The Guardian has a good article which makes the critical point that the vast majority of foreign aid flowing into Haiti since the devastating earthquake in Haiti (the fourth anniversary is this Sunday) has been directed almost exclusively to private, U.S.-based corporate development contractors.
See the data and the graph:
USAID claims that most Haitian NGOs and the government do not have sufficient internal financial controls to receive these contracts. They also cite that these data do not accurately account for less formal support to local organizations via subcontracting and local partnership and interactions. It is, however, impossible to know since the data on those subcontracts has yet to be published.
Despite a desire to reform from USAID administrator Rajiv Shah, major lobbying and entrenched interests exist to block reform.
Partners In Health, of course, is working to do things differently. Interested primarily in how we can best invest resources to build systems that can protect the human right to health, we know how vital it is to strengthen Haitian – particularly public – institutions. This has been the approach and rationale behind the major investment in the construction and operation of the University Hospital in Mirebalais, Haiti. Co-operated by the Haitian ministry of health and PIH, the hope is that through accompaniment, we can work to strengthen the capacity of the public institutions necessary for fulfillment of the right to health for Haitian citizens.
Beyond the rights-base requirement for the primacy of local, public institutions, the strategy also makes strong economic sense. New analysis by PIH and partners show that investment in health systems and necessary infrastructure like hospitals, can have a major economic multiplier in growing the Haitian economy. Using an input-output matrix, a well documented economic analytical tool, the team determined that for every $1.00 invested in the construction and operation of the University Hospital in Mirebalais, $1.82 was generated in revenue across many economic sectors in Haiti.
These results are entirely consistent with the case laid out by the Global Health 2035 Commission regarding the economic gains to be made by sound investments in health care delivery. As the movement lines up behind UHC as a major focus for the post-2015 global development goals, perhaps more evidence like this will help us move beyond the primarily self-serving orientation of foreign aid and development assistance as reported by The Guardian.