Port-au-Prince, 7 April 2018: “It could be one of the most important activities happening in Haiti now,” states Michel Ange, team leader of one of the 58 rapid response teams working relentlessly to eliminate cholera in Haiti. “We are saving lives, educating the local population around hygiene practices, and helping to eradicate a killer bacterium.”
In 2017, for the first time since cholera was introduced to Haiti in 2010, the epidemic was under control and the highest suspected cases were concentrated in three out of the ten Departments: West (31%), Artibonite (29%) and Centre (19%). 2018 began with the lowest numbers recorded, 995 cases between January 1st and March 31st compared to 4,248 cases for the same period last year (source: DELR/MSPP). This evolution is largely due to a strategy that combines reinforced local coordination, surveillance, solid rapid response, and enhanced prevention through water chlorination and intensified hygiene awareness. With the support of UNICEF, the Ministry of Health launched this “alert-response” strategy in 2014, resulting in the activation of rapid response teams that are staffed with agents of the Ministry of Health response teams and Non-Governmental Organizations (NGO). It required three years of close monitoring and technical support to reach a satisfactory level of performance, and now the results speak for themselves. Due to the availability of funding, all rapid response teams were activated in 2017, resulting in an unprecedented response rate of 95 percent to all suspected cases.
“We are good at what we do. You can see that in how the number of cases has dropped in the last year,” states Michel Ange. She is not showing off but simply stating a fact. Never has the chance to eliminate cholera been so close, yet the way there was hard. “It was an uphill battle but organizations like Solidarity International and UNICEF didn’t give up at all.”
UNICEF and the Ministry of Health continue to support a network of response teams nationwide. Four NGOs, are working hand in hand with the 13 teams from the Ministry of Health, called EMIRA (in French, Equipe Mobile d’Intervention Rapide), to deliver a complete package of activities: visiting affected households and an average of 12 houses living in a 50m perimeter around the patient’s house and establishing a “cordon sanitaire” to avoid the disease from spreading in the community. The teams provide oral prophylaxis to the patients and their families, disinfect homes, and distribute oral rehydration salt, soap and water chlorination tablets. They also secure water sources by establishing emergency water chlorination points or support DINEPA (National Directorate for Drinking Water and Sanitation) to chlorinate the water systems in affected areas when needed.
These NGO teams are composed 100 percent with skilled Haitian professionals who have been trained to investigate and respond to suspected cases of cholera and other types of acute diarrhea, which directly benefit children as diarrhea remains one the main causes of child morbidity in Haiti.
Fund predictability also allowed for the improvement of complementary health and hygiene promotion activities and community mobilization, activities, crucial to ensure quick outbreak control. In addition to the work of response teams, UNICEF’s NGO partners deployed community engagement teams which reinforced the rapid response by conducting hygiene awareness interventions in schools, churches, places or events gathering people in affected areas, and food hygiene sensitization in public market places.
In the metropolitan region of Port-au-Prince, rapid response agents like Michel Ange have contributed to respond to approximately 5,000 suspected cholera cases in 2017, and to sensitize over 360,000 people in affected neighborhoods. It is a labor of passion and love. “Haiti is my home, my country, and I love it with all my heart. Of course, it is a difficult place, but with the help of organizations like Solidarités International and UNICEF, we are learning techniques to address our problems, to take over,” says Michel Ange with a smile. “My children will grow up in a stronger Haiti, a better Haiti than the one I had…we will all help each other to learn and grow together.”
Today, the situation invokes optimism but the fight is not over. To avoid a resurgence of the epidemic, an effective set-up must be maintained to ensure surveillance, prevention and response until the last case is gone; this requires steady and predictable funding.
Haiti: Institutional death due to Cholera, Epidemiological Week 7 (February 2018):
Together, we can give each child more than a day, more than a month, more than survival.
Did you know that every year in Haiti, 9600 children die at birth? Although impressive and unacceptable, this figure is still marginal on a global scale. Indeed, according to a new report on neonatal mortality published today by UNICEF and available here, there are 7,000 newborns in the world who die every day.
“We know that the vast majority of these babies can be saved by providing affordable, quality health care for every mother and newborn. Small gestures from each of us would help ensure the first steps of these newborns in life. Says Henrietta H. Fore Executive Director of UNICEF.
