Outcomes-based financing: Possibility and promise in global health


Outcomes-based financing: Possibility and promise in global health



The Re-foundation of Haiti: Building a Strong Base with Education

On March 31, the Haitian government, the United States, and the United Nations will co-host an international donors’ conference, “Towards a New Future for Haiti”, at UN headquarters in New York. More than two months after a massive earthquake shook Haiti, humanitarian assistance and recovery efforts are still the focal point, but increasingly with an eye turned toward reconstruction – or “re-foundation,” as Prime Minister Jean Max Bellerive has called it – and long-term development of the country.[1] In particular, the education system in Haiti is in dire need of massive reform. Continued U.S. government leadership, both in terms of financial but also technical support, is needed to adequately address the scale of Haiti’s education problem. In particular, the expertise of the government and its partners in post-crisis educational recovery is a specialized skill and comparative advantage that should be brought to bear over the long-term. This is important not only for the future of Haiti’s children, but also for training of the youth and adults that is needed to improve Haiti’s security, energy, agriculture and healthcare.

Speaking with President Rene Préval in the Rose Garden earlier this month, President Obama reiterated his support for the Haitian recovery effort and stated that moving forward the U.S. would remain partners with Haiti on the long road to reconstruction, a sentiment reflected in USAID Administrator Rajiv Shah’s testimony before Congress when he stated that “as the operation transitions from rescue to recovery, the United States will continue to stand with the people of Haiti.” In order for the U.S. to effectively stand with Haiti, it must focus on two important principles of international cooperation: supporting the Haitian government’s own development plans while providing strong leadership – both financial and technical – among international donors.

In advance of the international donors’ conference, the Haitian government released its Preliminary Disaster and Needs Assessment (PDNA), which estimated that the damage from the earthquake alone was approximately $7.9 billion, which is more than 110 percent of Haiti’s GDP. Rebuilding the country beyond the immediate priorities of post-quake reconstruction will cost $11.5 billion over the next three years and address the significant economic and governance challenges Haiti faces to becoming a fully functional state. Raising the necessary level of funds to rebuild Haiti will require many donors – bilateral, multilateral and private – and will demand excellent coordination of funding. As the largest donor to Haiti, contributing one-quarter of official development assistance (ODA) in 2008, the United States plays an important role both in its relationship with Haiti and among its fellow donors.

It is important to note the existing tension, particularly in humanitarian disasters, between effectively supporting a national government with good donor practices of aligning with country-led planning versus dealing with the reality on the ground. Principles of development aid effectiveness rightly focus on recipient countries exercising leadership over their own development policies and donors working with these governments to strengthen and utilize countries’ own institutions and systems, including those for public financial management, accounting, auditing, procurement, and monitoring, to effectively support development efforts. Recent evidence from Afghanistan shows the damage that external donors can cause when systems and incentives aren’t aligned. For example, Clare Lockhart of the Institute for State Effectiveness reported that although most Afghan provinces had functioning finance offices with capable civil servants tracking the flows of money for the national treasury in 2002, many of those civil servants have now left their jobs to become drivers or translators for aid agencies. This consequently decimates the capacity and effectiveness of these financial offices and has broader impacts on the illegal flows of money to tolls and bribery.[2]

External donors must strive to reduce long-term aid dependency by building capacity and leadership within the country through country systems. However, in the immediate aftermath of a serious disaster or prolonged conflict, there may be serious questions around the capacity of the government to effectively fulfill its role of determining and implementing policies to achieve its development goals. In these cases, donors must balance action with capacity development. In these contexts, significant external assistance is often needed to resume basic services that are both life-saving and life-sustaining while at the same time working closely with government actors, so they can resume this function as quickly as possible. In the case of Haiti, the seat of the national government was ground zero for the earthquake – the Presidential Palace, main parliament building, tax headquarters, and the UN headquarters were all destroyed – and ongoing reports from citizens on the ground have often questioned where the government is. Two months after the earthquake, there are still dead bodies buried beneath piles of rubble on the streets of Port-au-Prince. On top of any capacity constraints the government had prior to the earthquake, the government of Haiti is far from being able to independently shepherd the nation through recovery, reconstruction and development without significant assistance from the outside.

Drawing on lessons from the Indonesian tsunami, Brookings’ scholar Homi Kharas has recommended establishing a Haiti Reconstruction Agency that would monitor projects, manage pooled aid resources, and play the leadership role on the government’s behalf with respect to all external donors. While the tsunami in Indonesia had devastating effects on the country, the central government was left relatively in tact. In the case of Haiti, this temporary government agency would likely need to begin with substantial technical assistance from external donors. However, it should be established in a way that facilitates the gradual shift of complete ownership to the Haitian government as capacity is built. But this is a matter of years, not months. Long-term, steady and smart external assistance will be one of the key ingredients for any hope of recovery in Haiti. According to the PDNA, Haiti will need to undertake a significant overhaul of some institutions and the complete rebuilding of others from scratch.

