Haiti: What's Working, What's Not, What's Next

Guests

Rajiv Shah, administrator of the U.S. Agency for International Development (USAID)
Alex Dupuy, professor at Wesleyan University. he wrote "One Year After The Earthquake, Foreign Help Is Actually Hurting Haiti" for The Washington Post.

It's been one year since the massive earthquake that leveled much of Haiti's capital, Port-au-Prince, and the surrounding area. While relief aid poured into the country after the quake, many complain that too little has been spent on the overall recovery and that reconstruction has barely begun.

Copyright © 2011 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

NEAL CONAN, host:

This is TALK OF THE NATION, I'm Neal Conan, in Washington. A year ago today the country of Haiti suffered catastrophe. A massive earthquake leveled much of the capital and surrounding towns. Estimates of the number killed go up to a quarter million. Many times that number suffered physical and psychological injuries. More than a million were left homeless.

The world responded quickly and generously in the immediate aftermath, but today many complain that too little has been spent to rebuild, that signs of reconstruction are few and far between. More than a million Haitians still live in temporary shelters. Very little of the rubble has been cleared. A cholera outbreak and a contested election further hampered recovery in a country that suffered from poverty, corruption and political instability, even before the disaster.

If you've been to Haiti this past year, how have you seen aid being used or misused? Give us a call, 800-989-8255. Email us talk@npr.org. You can also join the conversation on our website, that's at npr.org. Click on TALK OF THE NATION. Rajiv Shah is an administrator for the U.S. Agency for International Development, former under secretary for Research, Education and Economics, former director of agricultural development at the Bill and Melinda Gates Foundation. He joined us last March to discuss the U.S. response to Haiti and he's back with us today here in studio 3A to tell us where things stand. Nice to have you back on TALK OF THE NATION.

Dr. RAJIV SHAH (Administrator, U.S. Agency for International Development): Thank you, Neal, nice to be here.

CONAN: And why has there been so little obvious progress?

Dr. SHAH: Well, I think it's important to recognize, as you have, that this was a disaster of unprecedented proportions, with more than 200,000 Haitians tragically losing their lives and with a volume of rubble that was in the streets and in the environment that made it very difficult to get anything done.

In that context, actually a tremendous amount has been accomplished, mostly due to the perseverance of the Haitian people, but with great support from the United States and partners around the world.

The immediate relief effort fed more than three and a half million people and that has now transitioned into investments in Haiti's agriculture and food systems, so that we're not just pursuing handouts, but actually helping Haitians provide for themselves.

Water and shelter materials were distributed to more than a million and a half people. And to this day, even in the midst of another tragedy, the cholera outbreak that's ravaging the countryside, areas in Port-au-Prince, where people were getting clean drinking water from humanitarian efforts, have been relatively protected from the diarrheal disease, illness and death for kids.

So, in many different areas of work, the international community has come together with the people of Haiti to really create outcomes that are improved, even compared to where Haiti was before. But there is so much more to be done that it is absolutely appropriate to focus on how we can do this in a more effective and efficient way.

CONAN: And we hear what you say, still 95 percent of the rubble is still there. More than a million people still living in tents and as you say, this cholera outbreak, this is a preventable situation, a treatable situation. It seems a crime that earthquake victims are falling victim to a disease that is entirely preventable.

Dr. SHAH: Well, it is absolutely tragic, although the earthquake victims in Port-au-Prince, for example, are not the same people that are currently suffering from the cholera outbreak, which is mostly in the rural countryside and affecting children in that context.

The United States, consistent with the president's directive to us after the earthquake to have a swift, aggressive and coordinated effort to support the Haitian people, has been the largest and most significant provider of health services to help literally save thousands of children from death during this current cholera outbreak.

But I just want to step back for a moment and point out that there are some areas we'd love to see more progress. Rubble removal is one of them. But that's also an area where American assistance, provided through NGOs and humanitarian organizations and Haitian institutions, has effectively removed almost two million metric tons of rubble in just 10 months, which is has been faster than the rubble removal from even the Aceh earthquake in Indonesia. It's actually, more rubble...