In Haiti, at the maternity Isaie Jeanty near Cité-Soleil, a rather difficult area of the capital Port-au-Prince, this little miracle occurs every day. For Liliane Jean-Charles, a young mother living in the area of Canapé Vert, this second universal experience of childbirth went very well for her.
“There was pain, but the doctors took very good care of me during the delivery says Liliane. Despite the rather limited technical resources of this maternity, Liliane really felt that there was a pair of safe hands to accommodate her baby at birth and in the minutes that followed. “They showed a lot of patients waiting for the baby to show up,” says Liliale, already standing next to her bed, just minutes after giving birth.
His baby named Christopher is his second: “I love children because it’s a gift from God. It’s a gift that embellishes the house. Because without children, there are no flowers in the house.”
Thanks to the care of MIJ medical staff, Liliane Jean-Charles and her little Christopher will be able to return home quickly.
For the year 2017, 3340 childbirths were performed at the Maternity Isaie Jeanty of Port-au-Prince. UNICEF is contributing in his way to this challenge by strengthening the technical and logistical capacities of the maternity ward by distributing various equipment, accessories and materials such as gynecological tables, medical instruments and products.
Together, we can give each child more than a day, more than a month, more than survival.
For more informations https://www.unicef.org/french/every-child-alive/
The 2017 is about to come to an end, it has been a year rich in intervention for UNICEF Haiti. We have supported the actions of the Government of Haiti and reinforcing its capacities in the areas that have been linked to survival and development of the children. Our actions are guided by our mandate which is the wellbeing of all the children.
It is the principle of equity that guides us to allow the most vulnerable children and families and those living in the most remote places to benefit from a life-saving humanitarian intervention. UNICEF has been on all fronts this year 2017.
Among other actions:
-The certification of foster families is part of one of the alternatives to placement of children in institutions. We also proceeded to the Certification of ” Schools Friend of Hygiene” with partners. Children will be able to evolve in a healthier environment.
– UNICEF has also contributed to strengthening the health system by providing technical support to the MSPP and developing community health systems by training community health workers and strengthening the network of health workers. These agents will help save lives.
– From January to September, more than 32,000 children aged 6 to 24 months and 22,000 pregnant and lactating women received several micronutrients to improve their diet and fight iron deficiency anemia.
In addition, we continued with our interventions in the departments affected by Matthew:
- UNICEF enabled access to safe water to more than 640,000 people since the passage of Hurricane Matthew.
- 120 schools damaged by Hurricane Matthew have been rehabilitated, which facilitated the return to class for over 30,000 students. More than 10,000 items of school furniture were provided in 139 schools, and 27,000 children received psychosocial support.
- In 2017, a total of 10,628 children under five with severe acute malnutrition and 7,381 children with moderate acute malnutrition were treated. More than 32,000 children 6-24 months of age, and 22,725 pregnant and lactating women received micronutrients.
Due to climate change, cyclones are becoming more and more devastating. Strengthening awareness of risk and disaster management is a priority. We held consultations with young people in the South and Grand’Anse, the two departments most affected by Hurricane Matthew. Awareness also goes through our youth and adolescents.
2017 is leaving and 2018 is already knocking on the door. There will be new challenges, because the important thing is to capitalize on the good results recorded but also to correct those who deserve to be. Nevertheless, the goals will remain the same, creating an environment that allows Haitian children to develop their full potential.
We must strengthen the fight against cholera, victory is at hand, we can eliminate cholera.
I send a special greeting to all the children of Haiti, to our partners, and I wish you all a happy holiday.
The locality of Nirva (Department of Centre) is one of the first to be declared “End of open defecation” (ODF). Since the committee “Community Approach to Total Sanitation (ACAT) is doing everything possible, between hygiene awareness and home visit, to allow the community to continue on this good start. Cholera has virtually disappeared in this community.
“ACAT has had a major impact in the community. Before, cholera was wreaking havoc. Community members came together to solve the problem by helping people build toilets so that it does not happen again, “says Wilfrid Moise, chair of Nirva’s ACAT committee, who is satisfied with the current situation.
The locality has 150 families, there were only 66 latrines. As part of the ACAT, people have built nearly 42 latrines. Nirva is part of the communal section of Grand Boucan.
André Aimable, a member of the community, still remembers the difficult times the population had to go through, concerning the spread of cholera. “The ACAT is an extremely important experience for us, because before the parents had a lot of sadness. When their children had cholera, by taking them to the treatment center, they did not know if the children would come back alive, “he recalls.