One institution that will require a complete overhaul is the education sector. Prior to the earthquake, approximately 55 percent of school-aged children were not in school.[3] One of the biggest barriers to achieving universal quality education in Haiti is the fact that more than 80 percent of the classrooms with 90 percent of the country’s students are run by private entities. These entities are unregulated and have little to no oversight by the Ministry of Education, leading to wide ranges in the quality of education.

In a country where 80 percent of the population is living below the poverty line and more than half are in abject poverty, individual families still must pay tuition fees for their children to receive even a basic education, leaving many unable to afford schooling costs. Furthermore, without a formal tertiary education system, there is a lack of minimal levels of teacher education; nearly eight out of every 10 primary school teachers have no formal teacher training.[4] Many of those children that were enrolled in school were not learning with 70 percent of primary school student demonstrating learning levels that were at least two years below grade level.[5] According to the government’s own language in the PDNA, the education system fell far short of what was needed to play a significant factor in the growth of the country. “Overall, the Haitian education system already presented deficiencies before the earthquake that made it unfit to contribute to socio-economic development.”[6] In other words, before the crisis, the government education system was virtually non-existent and the question facing Haiti now is what does “re-foundation” mean for education?

During a speech at George Washington University in Washington on March 10, First Lady Elisabeth Préval described the situation in her country following the earthquake as a “nightmare,” with approximately 2 million children unable to go to school.[7] The Education Cluster Unit, coordinated by UNICEF and Save the Children, reports that 5,000 schools – more than 80% of the schools in the area – have been damaged by the earthquake. The earthquake’s impact on education stretched far beyond the affected areas around Port-au-Prince; the entire education system was effectively shut down for weeks after the earthquake, with “unaffected area” schools officially opening on February 1, but reporting only a sparse number of students attending.

Despite the enormity of the challenge facing education, Haiti has a unique opportunity to work with a clean slate. Mrs. Préval expressed her desire to create a free public school system, stating that “this will be our first demonstration for the dignity and respect for the Haitian community.”[8] In addition to covering those children who were enrolled prior to the earthquake, establishing a new system must address the more than 400,000 children who were not enrolled in school before the earthquake. According to Minister of Education Joel Desrosiers Jean-Pierre, this clean slate means that children, primarily those residing in more isolated rural areas, should also have the chance at a quality education with a target of their inclusion in the new system. How to do this in the wake of such a massive blow to Haiti is a question that will need the help of every citizen and every development worker with expertise in post-crisis recovery.

The benefits of education are clear. Educated people are healthier people and pass on those health benefits to their children. In a country where riots over food shortages threatened the stability of the government in 2008, it is important to consider that gains in women’s education have made the most significant difference in reducing malnutrition, out-performing interventions that increase the availability of food.[9] More schooling is associated with increasing personal earning, which translates into a one percent annual increase in GDP if good quality education is offered to the entire population.

In publicly announcing its plan to establish a free and comprehensive publicly-funded education system, the Haitian government recognizes that it will require substantial levels of both financial and technical support from the international community. This is the first step toward country-led development, and one that should be supported by the major international donors. As a leading donor in Haiti, the U.S. plays a crucial leadership role. Yet, out of the $292.8 million requested in the FY 2010 budget, only $12.6 million, just over 4 percent of all development assistance, supported education. Prior to the earthquake, the State Department decided to maintain this relatively low level of funding for education, instead prioritizing investments in security, agriculture, electricity and health,[10] despite the demonstrated success of its out-of-school youth livelihood initiative and basic education reform program. Anecdotal evidence from those working on the ground in Haiti showed that youth from USAID’s non-formal technical and vocational skills program that teaches construction put their new skills to use as they led efforts to clean up rubble in the neighborhood after the disaster. The scale of need in Haiti’s education sector means that all donors have a role to play. For the U.S., this is especially true in terms of the technical expertise it can bring.

The Senate Foreign Relations Committee’s ranking member Richard Lugar (R-IN) specifically called on the Obama Administration to include funds for education in the upcoming supplemental request for Haiti, stating that “only with a strong education initiative will Haiti have a chance at a better future.”[11] There has, however, been concern among U.S. government partners working on education in Haiti that U.S. government support for education is waning. Going into the donors’ conference, it will be important for the U.S. government to continue to renew its support for education, if not increase it. This is not a recommendation for U.S. assistance to be everything to all people, but instead to maximize its comparative advantages.

According to the Paris Declaration on Aid Effectiveness, the principle of “harmonization” includes the goal of “more effective division of labor,” referring to the fact that different donors have different strengths and cannot – and should not – be working in all sectors in all countries. Productive division of labor depends upon identifying and leveraging the comparative advantage of each donor. While Canada and France expressed their intent to take a leadership role in education in the 2009 donors’ conference for Haiti, USAID and its implementing partners have demonstrated that they are the well-placed to deliver both significant financial and technical resources to building education back better in Haiti. The U.S. government could miss a clear window of opportunity to leverage its own comparative advantages in this area and have a significant impact not only on the education of hundreds of thousands of Haitian children and youth, but on the overall long-term development of Haiti.