CONAN: Which is cited as a model of accomplishment.

Dr. SHAH: Which is cited as a model. And we do track our response to make sure that we are being effective and efficient against those types of international benchmarks. And in rubble removal, in housing transitions, in food and health in particular, this response effort has been more aggressive and, frankly, more effective than many of those previous efforts.

But that doesn't mean that this is enough and recovering from this kind of a tragedy in a context where Haiti was already the poorest country in the Western Hemisphere, where nearly half of all children in Haiti suffered from chronic malnutrition, to the point where we were reading articles in 2009 of children in Haiti that would eat mud pies that were literally some nutrition mixed with mud in order to provide density.

It's a tough place to achieve outcomes, but we've been very focused on standing with the Haitian people. And to their credit, time and again, Haitian companies are creating mobile banking services, using the incredible mobile phone platform that exists in Haiti. That was a project we did with a private sector partner. And Haitians are coming up with all types of solutions to some of the challenges they face, including rebuilding a construction industry that knows how to produce and construct homes to earthquake standards, compared to what took place prior to the earthquake.

CONAN: We want to callers in on the conversation. We especially want to hear from those of you who've been to Haiti over the past year and have some idea of how aid is being spent and used, or misused. 800-989-8255, email us talk@npr.org.

But Rajiv Shah, when you were here with us before you told us that your looking toward some of the results-oriented programs, rather than the shotgun approach of throwing money at a lot of different things - being specific, applying funds to specific areas with specific measurable results in mind.

Can you give us examples of things that have worked and maybe one that didn't?

Dr. SHAH: Sure. One thing that worked was we implemented a policy of distributing chlorine tabs, tablets with water distribution, to make sure that people in and around Port-au-Prince had access to clean drinking water.

CONAN: And that should prevent cholera, for example.

Dr. SHAH: That should prevent and has. In the Port-au-Prince area has prevented the cholera outbreak from being as intensified in those camps and in those settlements. As a result we measure -- and in June of this past year, the rate of diarrheal illness in Port-au-Prince was 14 percent lower than pre-earthquake levels amongst earthquake-affected populations.

Similarly, we've tried to transition from handing out food and food aid to helping Haitians develop their own agricultural system and their food system to feed themselves. We've seen in projects around the country more than doubling of agricultural production of maize, which is corn...

CONAN: Uh-huh.

Dr. SHAH: ...of rice, and a range of other staple crops like beans, that can help Haitians get access to better protein, especially for children.

So, as we're spending resources on these types of programs we are trying to measure in a statistically valid way the impacts and the results that we're generating.

There have been efforts that have been less successful. I'd say rubble removal is one of them. We had employed a great number of Haitians on the ground to help begin the process of rubble removal and it's been too slow and it has taken too long to get kind of heavy equipment and a national plan that's tied to points of rubble disposal and recycling. And that has slowed it down. Now it has accelerated again and that's important, but I certainly wish that had been something that took place even faster than it has.

CONAN: Let's go first to Glenn, and Glenn's with us from Grand Rapids.

GLENN: Yes, I guess I have a multi-part thing. I was wondering how much the corruption that I had heard early on of the leadership there - the lack of leadership there - is affecting the aid, and if we're actually experiencing resistance from the general population of America stepping in. I realize that our intentions might be good; however good they are, we always seem to be at the forefront of any of the headlines of assistance and we appear to be, you know, just like America's trying to get their finger in one more pie seems to be the reaction we get from the global community, rather than assistance from the global community.

CONAN: Let's see if we can give Rajiv Shah a chance to respond.

Mr. SHAH: Well, let me address both points of that. On the question of corruption and leadership, I will just say: We have worked with the Haitian government as a partner and created an institution called the International Haitian Reconstruction Commission to help organize all of the different donors, because one of the things we've learned from studying the past is that if there are too many different, uncoordinated and non-transparent aid programs, that leads to corruption, and that leads to ineffective implementation.