DINEPA, UNICEF and Zanmi Lasante came to them, raising awareness about the importance of latrines and promoting hygiene. They decided to take part in the program.
Difficulties to accept the project
Initially it was not easy, as members of the population expected to receive material or financial assistance to build the latrines. This was even more difficult, as at the same time other organizations were building free latrines. The committee members showed patience and pedagogy to convince people to agree to build the latrines themselves.
“We had to explain to them that they will be the big beneficiaries of these latrines. Because it will be a considerable gain for the health of their children and for them too. We all need these latrines and we are witnessing the ravages of cholera, we have to get together to get there, “says Casséus Mercidieu, another member of the committee.
To dig the holes of the latrines, it needed willpower and courage. The committee members gathered at the end of the day by helping the people of the community. There was a snowball effect and everyone wanted a toilet. The toilets are built with the means of the edge, either in straws, in cloths, and rarely in concrete.
The community was declared “End of Open Defecation” (ODF) in February 2015 and there is a big testimonial party. “Since then we have never had a case of cholera in our community,” says Casseus, satisfied.
A coalition of all partners for monitoring
Jean Montas, Community WASH Officer, within Nirva, is responsible for hygiene awareness. He admits that he has no free time because he must make regular visits to the homes to make sure that certain hygiene rules are respected. For example, if the latrines are clean, if the openings are covered, if the tipitap (sort of gallon for washing hands) are in good working condition. Hygiene awareness is raised in schools, in churches, and in all places of assembly. Jean Montas puts the emphasis on the measures to be applied to avoid catching cholera.
He wonders when he can take a vacation. “But we belong to the locality, we must help people, it is the mission that I gave myself,” he says.
UNICEF supports Zanmi Lasante, implementation partner in Central Plateau. It is executed with the support of the National Directorate of Drinking Water and Sanitation (DINEPA) and the Ministry of Public Health and Population.
The numbers of cholera cases have significantly reduced in 2017. They have never been so low. The new Cholera strategy has paid off. At the center of attention are the rapid response teams, who are true warriors. The members will fight cholera in the targeted departments, in good weather or rainy weather. Mainly in the department of Centre (Plateau Central), where the distances to be covered are sometimes immense. UNICEF is one of the key players in the fight against cholera in the country.
Mirebalais, November 23, 2017-The all-terrain car is rolling on the rocks, the road is not good. It is necessary to zigzag between the crevasses, to avoid the mud. It rained last night, but conditions are acceptable to reach Menaj, a locality close to the town of Laschaobas (Centre).
ACTED’s rapid response team, UNICEF’s partner, with their recognizable green T-shirts from several meters, is on the warpath. They come to conduct an awareness session. But the community is quiet because today is market day. However, there are still people who will be able to listen to messages and receive hygiene kits if it’s needed.
A member of the team with a loudspeaker has already broken off to bring together the people who are present. In the empty valley, his voice is echoed. He managed to gather about twenty women and a few children. Men are in the fields.
Important to continue awareness
The team begins to raise awareness about hygiene. Today, the team is there for a reinforcement of awareness. It usually takes place after the distribution of hygiene kits. These kits contain soap, oral rehydration serum, and aquatabs (chlorine tablets) and a pail with a robinet.
“You have to wash your hands in crucial moments, before eating and after getting out of the toilet. Use treated water for your health and that of your children’’. After these messages, the team asks the residents who do not live too far to bring the water they use to test the chlorine residual, to check if they have followed the instructions.
The activities of rapid response teams consist of three parts: investigation, response, awareness. “Regarding the situation for the Lower Plateau, it’s pretty quiet because we went from 38 cases per week to 14 cases and for the moment it’s only 7 cases,” says Jennyfer Joseph, cholera project manager for the Lower – Central tray.
To travel long distances
One of the biggest challenges for rapid response teams is returning to the long distances they must travel to reach remote locations. Sometimes it can take hours or even days. Because they must sleep on the way, to continue their activities and to make sure that everyone is sensitized to the principles of hygiene.
“In some mountainous places, even mules cannot pass, but we have to go if there are cases of cholera. It’s part of our mission. Sometimes we do missions of several days in these localities to reach everyone, “recalls Nadia Delmond, emergency team leader for Acted, recalling that the reception of people is always positive.
