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Haiti: Relief and Reconstruction

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Group Warns of Inadequate Cholera Response as UN Concedes “Band-Aid” Approach is Ineffective Print

Doctors Without Borders (MSF) warned on Wednesday that not enough has been done to prepare for the rainy season and the corresponding surge in cholera that is expected. The international humanitarian organization stated:

While Haiti’s Ministry of Health and Populations claims to be in control of the situation, health facilities in many regions of the country remain incapable of responding to the seasonal fluctuations of the cholera epidemic. The surveillance system, which is supposed to monitor the situation and raise the alarm, is still dysfunctional, MSF said. The number of people treated by MSF alone in the capital, Port-au-Prince, has quadrupled in less than a month, reaching 1,600 cases in April.

Data from the Ministry of Health (MSPP) backs up this increase noted by MSF. While the average daily case load reported by the MSPP was around 50 throughout March and early April, in the last two weeks of reporting (April 10-23) the average number of daily cases has increased to over 150. MSPP reports that 25 people have died due to cholera through in the first 23 days of April. While these numbers are still lower than last year, they point to an increasing caseload as the rainy season begins. Last year, just as cases were spiking, many NGOs were winding down their operations as donors pulled funding. MSF notes that the same phenomenon may be occurring this year as well:

“Too little has been done in terms of prevention to think that cholera would not surge again in 2012,” said Gaëtan Drossart, MSF head of mission in Haiti. “It is concerning that the health authorities are not better prepared and that they cling to reassuring messages that bear no resemblance to reality. There are many meetings going on between the government, the United Nations and their humanitarian partners, but there are few concrete solutions,” he said.

An MSF study in the Artibonite region, where approximately 20 percent of cholera cases have been reported, has revealed a clear reduction of cholera prevention measures since 2011. More than half of the organizations working in the region last year are now gone. Additionally, health centers are short of drugs and some staff have not been paid since January.

“Rain is just one of the risk factors for contamination. But as soon as the rains end, cholera subsides, and funding stops until the next rainy season, instead of money being channeled towards cholera prevention activities. As a consequence, people are still highly vulnerable when cholera comes back,” said Maya Allan, MSF epidemiologist.
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Fear and Loathing in Port-au-Prince (and Beyond) Print

An article by Tate Watkins in The American Interest attempts to explain some of the reasons why, as the title puts it, Haiti’s rebuilding “is…taking so long?”

Among the factors Watkins details are the often quick staff turn-overs at NGO’s and agencies, the differing priorities of foreign NGO’s and agencies versus those of Haitian organizations and the Haitian government, the disproportionately tiny number of contracts going to Haitian contractors, and bureaucratic hurdles. Watkins also focuses on what he sees as another key factor, and one that is less-often mentioned in the media (and which indeed may be much less-often noticed by foreign journalists): foreign aid workers and contractors’ disconnect from the local people where they work.

Many foreign organizations prohibit staff from traveling through certain areas of Port-au-Prince, or they’re forbidden to visit without an SUV with locked doors and windows, a local driver, and a security detail. Private security companies and insurance policies often dictate such travel guidelines. Offices and housing for foreign NGOs and aid agencies working in Haiti are concentrated in Pétion-Ville, an affluent section of the capital home to classy hotels and vibrant restaurants. But the concentration of expats also presents a cluster of targets for crime; the relatively upscale area can be just as dangerous as many other parts of the city. In March 2010, for example, two Swiss employees of the NGO Doctors Without Borders were kidnapped in Pétion-Ville after a night on the town and held for one week. The organization would not disclose whether it paid a ransom for their release.

[Sustainable Organic Integrated Livelihoods co-founder Sasha] Kramer says many of the security measures that foreign organizations take actually increase risks for aid workers, because the restrictions hinder international staff’s ability to forge relationships with locals and build community ties—further hampering their ability to work effectively and efficiently.

She describes it from locals’ point of view: “You come into my neighborhood and you’re already afraid of me? Well, that’s offensive. So I think it engenders a feeling immediately of sort of defensiveness in communities, understandably.” And aid projects suffer as well. She says that she’s sensed tremendous frustration among international employees working with large NGOs who feel disconnected from the people they’re here trying to help.

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Op-Ed: Haiti's Fight for Transparency Print

CEPR Researcher Jake Johnston wrote in the Caribbean Journal yesterday:

In the aftermath of the earthquake in Haiti, donors pledged billions of dollars for reconstruction efforts. With those dollars was a commitment to “build back better”; this time was supposed to be different from previous big aid campaigns. But so far less than half of donor pledges have been disbursed, and it has become clear that “building back better” remains nothing more than a slogan. While there clearly have been successes in Haiti since the earthquake and the hard work of thousands of aid workers shouldn’t be discounted, nearly half-a-million remain homeless and hundreds of thousands more are living in desperate conditions. With a visible lack of results and little hard data with which to assess progress, one question naturally arises: “where did the money go?” At the Center for Economic and Policy Research and together with many other organizations, we’ve been trying to track where exactly the money that did get spent, went. It hasn’t been easy. 

