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Deputy Special Envoy Dr. Paul Farmer’s Remarks to the United Nations Executive Committee on Humanitarian Affairs

Delivered by DSRSG Nigel Fisher
United Nations, New York
(18 July 2012)

Ms. Amos, thank you for inviting me today. I am sorry I cannot be here in person – I am currently in Rwanda with Special Envoy President Clinton, inaugurating a cancer center. Who would have thought, ten years ago, that Rwanda would be where it is today? Some valuable lessons can be learned from Rwanda, and I hope to share some of them here today.

I understand that the purpose of the meeting today is to discuss the UN’s vision for transition in Haiti and I am grateful for the opportunity to contribute. The question before us—here and elsewhere—is how to transition from humanitarian aid to development in countries beset by poverty and fragility.

What have we learned in Haiti since the earthquake? I would point to three major lessons:

First, we have learned that how aid is invested is as important as the disbursement rates. The latest figures tracked by our UN office show that 45.3 percent ($2.48 billion) of the pledges made at the NY conference in March 2010 have been disbursed in Haiti. Disbursement is not the same thing as implementation—far from it—but 46 percent is not bad compared to the results recorded after the 2008 hurricane season (15 percent of pledges disbursed) or to other pledging sessions before that. If we look at the modalities of disbursement, however, we get a more nuanced picture. Note for example that:

  • 99 percent of the $2.4 billion in humanitarian funding bypassed Haitian public institutions, making the already challenging task of moving from relief to recovery—which requires government leadership, above all— even more difficult;
  • An estimated 10 percent of the $5.63 billion disbursed in Haiti has gone through government systems.
  • In 2010, aid to Haiti was 4 times greater than the government of Haiti’s total internal revenue.
I understand that the figures for disbursement through country systems is less bleak for recovery funding, with an estimated 16.4% of the bilateral and multilateral funding disbursed through country systems.

These statistics bring me to the second major lesson, one we have learned, or have re-learned again and again: we need to make every effort to rely on and strengthen local institutions as we are in the midst of the humanitarian emergency. I know that this group gathered here today is committed to strengthening Haitian institutions and I would humbly recommend that today, we commit to doing as much as possible to invest in country systems, even at the outset of a humanitarian crisis.

This is why I am very grateful to the Secretary-General, to Nigel Fisher, and my colleagues here today for supporting last year’s Policy Committee recommendation of increasing the UN’s disbursement through state institutions, with a target of at least 10 percent over the next two years. This funding does not need to be allocated to budget support; former Prime Minister Garry Conille often reminded us that investments in ministries were equally effective in the short term. The Haitian proverb sak vide pa kanpe—“an empty sack cannot stand”—applies here. To revitalize Haitian institutions, we must channel money through them.

A third and related lesson: we need, as much as possible, to hire locally, procure locally and make job creation a benchmark of our success. We have heard from the Haitian people time and again that creating jobs and supporting the government to ensure access to basic services are essential to restoring dignity. And we have learned that in order to make progress in these two areas we need to invest directly in Haitian people and their public and private institutions.

I know that many in the room today, in particular UNDP, made every effort to create short-term jobs in the aftermath of the earthquake. We need to invest more in job creation—in particular, in the creation of sustainable jobs. In the months after the quake, when Haitians who had survived were looking for work to sustain their families, I saw countless Haitian doctors out of a job while international health workers and volunteers came in and set up their own clinics. Your help and leadership can help assure that local job creation is not seen as a secondary priority but as critical to our ability to stimulate meaningful development.

A word on civil society: I have to admit, I worry about the fetishization of civil society, especially in fragile settings. Civic engagement is something we can, of course, all agree is critical to a healthy society. But, in my experience, the majority of the civil society organizations supported by international aid in countries in fragility do not represent the views of the poor. Often the measures of success used by those who give out the money, or those who report on our progress, are different than the measures of success used by the citizens in Haiti. I think we ought to challenge ourselves to rethink our support of local civil society groups at the outset of an emergency. I know that Nigel is working to deepen our understanding in Haiti of the constituencies of grassroots organizations and am grateful for his support.

I realize that what I am proposing is not new; indeed it has been discussed in many policy fora. In my experience, three vexing questions regularly surface when these issues are discussed.

