Posted by Nathan Yaffe
A year into the epidemic, international attention is waning rapidly even as the number of cases continues to skyrocket. The tally of infections just topped the half million mark and the spread shows little sign of slowing. Nonetheless, the number of organizations providing prevention and treatment services has plummeted from 128 to 40 this year — a loss of nearly nine organizations per month. On top of that, assistance has further been delayed because less than half the promised relief aid has been disbursed.
In the current state of affairs, where fewer organizations are working with a smaller pot of resources, it’s crucial to allocate funds to the most effective intervention. Yet despite recommendations from experts like Farmer, there’s still no consensus about what that intervention would be.
The question of how to respond to cholera is fundamentally a technological one. There are several identifiable constraints: existing water and transportation infrastructure, the capacity of medical facilities and NGOs, and available funding. It’s possible, given these constraints, to determine the most effective potential intervention. Ideally, the response would be structured based on such a determination.
With a variety of public and private sector actors all pursuing different approaches, the response has been uncoordinated. Moreover, it’s extremely unlikely that this has yielded the most effective mix of efforts.
In the context of a complex humanitarian emergency, identifying that effective mix is enormously complicated. However, while plenty of people have thrown in their two cents about what ought to happen, there has been no serious effort to think about this from a systems level.
Haiti Rewired is a community of empirically minded practitioners who are passionate about exploring the best approaches to rebuilding. Thus, it seems like a natural place to set a precedent for how the conversation about cholera response should be structured.
Let’s draw on the diverse range of expertise present in this forum. This isn’t just a question for the medical experts, because many of the barriers to service delivery revolve around issues as diverse as physical infrastructure/accessibility and donor coordination. How should we go about determining the most effective response? Should it be divided by sector (e.g. public actors vaccinate, private NGOs rehydrate)? Does the most-needed intervention vary from location to location, or are the needs similar everywhere?
Let’s open this up to a concerted dialogue. Hopefully, in doing so, we can spark the broader dialogue that has been missing.