To be sure, aid projects shouldn’t be judged solely on what percent of an aid budget went to overhead, or how much went to American consultants or was spent on American products as opposed to Haitian consultants and products. Ideally, the effectiveness of projects should be based on their outcomes, not just on the breakdown of how funds are spent. But measuring outcomes often isn’t feasible. A nominally independent review of the U.S. government’s response in Haiti attempted to measure the quality and impact of aid, but “a disquieting lack of data on baselines against which to measure progress or even impact” prevented them from doing so.

As taxpayers, we have the right to know how our tax dollars are being used and if they are used effectively.  Specifically, this means looking at the United States Agency for International Development (USAID), which has spent well over a billion dollars in Haiti since 2010.  To their credit, it’s not difficult to obtain the first level of transparency: to which organizations USAID gave funds.  USAID factsheets reveal that close to 100 percent of humanitarian funds for Haiti were channeled through NGOs, U.N. agencies or right back to other U.S. government agencies. Included in this billion-plus dollars hundreds of millions of dollars in contracts which have gone overwhelmingly to “beltway bandits” -- firms located in D.C., Maryland or Virginia. Only 0.02% by our latest tally has gone to Haitian firms.

But this isn’t the end of the line when it comes to transparency.  Once funds are given to an organization, what are they spent on? What were they meant to achieve? How much goes back to the U.S. and how much goes to local firms? In a meeting last October in Port-au-Prince a USAID official defended the awarding of contracts to so-called “beltway bandits”, telling me that while certainly some money goes off the top for their profits, much gets spent in country or is given to local subcontractors. It was a back-of-the-envelope calculation, but he estimated that each international worker sent to Haiti could cost up to $250,000 a year.  The important part, he stressed, was that this money would be spent in Haiti on electricity, security, housing, etc. “He has to live here, eat here, dance here, whatever,” the official reasoned.
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Lack of Data Prevents Measurement of Aid Effectiveness, Impact Print

Yesterday, Vijaya Ramachandran and Julie Walz of the Center for Global Development provided a nice overview of the U.S government’s review of its Haiti earthquake response. Ramachandran and Walz found that while the review includes “some frank and enlightening assessments of USG [U.S. government] response and coordination” it contained “very little discussion of aid accountability.”

As Ramachandran and Walz point out, the authors of the review couldn’t determine the effectiveness or impact of aid because of a “disquieting lack of data.” Part of the problem seems to stem from how data collection and management is viewed by aid workers and USG employees, who made up the vast majority of sources for the review. The report states:

During the Haiti response, limitations related to information management followed two major lines. First, there were limited data available for tactical and operational decisions; and second, there were overwhelming requests for data and information from policy leaders in Washington that made systematic data collection more difficult. These demands were often driven by reports in the media.

Thankfully, the authors note that at least “some” of those they interviewed understood that the former led to the latter: limited availability of data was what generated the “overwhelming” number of requests. Others told the authors that requests for information “detracted from the on-ground response” as they were forced to “’chase down’ facts.”

Of course, data is important to the on-the-ground response as well, as the report points out:

Data collection, through surveys and assessments, is an essential component for managing a disaster response. Surveys and assessments are used to identify the needs of the affected population to direct the response. Ideally, these types of data can be used to measure the overall impact of the humanitarian response.
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A Review of the U.S. Government’s Review of Its Haiti Quake Response Print

This guest post is cross-posted from the Center for Global Development.

By Vijaya Ramachandran and Julie Walz

Last week, USAID finally published an evaluation report on its activities in Haiti: “Independent Review of the U.S. Government Response to the Haiti Earthquake”.  The report is dated March 28, 2011. Yes, 2011. It took over a year to post the document on the USAID website.  The review was conducted by MacFadden and Associates – which operates an $80M Indefinite Quantity Contract from USAID.  There are some frank and enlightening assessments of USG response and coordination, but very little discussion of aid accountability.

Here are some impressions of the report:

Let’s start with the good.

Strengthen USAID. The report very clearly calls for a strengthening USAID: improved institutional structures, more staff and capacity, investments in new technology, and a reduction in reliance on outside contractors.  It is a call that has been made many times before, as USAID has evolved from a development implementer into an organization that manages contractors and grantees.  For example, USAID’s direct-hire workforce has decreased from around 8600 in 1962 to 2900 in 2009, despite an increase in foreign assistance. The report says that USAID’s weaknesses were especially apparent because the President appointed USAID as the lead agency in the USG Haiti response.

Nix the “whole of government” approach in disaster response. The report recommends that a “whole of government” approach should not be used in future international disaster response.  It is a concern that our colleague Todd Moss has previously discussed.  Although the idea of having all federal agencies at the table seems logical, it also creates parallel chains of command and further constrains the USG’s ability to get things done.  This is especially true in a disaster situation where rapid response is needed.  After the quake, more than 12 federal agencies sent staff to Haiti.  This created problems in terms of clear lines of authority, with specific reporting structures and delineated functions between agencies.

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