  1. At the outset of a crisis, shouldn’t we focus on providing emergency supplies and services instead of strengthening national capacity? As a doctor, I too, make the provision of emergency supplies a priority. While I struggle with this question, I have come to realize we’ve got to do both at the same time which to me translates into making every effort to use existing local institutions, their systems and their people, and allowing them to take the lead. One good example of how to do both at the same time is the American Red Cross support to the General Hospital. In the immediate aftermath of the earthquake, creating jobs may not have been at the top of ARC’s list of priorities. But with the leadership of Gail McGovern they took on a riskier approach and invested an estimated $2.5 million in salary supplements to the General Hospital employees and to support operations and infrastructure.
  2. The second question relates to corruption: Why should anyone invest in a country that has a high level of perceived corruption? This is, of course, a valid question, and one about which, as you are all aware, our constituents are extremely vigilant. But I would argue that instead of focusing on the level of perceived corruption, we should focus on investing in the very technologies and systems that will enable the government of Haiti to be accountable, first to its own citizens, and then to us as their donors. If we don’t accompany the government of Haiti in its own efforts to develop transparency and accountability mechanisms, we will continue to bypass country systems, thereby feeding the vicious cycle of under-investment mentioned above. Now inasmuch as the issue of corruption is vitally real in the mindset of bilateral donors, our UN office has some research on the amount of aid that is truly unaccounted for in fragile settings. We are still in the very early stages of our research but initial findings are interesting. For example:
    • UK: In 2010-11, DfID spent over £7 billion in aid (including £643.7 million in budget support1) and reported losses due to fraud amounting to 0.016% of its overall expenditure2.
    • Australia: The potential loss from currently active cases is estimated to represent 0.017 per cent of the $20 billion appropriated to AusAID since 2004–053.
  3. The third question relates to absorptive capacity: Some of you are understandably worried about absorptive capacity—how much help can the government of Haiti actually accept? In my experience there is more capacity than we think. Look at education. You might say that there’s little capacity there. But is that so? Are people in Haiti unable to teach? No, teachers just haven’t been paid adequately, and so few qualified people have sought teaching careers. Are there limitations on how much Haitian students can learn? No, there have only been limitations on access to school. Thanks to your efforts, we have the power to move the limits that have held back Haiti’s educational infrastructure. Yes, the government has been historically unable to do all the people needed it to do; it needs to be strengthened. But let us build up resources and partnerships before we blame a lack of will or true capacity on the Haitians’ part.
We all know the phrase: hope is not a plan. But hope is, in this line of work, a necessary ingredient.

Two years after the earthquake, and nearly thirty years after I first came to Haiti, I believe that the only way to create durable and transformative change – to break the cycle of disease and poverty holding hostage the lives of millions of Haitians – is through the approach that my colleagues and I have termed accompaniment. It represents an approach that marries our policy ideals with an approach to tackling the real implementation challenges on the ground in order to achieve the aid effectiveness policies we have all signed on to. Every program that is designed needs to have at its core the plan for transfer of functions to Haitian institutions. Scores of colleagues in Haiti, including Nigel Fisher and Mariano Fernandez, have stated their commitment to Haitian institutions and leaders, and are pushing themselves and everyone they work with to think in large-scale and transformative ways. President Martelly and Prime Minister Lamothe are equally committed and have been working closely with Nigel on the roll-out of the accompaniment approach, especially as it relates to the aid coordination framework.

Those of us who have been working in countries struck by extreme poverty and disease know that Haiti is not the exception: one-and-a-half billion people worldwide live in areas affected by fragility, conflict, or large-scale, organized criminal violence, and no low-income country in fragility has yet to achieve a single United Nations Millennium Development Goal.4 Except for Rwanda. Time for a lesson from Rwanda.

We can all admire the Rwandan aspiration to be finished with international assistance entirely by 2020. To the naysayers, let me remind you that in 1998, Rwandans’ per capita income was $268 a year. In 2008, their per capita income was $1,150 a year. They quadrupled their income in a decade and presided over one of the most dramatic reductions in premature mortality, including child and maternal mortality in history. How did they do it? For one, the Rwandan government insisted that donors channel their funding through country systems. When NGOs did not support the national strategies, they might have been asked to work elsewhere. This allowed unprecedented capacity-building, and allowed the elected leadership of the country to develop road maps for recovery to which all institutions and their resources were dedicated.

In closing, I’d like to take a step back and remind us that Haiti was and always will be the locus of a genuine miracle of modernity: the fight against slavery and for equality. The cost of this fight was great, enduring, and ongoing, as any Haitian will remind you. The 2010 quake has been followed by other disasters, including a runaway cholera epidemic and a failure to invest sufficiently in rebuilding the very institutions that any country needs to protect its citizens from want and danger. This work, the desire of the Haitian people, continues to call for our unstinting support undergirded by respect and solidarity. There is little doubt that such a project is well within our reach.

Thank you.

1DfID 2011. ‘Annual Report and Accounts 2010-11. Volume I: Annual Report,’ London, p. 97

2House of Commons, Public Accounts Committee 2011. ‘Fifty-Second Report: DfID Financial Management.’ London, chapter 1, paragraph 8. Available at:

3AusAid. ‘Independent Review of Aid Effectiveness’ (April 2011). Available at:

4The World Bank, 2011, ‘World Development Report 2011: Conflict, Security and Development,’ Washington D.C., p.1