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Development in Haiti: Q&A with Ruth Levine

January 14, 2010

The earthquake in Haiti and the U.S.-led humanitarian relief response has drawn attention to one of the world's poorest countries located a mere 600 miles off the coast of the United States. Ruth Levine, CGD senior fellow and vice president for programs and operations, recently visited Haiti as part of a delegation assessing opportunities for donor support to health programs. This was not her first visit to the country: in the mid-1990s, she was responsible for negotiating the Inter-American Development Bank's health programs with the Government of Haiti.

Q: The earthquake comes at a time when some observers were beginning to see things looking up for this troubled country. What was your impression during your recent visit?

A: I was there for only one week, but my impression, both in meetings and in field visits, was that things were much the same as they had been 12 years ago, when I was last in Haiti and had the chance to spend much more time. If anything, the crowding and general precariousness of life seemed more acute.

I’d expected the same sort of signs of change that I’ve seen in other poor countries in the past ten or 15 years: many more signs of foreign investment, internet cafes everywhere, and a general improvement in infrastructure —airports, traffic lights, that sort of thing. I mentioned this sense that the country was frozen in time to a Haitian colleague with whom I’d worked many years ago, and he said, “Oh, no. You just missed the bad years. We got much worse for a while, and now we’re on the way up.” So I came away with a bit of optimism, but a clear sense that there’s no linear path.

Q: The earthquake is a natural disaster, but the high death toll and the lack of proper equipment to rescue those beneath the rubble—those trying to help them were reduced to digging with their hands—are the result of human shortcomings, a failure of development. Why was Haiti such a mess, even before the quake?

It would take a scholar of the history of slavery, colonialism, and dictatorial rule to explain how centuries of exploitation of people and natural resources have led to contemporary Haiti. There is more than enough blame to go around. Some belongs to U.S., French, and other external interests that have at times extracted resources from Haiti and at other times subjected the country to economic embargoes. Some blame belongs to a series of national figures who have done everything in their power to profit while letting the Haitian people live in desperate conditions. Certainly one feature that has characterized Haiti’s history is a whole series of set-backs—coups disrupting incremental progress toward better governance, natural disasters, the emergence of HIV/AIDS and more. This devastating earthquake is yet another, and it’s a major blow at a time when the international community was, I think, prepared to make some long-term commitments to support the current government’s development plans.

Q: Against such a grim historical background, is there scope for outsiders to be helpful, beyond simple humanitarian relief?

I absolutely think that there are ways that we can contribute to the development of Haiti, and there are certainly some examples of constructive involvement by both public and private donors. Just a few weeks ago, we hosted a seminar by Dr. Marie Marcelle Deschamps, who leads work at GHESKIO, a very impressive AIDS service-delivery and research center in Port-au-Prince, which also works in some of the rural areas. This is a Haitian organization that is able to do incredible work providing high-quality services in slum areas and contributing research about the best ways to prevent and treat the disease—all with the support of lots of the donor community, including PEPFAR, the Global Fund, the National Institutes of Health, and more. There have also been impressive gains made in the delivery of health services through NGOs, in USAID-funded programs—some of that is described in our video on performance incentives and a working paper. And of course the inspirational work of Partners in Health has brought high-quality health services to rural communities. A different example is in infrastructure development. One of the few things that was markedly better than what I’d seen in the past was the road connecting Port-au-Prince to some of the more rural areas—and that was built with funding and technical input from the Inter-American Development Bank as well as European donors. So I do think there are specific ways that traditional types of international development aid can help.

But, looking beyond the specific ways that dollars and expertise from outside can do good, Haiti faces problems that, in many ways, can be addressed only over the long term if a reasonably capable government that is attentive to the population’s needs is sustained over many years, and there are a series of peaceful political transitions.

Q: What about just letting Haitians come here, as your colleague Michael Clemens has proposed?

Michael’s argument about the power of migration as a force for development is compelling, and of course you just have to look around at the impressive achievements of Haitian immigrants. But relaxing the barriers to immigration is not, in my view, going to address the fundamental challenges that Haiti faces so many areas: creating a functional economy that is able to trade with neighbors, including the United States; providing educational opportunities and health services to the most people, who live in extreme poverty; managing natural resources in sustainable ways; or reducing the threats of violence. The “solution” for individuals, which may lie in being able to move to a place that is more stable politically and economically, doesn’t add up to the “solution” for the country.

Q: President Obama has directed Raj Shah, who was sworn in just last week as the new head of the U.S. Agency for International Development (USAID) to coordinate U.S. relief efforts. Is this a departure from the agency's traditional focus on long-term development challenges? Do you worry that the urgent demands of relief will compete with the development efforts that could make Haiti and other weak states more resilient in the face of such natural disasters?

No, it’s not a diversion from the core mission, but it’s also not the sum total of the organization’s role. USAID has done a lot of humanitarian relief over the years, and I think that makes a lot of sense. The people who best know how to work in a particular country—and that’s usually the USAID personnel, who accumulate a tremendous amount of on-the-ground implementation-level expertise—are often the best positioned to know where and how help can best be used in a crisis. Certainly my own recent experience getting to know some of the staff in the USAID mission in Port-au-Prince gave me a lot of confidence in their understanding of the needs and capacities of different communities and organizations in Haiti—understanding based on long working relationships. They need to work closely with other parts of the U.S. Government, of course, like the Department of Defense, that can come in with equipment, specially trained teams, and other assets. But coordinating the effort, and being prepared to transition to reconstruction and back to the development agenda, is something USAID is—or should be—prepared to do.

Q: Are there lessons from other disasters that should be taken into account in this case?

There’s no question that the experiences with the Asian tsunami and several different earthquakes have yielded important lessons about how to organize the relief effort, and then move from relief to reconstruction. A couple come to mind: that setting up field hospitals can often take too long to make them particularly useful and that from a public health perspective burying the dead is not a top priority.

Because of the uniquely challenging environment of Haiti, as well as the importance of knowing the language and being trusted by communities that have suffered so much over the years, it’s particularly important in this case to depend on organizations that are already familiar with Haiti and have the capacity for large-scale actions. In my view, the last thing Haiti needs is to have lots of well-meaning people arrive who are not affiliated with organizations that can effectively deploy them. Relief and aid workers themselves place lots of demands on housing, communications, security, and other very scarce resources. And the proximity of Haiti to the United States makes the risk that “freelancers” will go to help all the more acute. What all of us can do is write a check (or send a text to organizations that are set up to use the money well.

I am also sure that many of the experienced development organizations working in Haiti have their own hard-won lessons, which hopefully are mitigating some of the impacts now. When I was in Haiti recently I learned that as a result of experiencing stock-outs of medication after a particularly severe set of hurricanes, health facilities treating AIDS and TB patients had instituted a practice of having several months’ worth of drugs stockpiled at all times, to ensure uninterrupted care. That’s just one example of how those who live and work in Haiti are, sadly, all to accustomed to working in hardship conditions, and figuring out how to get through. As a Haitian colleague just wrote to me, “We are courageous and confident that we will get out of it with your support and prayer to build a better Haiti.”