Water and Sanitation in Haiti : A Global Health Issue

Haiti is the most impoverished nation in the Western hemisphere and is home to nearly 10 million people (Central Intelligence Agency [CIA], 2014).  The nation occupies less than 28 thousand square kilometers on the Western half of the island of Hispaniola situated in the Caribbean Ocean and is prone to devastating natural disasters including hurricanes, earthquakes, and typhoons (World Health Organization [WHO], 2012).  Natural disasters removed, Haitians struggle to survive.  Waterborne illnesses including cholera, typhoid, hepatitis, and chronic diarrhea are among the leading causes of death for all age groups in Haiti (WHO, 2012).  Although awareness and aid have grown over the past few decades there is still much progress needed and there are more lives to be saved.

Significance of the Issue

More than 2.5 billion people worldwide have no access to basic sanitation resulting in the deaths of an estimated 3.5 million people including 1.6 million children annually (Wake & Tolessa, 2012).  Zeroing in on Haiti, 80% of the rural population has no access to sanitation and open defecation is commonplace (International Federation of Red Cross and Red Crescent Societies [IFRC], 2010).  The result is contamination of already limited water sources that are used for cooking, drinking, and bathing.  In early 2010 a magnitude seven earthquake resulted in devastating destruction of an already crumbling infrastructure, loss of an estimated 160,000 lives, and displacement of nearly 1.5 million people (Bliss & Fisher, 2013).  An outbreak of cholera followed that infirmed greater than 670,000 and killed more than 8,000 people over the next 3 years (Bliss & Fisher, 2013).  A ten year plan was initiated by the Haitian government to eliminate cholera by means of improved sanitation, clean water supply, and education of citizens on proper hygiene practices.  According to Bliss and Fisher (2013), this was projected to cost around $2.2 billion over the ten year period with the United States providing more than $95 million in the immediate post-outbreak phase alone.

Current U.S. Global Health Policies/Initiatives

The United States Agency for International Development (USAID) is committed to improving life in the global community on many fronts including water and sanitation.  The agency launched its first global Water and Development Strategy in 2013 with a focus on  sustainable improvements in water supply, sanitation, and hygiene (WASH) (USAID, 2013).  The plan is projected to sustainably improve access to clean water for more than 10 million people and improve sanitation for more than 6 million people worldwide, including in Haiti over five years.  In addition, the U.S. is aiding Haiti’s 5.5 million farmers to improve the safety and abundance of their harvest through sharing valuable agricultural cultivation, irrigation, and fertilization techniques (USAID, 2013).b

Who Else is Helping?

There is an army of other nations and organizations participating in various capacities in the efforts to improve water and sanitation in Haiti.  The Regional Coalition on Water and Sanitation to Eliminate Cholera in Hispaniola was organized by the Pan American Health Organization/World Health Organization, the Centers for Disease Control and Prevention, and the United Nations International Children’s Fund in 2012.  It has grown in membership since its inception to 21 members and functions to train Haitian technicians on epidemiology and outbreak surveillance and on setting up cholera treatment units as well as mobilizing resources towards meeting the goal of cholera elimination in Hispaniola by 2022 (Bliss & Fisher, 2013).

The Haitian government has established the National Directorate for Water Supply and Sanitation (DINEPA), charging it with the responsibility of rehabilitating the earthquake damaged water network in the Port Au Prince area, implementing sanitation projects throughout the country, establishing community level water committees, and training native water and sanitation professionals.  Also involved in the efforts are a montage of faith-based organizations and private sector groups as well as numerous countries including the European Union, France, the United Kingdom, Sweden, Cuba, Brazil, and France (Bliss & Fisher, 2013).

Forward Progress with More to be Done

DINEPA was established in 2009, just nine months prior to the devastating earthquake that shook the already fragile infrastructure of Haiti.  It arose out of pre-earthquake recognition of disease and pestilence related to poor water quality and lack of sanitation.  The agency had to almost immediately after being established, go into emergency response mode.  Although it is growing and slowly progressing toward the goal of cholera elimination, the agency remains in its infancy and struggles to transition from emergency response mode to routine operations mode.  Greater funding is required to assist this agency in its efforts to establish long-term, sustainable solutions to the water and sanitation problems in Haiti.  Collaborating with DINEPA with a greater goal of recruitment of a work force to include the private sector for the building and maintenance of public utilities, particularly in the rural areas where the most disparaged people reside is the greatest need (Wake & Tolessa, 2012).  Further energies are required also in the education of Haitians on hygiene and hand washing and the importance of clean water sources and adequate sanitation in the prevention of disease and illness.


Clean water and sanitation for residents of developed nations are often taken for granted.  Basic commodities such as these are considered luxuries in Haiti and many other poverty-stricken nations of the 21st century and billions worldwide struggle to survive without access to these seemingly standard utilities.  Illness and death directly related to lack of clean water and sanitation are rampant yet amenable. Efforts to address this global disparity have been underway for many years, but must be magnified if significant progress is to be made toward elimination of preventable waterborne illness and death.

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