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Haiti Earthquake 2010 Case Study Responses To Conflict

Saturday marked the third anniversary of the tragic earthquake in Haiti that claimed between 230,000 and 300,000 lives. The grim landmark has prompted much discussion about the struggles surrounding reconstruction and also some hope about what may come next.

Most observers agree that the international response to the quake was overwhelming. Haiti received an unprecedented amount of support: more than $9bn (£5.6bn) in public and private donations. Official bilateral and multilateral donors pledged $13bn and, according to the UN Office of the Special Envoy for Haiti, almost 50% of these pledges ($6bn) have been disbursed. Private donations are estimated at $3bn.

Where has all the money gone? Three years after the quake, we do not really know how the money was spent, how many Haitians were reached, or whether the desired outcomes were achieved. In a policy paper published in May, and in a more recent blogpost, we unpacked the numbers, many of which came from the UN Office of the Special Envoy.

We found that about 94% of humanitarian funding went to donors' own civilian and military entities, UN agencies, international NGOs and private contractors. In addition, 36% of recovery grants went to international NGOs and private contractors. Yet this is where the trail goes cold – you can look at procurement databases to track primary contract recipients, but it is almost impossible to track the money further to identify the final recipients and the outcomes of projects.

Breaking the figures down by donor isn't much better: 60% of US-disbursed recovery funding is "not specified" (pdf), as is 67% of Canada's aid to Haiti (pdf). Data for the European commission shows that 67% of humanitarian funding and 43% of recovery funding is to "other international NGOs" (pdf). Data reporting becomes even more opaque when one looks for the specific organisations, agencies, firms or individuals that have received grants or contracts in Haiti. Detailed financial reports and rigorous impact evaluations are hard to find.

There are some exceptions, but most organisations only publish case studies or other descriptions of their work; negative outcomes or failures are almost never documented. Of the thousands of projects being run in Haiti, we found only 45 organisation- or project-level evaluation reports at the end of 2011. A total of 23 reports do not have specific project data and only four have any specific detail about how the money was spent.

It is a contradiction that the Haitian government is asked to improve transparency when the international aid community itself fails to provide adequate information to the public. Pierre Erold Etienne, director general of the Haitian finance ministry, said: "[The] real problem is that we do not have – or, I should say, we have only very little – overall information on aid (pdf) … We are required to be transparent. We publish the financial information relevant to the execution of our budget. All we ask is for the same transparency from our donor friends, which should help both us and them."

It is very hard to achieve good outcomes when we cannot determine who received the money and how it was spent. Haiti received an amount almost equal to its gross domestic product, but several hundred thousand people remain in tent camps set up in the aftermath of the quake. Port-au-Prince still lacks good roads, electricity and safe drinking water. The problems that characterise the delivery of development assistance to Haiti are not unique – tracking exercises in other countries would probably produce similar results.

The situation in Haiti highlights the need for greater transparency, and we are hopeful that existing initiatives can be used to meet this goal. Particularly important tools for the donor community are the International Aid Transparency Initiative (IATI), a multi-stakeholder scheme with a standard for publishing information about aid spending, and Publish What You Fund's aid transparency index.

Transparency is a critical step towards better project design and implementation in Haiti and other poor countries. Donors, NGOs, private foundations, private contractors and other civil society organisations must report to IATI and must do so in a timely manner. We can and should do a better job of helping people to regain control of their lives in the aftermath of disaster or conflict.

Vijaya Ramachandran is a senior fellow, and Julie Walz a research assistant, at the Center for Global Development

1. United Nations Development Programme. Table 1: Human Development Index and its components. 2011. At http://hdr.undp.org/en/statistics/hdi/

2. Binder A, Grünewald F. Haiti: IASC Cluster Approach Evaluation, 2nd phase country study, April 2010. http://reliefweb.int/sites/reliefweb.int/files/reliefweb_pdf/briefingkit-926211c15c9de387a6c65c83d71c059d.pdf.

3. Farmer P. Testimony to the Congressional Black Caucus: focus on Haiti. July 27, 2010. http://act.pih.org/page/-documents/PEF-Testimony_072710.pdf.

4. Belkin G, Unützer J, Kessler R, et al. Scaling up for the “bottom billion”: “5×5” implementation of community mental health care in low-income regions. Psychiatr Serv. 2011;62:1494–502.[PubMed]

5. Moszynski P. International response risks undermining Haiti's health system, warns relief agency. BMJ. 2011;342 d182. [PubMed]

6. Refugees International. Haiti: from the ground up. 2010. http://www.refugeesinternational.org/policy/field-report/haitiground.

7. Merlin. Is Haiti's health system any better? A report calling for a more coordinated, collaborative approach to disaster response. 2011. http://www.who.int/workforcealliance/knowledge/merlinhaiti_2011report.pdf.

