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.
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)
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)
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.
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.
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.
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.
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
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)
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
Editor's Notes
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
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)
