|dc.description.abstract||Due to the lack of potable piped water, drinking water access is a concern in Haiti. Families often gather water for household use from private wells, springs, and rivers. These local water sources are often of unknown or poor quality due to poor sanitation. Public health events such as the cholera outbreak of 2010 demonstrated the vulnerability of the Haitian populations to water contamination and government capability to address these issues have been weak. Attempts have been made to reduce the prevalence of waterborne disease by establishing for-profit kiosks that sell treated drinking water treatment. However, kiosk water is not regulated or routinely tested. There is some evidence that it does not meet drinking water standards, leading to concerns about waterborne disease. If kiosk water testing is implemented, the costs must be supported by water vendors. These costs may not be feasible due to Haitian economic conditions and reliance on imported products that often disrupt the financial sustainability of businesses.
This dissertation examines challenges to providing safe drinking water in the Northern Corridor of Haiti and evaluates potential improvements. This research assessed, first, the main factors that hinder access to water testing and that lead to high cholera infection rates among communities in the Northern Corridor. Second, the quality of drinking water sold at for-profit kiosks was appraised for the main urban municipalities in the region, and the kiosk owners’ willingness to periodically test the drinking water sold and pay for testing was assessed. Finally, a rigorous assessment of financial sustainability of a university-based drinking water laboratory in the Northern Corridor of Haiti was done by calculating internal rate of return (IRR) and net present value (NPV) following some risk assessments.
In the first study, correlation, regression, and travel time analysis were performed to identify community-level factors that are associated with cholera infection rate and prevent access to a new water testing laboratory in Limonade. Poor road conditions, high elevation, mountainous terrain, and limited transportation options lead to long travel times up to 5.7 minutes/km between remote communities and the laboratory. The presence of springs in communities had a significant positive correlation with cholera infection rate at the community level. However, socioeconomic factors had no significant correlation with cholera infection rate. While the new laboratory will play a vital role in promoting safe drinking water for the cities near Limonade, these findings demonstrate that many remote communities will not be served by the lab. There is a need to establish small water testing and treatment facilities in these vulnerable remote areas to limit the spread of waterborne diseases.
In the second study, surveys of for-profit water vending kiosks were conducted. Water samples were collected from selected kiosks and the kiosk operators were surveyed about their water treatment practices and willingness to participate in a water testing program. The samples were tested for total coliforms, E. coli, residual chlorine, pH, and conductivity. Third, survey data were analyzed using descriptive statistics and logistic regressions to assess the water vendors’ willingness to test the kiosk water, determine the amount they would be willing to pay for testing, and identify the best incentives to motivate kiosk owners to pay for water testing services. Water samples from downtown of Cap-Haitian and its peripheral districts contained high levels of E. coli exposing consumers to high health-risk. In addition, the residual chlorine level was below both WHO and DINEPA standards, which could explain the presence of coliforms. Further, many kiosk owners do not properly maintain their facilities. Fifty percent of kiosk owners did not remember the last time the water treatment equipment was maintained and around one quarter performed maintenance once a year. Survey results also indicated that many drinking water vendors would only be willing to pay for regular testing if it was mandatory. These results indicate the importance of drinking water regulations and enforcement and the need to increase public awareness of drinking water safety in the Northern Corridor of Haiti.
In the final study, the financial sustainability of a university-based drinking water laboratory in the Northern Corridor was assessed through sensitivity analysis of a range of factors that may affect laboratory revenues. Profitability was determined by calculating the internal rate of return (IRR). This analysis showed that the laboratory must perform microbiological testing for an average of five samples per day to reach financial sustainability. Price-based incentives for new clients have relatively small impacts on profitability whereas lowering the number of daily samples performed has a high impact on the projected IRR. Finally, international and Haitian inflation could affect the sustainability of the drinking water laboratory. These economic factors will be among the key drivers of laboratory operating costs and subsequent financial viability. A relevant marketing plan must be designed to the demand for water testing and price-based incentives will be the best strategy to keep demand high.
This dissertation identified relevant strategies that will improve access to safe drinking water for households in the Northern Corridor of Haiti. Further studies are needed to identify municipalities with the appropriate infrastructure and willingness of local governments to implement drinking water testing and treatment. Additionally, private kiosk surveillance must be mandated by public health authorities and drinking water regulators to ensure safe water for consumers. DINEPA, the Ministry of Public Health, and the Ministry of Commerce should promote regular maintenance and optimum water treatment methods at the kiosk level. For that, kiosk water maintenance must be regulated followed by law enforcement that should be established for all.||en_US