Despite considerable investment, access to water and sanitation in Haiti is still the lowest in the Western Hemisphere. The main challenges in achieving sustainable management of water and sanitation in Haiti are limited government capacity, low user demand for improved water and sanitation services, lack of accessible finance, poor management of water resources, and geographic vulnerability to extreme events. As a result, 58 percent of Haitians have access to basic water sources, a decrease since 1990 when the access rate was 62 percent, while only 28 percent of Haitians have access to basic sanitation. Low levels of water and sanitation services and poor hygiene practices result in high levels of diarrheal disease and malnutrition throughout Haiti, and contribute to the severity and spread of the cholera epidemic that began in Haiti in October 2010, afflicting nearly 800,000 people to date and resulting in more than 9,000 deaths.

USAID is addressing these challenges by building water and sanitation infrastructure, increasing capacity to manage service delivery, and improving the enabling environment for the sustainable implementation, operation, and maintenance of water and sanitation services. Guiding principles within the portfolio include: 1) aligning with Haiti’s new Cholera-Elimination Plan; 2) supporting decentralization within the sector; 3) using market-based approaches, where feasible, and building private-sector capacity; and 4) increasing emphasis on sanitation, including the safe disposal of waste. The primary USAID activity to support these investments is the $44 million Haiti WASH Project (subject to the availability of funding), which works in priority cholera hotspots and areas that are recovering from cyclical disasters. Other USAID activities focus on rehabilitating water-supply systems, promoting hygiene behavior change through community health workers and mass media, and supporting the promotion and sales of socially marketed household water treatment products. These activities seek to facilitate Haiti’s transition from emergency response to the sustainable delivery of water and sanitation services, and are closely aligned with the Government of Haiti’s National Cholera-Elimination Plan and other funding from Spain, the Inter-American Development Bank, and the World Bank.

In addition to USAID’s development programming, USAID/Office of Foreign Disaster Assistance (OFDA) and U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC) have focused on response efforts. USAID/OFDA supported efforts to prevent the spread of cholera in 2010–2011 (and again immediately following Hurricane Matthew) by providing logistics support and relief commodities, while HHS/CDC supports surveillance and response activities.

USAID’s activities are expected to provide more than 250,000 Haitians with sustainable access to basic water supplies, and help 75,000 Haitians gain access to basic sanitation by 2022.