 7: ONGOING MANAGEMENT • • Compensation • Disbursement of compensation • Validation of claims and beneficiaries Community Compensation and improvement • Water Sanitation persons served / $ • Cholera Eradication cases / month • Clinical infrastructure persons served / $ •Support for 3rd party Solutions • Annual project review by Evaluation board • UN, Federal, and Haitian community leaders • Support continued for half of project organizations

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