Haiti, Five Years After the Earthquake: Resilient and Complex

Haiti, Five Years After the Earthquake: Resilient and Complex

 {Photo credit: Julie O'Brien/MSH}Haiti.Photo credit: Julie O'Brien/MSH

This post is part of MSH's Global Health Impact Blog series, Improving Health in Haiti: Remember, Rebuild. The post originally appeared on LMGforHealth.org, the blog of the US Agency for International Development (USAID)'s Leadership, Management & Governance (LMG) Project, led by Management Sciences for Health (MSH) and a consortium of partners.

It has been nearly a year since I first arrived in Haiti to take on the role of Project Director for the US Agency for International Development (USAID)-funded Leadership, Management and Governance project in Haiti (LMG/Haiti). Before making the decision to move halfway across the world from Kenya with my family, I spoke with colleagues, friends, and others who had had some experience visiting, working, and living here. The picture painted by these individuals was a strange amalgamation of perspectives, experiences, and impressions: several spoke about the challenges of working and living in Haiti—the slow pace of work, the challenges with the infrastructure, a lack of coordination, differing priorities—while others spoke of the positive aspects—the striking beauty of the mountains, the persevering spirit and joie de vivre of its people, the colors, the heat, the history, the amazing beaches…. But, in each interaction I heard the same two words: resilient and complex.

Those who have never visited the island country associate the name of “Haiti” with the devastating earthquake that hit on January 12, 2010, five years ago. No one who saw the images of devastation that were broadcast across the world could forget them—in fact the international response to the tragedy saw an unprecedented $8 billion dollars donated by both public and private donors. In more recent years there has been both international and local criticism around the use of the funds and the subsequent limited results and impact. My own perspective speaks to the whole “complex and resilient” description of Haiti.

As with all milestones that mark our common history or our personal lives there is a strange time effect that often occurs, where it seems that the hours and years both stretch and shrink at the same time. I completely understand and agree with those who are frustrated by the slow progress—after all it has been five years. There have surely been mistakes and problems—and these have been well documented by the international press. However, living in Haiti has given me another perspective. Only five years after the earthquake there has been remarkable progress.

First and second wave responders describe the complex environment they had to work in immediately following the earthquake. There was tremendous pressure to find survivors and an impossible amount of rubble with limited equipment to remove it. “Rubble that would take years to remove,” one of my friends remarked, “but so much pressure to produce immediate results.” Additionally, the country received an overwhelming amount of donations—medicines, equipment, clothing, etc. But often the donations were a burden rather than a blessing—expired medicines, pharmaceuticals with instructions written in foreign languages, impossible for local health workers to interpret—now had to be appropriately managed and disposed of.

Five Years Later: Progress, Challenges & Results

Five years later, I have not found that working in Haiti is equal to being perpetually frustrated. In fact, working in Haiti has been one of the most professionally rewarding experiences I have had to date. And while I admit that my perspective is limited in terms of time in the country and the fact that I am working primarily at the national level in the capital, I have found a ministry of health (called The Ministry of Public Health and Population, or the MSPP) that is engaged and enthusiastic about setting priorities and achieving results for the health sector—often encouraging us to move faster and to do more. Equally, I have found a donor (USAID) eager to follow the lead of the country and support its priorities, as well as several partners who are open to actively coordinate and participate.

[Haiti's Minister of Health, Hon. Florence Duperval Guillaume.] {Photo: Terry Cafaro/USAID/Haiti}Haiti's Minister of Health, Hon. Florence Duperval Guillaume.Photo: Terry Cafaro/USAID/Haiti

This experience was validated on January 29, 2015, in Washington, DC, at the recent event Five Years After the Earthquake: Moving Forward for a Healthy Haiti on Capitol Hill. Funded jointly by USAID/HaitiManagement Sciences for HealthPathfinder, International Medical Corps, and InterAction, the summit brought together key global health stakeholders and Members of Congress and their staff for a day of knowledge exchange with local leaders, aid workers, and civil society organizations who work in Haiti. Participants engaged in educational sessions on the impact of US Investments in Haiti, including the valuable lessons learned. The Minister of HealthDr. Florence Duperval Guillaume, presented locally led efforts and some of the MSPP’s plans to develop a strong and sustainable national health care system.

One of these initiatives is the implementation of a National Results-based Financing (RBF) Strategy.

RBF is a national strategy that was adopted by the MSPP in 2013, which is fundamentally different than the traditional means of financing health services. This innovative approach pays for results (as the name implies), i.e., achievement of predetermined targets. We work closely with the World Bank and USAID to support the MSPP to implement the national RBF Strategy. The partnership between the project, the donors, and the Ministry has been highly successful and is hallmarked by transparent and frequent communication and is just one example of the innovative programs the MSPP is spearheading.

Back in Port au Prince, Haiti’s capital city, which was struck the hardest by the earthquake, I see little remaining visual evidence of the earthquake’s impact. But the earthquake is often present in the minds and hearts of those who live here. However, a mere five years later, life goes on. Despite the tremendous loss in terms of life there have been results: between 2011 and 2014 more than 222 health facilities have been renovated or built; recent data suggests that maternal mortality has been reduced by 50 percent since 2010 (from 350 to 157/100,000 in 2013); vaccination coverage has remained stable in the country for the last three years at 89.5 percent; and a national ambulance service has been established, as have mobile clinics for schools.

It is also important to remember that prior to the earthquake Haiti had its challenges, which were merely aggravated by or became neglected as a result of the earthquake. Those challenges are rooted in Haiti’s history and politics and are in their very nature challenging to overcome.

Supporting Haiti's health priorities

For the health sector, many challenges remain. What is important is that the MSPP acknowledges them and has set clear priorities to overcome them—reaching the approximately 40 percent of the population who lack access to health services by increasing the number of community health workers in these areas, ensuring that there are the necessary staff to deliver quality services, making sure that health facility data are accurate and timely, and developing a healthcare financing strategy that will ensure quality, affordability and accessible health service to all Haitians.

These are the priorities of the MSPP and, consequently, those of the partners who support them.

[Carnaval in Haiti.] {Photo: Karen Caldwell/MSH}Carnaval in Haiti.Photo: Karen Caldwell/MSH

Haiti is preparing for Carnaval, an annual national holiday that encompasses all the music, colors, energy, and warmth the country can muster. I attended the Carnaval in Jacmel this past weekend (which always takes place one week earlier) and found the celebration to be as complex as the country itself.  People disguised in giant masks of papier-mâché that look like demons and devils alongside colorful masks of butterflies and doves dance down the city’s main street to intricate drumbeats.  Much of the imagery created in the parade is linked to Haiti’s multi-faceted past—colonialism and slavery—and current—women’s empowerment, sanitation, and prevention of infectious disease. The experience was powerful, intense, beautiful, and whimsical, leaving me with a glimpse of a country that has much to be hopeful about—a snapshot of the resilience and complexity I experience every day working here.