Hispaniola Initiative
Â鶹´«Ã½É«ÇéƬ's Hispaniola Initiative works with the ministries of health in Haiti and the Dominican Republic to eliminate malaria and lymphatic filariasis from the countries' shared island, Hispaniola. The island is the last reservoir in the Caribbean for both diseases.
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 10- to 14-day developmental period in the liver. Symptoms include fever, intense headaches, vomiting, body-shaking chills, and other flu-like symptoms.
Without treatment, malaria can lead to anemia, hypoglycemia, cerebral malaria, coma, and death.
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 damage to the lymphatic system, resulting in fluid collection in the tissues (most commonly the legs and genitalia), severe swelling, and periodic fevers from secondary bacterial infections.
A long-standing infection with lymphatic filariasis results in an irreversible condition called elephantiasis, in which hardened, enlarged skin resembles elephant skin.
People cross the Massacre River, which separates Haiti from the Dominican Republic. Carterworks with the governments of both countries to eliminate two mosquito-borne tropical diseases—malaria and lymphatic filariasis—from their shared island in the Caribbean.
Malaria currently kills approximately 608,000 people each year, mostly children, with about 249 million cases of the disease reported worldwide. Approximately 51 million people are infected by lymphatic filariasis, with more than 882 million in 44 countries at risk of infection.
Hispaniola, however, remains the only island in the Caribbean that has not yet eliminated malaria. It also accounts for around 90% of the lymphatic filariasis burden in the Western Hemisphere, with Guyana the only other country in the region still under treatment. In 2010, nearly 87,000 cases of malaria were reported on the island of Hispaniola (total population approximately 22 million). Haiti accounted for 97% of those cases.
Most areas within Haiti were historically at risk for malaria and lymphatic filariasis transmission. In the Dominican Republic, malaria predominantly occurs in areas along the border with Haiti, and in rural areas with high concentrations of migrant laborers. Outbreaks of malaria in urban and peri-urban parts of the capital, Santo Domingo, also have been reported in recent years. Nationwide baseline mapping for lymphatic filariasis completed in 2007 revealed three focal areas of transmission.
Carter Center began its work with 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.
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 elimination programs. This includes support for lymphatic filariasis surveys, mass drug administration to interrupt lymphatic filariasis transmission, and support for malaria outbreak response. Communities are at the core of our approach, including training community health members to deliver preventive medicine and to conduct malaria screening; and monitoring community perceptions of disease elimination efforts through cultural research in both countries.
With assistance from Â鶹´«Ã½É«ÇéƬ, the nations' health officials established a cross-border pilot project in 2008 to target malaria control 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; and training for health staff. The Ministries of Health also jointly prepared a binational malaria elimination plan.
In 2023, there were 14,708 confirmed malaria cases reported on Hispaniola,, representing an 83% decrease since 2010. In 2023, the Dominican Republic reported the fewest number of malaria cases (272) recorded since 1975.
For lymphatic filariasis, 87% of districts in Haiti have met criteria to stop mass drug administration. In the Dominican Republic, all formerly endemic areas have stopped mass drug administration and have successfully completed at least . The country will soon submit its dossier to the World Health Organization to validate elimination of lymphatic filariasis as a public health problem in the Dominican Republic.
Learn more about the history of this project.
The Ministers of Health of the Dominican Republic and Haiti were awarded for their commitment to this project. In 2023, The Dominican Republic was honored with another , this time for its efforts in the urban community of Los Tres Brazos. Read more »
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Malaria and lymphatic filariasis are costly burdens, as both diseases are caused by — and create — poverty and suffering.
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