Doomed for Worse?

As we continue to send aid to Haiti after the devstation wrought by an earthquake of severe magnitude, it is time to begin thinking long-term. How do we avoid this from happening again? The earthquake was obviously uncontrollable, and may occur again in the future of Haiti as the country rests on an earthquake prone area. But I do believe that the country could have avoided as many casualties if its healthcare system was established and organized differently, or at all. I say this, however, with a bit of reservation because I do not place the blame on Haiti’s government or its people. Rather, America must be held accountable for the disorganization and disenfranchisement of the Haitian healthcare system. This blame is twofold.

Decades of international aid from American NGOs and Governmental organizations alike has led to the Haitian government taking a secondary role in its own healthcare system. When major organizations such as Partners in Health set up free health clinics, it is not feasible for the government’s clinics that take pay to compete. With thousands of NGOs like PIH in Haiti, one can imagine the level of competition. Just to restate the point, I do not believe it is a problem that these NGOs are in Haiti, rather the problem lies in the absence of any integration.

The logical result of such non-cooperation, which occurred in Haiti, is that the government lost any incentive to fund its own hospitals or clinics, or even invest in its next generation of doctors (another reason why we are seeing less and less native doctors not only in Haiti, but most of the developing world). When foreign organizations and foreign doctors are running the healthcare system of another country, the government of that country simply focuses its attention and funds to areas that it does have control over. This is incredibly problematic because it leads to a dependency on outsiders to run a major component of its own country, the healthcare system.

American NGOs and the U.S. Government distancing themselves from the Haitian government may be explained by the corruption that undeniably was part of the Haitian military government for several years. However, as the Paris Declaration of 1985 noted, any plan of international intervention must be based on a principle of “country ownership”, the country’s government “must at least be a key player in the process.” Regardless of the type of government a country may posses, this declaration established this as principle for all international intervention.

I began to wonder about this Haiti and its long term future after reading the arguments of Anne Mills in “Mass Campaigns versus general health services, what have we learnt in 40 years about vertical versus horizontal approaches” and of Julio Frenk in “Reinventing primary health care: the need for systems integration.” In these two articles, both authors were addressing the lack of cooperation that exists between the existing health providers within developing countries. This is the discrepancy of which Mills refers to as mass campaigns versus general health services, mass campaigns referring to the foreign intervention and general health services referring to the governmental institutions of health. The argument is the same for that of Haiti, these two components cannot persist to be separate from each other as they too often are. If real aid is to be given, it must be given in cooperation centered on country ownership.

The short term is bad in Haiti, but the long term can be worse. The earthquake has proven that Haiti cannot continue with foreigners running its healthcare system. If we don’t start working with the government of Haiti as a key partner, Haiti may only be doomed for worse.

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