So we've put in place a system that's designed to prevent that, and it has begun to start working by approving projects in a coordinate way against the government of Haiti's plan.

The second point, on the population's response, is really extraordinary. You know, more than half of all American families gave in some form to the Haitian effort. And I'm just so proud of that.

If you think of how excited we get as a country to say that 160 million Americans watched the Super Bowl together, this coming together and sharing our moral values has made a huge difference.

And polls show that the Haitian people have appreciated that, that they recognize the partnership with America as a unique one. They believe U.S. contributions have been as effective as they can be in the context of what is happening.

And frankly, the rest of the world has also stood up. We saw from last March, we held a donors' conference to bring together donors from around the world and make significant pledges not just to the immediate relief but to the long-term reconstruction because, frankly, to help Haiti be self-sufficient and resilient and build back better, we all have to be committed for the long run, as President Obama and Secretary Clinton have expressed the U.S. commitment.

CONAN: A conference - and Glenn, thanks very much for the call - a conference at which $5 billion was pledged. How much of that has actually been forthcoming?

Mr. SHAH: Well, you know, in relief terms, most of the money that goes to immediate relief efforts has been quite forthcoming and has enabled a whole host of nongovernmental organizations, the government of Haiti and local institutions, to go about assessing 400,000 home structures, starting to reconstruct homes to an earthquake standard, putting in place 11,000 transitional shelters and supporting service delivery in the camps and settlements so people have access to education and healthcare and clean water and food.

But the reconstruction money, that will take longer, and the commission has developed, with the government of Haiti, plans for the Haitian economy. We're starting to see progress. Just a few days ago, we announced a major commitment to Digicel, the local mobile services company, to create a mobile banking system so that Haitians have a place to save money and can transact, because so few Haitians have access to the banking system. And there are other examples as well.

CONAN: Of the $5 billion pledged, how much has shown up?

Mr. SHAH: Well, I can speak to the U.S. contributions, and we've made pledges of - and have made, have executed projects of several hundred million dollars in the reconstruction. That's in addition to more than $600 million in the actual immediate relief. And so we will continue to spend our resources in a transparent way to achieve results.

CONAN: Rajiv Shah, the head of USAID, about the process of rebuilding and recovery in Haiti, what's worked, what hasn't, and why.

If you've been to Haiti this past year, how have you seen aid being used or misused? 800-989-8255. Email talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION from NPR News. I'm Neal Conan in Washington. Later in the hour, we'll talk with two Haitian-Americans about their families and the future of the other country they love.

A year to the day after the 7.0 earthquake that flattened much of Port-au-Prince, more than a million Haitians continue to live in tent camps and makeshift homes. Rubble still clutters the streets. Many wonder why the rebuilding process does not go faster.

Our guest is Rajiv Shah, the head of USAID, which leads the U.S. relief effort in Haiti. If you've been there this past year, have you seen aid being used or misused? 800-989-8255. Email us, talk@npr.org.

We'll go to Matthias(ph), Matthias with us from Vestal in New York.

MATTHIAS (Caller): Hi, Neal, how are we doing?

CONAN: Very well, thanks.

MATTHIAS: Good. Myself and three other students from SUNY Plattsburgh, the State University of New York, went over to Haiti in March of this past year and we hooked up with an NGO out of the Dominican Republic and were given, actually through USAID, some money for lodging and transportation.

We wanted to express our gratitude for USAID for helping us do that, but I have a few things I want to talk to Mr. Shah about and see if I can get his comments.

Part of the stipulation of us getting the money was to hand out hygiene packets, hundreds of these, to Haitian people in the towns that we visited. And to us it seemed sort of - potentially inappropriate to give out things that were maybe secondary needs and wants when the Haitians on the ground were desiring clean water and food.

I'm wondering what sort of precautions or things are being implemented for the next time around, when people from the United States go on the ground immediately after a disaster, to get access to clean water tablets or food sources and that nature. Again, I take my comments off the air, and thank you very much for the work you've done.

CONAN: All right, Matthias, thanks very much.