8. Farmer P, Nizeye B, Stulac S, Keshavjee S. Structural violence and clinical medicine. PLoS Med. 2006;3:e449.[PMC free article][PubMed]

9. Farmer P. Challenging orthodoxies: the road ahead for health and human rights. Health Hum Rights. 2008;10:5–19.[PubMed]

10. Patel V. The future of psychiatry in low- and middle-income countries. Psychol Med. 2009;39:1759–62.[PubMed]

11. Farmer P, Furin J, Katz J. Education and practice: global health equity. Lancet. 2004;363:1832.[PubMed]

12. Bauer A, Fielke K, Brayley J, et al. Tackling the global mental health challenge: a psychosomatic medicine/consultation-liaison psychiatry perspective. Psychosomatics. 2010;51:185–93.[PubMed]

13. Almedom A, Summerfield D. Mental well-being in settings of ‘complex emergency’: an overview. J Biosoc Sci. 2004;36:381–8.[PubMed]

14. Pupavac V. Psychosocial interventions and the demoralization of humanitarianism. J Biosoc Sci. 2004;36:491–504.[PubMed]

15. Stein DJ, Seedat S, Iversen A, Wessely S. Post-traumatic stress disorder: medicine and politics. Lancet. 2007;369:139–44.[PubMed]

16. Wessely S. Victimhood and resilience. N Engl J Med. 2005;353:548–50.[PubMed]

17. Mukherjee J, editor. Boston, MA: Partners in Health; 2006. Partners in health guide to the community-based management of HIV in resource-poor settings.

18. Farmer P, Léandre F, Mukherjee J, Gupta R, Tarter L, Kim JY. Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy) Bull World Health Organ. 2001;79:1145–51.[PMC free article][PubMed]

19. Mukherjee J, Rich M, Socci A, et al. Programmes and principles in treatment of multidrug-resistant tuberculosis. Lancet. 2004;363:474–81.[PubMed]

20. Walton DA, Farmer PE, Lambert W, Léandre F, Koenig SP, Mukherjee LS. Integrated HIV prevention and care strengthens primary health care: lessons from rural Haiti. J Public Health Policy. 2004;25:137–58.[PubMed]

21. Koenig S, Ivers LC, Pace S, et al. Successes and challenges of HIV treatment programs in Haiti: aftermath of the earthquake. HIV Ther. 2010;4:145–60.[PMC free article][PubMed]

22. Raviola G, Becker A, Farmer P. A global scope for global health—including mental health. Lancet. 2011;378:1613–5.[PubMed]

23. Sontag S. In Haiti, mental health system is in collapse. N Y Times. 2010 20 Mar. http://www.nytimes.com/2010/03/20/world/americas/20haiti.html?pagewanted = all.

24. Ellingwood K. Haitians' deep aftershocks. Los Angeles Times. 2010. 7 May. http://articles.latimes.com/2010/may/07/world/lafg-haiti-mental-20100508.

25. Farmer P. The birth of the Klinik: a cultural history of Haitian professional psychiatry. In: Gaines A, editor. Ethnopsychiatry. Albany: State University of New York Press; 1992.

26. Fawzi MCS, Eustache E, Oswald C, et al. Psychosocial functioning among HIV-affected youth and their caregivers in Haiti: implications for family-focused service provision in high HIV burden settings. AIDS Patient Care STDs. 2011;24:147–58.[PMC free article][PubMed]

27. Ben-Ezra M, Shrira A, Palgi Y. The hidden face of Haiti's tragedy. Science. 2010;327:1325.[PubMed]

28. Haiti Advocacy Working Group. Health challenges in Haiti. 2010. http://ijdh.org/wordpress/wp-content/uploads/2010/07/HAWG_Health_FINAL.pdf.

29. Institute for Justice and Democracy in Haiti. Our bodies are still trembling: Haitian women's fight against rape. 2010. http://reliefweb.int/node/362241.

30. UN Office for the Coordination of Humanitarian Affairs. Humanitarian Bull. 2011 10–25 Mar.

31. UNICEF. Children in Haiti. One year after: the long road from relief to recovery. 2011. http://reliefweb.int/node/379968.

32. UNICEF. Humanitarian action report mid-year review: partnering for children in emergencies. 2010. http://www.unicef.org/files/HAR_Mid-Year_Review_2010.pdf.

33. Carson N, Cook BL, Alegria M. Determinants of mental health treatment among Haitian, African American, and white youth in community health centers. J Health Care Poor Underserved. 2010;21:32–48.[PMC free article][PubMed]

34. Cox L. Haiti relief workers risk their minds. 18 Jan 2010. http://abcnews.go.com/Health/WellnessNews/haiti-relief-volunteers-risk-minds-lives experts/story?id = 9576127.

35. Montpetit J. Depression, psychological trauma in Canada's Haitian community year after quake. Canadian Press. 2011 12 Jan.

