Download - Team 3
Strategic Plan for the UN Haiti Cholera Settlement Fund
Restoring Justice and Building Capacity
Alexander BazaziAdam BeckmanAmara Frumkin
Oren KannerCelso Perez
Robert Thompson
Development Consulting Group
Solutions must address injustices across time.
Handling claims for harm caused by cholera outbreak
Past
Mitigating cholera transmission and treating current cases
Present
Strengthen Haitian institutions and UN policy to prevent future harm
Future
Problem of Cholera in Haiti
Framework for a Solution
Empowering Haitians and
building accountable institutions
Claims process
($.7B)
Cholera elimination
plan
($2.3B)
United Nations
guidelines
Our three pillars empower Haitians and build accountable national and international institutions.
Claims OverviewGoals
Structure of the Commission
Categories of Claims
Claims Process
Challenges and Opportunities
Goals of the Claims Process
Cooperation among key
actors
International law and
practices
Resource constraints
Sensitivity to needs of Haitians
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.
Structure of the CommissionUN SG/UN
CommissionerGovernment
of Haiti
Haitian Claims Commission
Joint Appointees (3)
Haitian Appointees (3)
UN Appointees (3)
Executive Secretary
Secretariat
Independent Auditors
(local staff to the extent possible)
Compensation Fund
The commission structure blends the vision of the SOFA and past claims commissions to build an efficient and accountable mechanism.
Collective Claims
Individual Claims
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.
Claims Process: A and B
Notification and call for
claims
Submit claims form with evidence
Determination by the
commission
Notification of decision Award
Limit of UN liability
End date for receiving
claims
A and B claims are handled through the same administrative process.
6-18 months
8-10 years
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 Award
C claims are handled through an individualized determination process.
8-10 years
Challenges and Opportunities
• Dedicated commission staff• Contingency fees
Preparing individual claims
• Low evidentiary burden• Cooperation with victims’ lawyers
Evidence for individual claims
• Identifying representatives for the community• Oversight of the spending
Communal claims
• Transparent process and reporting• Feedback from the communities Legitimacy
Gathering claims, evaluating evidence, administering communal claims, and ensuring legitimacy will be the main challenges of the claims process.
Framework for a Solution
Empowering Haitians and
building institutions
Claims process
Cholera elimination
plan
United Nations
guidelines
Our three pillars empower Haitians and build accountable national and international institutions.
Solicit proposals from all sectors.
Evaluate potential for efficacy and
capacity-building.
Haitian government alone lacks capacity to eliminate
cholera
Foreign aid bypasses public sector, hindering
improvement
Need for increased partnerships between
government and NGOs/private sector
Partnerships for strong response & capacity building
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)
Intervention Oversight
Working Groups
Recommendation and assessment
OversightUN
Executive Commission
Strategic Committee
Technical Committee
Treatment & prevention
Water supply & waste
management
Solid waste management
Cholera treatment, prevention, & surveillance
• Lacks capacity to respond to cholera epidemic
Haitian Government
• Demonstrated effective programs critical to cholera responseNGOs
• Increased partnerships between NGOs and Ministry of Public Health
Future Directions
Cholera treatment, prevention, & surveillanceFunding Priorities: Community-Based Responses
20,000 Community
Health Workers
Active Surveillance
Case Management
Education
Vaccination
Water supply & wastewater management
• DINEPA demonstrates strong institutional capacity
Haitian Government
• Smaller role in long-term response
NGOs
• Increased funding directly to DINEPA
Future Directions
Wastewater management
Latrine location & set up
Sewage collection & treatment
Potable water
Disinfecting water Infrastructure
Rural Urban
Community Water Supply & Sanitation Technicians
Target based on DINEPA
Infrastructure Inventory
Community Led Total Sanitation (CLTS)
Water supply & wastewater managementFunding Priorities: Decentralization of water management.
Solid waste management
• Lacks capacity to meet societal needsHaitian Government
• Limited, small-scale interventionsNGOs
• Stimulate private sector investment • Consider long-term public-private partnerships
Future Directions
Proper disposal of medical waste
Seed grants for local reuse businesses
Engage private sector
Solid Waste ManagementFunding Priorities: Urban areas
Haiti Corps Leadership Training Initiative
Steering Committee includes Haitian leaders and settlement fund appointee
Haiti Now Future Corps
Intensive training for current government
employees and leaders
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.
Mitigating Potential Challenges
• Expedited review of early proposals in heavily affected areas
Urgency of current situation
• Plan will become less necessary over time• Simultaneous increase in domestic capacity Sustainability of plan
• Train national employees in management and strategy
Managing rapid workforce increase
• Financial incentives encourage partnershipCollaboration
between NGOs and Gov’t
Framework for a Solution
Empowering Haitians and
building institutions
Claims process
Cholera elimination
plan
United Nations
guidelines
Our three pillars empower Haitians and build accountable national and international institutions.
UN Guidelines for Future Peacekeeping Operations
• Ineffective• Asymptomatic peacekeepers✗Screening
• Ineffective, not recommended✗Antibiotic Prophylaxis
• 2-3 week lead time• Temporary protection✗Vaccination
• Effective way of controlling• Requires case-by-case oversight✔Sanitation
Sanitation is the only reliable method for preventing future outbreaks.
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.
Conclusion
Empowering Haitians and
building accountable institutions
Claims process
Cholera elimination
plan
United Nations
Guidelines
Our three pillars empower Haitians and build accountable national and international institutions.
Summary and Outcomes
Equitable and effective community-based response to redress past harms, improve health, and prevent future catastrophes.
✔
✔
✔
✔
✔
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
Thank you!
ReferencesBarzilay 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-world- factbook/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.
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 Haitienne 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.