Mr. SHAH: Matthias, thank you for the service you've provided. I think it's an extraordinary commitment from Americans from all walks of life that managed to go to Haiti and provide services and be part of the response, and we really appreciate it.

I think in the initial aftermath of the response, we were trying very hard to save lives, and we sent heavily equipped urban search and rescue teams that saved more than 130 people, literally pulling them from the rubble in what was the most successful international rescue effort of that type.

But then quickly the focus did become on food and water. And we found that the most effective ways to distribute that were often through either Haitian organizations or, in the case of water, we actually brought in Dominican Republic trucking companies to bring water to people in Port-au-Prince.

The distribution of things like hygiene packets, shelter materials, longer food rations that would last people a month or two that they could use in their cooking, as they were cooking and taking care of themselves, became the next level of priority.

And, you know, the hygiene kits in particular were very important, and we see that now. We see communities that got access to those things, have had practices like hand-washing and soap distribution that have improved their own ability to protect themselves against chronic disease spread.

And so all of these things have been an important part of the response, but the focus on prevention, whether it was the hygiene kits or the more than million immunizations that we provided through partners to people in Haiti, have clearly helped reduce the threat of certain types of diseases spreading, like Dengue or malaria or - or polio.

And we also, of course, are very focused on cholera, which unfortunately has been spreading in the rural areas and represents a current health emergency.

CONAN: Rajiv Shah, we know you've got limited time today, but in just a moment we're going to speaking with Professor Alex Dupuy, a native of Haiti and a professor of sociology at Wesleyan University, and as I suspect you know, he says the US aid has primarily benefitted American firms and has done little to support Haitian firms or rebuild the Haitian economy. He also complains the Interim Recovery Commission has effectively displaced the Haitian government. I wonder if you could give us a response to that.

Mr. SHAH: Sure. Well, I've been familiar with Alex's writings, and I'm glad that he's going to be joining you.

You know, we have tried to approach this work in a very different mindset and approach than previous humanitarian response efforts and previous efforts to reconstruct and rebuild over the long term.

We have invested directly in Haitian institutions. One of the first things I did was relax or change some of the regulations that were in place so that we could hand food to Haitian NGOs so the Haitian organizations could get food out, because in the early period of relief, they were required in order to reach so many people that were in a state of acute need.

On one of my trips this summer, I had the chance to see our Housing Assessment Program in action. And I was proud of that project because through the program, we were actually working with local Haitian masons and construction workers to help them learn how to use rebar, how to improve the quality of production of cement so that when you reconstruct a wall in a home that is partially damaged, you're achieving a much higher level of earthquake protection.

Those efforts, to build a viable Haitian construction industry, to engage Haitian private-sector companies ranging from their local Coca-Cola affiliate to create mango juice, to any number of other partners, is ultimately a big part of the reconstruction.

We have studied the past, and we have all been providing assistance to Haiti for decades, much of which has not led to a viable Haiti characterized by strong institutions and a resilient economy.

So we've pushed ourselves to do things very different, from the way we procure services to the way we spend our resources through Haitian institutions.

And it often actually means that we have to go a little bit slower in doing this work. It probably would've been faster to just bring in U.S. firms and reconstruct those homes. But by training Haitian firms and working with them, we're trying to create a more viable and independent economy there, and that's a tradeoff, but we think it's worth it in order to do things right.

CONAN: Rajiv Shah, thank you very much for your time, and everybody wishes you the best of luck.

Mr. SHAH: Thank you.

CONAN: Rajiv Shah, administrator of the U.S. Agency for International Development, with us here today in Studio 3A.

Well, as mentioned, Alex Dupuy joins us now. We've posted a link to his recent op-ed piece in the Washington Post, "One Year After The Earthquake, Foreign Help Is Actually Hurting Haiti," and he joins us by phone from his home in Connecticut. Nice to have you today on TALK OF THE NATION.

Professor ALEX DUPUY (Wesleyan University): Thank you for having me.

CONAN: And I hope you're not too deeply buried there.

Mr. DUPUY: Yeah. Well, we pretty much are.