On November 21st, the hygiene certification ceremony of 152 schools took place at the Montana Hotel in Port-au-Prince.
This activity was organized by the Ministry of National Education in collaboration with the Ministry of Public Health and Population, DINEPA, UNICEF and several other partners including the Inter-American Development Bank.
The project/program officially launched in November 2014, aims at the constitution of a number of model schools, in hygiene, in each of the ten departments of the country. In order to receive their certification, the 152 schools had to comply with a number of standards and criteria related to hygiene, water and sanitation.
Deserving schools represented at the ceremony all demonstrated during the inspections that they had available toilets and latrines, handwashing points near the toilets, the availability of water for everyday use and that technical supervision was provided by school inspectors and engineers. School principals also presented their commitment and participation in hygiene education and the establishment of a functioning health club in their respective institutions.
New hygiene behaviors
“I find that there are a lot of differences because now we are trying to create new hygiene behaviors among students. Says Emeline Rafael, director of the Jérémie Young Women’s High School, just after receiving her plaque confirming the certification of her institution.
“They are given guidelines but it is up to them to manage their own health conditions, they are young teenagers from 11 to 12 years, they understand very well what we expect from them. They are asked to set up committees and give them instructions on hygiene. They are taught to have positive behaviors, to wash their hands after going to the bathroom if not, they do get sick and go out of school. If we are not in good health, we will not stay in school either, says the director.
“The certification of the schools is an absolute necessity. The analysis of the situation carried out in 2012 gives the following figures: 25% of Haitian schools have drinking water installation, 50% have functional toilets, 69% have handwashing station. 52% of them teach hygiene or promote it.” Said Mr. Marc Vincent, UNICEF Representative during his remarks.
13 schools supported by UNICEF
During this first evaluation in 2017, of the 17 certified schools in the departments of the Center and Artibonite, 13 are supported by UNICEF (9 in the Center and 4 in the Artibonite). 8 other schools in Artibonite are ready and awaiting evaluation for their certification.
The schools that UNICEF helped rebuild across the country, after the January 12 earthquake are all equipped with toilet blocks with possibility of collecting rainwater because the issue of water can be a challenge in some parts of the country. UNICEF also conducted hygiene awareness sessions for school staff and schoolchildren.
“This certification will help to make schools safer. Because of the insalubrity of some schools, they can become a threat to the health of children. School should be a protective environment. We know they are particularly vulnerable to microbes and the health of our children is a top priority, “said UNICEF Representative Marc Vincent.
Still a lot of effort
Despite the success of this program, there is still much work to be done. According to the latest available statistics, the pupil/toilet ratio in Haiti is currently 128, whereas the standards provide for 25 to 50 students per cabin. 72% of the Haitian population does not have access to adequate sanitation and 42% do not have adequate access to drinking water while access to health services is limited. Even though 20% of drinking water control in schools is provided by DINEPA, 73% of schools in the country still have no control over the quality of this water.
In this sense, through the representative of the Director General, Mr. Guito Edouard, DINEPA is committed to strengthening its collaboration in the project to enable the achievement of common objectives for the well-being of Haiti’s children.
All children have the same rights
“UNICEF places a lot of emphasis on equity that advocates for access to care and service for all children without distinction. All children have the same rights. These certified schools are in line with Sustainable Development Goals 3, 4 and 6, which refer to “good health and well-being, quality education, clean water and sanitation, respectively. We need to do a lot more, so that the SDGs, more than accounting goals, become a reality, “said UNICEF Representative Marc Vincent.
The project carried out by the School Health Department aimed to certify over 2 years, a minimum of 100 schools, (10 on average per department), from the point of view ” water, sanitation and hygiene “, so as to propose them as models at national level. With already 152 schools that have been awarded the certification, the country is on the right track.
Hygiene, keys to development
Mr. Charles Ernest Chatelier, Director General of the FAES, declared in front of the room: “Let’s all be friends of the hygiene because it is one of the keys of the development of the country.”
Establishments certified received a plaque of honor. This status will be reviewed every two or three years, after evaluation. A new sticker will then be affixed to the plate in case of maintenance of good hygiene practices. Other institutions will gradually be added to the list, at the level of each geographical department.
“We have to go beyond a simple project. We need to build better citizens, “said Pierre Josué Agénor Cadet, Minister of National Education.
