Increasing Access to Improved Water and Sanitation
Increasing Access to Improved Water and Sanitation: Increasing access to clean water and improved sanitation are key to preventing the spread of water-borne and diarrheal disease. CDC supports the National Directorate of Potable Water and Sanitation (known by its French acronym DINEPA) to improve waterborne disease prevention and build capacity of the national water and sanitation workforce, both at the central and local levels.
- Communal Potable Water and Sanitation Technicians: CDC Haiti supports building the capacity of local rural water and sanitation technicians known by the French acronym TEPACs. CDC designed and helped implement the initial training for this entirely new workforce. This program placed two technicians in each commune outside the capital area. CDC trained and deployed the TEPACs in late 2012 and early 2013, and as of 2018 after a national evaluation of the program, 209 of the 242 trained TEPACs continue to work in 133 communes nationwide. CDC also collaborates closely with the World Bank, InterAmerican Development Bank, UNICEF and other partners to ensure ongoing support for the TEPAC program.TEPACs provide commune-level water, sanitation, and hygiene (WASH) support through routine assessments of the water systems and reinforce local water committees’ capacity to monitor free chlorine residual in rural water networks. They also performed the first national inventory of community water systems in Haiti, providing valuable data for donors to target resources. During emergency response efforts, TEPACs participate within the humanitarian emergency framework in the implementation of WASH activities. After Hurricane Matthew greatly damaged the southern claw of Haiti in October 2016, the central DINEPA office and many other WASH humanitarian actors relied heavily on the TEPACs to identify and access restricted areas, identify needs, and facilitate response activities. The TEPACs conducted an assessment of hurricane damage for all community water systems in the hurricane-affected areas which helped to target response efforts. Their activities also included monitoring free chlorine residual in tanker trucks and distribution points, visiting water systems with humanitarian WASH actors, and supporting the distribution of water treatment products and other hygiene kit items. Having this existing workforce in the field made the hurricane response more efficient and effective.
- Household Water Treatment and Storage: Since the onset of the cholera outbreak in 2010, there has been a concerted effort to develop a national strategy for household water treatment and storage (HWTS) and expand HWTS program. HWTS can help fill the gap in providing drinking water to households that do not have access to safe drinking water from a community water system or municipal source, particularly in rural areas. CDC is supporting DINEPA to develop a HWTS national strategy, conduct an evaluation of HWTS programs and products in Haiti, and develop a protocol for certifying HWTS products. DINEPA is now working to implement this national strategy with various partners, including NGOs and international organizations working in Haiti.To increase access to and the availability of HWTS products, CDC began working with the International Organization of Migration (IOM) in 2013 on a public-private partnership with La Perle, S.A. to promote, distribute, and sell Aquajif — a locally produced, liquid-based chlorine disinfection product — in Artibonite. Initially sold by community health workers and hygiene promotors, the Aquajif distribution network expanded to include over 200 established retailers and 40 wholesalers, including private businesses and pharmacies, Ministry of Health dispensaries, and community-based organizations. La Perle, S.A. continues to manufacture and sell Aquajif, both wholesale to NGOs and on the retail market.
WASH Assessments and Evaluations: CDC Haiti has conducted and supported multiple WASH-focused assessments to better understand trends in WASH related behavior and to evaluate the performance and capacity of various WASH programs
- Water Quality: CDC, in collaboration with the Haitian Ministry of Health (MOH) and DINEPA, conducted a baseline inventory of private water kiosks in Metropolitan Port-au-Prince in 2013 to better understand the scale and quality of private water sales. The study assessed the kiosks in terms of scale and distribution, major companies and supply and treatment chains, sales volume and price, and water quality at point-of-sale and site of production. With CDC support, the MOH created a database using the results of the assessment to help regulate water sales. This was the first comprehensive assessment of the scale and characterization of private water kiosks in Port-au-Prince and represents an important initiative by the Haitian government towards the regulation of this sector to protect the public health of Haiti.
- HWTS: CDC carried out two assessments – a baseline assessment in 2012 and a follow-up assessment in August 2016 — of water use and household water treatment product use in Artibonite. These assessments included a household survey as well as water quality testing of both improved and unimproved water sources used by households in the area. Results from these assessments indicated that access to improved drinking water sources increased from 43% in 2012 to 59 % in 2016 in rural areas, but concerns remained about the quality of water with 43% of improved sources testing positive for E. coli. In addition, latrine use increased and open defecation decreased in rural areas. Access to safe water remained a challenge in Artibonite, with inconsistent availability and incorrect dosing of HWTS products.
- Sanitation/Fecal Sludge Management: Prior to the 2010 earthquake, no waste disposal or treatment facility existed in Port-au-Prince. Residents largely relied on on-site sanitation facilities such as latrines that require regular emptying and disposal of the waste – known as fecal sludge (FS). FS taken from sites was often dumped into open canals or municipal solid waste dumps. The earthquake and devastating cholera outbreak precipitated the construction and opening of the Morne a Cabri wastewater treatment facility in June 2012. CDC conducted a performance evaluation of Morne a Cabri’s operational capacity to determine if the facility operated in accordance with its design. CDC determined that the facility was effective in treating FS, but much more capacity for disposal and treatment is needed in the capital Port-au-Prince and around Haiti. As a result of the evaluation, DINEPA is working with partners to rehabilitate other existing, but not functional, facilities to expand disposal capacity.
- TEPAC Program: CDC supported the 2016 national evaluation of the TEPAC program in order to assess effectiveness in meeting its objectives and to make recommendations for future training cohorts. In addition to highlighting challenges faced by the TEPAC program, the evaluation recommended streamlining the program to align the number of TEPACs with existing resources; subsequently the number of TEPACs has been reduced.
- Rural Water Supply: CDC supported the rehabilitation of 32 rural community water systems and the installation of chlorination equipment in cholera hotspot communes in Artibonite and Centre to improve service and drinking water safety.
- Hubbard B, Lockhart G, Gelting R, Bertrand F. Development of Haiti’s rural water, sanitation and hygiene workforce. Journal of Water, Sanitation and Hygiene for Development. 2014. 4(1):159-63.
- Gelting, R., Bliss, K., Molly Patrick, M., Gabriella Lockhart, G., Handzel, T. (2013). Water, Sanitation and Hygiene in Haiti: Past, Present, and Future. American Journal of Tropical Medicine and Hygiene. 89(4), 2013, pp. 665–670.
- Domercant J., Guillaume F., Marston B., Lowrance D. Update on Progress in Selected Public Health Programs After the 2010 Earthquake and Cholera Epidemic — Haiti, 2014. MMWR Morb Mortal Wkly Rep 2015;137-140.
- Patrick, Molly, et al. “Access to safe water in rural Artibonite, Haiti 16 months after the onset of the cholera epidemic.” The American journal of tropical medicine and hygiene 89.4 (2013): 647-653.
- Williams, Holly Ann, et al. “Perceptions of health communication, water treatment and sanitation in Artibonite Department, Haiti, March-April 2012.” PloS one 10.11 (2015): e0142778.
- Patrick, Molly, et al. “Assessment of drinking water sold from private sector kiosks in post-earthquake Port-au-Prince, Haiti.” The American journal of tropical medicine and hygiene 97.4_Suppl (2017): 84-91.