CONAN: And you should note, your critique is not aimed at the global humanitarian relief, to the response(ph) - this is about the subsequent relief.

Mr. DUPUY: I'm sorry, I didn't quite get that.

CONAN: Is your critique aimed at the immediate humanitarian response or the subsequent response?

Mr. DUPUY: No, no, it's not - I try to distinguish between the humanitarian assistance after the earthquake from both the short and long-term objectives of the international community concerning Haiti. And my critique is primarily aimed at the latter set of issues.

So you know, I've heard your - Rajiv - I heard the USAID gentleman, what he had to say, but what he also doesn't say is that the USAID and U.S. food policy towards Haiti have been precisely part of the problem, because since at least the 1980s the U.S. has fostered, has compelled the Haitian government to adopt free trade policies, to dismantle the protectionist tariffs that Haiti used to have that allowed Haiti to produce 80 percent of its food, you know, as late as 1986.

But since then, of the - the dismantling of the sort of agricultural policies within Haiti and opening up Haiti to foreign imports, especially from the United States, have devastated Haitian agricultural production to the point where Haiti now produces only 42 percent of its food.

And even President Clinton, former President Clinton, acknowledged openly, in testimony to the U.S. Foreign Relations Committee, that the policies that he fostered on Haiti when he was president were quite helpful to his farmers in Arkansas, in exporting rice to Haiti, but quite detrimental to Haitian agriculture.

CONAN: And fascinating history, and speaks to the situation before the earthquake. But since the earthquake and the situation which Mr. Shah is trying to address, is that being turned around?

Mr. DUPUY: No. There is no - there is no talk at all in Washington, by the Obama administration, nor is there a call by Mr. Clinton, who is co-chairing the Interim Haiti Reconstruction Commission, to change policy towards Haiti.

And part of - one of the negative consequences of the USAID also in Haiti is through the (unintelligible) food aid policy that they have for Haiti, which again hurts Haitian farmers because the food is being provided much more cheaply than Haitian farmers can produce it.

So all the talk about helping Haitian agriculture grow is simply a palliative, when the real issue is that Haiti's ability to be self-sufficient in food production has been precisely set back drastically by the policies of the USAID and the United States in particular.

CONAN: As you know, donors suggest there are too few Haitian firms that are up to the task and that, indeed, in the interest of speed, sometimes outside firms and outside resources have to be brought into get things done.

Prof. DUPUY: Well, that's not entirely true. The - it's not exactly clear that there are no Haitian firms at all that could contribute to the rebuilding process. In fact, most of the contracts that, so far, has been given out from news reports have gone to U.S. firms rather than the Haitian firms. And they're even buying their supplies from American firms when the - many Haitian firms could supply those services that they need for the reconstruction process.

So, again, I want to distinguish between the short-term aid policies, the short-term humanitarian policies from the objectives, the long-term trajectory and the policies that have been devised for Haiti by the international financial institutions that have not resulted in either decreasing the rate of poverty - if anything, they exacerbated it - nor help build the capacity in Haiti for Haitian firms and the Haitian government to respond to the needs of the Haitian population.

Haiti, in fact, has been transformed into what many have called the Republic of the NGOs. And this is a policy that dates for at least three decades where, again, the foreign donors, the USAID and the U.S. government and other governments bypassed the Haitian state by giving money directly to NGOs to provide services to the Haitian population, and they can only serve in - you know, a minimum percentage of the Haitian population at best. But yet all those - the diversion of aid directly to the NGOs has even weakened further an already weak Haitian state and prevented the state from being - from facing its responsibilities to respond to the needs of its citizens.

CONAN: And as you know, part of the reason for that, at least, was fear that those funds, if funneled through Haitian government agencies, would vanish into the pockets of Haitian politicians.

Prof. DUPUY: Well, you know, this is rather interesting. Of course, the Haitian state is quite corrupt. There's no question about that. But who has worked with those governments? It's - the U.S. supported the Duvalier dictatorship since it came to power in 1957. It continued to support the Duvalier dictatorship all the way through.

