With Accompaniment and Implementation Science, Aid Can Work in Haiti
Abbey Gardner and Jéhane Sedky
Co-Directors, Science of Implementation Initiative
NEW YORK, September 15, 2022 – The recent statement released by the Organization of American States (OAS) on the role and responsibility of the international community in the current crisis faced by Haiti has spurred increased debate. While the immediate political and security crisis will understandably be the focus of discussion at the United Nations General Assembly, we urge those committed to Haiti’s future to keep the issue of effective development assistance high on the agenda.
The portion of the critique by the OAS regarding the failures of development assistance in Haiti echoes the analytical work we have undertaken at the Science of Implementation Initiative (SII), the successor to Dr. Paul Farmer’s United Nations Office of the Special Adviser to the Secretary-General. While at the United Nations, our office tracked the $13 billion of assistance pledged to Haiti by the international community in response to the 2010 earthquake and found that the majority of aid went around Haiti’s national institutions rather than working to directly strengthen the public sector. The pooled donor fund that was created for earthquake recovery had no mechanism to disburse directly to Haitian bodies.
The OAS gets to the heart of the problem with aid to Haiti, stating that “after 20 years, not a single institution is stronger than it was before.” The irony is that, from 2005 on, donors have agreed in principle to behave differently, making commitments to aid effectiveness at high-level meetings in Paris, Accra and Busan that call upon them to invest directly in national organizations.
So what can be done now? It is not lost upon the OAS that relying on the same major donors that pledged hundreds of millions of dollars at the time of the 2010 earthquake begs the question of why their involvement would produce a different outcome this time. Yet, we would argue that there is a way forward for the international community to deliver effective development assistance. The path is achievable, but it will not be easy, as it will require a shift in the mindset and practices of the donors.
An implementation model based on accompanying national partners as they build and run public sector institutions has been successfully implemented by Dr. Paul Farmer’s colleagues at Partners In Health (PIH) and Harvard University in Haiti and other resource-poor settings over the past thirty years. Paul Farmer’s legacy can be seen in institutions such as Mirebalais University Hospital in Haiti and the University of Global Health Equity in Rwanda. Both of these institutions have been recognized by international bodies for the ongoing positive impact for the poorest in their countries and regions and should serve as development models to be replicated.
Evidence based on these case studies as well as independent research conducted by SII shows that there are four key strategies that lead to building durable national institutions that serve as social safety nets and can offer a roadmap toward achieving the UN Sustainable Development Goals.
The four overarching implementation principles below are not simple but we believe they should be the international community’s roadmap if we hope to see results in Haiti. Under the late Dr. Farmer’s leadership while serving as a Special Adviser to the United Nations Secretary-General (2009-2019), our team developed this implementation roadmap for development partners to use in their efforts to reduce poverty and disease in the poorest countries.
1. Support the public sector to do its job: The evidence is clear: there is a direct correlation between investment in national institutions and the reduction of poverty and disease. Yet, the international community has consistently sidestepped public institutions in Haiti, effectively perpetuating the weakness of the one stakeholder that is both accountable to the Haitian people and responsible for the country’s development. After decades of weakening Haitian institutions, the current crisis should come as no surprise.
While strengthening the public sector (which would include investing in public infrastructure and public sector operations) may be difficult in times of crisis, donors have done it before in fragile settings – including in Colombia and Somalia where UNDP created pooled funds with 1% administrative fees that could disburse directly to public institutions. Corruption is often cited as a reason for donors to avoid direct support to national systems in resource-poor settings. Of course, this concern is legitimate, but the question is how much aid money to governments in poor countries is lost to corruption. The truth is that there is very little data to answer that question and donors know how to mitigate risk.
2. Always aspire to the highest quality standards that evidence supports: If evidence-based standards exist that can improve people’s lives, these standards should always be the aspiration of any development program. Unfortunately, this rarely happens in Haiti, with donors often investing in programs that deliver “results” that look more like low-hanging fruit rather than strengthening permanent institutions that will deliver high-quality services to the population. The idea that it is too expensive to do things the right way is wrong; we need only look to Mirebalais University Hospital which provides the highest quality medical care, facilities and treatment– including extremely complex surgeries such as separating conjoined twins and maintaining a biosafety level 3 laboratory– on a budget that would be considered minuscule in any donor country. Mirebalais University Hospital is a 205,000-square-foot public facility with 300 beds that provides care across a referral area in which 1.3 million people live, providing treatment to approximately 1,000 people a day. Researchers from PIH in Haiti and the US analyzed the economic impact and determined that for every $1 invested in building the hospital, $1.82 was pushed into the Haitian economy.
3. Prioritize stimulating the local economy: Of the billions of dollars of procurement contracts issued by one of the top five bilateral donors to Haiti following the earthquake, only 2.4 percent went to Haitian businesses. Too often development funding is spent without sufficient consideration of how it can be used to stimulate the national economy. Donors in Haiti can change this dynamic by purchasing goods and services in such a way that Haitian individuals, families and small businesses benefit. USAID Administrator Samantha Power’s commitment to increase localized investment globally to 25% over the next four years is a welcome shift in the right direction. In addition, cash transfers, particularly those that are unconditional, should be prioritized as evidence shows they are among the most effective ways to address poverty.
4. Promote an accompaniment approach to implementation: Guided by a pragmatic solidarity with the poor, the accompaniment approach calls upon donors to listen, not only to the goals and plans of citizens and their institutions, but also to the challenges that they face in their day-to-day operations and their perspectives on how to meet them. Donors should follow the lead of national and local partners and provide them with the support they need. With a strong emphasis on implementation through partnership, accompaniment in development work is specifically focused on guiding international partners to transfer more resources and assets directly to national and local institutions.
As much as the organizations that make up the international aid ecosystem may believe that they follow these four strategies in Haiti, the bad news is that investment flows show that they rarely do. The good news is that if the donors and their implementing partners could embrace this roadmap, transformational change is possible.
Haiti has suffered through centuries of racism, colonialism and imperialism. It’s time for donors to break with the business-as-usual approach and honor their commitments to the aid effectiveness agenda by accompanying their Haitian colleagues to meet the critical needs of their country.
About the Science of Implementation Initiative:
The Science of Implementation Initiative (SII) was established by the late Dr. Paul Farmer to build upon the work of his team at the United Nations Office of the Special Envoy for Haiti (2009-2012) and the United Nations Office of the Secretary-General’s Special Adviser on Community Based Health and Aid Delivery (2013-2019). SII gathers data, conducts research, tracks funding, and provides analysis with the goal of making official development assistance more effective, equitable, transparent, and accountable from the perspective of partner countries. SII is supported by private foundation grants.
Learn more at: www.siidata.org
Additional SII statements in regard to Haiti:
https://siidata.org/its-time-to-do-the-right-thing-for-haiti/
https://siidata.org/dont-blame-haiti-for-failed-aid-science-of-implementation-initiative/