Appendices
Problem of Cholera in Haiti
Disempowerment and lack of
accountability
Past harm to individuals
and communities
Persistent ongoing disease burden
Lack of prospective measures to
prevent future harms
Cholera has created a situation of injustice and disease.
Legal basis for claims
Article 105
• United Nations Charter
Section 29
• Convention on the General Privileges and Immunities of the United Nations
¶7• MINUSTAH 2004 Mandate
¶55• Status of Forces Agreement
The legal claims process is based on obligations under international law.
Claims reporting process
Government of Haiti
UN Secretary General
Haitian Claims Commission
Executive Commissioner
Independent Auditors
Category C claims
“Most affected communities” determination
Definition of community
Parameters for “most affected”
Agency problem
Who speaks on behalf of the community
Do they have a legitimate mandate
Oversight
How will the money be spent
How can the community hold
the representative accountable
“Most affected” communitiesDepartment Capital Population Number of Cases % by cases
L'Artibonite Gonaives 1,571,020 125,181 7.97%
Centre 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-Haitien 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%
Total 9,923,243 568,346 5.73%
Claims BudgetNumber of claims
Award or cost per claim ($)
Estimated total ($ in millions)
Total A and B Awards $500
Category A 8300 $4,000 $30
Category B 650,000 $725 $470
C Communal Fund $110
Cost A and B Claims 658300 $140 $89.8
Cost C Claims 1000 $200 $0.2
TOTAL $700
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 $504,450,000
Processing A and B Claims
UNCC claims resolved 2,686,131
UNCC total cost $362,600,000.00
UNCC cost per claim $134.99
Claims in Haiti 658300
Cost A and B Claims $88,863,715.14
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 992
Total cost processing C claims $160,744.26
Estimated comparative costs of sanitation
Cost/unit ($) Units People Cost/Month
Vaccine $1.85 2 11857.5 $43,872.75
Testing
Stool culture $4.00 1 11857.5 $47,430.00
RDT $19.00 1 11857.5 $225,292.50
ProphylaxisDoxycycline (100mg) $0.02 3 11857.5 $711.45 Azithromycin (250mg) $0.16 4 11857.5 $7,588.80
Turnover/month 10%
DPKO personnel 118,575
Estimated comparative costs of sanitation
Wage/month Units People Cost/month
Sanitation
Sanitation officer $3,333.33 1 5 $16,666.67
Wage/year $40,000.00
Months/year 12
No. Employees 5
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)
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)
20,000 Community
Health Workers
Cholera treatment, prevention& surveillance
20,000 Community
Health Workers
Active Surveillance
Case Management
Education
Vaccination
Cholera treatment, prevention& surveillance
Cholera treatment, prevention& surveillance
20,000 Community
Health Workers
Active Surveillance
Case Management
Education
Vaccination
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.
Cholera treatment, prevention& surveillance
20,000 Community
Health Workers
Active Surveillance
Case Managemen
t
Education
Vaccination
• Assessment of severity
• Treatment or referral to health facility
Cholera treatment & prevention
• Household water safety
• Proper use of chlorine
20,000 Community
Health Workers
Active Surveillance
Case Management
Education
Vaccination
• Hand washing after defecation and before food preparation
• Educate traditional healers
20,000 Community
Health Workers
Active Surveillance
Case Management
Education
Vaccination
Cholera treatment, prevention& surveillance
• Target high-risk communities
• Geospatial analysis
Budget for health intervention
Short term (2014-15)
Medium term (2016-2018)
Long term (2019-2024) TOTAL
Total Claims Expense 700,000,000
HEALTH RESPONSE (ENDORSED NATIONAL PLAN & INNOVATIONS)
DINEPA Water supply 81,000,000 575,000,000 168,612,500 824,612,500
Wastewater and excreta treatment 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
Ministory Public Works/LC/T
Institutional strengthening of solid waste and management 1,000,000 1,500,000 500,000 3,000,000
Waste Collection and treatment (incl. technicians) 140,000,000 230,000,000 33,425,903 403,425,903
Ministory of Public Health 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
SMS 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 958,309 1,908,392 102,934 2,969,635
Total Plan Expense 500,368,309 1,221,314,395 558,906,340 2,300,000,000
TOTAL PLAN COST 3,000,000,000
Haiti NowIdentify 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.
Recruit Future Leaders in Secondary Schools
Train for Work in Public Sector
Employ in Government Agencies
Haiti Future will strengthen long-term domestic capacity through comprehensive leadership training.
Focus on gender
equity and geographical
diversity
Improve management of health and development
Strengthen domestic
institutions
Future Corps
Future Corps incentivizes talented students to pursue public sector careers.
Advertise in schools and communities.
Pay participants families.
Provide summer programs.
Step 1:
RecruitMatch students based on interest and skills.
Duration dependent on job.
Step 2:
Train
Step 3:Employ
Place at low-level in government agency.
Provide mentoring in early years.
Promotion dependent on performance.
Future Corps: Program Details and Logistics
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
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 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
Future Corps: Program Details and Logistics
• Creation of Haiti Corps Planning Committee with representatives from Haitian Government and Appointee from Settlement Fund
• Students based at University of Haiti
Oversight
• United Nations recognizes institutional capacity building as key to poverty reduction
• Incentive-based training programs work on small and large scales
Evidence
• 100 students recruited annually• Funding provided for first 10 years of program• Funds cover administration, implementation and student costs
Finance
Future Corps: Investing in a Cycle of Empowerment
Recruit Young
Haitians
Provide Training for
Public Sector
Placement in
government agency job
Opportunity for
promotion and
leadership
Empowering individuals
and institutions
Haiti Corps BudgetFuture 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
UN Guidelines – Epidemic Control
Response
Initial investigation
Intervention
Community engagement
Monitoring
Response Coordination
Task force committees
National and field
Government and non-profit