When there was, in fact, an election in Haiti in 1990 where a president came to power and was trying to clean the house, bring about reforms in the public administration, challenge corruption but also change the policies to favor the increased minimum wage for the Haitian workers in the assembly industries, you know, provide them more health care services and so on, he was considered to be too radical for the United States. And he was undermined by U.S. policies. So -and the World Bank and the IMF, you know, never supported these efforts.

So, and in fact, what we have is, you know, the claim that the Haitian government is being bypassed because it is corrupt. Yes. And at the same time, these corrupt practices are tolerated because these governments in turn respond to the interests and the policies that the U.S. and other governments and international financial institutions, want to push on Haiti. So you can't have it both ways.

CONAN: Alex Dupuy of Wesleyan University in Middletown, Connecticut. You're listening to TALK OF THE NATION from NPR News.

And let's get another caller in on the conversation. This is Janice(ph), Janice calling from North Garden in Virginia.

JANICE (Caller): Hello. It's nice to be with you today. And I've had the extreme pleasure of working with an NGO that gives money to Haitians rather than the other way around, and that is the Ford Haitian Orphanage in Grison-Garde, northern Haiti. It's rural. And the first time I went to the orphanage, I was shocked at students trying to learn to sew with little squares of fabric and six sewing machines for 42 students. I started sending fabric and, eventually, started a side NGO of having some women sew scrubs that I'm trying to sell in the United States.

CONAN: Surgical scrubs.

JANICE: Yes, like nurses wear.

CONAN: Got you. And how is it going? And how do you see aid being used?

JANICE: Well, I think the aid that I have seen is all been in the rural areas, and I see doctors give up a week of their practice and donate their services at a clinic that's run out of Providence United Methodist Church in Charlotte. No one who goes gets any money. They all spend their own money to get there. And they give out soap. They've (unintelligible) wells. It's kind of amazing what U.S. citizens are willing to do in extreme hardship. And working in the clinic, it's 110 degrees. And people come - the patients come and wait all day in the sun to be seen by a doctor.

I have just the most respect for Haitians. They work so hard just trying to get enough to eat for a day. They care so much about their children. It's amazing to see how the communities raise the children. We'll often at the clinic see someone who's a grandmother or a mother or a neighbor who brings in a child that, you know, they have made carried or walked for miles to get there. But that's in rural northern Haiti. That's nothing to do with Port-au-Prince, even though we were seeing people with broken arms 100 miles from Port-au-Prince right after the earthquake.

CONAN: Janet(ph), thank you very much for that. And Alex Dupuy, we just have a minute or so left. But as important and as valuable as those contributions that Janet described are, clearly, the answer for the future of Haiti is Haitian medical students starting a Haitian medical schools and...

Prof. DUPUY: Correct.

CONAN: ...and going out into the countryside on their own.

Prof. DUPUY: Correct. That's exactly right. And here, we could - the U.S. could take a page out of Cuba's help to Haiti where Cuba, in fact, is helping train Haitian doctors at Cuba's expense and returning them to Haiti to work with Haitian - to provide health care services to the Haitian people.

This is, perhaps, the kind of aid that would help build the capacity in Haiti by both Haitians and the Haitian government to face up to its responsibilities towards the Haitian citizens.

CONAN: Alex Dupuy, thank you very much for your time today.

Prof. DUPUY: You're welcome.

CONAN: Alex Dupuy, a professor of sociology at Wesleyan University in Middletown, Connecticut. The author most recently of " The Prophet and Power: Jean-Bertrand Aristide, the International Community and Haiti." We have a link to his op-ed at our website, at npr.org. Just click on TALK OF THE NATION. And he joined us by phone today from snowbound Connecticut.

When we come back, we'll continue our focus on Haiti one year after the quake. Two Haitians living in the United States join us to explain what this day means to them and to their families.

If you're Haitian-American, join the conversation. 800-989-8255. Email us: talk@npr.org. Stay with us. I'm Neal Conan. It's the TALK OF THE NATION from NPR News.

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