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The Feasibility of Malaria Elimination on the Island of Hispaniola, with a Focus on Haiti

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The Feasibility of Malaria Elimination on the Island of Hispaniola, with a Focus on Haiti The feasibility of malaria elimination on the island of Hispaniola, with a focus on Haiti An assessment conducted January–June 2013 Photo © 2012 Natalie Briggs/Global Health Outreach, Courtesy of Photoshare In St. Marc, Haiti, two boys play with playdough while their parents are at the dentist. The cover photograph is used for illustrative purposes only; it does not imply any particular health status, attitudes, behaviors, or actions on the part of any person who appears in the photograph. 1 Contents Abbreviations ................................................................................................................................................ 6 Executive Summary ....................................................................................................................................... 8 Objectives ................................................................................................................................................. 8 History ....................................................................................................................................................... 8 Current response ...................................................................................................................................... 8 Technical assessment ................................................................................................................................ 8 Operational assessment............................................................................................................................ 9 Financial assessment............................................................................................................................... 10 Limitations .............................................................................................................................................. 10 Next steps ............................................................................................................................................... 11 Introduction ................................................................................................................................................ 12 Background ............................................................................................................................................. 12 Objectives and overview ......................................................................................................................... 13 Situational Review ...................................................................................................................................... 15 History of malaria in the Caribbean ........................................................................................................ 15 Malaria on the island of Hispaniola: context .......................................................................................... 17 Malaria on the island of Hispaniola: history of the response ................................................................. 19 Overview of the current response on Hispaniola ................................................................................... 24 Technical Feasibility .................................................................................................................................... 31 Epidemiology of malaria in Haiti in time and space................................................................................ 31 Where is malaria in Haiti? ....................................................................................................................... 35 Technical strategies for attacking malaria foci ....................................................................................... 39 Attacking foci strategically ...................................................................................................................... 48 Maintaining the gains ............................................................................................................................. 50 Technical feasibility summary ................................................................................................................. 51 Operational Feasibility ................................................................................................................................ 53 Improving systems for identification and treatment of infections ......................................................... 53 Targeting attack measures ...................................................................................................................... 59 Strengthening governance and coordination ......................................................................................... 65 2 Planning to maintain elimination ............................................................................................................ 70 Financial Feasibility ..................................................................................................................................... 72 Current financing .................................................................................................................................... 72 Costing elimination ................................................................................................................................. 73 Efficiency and effectiveness .................................................................................................................... 77 Financing to maintain the gains .............................................................................................................. 79 Conclusions ................................................................................................................................................. 82 References cited ......................................................................................................................................... 84 3 ACKNOWLEDGEMENTS This report was authored by the Clinton Health Access Initiative in close collaboration with the Haitian MSPP/Programme national de lutte contre le malaria, the Global Health Group of the University of California, San Francisco, David Smith of Johns Hopkins University, Azra Ghani, Griffin Jamie, and Lucy Okell of Imperial College, Andrew Tatem of the University of Southampton, and Linus Bengtsston from Flowminder. It summarizes the work and contributions of many individuals, without whom this report would be impossible. In particular, we acknowledge the generous sharing of data by the Haitian MSPP/Programme national de lutte contre le malaria, the Dominican Republic's CENCET, the United States Centers for Disease Control & Prevention, Population Services International, Flowminder and Digicel, and all of the GFATM sub-recipients We gratefully acknowledge funding for this work from the UCSF Global Health Group. The below individuals were interviewed during the course of this project, and we thank them for their contributions: Organization Name AOPS Dr Philippe Hirsh Catholic Medical Mission Board Dr Dianne Jean-François Catholic Medical Mission Board Dr Syndie Saint-Hilaire CCM Edner Boucicault CDC Dr Alexandre Fils Semé CDC Michelle Chang CDC Kimberly Mace CDC Amber Dismer CDS Dr Lionel Barthelemy CENCET Dr Jose Manuel Puello CENCET Luz Mercedes CENCET Gilda Ventura CENCET David Joa CENCET Dr Keyla Ureña Consultant Dr Maryse Narcisse Cornell University Dr Linnie Golightly MSPP/Departement Epidemiologie, Laboratoire et Recherche Ernst Jean-Baptiste FOSREF Dr Fritz Moise GHESKIO Dr MacArthur Charles IDCP Jose Vicente Ruiz MSPP/Laboratoire national de santé publique Dr Jacques Boncy MSPP/Laboratoire national de santé publique Dr Alexandre Existe MSPP/Laboratoire national de santé publique Professeur Christian Raccurt MARCH Dr Antoine Augustin Ministry of Agriculture Dr Max Millien Ministry of Agriculture Jean Rodney Jacques Simon Ministry of Environment Jean Fanfan Jourdain MSPP - Direction générale Dr Marie Guirlaine Raymond 4 PAHO Dr Jean-Marie Rwangabwoba PAHO Dr Yacouba Zina PESADEV Weaver Destine MSPP/Programme national de lutte contre le malaria Dr Roland Oscar MSPP/Programme national de lutte contre le malaria Darlie Augustin MSPP/Programme national de lutte contre le malaria Joseph Frederic MSPP/Programme national de lutte contre le malaria Yvan Saint-Jean MSPP/Programme national de lutte contre le malaria Dr Jean Frantz Lemoine PSI Martin Finnegan PSI Emery Nukunziza PSI Alain Fournier Guerrier PSI Berlin Florial PSI Samuel Jean Service national d'eradication de la malaria (former consultant) Gretchen Bergrren Service national d'eradication de la malaria (former consultant) Warren Bergrren Service national d'eradication de la malaria (former director) Dr Marie Yolene Surena MSPP/Unité de coordination des programmes Dr Brunel Delonnay MSPP/Unité de coordination des programmes Jean-Robert Theloussaint University of Florida Dr Bernard Okech University of Notre Dame Dr Thomas Streit VDH Arnoux Descardes Zanmi Lasante Dr Joanel Joasil Zanmi Lasante Marie Mirlande Tulme 5 ABBREVIATIONS AOPS Association des Oeuvres Privées de Santé ACT Artemisinin-combination therapy API Annual parasite index BCC Behavior change communication CAPS Centre d’ Appui aux Politiques de Santé CARICOM Caribbean Community CIFAS Centre d'Information et de Formation en Administration de la Santé CDS Centres pour le Développement et la Santé CENCET Centro Nacional de Control de Enfermedades
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