Country cries for aid that really helps
February 5, 2011

The troubles at the municipal nursing home illustrate the promise and perils of the humanitarian response in Haiti, reports William Booth in Port-au-Prince.

In the days after the earth shook and the government collapsed, the municipal nursing home here became one of the most desperate sights in Haiti, as old people lay swaddled in dirty sheets, huddled in cramped tents, begging visitors for water.

But little by little, order was restored. A humanitarian aid group called HelpAge International arrived at the nursing home. They paid salaries for security guards, healthcare workers and cooks. The last building left standing was patched up, and the elderly residents no longer were bathed with buckets in the yard.

But six months later, HelpAge abandoned the project after it failed to negotiate a new agreement with the city council. The group Project Concern International, which ran a clinic on the grounds of the nursing home, closed down as well after the mayor asked for rent.

The travails at the municipal nursing home illustrate the promise and perils of the unprecedented humanitarian aid response in Haiti.

Hundreds, maybe thousands, of non-governmental organisations, or NGOs, poured into the country after the earthquake to provide emergency services. The groups - from international brand names like Save the Children to unknown Baptist missionaries - were supported by overwhelming global generosity, including more than $US1.4 billion in donations from Americans.

But the effectiveness of the NGOs is being questioned by the groups themselves, and especially by Haitian leaders who complain NGOs have become a parallel government hobbled by poor co-ordination, high turnover and lack of transparency.

In the squalid camps where 800,000 still languish, many Haitians say their misery is exploited by NGOs to raise funds rather than raise them up from poverty. Children throw rocks at photographers from aid groups trying to take their pictures.

Haitian officials speak of being ''overrun'' by ''an invasion'' of NGOs. The Prime Minister, Jean-Max Bellerive, said foreign NGOs operate with little regard to government planning, and that their presence, while necessary, can undermine long-term recovery efforts. By funnelling most aid dollars through the NGOs, rather than the government, the NGOs condemn the country to a cycle of dependence, he said.

Michel Martelly, the popular carnival singer who is in the running to be president, promised that if elected, his government would rein in the NGOs and change how they do business in Haiti. ''We will allow them to function, but I will tell them what to do and where to do it,'' he said.

The Disaster Accountability Project, a non-profit organisation staffed by law students and interns, solicited data from 196 NGOs operating in Haiti and got responses from 38 organisations, which reported that they had raised $US1.4 billion in donations for earthquake relief in Haiti and spent $US730 million on the ground.

Of the 196 websites operated by the NGOs in Haiti, only eight contained information the group considered ''average or better than average'' at transparency. ''Most of the websites rely on anecdotes, aggregations and appeals to emotion,'' said Ben Smilowitz, the group's founder.

Aggregations are a common tactic in which an NGO or donor government compiles overall numbers - latrines, meals, tents - and implies it alone was responsible, when the tallies represent the work done by many.
It is difficult for an ordinary donor who writes a $50 cheque to know where the money goes.

Alex Cottin, a director for Merlin, an international health charity, issued a report asking ''Is Haiti's healthcare better?'' after a year of massive aid and concluded: ''To be honest, I'd say the answer is mixed.''

Cottin said international groups took over services. ''What happened too often is that local health workers were overlooked and sidelined. I learned of one Haitian surgeon who reported going to the General Hospital to offer her services only to be told the international team had brought enough foreign personnel with them.''

An Oxfam report on the one-year anniversary of the earthquake stressed that Haitian authorities needed to show greater strategic leadership but that the international community should do more to support the capacity of Haitian institutions.

Sylvain Groulx, head of the mission for the group Medecins Sans Frontieres, said that ''it is true that a major, major challenge for the NGO community in Haiti has been co-ordination''. The 12 Haitian members of the Interim Haiti Reconstruction Commission sent its co-chairman, Bill Clinton, a letter in December protesting that they were ''completely disconnected'' from the decision-making process that helps shape how more than $US4 billion in recovery aid is spent.

Of 1583 contracts given in Haiti from the US government, totalling $267 million, only 20, for a total of $US4.3 million, went to Haitian-owned companies, according to a review by the Associated Press.

Charity groups have been in Haiti for decades, supplying a majority of health and human services, but it is worse off economically than during the days of dictator Jean-Claude ''Baby Doc'' Duvalier, ousted in 1986 and under house arrest after his return to Haiti two weeks ago.

Donors often prefer to funnel money through NGOs than the Haitian government because they fear the aid dollars will be squandered on cronyism and inefficiencies. Transparency International ranks Haiti 146 out of 178 countries in its Corruption Perception Index.

At the municipal nursing home, Joseph Saintime, a young security guard, said that ''when the NGO was here, the old people ate better, they had better care, a doctor came. But I don't think the NGO will ever come back. We are now alone.''

Emmanuel Jean, a manager of the nursing home, sat in a barren office tallying figures. ''The NGOs come and go, they don't have time to learn from us, the way we do things in Haiti. They don't know what we really need. They tell us what we need. This is why they can't work with us.''

Caroline Graham of HelpAge, said: ''When it was time to sign a new agreement with the mayor about our next phase of work at the home, he refused to work with us unless we paid his staff.'' The group also thought the nursing home, located in a tough slum, and now surrounded by gangs and a tent camp filled with earthquake refugees, should be relocated.
''We wanted to move them elsewhere, but the mayor would not allow it,'' Graham said.

For his part, the mayor of Port-au-Prince, Muscadin Jean-Yves Jason, complained in an interview about his former partners from the international aid community. ''They wanted to take over our nursing home, not help us, but take it over,'' the mayor said. ''And I asked them, what do you want me to do, give you our old people as a present?''

The Washington Post
HelpAge International replies
This story says that "the effectiveness of NGOs is now being questioned, especially by Haitian leaders who complain that NGOs have become a parallel government hobbled by poor co-ordination, high turnover and a lack of transparency".

From the outset of our relationship, HelpAge International worked, not parallel to but alongside the Port-au-Prince city government, which was suffering capacity issues in the aftermath of the earthquake, to rehabilitate its nursing home. Indeed even before the earthquake, the home had suffered significant neglect.

Our response was to provide emergency medical support, removing the most ill residents to a local hospital we helped rehabilitate.

All residents received three hot meals a day and weekly doctor visits, and nurses and care staff were paid and trained in geriatric care for the first time.

We also paid for security and support staffers, all of whom had not been compensated for months before the earthquake.

When time came to renew the co-operation agreement, HelpAge did not abandon the project, as The Washington Post's story implied. We were in no uncertain terms expelled from the site. This expulsion order, which came from the mayor's office, was enforced immediately after the meeting in which we refused to continue to pay salaries.

The article quoted "Haitian leaders who complain that NGOs have become a parallel government," rightly suggesting that this is a bad thing, yet criticised HelpAge International for refusing to do just that.

Richard Blewitt, Chief executive, HelpAge International, London