First, as highlighted in a recent Center for Universal Education working paper, the U.S. government has substantial strengths in education work in countries affected by fragility, particularly with respect to the level of resources dedicated and technical expertise. Both within the U.S. government and among the non-government organizations with which it partners, there are many highly-qualified technical experts who are at the forefront of post-crisis educational recovery. Both USAID and its partners have years of experience working on the ground in post-disaster situations and have cultivated agency-wide tools to utilize in these situations. These are exactly the types of skills that are needed in Haiti today. This demonstrated comparative advantage in the field of education in situations of crisis worldwide should be leveraged in Haiti.

Second, USAID’s EQUIP2 program that focuses on educational policy, systems development and management has demonstrated the U.S.’s success at improving quality education by facilitating access to technical expertise and resources. John Gillies has authored a report, publication pending, on long-term education reform based on case studies in five countries provides evidence on the challenges of system reform, highlighting the need for political will and institutional commitment, the role that outside forces place in “creating space” within the system for significant reform, and the importance of focusing on sustained system improvement over the sustainability of specific activities.[12]

Finally, recent education reforms in New Orleans after Hurricane Katrina offer an example of how a fundamentally different education system can be built in the wake of a disaster. Before Katrina, New Orleans’ public school district was viewed as one of the worst urban public school districts in the country with 6 out of 10 schools deemed academically unacceptable. Nearly five years after the storm, New Orleans now has a mixed system of schools, which includes 37 traditional schools and 51 charter schools. School leaders and district administrators have cited rising student achievement as the main success of public education over the last few years and voters and parents have expressed support for the major education reforms, including the state takeover of public schools and the expansion of charter schools.[13] Paul Vallas, who headed up the school systems in Chicago and Philadelphia before being recruited as superintendent of the Louisiana Recovery School District, has partnered with the First Lady and Congressman Chaka Fattah (D-PA) to share lessons learned from New Orleans to assist in Haiti’s effort to increase access to quality publicly-funded education for all.

The devastation of the earthquake has opened a window of opportunity for the next generation of Haitians to break the cycle of inter-generational poverty that plagues a majority of citizens. What type of education system Haiti decides to implement in order to ensure that all its children and youth have equitable access to a quality education ultimately will be up to the government. However, the United States has the technical capacity and financial resources to set Haiti up for success and should strongly continue its support. Reducing  U.S. support of education could send the wrong message to other donors about the viability of education reform in Haiti and a gap in support to education will have a significant impact on the rest of Haiti’s development, including the United States’ stated strategic priorities of energy, agriculture and health. The supplemental appropriations bill should explicitly include support for education to leverage the U.S.’s comparative advantage in this field. Further, the U.S. should come to the international donors’ conference on March 31 ready to strongly support the government of Haiti’s plans for redevelopment of the education sector. Without strong donor financial and technical support, these ambitious education reforms will languish. However, with the Haitian government in the lead and close collaboration among the United States and other international donors, it is possible for Haiti to use this devastating tragedy to finally establish a quality, inclusive, publicly-funded education system.

[1] Davidson, Adam and Chana Joffe-Walt. “In Haiti, A Prime Minister’s Lament.” Audio Blog post. NPR, Mar. 16, 2010.

[2] Kenyon, Peter. “Exploring The Taliban’s Complex, Shadowy Finances.” Audio Blog post. NPR. 19 Mar. 2010. Web. 19 Mar. 2010.

[3] Enquête de Morbidité, Mortalité et Utilisation des services, 2008.

[4] Wolff, Lawrence (2008). Education in Haiti: The Way Forward. PREAL at the Inter-American Dialogue. Washington, D.C.

[5] Preliminary Disaster and Needs Assessment, Haiti – Education Sector. Draft submitted on 12 March, 2010.

[6] Preliminary Disaster and Needs Assessment, Haiti – Education Sector. Draft submitted on 12 March, 2010.

[7] Preval, Elisabeth. Priorities for Education in Haiti after the Earthquake. The George Washington University, Washington, D.C. 10 Mar. 2010. Speech.

[8] Preval, Elisabeth. Priorities for Education in Haiti after the Earthquake. The George Washington University, Washington, D.C. 10 Mar. 2010. Speech.

[9] Smith, Lisa and Lawrence James Haddad (1999). “Explaining Child Malnutrition in Developing Countries: a cross-country analysis.” IFPRI Food Consumption and Nutrition Division Discussion Paper 60, Washington DC.

[10] Dilanian, Ken. “Rebuilding Will Mean Reversing Past Failures.” USA Today. Feb. 3, 2010.

[11] According to OCHA’s online Financial Tracking Services, Australia, Brazil, Bulgaria, Japan, and the United States are funding education-related projects through the current humanitarian appeal.

[12] Gillies, John, (2009). “The Power of Patience: Education System Reform and Aid Effectiveness.” Manuscript submitted for publication at AED/USAID, Washington, DC.

[13] Cowen Institute for Public Education Initiatives at Tulane University (2010). “2010 State of Public Education in New Orleans.” New Orleans, Louisiana.