36. Muller D. Haiti: a piece of my mind. JAMA. 2011;305:447–8.[PubMed]

37. Nicholas G, DeSilva A, Prater K, Bronkowski E. Empathic family stress as a sign of family connectedness in Haitian immigrants. Fam Process. 2009;48:135–50.[PubMed]

38. Stige SH, Sveaass N. Living in exile when disaster strikes at home. Torture. 2010;20:76–91.[PubMed]

39. Collins P, Patel V, Joestl S, March D, Insel T, Daar A. Comment: Grand Challenges in Global Mental Health. Nature. 2011;475:27–30.[PMC free article][PubMed]

40. Kleinman A. Global mental health: a failure of humanity. Lancet. 2009;374:603–4.[PubMed]

41. National Institute of Mental Health, Office for Research on Disparities and Global Mental Health. Grand Challenges in Global Mental Health. 2010. http://grandchallengesgmh.nimh.nih.gov/

42. Patel V, Araya R, Chatterjee S, et al. Treatment and prevention of mental disorders in low-income and middle-income countries. Lancet. 2007;370:991–1005.[PubMed]

43. Patel V, Kleinman A. Poverty and common mental disorders in developing countries. Bull World Health Organ. 2003;80:609–15.[PMC free article][PubMed]

44. Patel V, Saraceno B, Kleinman A. Beyond evidence: the moral case for international mental health. Am J Psychiatry. 2006;163:1312–5.[PubMed]

45. Prince M, Patel V, Saxena S, et al. No health without mental health. Lancet. 2007;370:859–77.[PubMed]

46. World Health Organization. Geneva: WHO; 2003. Caring for children and adolescents with mental disorders: setting WHO directions.

47. World Health Organization. The global burden of disease: 2004 update. http://www.who.int/healthinfo/global_burden_disease/2004_report_update/en/[PMC free article][PubMed]

48. Patel V, Thornicroft G. Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries: PLoS Medicine Series. PLoS Med. 2009;6 e1000160. [PMC free article][PubMed]

49. Patel V, Simon G, Chowdhary N, Kaaya S, Araya R. Packages of care for depression in low- and middle-income countries. PLoS Med. 2009;6 e1000159. [PMC free article][PubMed]

50. National Institutes of Mental Health. RFA-MH-11–070: collaborative hubs for international research on mental health. 2011. http://grants.nih.gov/grants/guide/rfa-files/RFAMH-11–070.html.

51. The MANAS program. Manual for family physicians in collaborative stepped care clinics. http://www.sangath.com/images/file/Manas-doctors-manua-draft.pdf.

52. Patel V, Weiss HA, Chowdhary N, et al. Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet. 2010;376:2086–95.[PMC free article][PubMed]

53. Ford N, Calmy A, Mills E. The first decade of antiretroviral therapy in Africa. Globalization Health. 2011;7:1–6.[PMC free article][PubMed]

54. Ivers LC, Jerome JG, Cullen KA, Lambert W, Celletti F, Samb B. Task-shifting in HIV care: a case study of nursecentered community-based care in rural Haiti. PLoS ONE. 2011;6 e19276. [PMC free article][PubMed]

55. Rahman A, Mali A, Roberts C, et al. Cognitive-behavior therapy based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomized controlled trial. Lancet. 2008;372:902–9.[PMC free article][PubMed]

56. World Health Organization. Geneva: WHO; 2010. mhGAP intervention guide for mental, neurological and substance use disorders in nonspecialized health settings: Mental Health Gap Action Programme (mhGAP) [PubMed]

57. World Health Organization. mhGAP Newsletter. Jan 2011. http://www.wfmh.org/2011DOCS/WHO-mhGAP-Newsletter_170111.pdf.

58. Bolton P, Bass J, Neugebauer R, et al. Group interpersonal psychotherapy for depression in rural Uganda: a randomized control trial. JAMA. 2003;289:3117–24.[PubMed]

59. Verdeli H, Clougherty K, Bolton P, et al. Adapting group interpersonal psychotherapy for a developing country: experience in rural Uganda. World Psychiatry. 2003;2:114–20.[PMC free article][PubMed]

60. Verdeli H, Clougherty K, Onyango G, et al. Group interpersonal psychotherapy for depressed youth in IDP camps in northern Uganda: adaptation and training. Child Adolesc Psychiatr Clin N Am. 2008;17:605–24.[PubMed]

61. Verdeli H. Towards building feasible, efficacious, and sustainable treatments for depression in developing countries. Depress Anxiety. 2008;25:899–902.[PubMed]

62. Becker A, Eustache E. Developing research capacity for mental health interventions for youth in Haiti. NIMH grant no. 1R21MH093298–01. Project period: 13 Sep 2011–31 Aug 2013.

63. Muijen M. Local excellence and national strategy: bridging the gap. Psychiatr Serv. 2011;62:1405.[PubMed]