January 11, 2012
As the two year mark approaches, many are justifiably asking, where did the money go? With billions pledged by donors, and billions more in private donations, it is a natural question. As important as the level of disbursement is the question of where that money has gone and whether it has been spent appropriately. Independent evaluations have shown that many NGOs were responding more to their donors than to those whom they are supposedly in Haiti to help. Last year, the United Nations Special Envoy to Haiti (OSE) released a report, “Has Aid Changed? Channeling Assistance to Haiti Before and After the Earthquake,” which analyzed whether donors “have changed the way they provide their assistance in accordance with the principle of accompaniment” which “is specifically focused on guiding international partners to transfer more resources and assets directly to Haitian public and private institutions as part of their support.”
Yet the vast majority of aid projects and donor support bypassed the Haitian government. In fact, there was less direct budget support in 2011 than there was in 2009 before the earthquake. Additionally, many aid projects were undertaken outside the purview of the government. Rather than reinforcing the government’s capabilities, these types of projects have historically undermined them. Despite this, there are examples of aid done right; the construction of a new teaching hospital in Mirebalais by Partners in Health is one such example.
Partners in Health/Zanmi Lasante (PIH) had been in Haiti for 25 years before the earthquake and has a history of working closely with the government. Dr. Paul Farmer of PIH, writing in the introduction of the OSE report referenced earlier, stresses the importance of working with, not around Haitian institutions:
We know from our shared experiences in Haiti and elsewhere that the way aid is channelled matters a great deal, and determines its impact on the lives of the Haitian people. For example, with over 99 percent of relief funding circumventing Haitian public institutions, the already challenging task of moving from relief to recovery—which requires government leadership, above all—becomes almost impossible.
We have heard from the Haitian people time and again that creating jobs and supporting the government to ensure access to basic services are essential to restoring dignity. And we have learned that in order to make progress in these two areas we need to directly invest in Haitian people and their public and private institutions. The Haitian proverb sak vide pa kanpe—“an empty sack cannot stand”—applies here. To revitalize Haitian institutions, we must channel money through them.
It should be little surprise then that the largest reconstruction project undertaken by PIH is one of the few projects in Haiti that has truly adhered to the principal of accompaniment. Prior to the earthquake, PIH had been planning to build a community hospital in Mirebalais. After the earthquake, PIH received a request from the Haitian Ministry of Public Health and Population, with whom they had a previous relationship, to scale up the project. The result is that:
When it opens its doors in 2012, the 180,000-square foot, 320-bed hospital will offer a level of care never before available at a public facility in Haiti. And at a time when Haiti desperately needs skilled professionals, Mirebalais National Teaching Hospital will provide high-quality education for the next generation of Haitian nurses, medical students, and resident physicians.
The hospital is expected to be the largest employer in the area, and:
Once the hospital is running at full capacity, it will have over 30 outpatient consultation rooms, six operating rooms, and space to host trainings with over 200 participants. It will offer innovative technology — some of which was previously unavailable in Haiti — including digital radiography, a full-body CT scanner, teleconferencing capabilities, solar panels that will fully power the hospital during the day, on-site waste water treatment, and wall-mounted oxygen for over 60 percent of inpatient beds. The hospital is also designed to withstand earthquakes and high-winds from tropical storms.
In agreement with the government of Haiti, PIH is covering the costs of operating the hospital until 2021 when the responsibility will be transferred to the Haitian government.
When HRRW visited the construction area in October, a PIH employee explained that they hope to stand this project up as an example of how aid can be done right in Haiti and as proof that it can be done. By working with the government, involving Haitian communities and building a sustainable institution, when the new hospital in Mirebalais opens in a few months, it will indeed be an example of aid done right.