Through this program, the Ministry of National Education intends to: make known and propose as models, at the national level, the certified schools; encourage principals, school staff, students, parents and the community to maintain schools, with the support of the School Health Department; to encourage the regular inspection of these schools from the physical, health and educational points of view; Encourage the establishment in these institutions of a health club made up of pupils and operating under the aegis of the Direction and / or the School Council; to show decision-makers and the general public that, as things stand, health is the best gateway to excellence and the quality of education.
The Deputy Secretary General of the UN and the Special Envoy for Haiti visit UNICEF’s Cholera frontline teams
Haiti, St Michel-de-l’Atalaye, November 4th 2017 – On the occasion of a three-day visit to Haiti, the United Nations Deputy Secretary-General (DSG), Ms. Amina J. Mohammed and the United Nations Secretary-General’s Special Envoy for Haiti, Ms. Josette Sheeran, visited UNICEF supported cholera and sanitation projects in the Artibonite department. Accompanied by UNICEF Representative Marc Vincent and other members of the office, the visitors came to witness an approach that combines rapid response with prevention in the fight against cholera, and which has yielded promising results over the past two years. The country is now seeing the lowest number of cases since the beginning of the epidemic in 2010. Yet much remains to be done.
According to latest DINEPA data, 72 percent of the Haitian population does not have access to adequate sanitation and 42 percent lacks adequate access to safe water while access to health care services is limited. One of the locations where access to water, sanitation and health care remains a challenge is Saint-Michel-de-l’Atalaye, one of the epidemic’s current hotspots and the destination of the field visit.
Upon arrival by helicopter, the delegation first visited a centre for the treatment of cholera and acute diarrhoea, and received a briefing from Ministry of health staff. Six patients, including two children were present showing the human face of the cholera bacteria. The visit left no doubt—one death from cholera, is one too much.
Following the treatment centre the delegation went on to observe the work of a rapid response team, managed by UNICEF partner Action against hunger. Within 48 hours after a suspected case of cholera is identified, teams decontaminate the affected household and those in its immediate vicinity, deliver emergency cholera packages—comprised of water purification tablets, ORS, and other hygiene products—and conduct sensitization/education outreach. The Special Envoy for Haiti has noted on a number of occasions, most recently with the Prime Minister of Haiti, that it is this innovative approach that has led to the dramatic reduction in the transmission of cholera. “These are the true heroes,” underlined the SE.
The visit concluded at the village of Peltam, one of the first communities to declare itself free from open-defecation. The UNICEF-supported Community Approach to Total Sanitation (ACAT), accompanies families in 16 high risk communes to eliminate open defecation. Its success is based on the commitment of the local population, especially their hygiene committee. Peltam’s hygiene committee is special – not only does it have an equal number of women and men, it also has two children as members. “I wanted to do something for our future, and the hygiene committee allows me to get things done,” explains Adziz; who just turned 14. “In a couple of years, you will be seen as heroes.” Said Ms Mohammed. “The present is hard, but if you keep up the hard work it will pay off.”
Tackling cholera requires an integrated package. Surveillance, response and prevention, all three must be in place, and their respective weight adjusted in view of the evolving situation.
“2018 offers a unique opportunity for decisive steps in the battle against cholera”, stressed UNICEF Representative Marc Vincent. Cholera transmission has dropped dramatically from over 18,000 new cases per week at the onset of the epidemic to 250 per week this year, yet eliminating cholera will require more funding
“An average of between 150 and 250 women, children and men continue to be infected every week. We can and must stop this.” It appears that all major players agree on this.
On the first day of the visit, a High-Level Cholera Committee meeting was organized. The meeting served as an occasion for the Haitian Government and the UN representatives to jointly express their determination to achieve zero transmission of cholera. They reiterated their commitment to achieving the 2030 Sustainable Development Goals, including improving access to water, sanitation and healthcare.
At the conclusion of her trip, the DSG noted that “In our visit we saw community efforts by women, men and young people—some very young—who are involved in fighting cholera every day on the front lines. They are driving their own solutions, and together addressing the challenges of accessing water and sanitation. We saw this yesterday in Saint-Michel-de-l’Atalaye, where the community has empowered itself and come up with its own solutions to accessing sanitation by building toilets in many homes and in community spaces, and by supporting people who fall victim to cholera. When they succeed together, even on a small scale, it shows that they and we together can also succeed on a large scale—for all Haitians. They are the real heroes, and we must support them to end cholera in Haiti,” emphasized the DSG.
