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Eliminating Malaria and Lymphatic Filariasis from Hispaniola

Read the plan: Eliminating Malaria from Hispaniola: A Binational Effort (PDF) >

Read the plan: Eliminating Lymphatic Filariasis from Haiti (PDF) >

In 2006, the International Task Force for Disease Eradication (ITFDE) concluded that elimination of malaria and lymphatic filariasis (LF) from Hispaniola (Dominican Republic and Haiti), which is the only endemic island remaining in the Caribbean for both diseases, is "technically feasible, medically desirable, and would be economically beneficial." Malaria affects all 133 of Haiti's communes and LF prevalence exceeds 5 percent in 117 communes, while malaria is concentrated in 14 of the Dominican Republic (DR)'s 152 municipios and LF is limited to 5 foci, the main ones being in the Southeast Region and the La Cienaga Sector, pending evaluation to certify elimination. In October 2008, The Carter Center began an 18 month long US$379,000 bi-national pilot project to accelerate cooperation against malaria in two adjacent border towns (Dajabón, DR and Ouanaminthe, Haiti). Dajabón is the most highly malaria-endemic district of the DR. The project is also testing the use of bed nets against LF transmission in the nearby Haitian town of Trou-du-Nord.

The two countries have now adopted a standard protocol and procedures for combating malaria, including free diagnosis and treatment, addition of the drug primaquine in treatment to reduce transmission, and intensified surveillance and use of microscopy to confirm diagnosis. Long-lasting insecticide-treated bed nets (LLINs) have been distributed in both border communities (6,000 on each side), and local health workers are conducting health education about malaria prevention and treatment in both communities, which have been digitally mapped to locate homes and mosquito breeding sites. Facilities were refurbished, additional staff hired and trained, and the project provided motorcycles, microscopes, computers, communication equipment and other supplies. A bi-national committee was formed and meets every other month on alternate sides of the border to coordinate bi-national cooperation.

Former U.S. President Jimmy Carter and staff from The Carter Center visited Dajabón and Ouanaminthe (clinics, malaria prevention and control offices, homes of families, and mosquito breeding sites) on Oct. 7, 2009 and met with the respective heads of state, ministers of health, partner organizations, and donor representatives on October 8. During the visit, the two Ministries of Health announced a bi-national plan to eliminate malaria from the entire island by 2020, at a combined cost of US$194 million (two-thirds for Haiti, one-third for DR) or $1 per person per year, using active epidemiological surveillance, free diagnosis and treatment, health education, and vector control, including selective indoor residual spraying and LLINs. The two ministries currently spend about $5 million per year for malaria control, and have just received new grants for malaria control of $45 million in Haiti and $7.7 million in the DR from the Global Fund to Fight AIDS, Tuberculosis and Malaria for the period of 2009-2013.

Haiti also announced on Oct. 8 its plan to eliminate LF by 2020 at a cost of US$49.4 million for the period 2011-2020. With major funding from the United States Agency for International Development (USAID) and the Bill & Melinda Gates Foundation, and technical assistance by the Centers for Disease Control and Prevention (CDC), IMA World Health, the University of Notre Dame of Indiana and other partners, by May 2009 Haiti's Ministry of Public Health (MSPP) had conducted Mass Drug Administration with albendazole and diethylcarbamazine (DEC) in 77 of its highest endemic communes. Haiti plans to cover 108 communes in 2010, and all 117 LF-endemic communes by 2011. Efforts to assess the efficacy of LLINs and of DEC-fortified salt as additional tools against LF in Haiti are also underway. The DR expects to eliminate LF by 2010.

President Carter promised to help seek the additional resources that are needed to implement the plans, and representatives of both ministries of health will report on progress to the ITFDE at The Carter Center in Atlanta each year.

ITFDE Recommendations (PDFs)

2006 Recommendations

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2007 Recommendations

2008 Recommendations

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