Rebuilding Public Health in Haiti
Three years after a devastating earthquake took the lives of 200,000 Haitians, displaced millions more and disrupted the public health infrastructure of the country, two new public health buildings opened yesterday in the country’s capital city of Port-Au-Prince with funding by the CDC Foundation and several partners including the Robert Wood Johnson Foundation, the GE Foundation and Kaiser Permanente. The CDC Foundation was established by Congress to forge partnerships between the Centers for Disease Control and Prevention (CDC) and corporations, foundations and individuals to support CDC's work in the U.S. and abroad.
“‘Building back better’ isn't just a slogan, it's a reality in public health. These buildings represent an important step forward to save lives in Haiti,” said CDC director Thomas Frieden, MD, MPH, at the opening in Port-Au-Prince. "These new buildings have an importance far beyond their physical presence—they will serve as a basis and catalyst for programs that will save literally tens of thousands of lives,” Frieden said.
One building replaces the Haiti Health Ministry, which was destroyed in the earthquake. The second building will house some of the ministry’s surveillance, epidemiology and laboratory staff as well as Haiti-based CDC staff, who are now working side-by-side in the country.
Representatives of the partners critical to the funding of the new buildings were on hand in Port-Au-Prince for the buildings’ ribbon cutting ceremony, including Susan Mende, senior program officer at the Robert Wood Johnson Foundation. “The earthquake in Haiti wrought great destruction and suffering to some of the most vulnerable in society as well as to the health and public health infrastructure so critical to the nation’s health,” said Mende. “The Robert Wood Johnson Foundation made a $500,000 grant to help build a public health laboratory research center to be used by Haiti’s Ministry of Public Health and Population. The Foundation recognizes that a stronger public health system is the network that protects communities, saves lives and directly improves people’s health and well being.”
To learn about the significance of the new buildings and the continuing efforts to improve public health in Haiti, NewPublicHealth spoke with Charles Stokes, president of the CDC Foundation, and Justin Tappero, MD, MPH, Director for the Health Systems Reconstruction Office in the Center for Global Health at CDC. Both were on hand for the ceremonies this week.
NewPublicHealth: How did the CDC Foundation become involved in this project?
Charles Stokes: CDC has had a presence in Haiti for quite a few years, particularly working on HIV/AIDS so they had a relationship when the earthquake happened. They quickly saw the many needs when the ministry building and 60 staff members were lost in the earthquake. They asked the CDC Foundation first for help replacing a core building to serve as a home base for the ministry and then they let us know that a second building added to the national laboratory complex would be invaluable as well.
The second building, in particular, I think will have a dramatic impact because of its location in the national laboratory complex. It allows additional CDC staff in addition to HIV/AIDS experts to co-locate with and work side by side with the ministry of health staff in Haiti on myriad programs.
NPH: What were the critical roles of the CDC Foundation in the buildings that opened this week?
Charles Stokes: We like to say we help CDC to do more, faster. We help do things CDC can’t do otherwise, by bringing resources and partners to the table, and this is a perfect example. There’s a dramatic need in Haiti. CDC was willing to help. CDC had additional staff to commit, but no place to put them, and so they reached out to us to perform our traditional role of trying to bring other partners to the table that could bring the flexibility that was necessary.
NPH: What’s next for the CDC Foundation in Haiti?
Charles Stokes: We tend generally to follow CDC’s lead in that arena, but I think what this project has done is cemented partnerships. In Haiti, we’ll be meeting with the ambassador, the minister of health and the head of the national lab there, and I find that relationships that are formed in a response like this one tend to take on a life of their own for the better and for the good of the country going forward.
NPH: Dr. Tappero, how will the new buildings help improve public health in Haiti?
Dr. Tappero: At CDC find that we do our best work in providing technical assistance with ministries of health when we sit together. This not only gives the ministers of public health and epidemiologists a place to work, but it also allows us to provide technical assistance to them in a day-to-day routine setting.
One of the programs that we are funding from the post-earthquake funds from congress is a field epidemiology training program, and in Haiti before the earthquake, there really wasn’t a functioning reportable disease surveillance system, and there really wasn’t a regional laboratory network for confirmation of causes of illness. And now, this building where the field epidemiology training is located is on the campus of the national public health laboratory. [Haiti's Field Epidemiology Training Program (FETP) is a CDC project that works with health ministries along with other partners, to train public health workers to detect, investigate, and control threats to public health.]
Training program participants will eventually become the next generation of Haiti’s public health practitioners.
NPH: Are there ways in which helping Haiti rebuild its public health infrastructure also helps improve health across the world?
Jordan Tappero: The world is now such a global environment that anyone in any country can be on a plane, and in less than 24 hours, be anywhere else in the world. So, we can’t think about protecting our border from public health communicable disease in a vacuum. We need to improve public health infrastructure to respond in every country whether it’s Haiti or anywhere in order to protect all citizens of the world. Specific to Haiti, there is quite a bit of travel and exchange between Haiti and the United States. There, the risk of TB transmission is real, so improving TB control in Haiti will also eventually decrease TB outside of Haiti.
I think improving health in general in Haiti will also lead to investment in Haiti and allow them to grow their economy. If investors and companies perceive Haiti as being a healthier and safer place to live and work, that will create economic opportunity for Haiti as well. And, if we can see improvements in water and sanitation in Haiti that will have a profound impact on an individual family’s own productivity just for the simple fact that they won’t need to spend every day going to a river or stream to collect their daily water. That’s something that we in the United States take for granted when we wake up in the morning and brush our teeth or use the toilet.
NPH: What are some key public health improvements since the earthquake?
Jordan Tappero: There have been improvements in public health despite the challenging environment, and I think that Haiti’s system of public health is moving in the right direction, and we’d like to see that continue. We have worked in partnership to make profound differences in HIV/AIDS, cholera, and childhood vaccine coverage, all of which will improve the health of those children in the coming generation.
Read a recent article in Lancet by Dr. Tappero and colleagues about public health improvements in Haiti. Some of those improvements include:
- Twice as many people now receive treatment for HIV than before the earthquake.
- HIV testing of pregnant women has increased by 55 percent.
- The government has trained technicians who are routinely testing water and providing education about improved sanitation throughout the country.
- Vaccination rates for children are nearly twice as high than before the earthquake. Before 2010, measles vaccine coverage was just 47 percent. Following the recent 2012 campaign, 91 percent of children sampled were vaccinated against measles-rubella.
- Haiti is on track to eliminate lymphatic filariasis. For the first time mass drug treatment is beginning to protect the entire population, which has been at risk from this permanently disabling, disfiguring, and painful disease. Known as elephantiasis, LF is caused by worms and carried by infected mosquitoes.
Also read a NewPublicHealth profile of CDC Foundation President and CEO Charles Stokes.