The Beginning of the End of Malaria in Haiti?

“Test before treatment,” Jeanine Hyppolite repeats the words over and over like a mantra. “I was very impressed by that. It works.” Jeanine is standing in the Solino Health Center in the Haitian capital, Port au Prince, and she’s describing the effects of the national malaria program training she attended with other nurses and lab technicians in December 2012. It introduced Haiti’s healthcare providers to three cardinal concepts. Test every person with fever. Treat only those with malaria. Use both chloroquine and primaquine: one to treat and the other to reduce transmission.

“Cases are down,” says Jeanine, “I can see that.”

She should know. She’s worked 23 years at the Solino Health Center, in the crowded Nazon neighborhood in southeastern Port au Prince.

The turning point, she says, is the free treatment that’s been available since July. As she says this she smiles at Merisma Alcime, Malaria Officer for all of Haiti’s most populous Ouest region. Merisma is the one who brings the rapid diagnostic test (RDT) kits over to the Solino Health Center every few months, along with the medications.

“It makes a huge difference that both tests and treatment are free. Earlier, people might have just enough money for the test but couldn’t afford the treatment,” says the Center’s lab technician Jean Felix Micanor.

After 16 years at the Solino Health Center, he’s seen far too many malaria cases diagnosed without the patient able to go on to the next step—treatment. Or patients would choose to buy treatment without knowing for sure that malaria was the cause of their fever.

In many ways, the Solino Center illustrates perfectly the challenges and the progress in Haiti’s fight against malaria. The national malaria program is making headway, and last year, Haiti’s Ministry of Public Health and Population, with CDC support, trained health workers from 146 institutions, in seven of Haiti’s ten departments, on RDTs. One of them was Jeanine. Getting to this point—being able to diagnose and treat malaria more easily and readily—is the culmination of several years of work. First RDTs needed to be adopted as national policy, test kits needed to be obtained and delivered, and training had to begin rolling out to reach all 800 health facilities.

The availability of accurate malaria diagnosis, coupled with prompt, free treatment, is Haiti’s determined progress toward laying the foundation to eliminate malaria in the country. The focus on finding people who are infected and treating them quickly will be the cornerstone of the country’s success in getting rid of malaria.

The significance of malaria in Haiti is two-pronged. First, it could be eliminated given the right strategic push in Haiti and its neighbor on the island of Hispaniola, the Dominican Republic (DR). For Haiti, this means preventing and treating an estimated 130,000 cases per year, and for the DR, 1,300 cases. Second, if malaria is eliminated in both countries, which is their goal, it’s reasonable to expect the entire Caribbean would be free of the disease since this island is the last dominion of malaria in the region.