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The Hispaniola Initiative

Our Goal

The Carter Center's Hispaniola Initiative works with the ministries of health in Haiti and the Dominican Republic to accelerate the elimination of malaria and lymphatic filariasis from the countries' shared island, Hispaniola, by 2020.

What is Malaria?

Malaria is a potentially fatal mosquito-borne parasitic disease, widespread in tropical and subtropical regions. Transmitted by female Anopheles mosquitoes, malaria parasites inhabit and destroy a person's red blood cells following an initial developmental period (10-14 days) in the liver. Symptoms include fevers, intense headaches, vomiting, body-shaking chills, and other flu-like symptoms.

Without treatment, malaria can lead to anemia, hypoglycemia, cerebral malaria, coma, and death.

What is Lymphatic Filariasis?

A leading cause of permanent and long-term disability worldwide, lymphatic filariasis is caused by thin worms transmitted to humans by the bites of mosquitoes in tropical and subtropical regions. These worms cause blockage in the lymphatic system, resulting in fluid collection in the tissues (most commonly the legs and genitalia), severe swelling, and periodic fevers from bacterial infections of the collected fluids.

A long-standing infection with lymphatic filariasis results in an irreversible condition called elephantiasis, in which hardened enlarged skin resembles elephant skin.

How Widespread Are the Diseases?

Malaria currently kills an estimated 655,000 people each year, mostly children, with about 250 million cases of the disease reported worldwide. Approximately 120 million people are infected by lymphatic filariasis, with more than 1.1 billion in 72 countries at risk of infection.

Hispaniola, however, remains the only island in the Caribbean with active malaria transmission. It also accounts for approximately 90 percent of the lymphatic filariasis burden in the Western Hemisphere. In 2010, nearly 87,000 cases of malaria were reported on the island of Hispaniola (total population approximately 20 million). Haiti accounted for 97 percent of those cases.

Most areas within Haiti remain at risk for malaria and lymphatic filariasis transmission, while in the Dominican Republic, the diseases occur mainly in areas along the border with Haiti and in areas with high concentration of migrant laborers.

Our Strategy

The Carter Center began its work in Haiti and the Dominican Republic after a 2006 recommendation of the Carter Center-sponsored International Task Force for Disease Eradication (ITFDE) that concluded elimination of malaria and lymphatic filariasis from Hispaniola was "technically feasible, medically desirable, and would be economically beneficial" to both countries. Learn more about ITFDE here.

Since 2008, The Carter Center's Hispaniola Initiative has assisted both countries' ministries of health by strengthening binational cooperation, providing technical assistance for elimination of both diseases, and helping to integrate activities between the countries' malaria and lymphatic filariasis programs.

The Center is helping Haiti's Ministry of Health reorient its malaria program from control to elimination and promote operational linkages between the countries' malaria and lymphatic filariasis programs. In the Dominican Republic, the Center provides technical and financial assistance to the Ministry of Health, including support for lymphatic filariasis surveys, mass drug administration to interrupt lymphatic filariasis transmission, and malaria surveillance.

In 2014, The Carter Center expanded its support for malaria and lymphatic filariasis elimination in both countries, including participation in Malaria Zero, a consortium of partners working to accelerate the elimination of malaria from Haiti. The Carter Center is leading efforts to deliver anti-malaria interventions to affected communities.

Results and Impact

With assistance from The Carter Center, the nations' health officials established a cross-border pilot project in 2008 to target malaria in Ouanaminthe, Haiti (pop. 92,000), and Dajabón, Dominican Republic (pop. 27,000). The project included purchase and distribution of insecticide-treated bed nets; provision of laboratory supplies, motorbikes, and other equipment; training for health staff; and protocol standardization for malaria diagnosis and treatment. Learn more about the Center's Hispaniola Initiative from 2008-2012.

In 2009, Haiti and the Dominican Republic produced, with Carter Center assistance, a binational plan to eliminate the two diseases from Hispaniola by 2020, and since 2012, the Center has supported quarterly binational meetings to promote coordinated elimination activities.

There were 17,368 confirmed malaria cases reported in Hispaniola in 2014, representing an 80 percent decrease since 2010, indicating that the national programs are achieving success against malaria. For lymphatic filariasis, 58 percent of Haiti's communities have received at least five rounds of mass drug administration to interrupt transmission, while in the Dominican Republic, transmission has been interrupted in two out of the three focus areas.

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Malaria and lymphatic filariasis are costly economic burdens, as both diseases are caused by — and create — additional poverty.

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