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