The Dominican Republic developed an action plan for environmental health that was decisive in the prevention and control of the cholera outbreak that occurred there in November 2010. This plan emphasizes the importance of clean water, sanitation, and promotion of hygiene and can serve as an example for other health emergencies.
In an emergency or disaster situation, whatever its nature, coordination is the greatest challenge. The countless short- and mid-term actions needed to strengthen environmental health and to prevent and control epidemic outbreaks must be set into motion in an efficient and timely manner.
For the sector responsible for drinking water, sanitation, and hygiene, the main objective of emergency procedures is to restore conditions and services to the level existing prior to the event or to strengthen these services in case of a health emergency.
In a health emergency it is important to have clear strategies, with the following objectives:
- Improve the response capacity of the water, sanitation, and hygiene sector in the face of environmental hazards;
- Enhance coordination between sectors in order to stay aware of risk factors;
- Implement key interventions for water, sanitation, and promotion of hygiene;
- Develop dynamic mechanisms for managing information regarding environmental health;
- Promote advocacy, communication, and social mobilization strategies that have the needed force to achieve positive and timely impacts on health at the local level.
Leadership by the Ministry of Public Health has been essential in responding to the presence of cholera in the Dominican Republic. The Ministry made it possible for different stakeholders in different sectors to take immediate action to confront the hazard created by the cholera situation in Haiti.
The environmental health division (Dirección General de Salud Ambiental—DIGESA) of the Ministry of Public Health formulated the Plan of Action for Environmental Health and the Prevention of Cholera. The response plan addresses the first cholera case in Dominican territory.
Another group dealing with water, sanitation, and hygiene sectors is GASH (Grupo de Agua, Saneamiento e Higiene). It works to bring together all entities in these sectors, including operators of water and sanitation systems, environmental health authorities, health authorities, United Nations agencies, civil defense, NGOs, and the community at large. GASH designed a plan for a massive mobilization to: improve drinking water and sanitation conditions in the most vulnerable areas; develop capacity at the local level; make protocols and technical guidelines available; provide supplies to treat and monitor drinking water quality; evaluate environmental hazards; assess technical options for treatment and disposal of human waste; provide information to those responsible for epidemiologic surveillance of cases of diarrhea and cholera; monitor water sources; and increase the capacity of environmental laboratories.
As a result of the cooperation among different actors and in particular with the Dominican Emergency Operations Center (EOC), it was proposed that a committee representing GASH establish procedures in line with those of the EOC to strengthen operational plans laid out by GASH. In this way, necessary interventions can be put into black and white, and the “when, where, who, and how” of operations can be defined. An established structure for coordinating response will have terms of reference that make it possible to monitor progress and a work dynamic that will have impact wherever necessary.