On Saturday, October 14th, in the margins of the celebration of the “Global Handwashing Day”, the Gymnasium Vincent (Port-au-Prince) was celebrating an important event for the good of the children: the launch of an album songs inspired by the manual “Facts for life” (“Konesans pou sove lavi”).
Taking into account the playful aspect of singing, its capacity to gather and to raise people’s awareness, beyond differences, this medium has been privileged to convey essential family practices to a large number of people.
Nearly 200 children from the “Orchid” group sang, danced and mimed the key messages contained in the 14 chapters of the document “Konesans pou sove lavi” through the festival called “A la bèl bagay se lasante” (Health is a beautiful thing).
The show was divided into two parts:
-That of singing on the rights of the child has seen nearly fifty children from several schools in the square and who shone one by one the rights of the child by turning in a circle.
– the second part featured a group of children dressed in peasant dress and carrying various provisions on their heads while dancing to the rhythm of the song on nutrition “Three kind of eats”. The room vibrated to the rhythm of the choreography of the tube music from the album “ala bel bagay se lasante” performed by children wearing different style outfits.
However, in the opinion of all, the performances were some more magnificent than the others and the actors outdid themselves to offer a colorful show that raised a collective enthusiasm communicative.
It should be noted that the idea of preparing an album of songs is part of a global strategy to promote essential family practices for the promotion of health and child development. These songs will be used primarily in the health clubs that are an integral part of this strategy and during the realization of various awareness activities.
In general, this album of songs is intended to be an important contribution to the Haitian community in its quest to have healthy Haitian children. It was designed in collaboration with the Ministry of Public Health and Population to ensure that the messages on health and child development it contains are culturally accessible to all segments of the population. Note that the album was produced by the group “Hi” thanks to financial support from UNICEF in the framework of a partnership with the Institute Preventive Health, Environmental, and Community (SPEC).
“The punching operation against cholera” continues through the West and Centre departments. The various partner organizations have sent their agents to public places to raise awareness about cholera. Public markets are especially strategic because there is a big number of people who go to these places every day.
It is noon this Thursday, October 12, around the market of Gerald Bataille, it is the big crowd, as always. The agents of the Mayor of Tabarre, selected to make the sensitization as part of the operation “punch against the cholera”, are already at work dressed in their green T-Shirt and Caps with slogan “Yon Ayiti san Kolera “(A Haiti without Cholera). For this session, a team of UNICEF and the French Red Cross accompany them.
The agents, very active and expressive, explain to people, the precautions they must take in order to avoid catching cholera. “You have to wash your hands in key moments, wash fruits and vegetables with treated water, cover food and drink clean water,” among other things, there are the messages conveyed. Leaflets on cholera are also distributed to people.
One of the merchants was full of praise for the field workers. “I am very happy to have all this knowledge about cholera. This will protect my family and myself. In addition, the explanations of the agents are clear and simple, “she explains.
Cholera is still present
“My job is to educate merchants, buyers by insisting that cholera is still there. And they must take precautions to avoid getting the disease by applying hygiene principles, “says Rolph Moise, one of the sensitization agent.
At the beginning it was not easy for outreach workers, because of a certain reluctance of people who did not want to listen to them. There was even hostility. “Now people are more receptive. They listen to what they are told. There is now some familiarity with them. Because we have been trained for work and we know how to approach them, “he continues.
A Behavior Change Strategy
The communication component of the “punch operation” focuses on changing the behavior of the population. This strategy engages and empowers communities and networks to influence or strengthen social norms; it uses all media (interpersonal, group, mass) to achieve its goal.
“Inter-personal communication is a strategic axis of the process of behavior change because it allows to discuss with individuals to understand the reasons for change. It is within this framework that this initiative has been introduced in the markets to reach a large number of people. “said Ghaffar Gomina, UNICEF Development Communication Specialist (C4D), adding that” community engagement is an effective way to strengthen behavior change “.
The main objective of the “punch operation” is to achieve a national incidence of less than 0.1% by the end of 2017. Awareness-raising activities also take place in the departments of the West, Artibonite and the Central Plateau. This project received financial support from the Embassy of Japan, the Canadian Embassy and the United Nations Central Emergency Response Fund.