Guest blog post by GIRIJA SANKAR, with GLOBAL HEALTH ACTION
What is the magic solution going to be for Haiti? It’s all about education some say. Build schools, provide children with the best learning tools and supplies, and pay qualified teachers regularly. Some argue that it's population control. Look what China did, they would argue. Aggressive family planning, distributing condoms at high schools, colleges, primary health centers, village fairs… OK, that might work. No, it’s all about rural employment generation, development experts would say. In order to de-congest Port-au-Prince (which was home to almost three million people, or a third of the country’s population before the earthquake), we need to provide viable alternatives for people in the country side so they don’t migrate to the cities, which in Haiti’s case is just one city, Port-au-Prince. Sounds reasonable, but what kind of opportunities? Industry? Commerce? The service sector? Or perhaps, agriculture? But, opportunities in industry or commerce require skilled or semi-skilled labor force. Opportunities in the service sector require at least high-school if not college education. Which in turn depend on a developed educational system, and a robust institutional mechanism that supports the educational system. How about agriculture? Maybe. Notwithstanding the widely accepted unemployment figure of 70%, the majority of rural Haitians are subsistence farmers, who live off the meager produce that they cultivate in meager plots of land, supplementing the income with a “petit marchand” or wood work on the side.
Well, perhaps its also about improving Haiti’s weak legal structure, other experts say, especially since post-earthquake, the issue of land rights has become another issue of contention, causing in large part the late start to re-building efforts.
Perhaps it’s about building skills incrementally- some basic literacy for adults, then some financial management, or micro-credit. Nicholas Kristof’s recent column in the New York Times points to some successful micro-credit initiatives in Haiti. What about public health? Perhaps the answer lies in improving the basic health outcomes of infants, and young mothers. A healthy populace is after all a pre-requisite for a viable workforce.
How do we “build back better” in Haiti? Is it education, is it improved public health systems, is it employment opportunities, or is it strong institutions?
The answer is none of the above IF, each of these “solutions” are proposed or rendered independent of each other. But, what if we approached each of these problems differently? What if we fostered development corridors or oases that can then be replicated elsewhere? Integrated development and holistic development are not new buzzwords in the development landscape. But it still remains an ideal in Haiti with very few instances of replicable success stories.
Global Health Action (GHA), an international NGO based in Haiti and the USA, has been supporting a number of community-based initiatives since the early 80s in the Leogane district of Haiti. The earthquake, however, gave us a moment of pause. It has led us to look inwards and ask ourselves how we can work with our communities to truly contribute to better lives. So, while we may have trained 4000 farmers in goat care and husbandry, we realize that alone may not be enough.
For instance, let’s consider the issues of hunger, food security and under-nutrition. GHA has a goat program in Darbonne, Haiti that trains a number of local community members every month in goat care and husbandry. But does training framers in animal husbandry serve food security? Well, indirectly it does. After the training, farmers receive a pregnant doe that has been cross-bred with an improved buck. These goats are now mobile banks in that they can be sold in the market for up to four times the price of other goats in the market. The income then provides a capital influx for the farmer families which they use for several different purposes-to put a child through school, for home repairs, perhaps even to expand their brood of cattle, chicken or goats. Will this improve nutrition? Perhaps, yes, through improved income and through the creation of a business climate where other goods can be traded. But, we realize that training and providing farmers with a goat is alone not enough. If we want them to become goat farmers (and more importantly, if they want to become goat farmers), we need to develop their skills in managing money, cash flow, basic business and commerce.
Integration means that you don’t just train the farmers but build an ecosystem that fosters sustainable growth.
Similarly, consider our community health workers who serve their communities in Petit-Goave commune. They are trained to be health promoters or educators and are often the first or only point of contact for communities far removed from a health center. True integration means that the farmers that attend the trainings on goat care are also familiarized with their community’s health worker. The health worker visits the farmers at home, following up on immunizations, post- or pre-partum clinic visits, and provides them with a supply of family planning prophylactics. She also advises the farmer’s family on appropriate and locally available nutritive foods, perhaps even ready-to-use therapeutic food such as medika mamba(available in Haiti). The family, thus empowered by their health workers, invest in appropriate, healthy and locally available foods. This then will lead to better nutritive outcomes in the long run.
Switching to a top-down perspective, the health workers need to be supported for their work. But who supports them? Ideally, their community members. But in a nascent public health system such as Haiti's health workers need to be supported by institutions, either governmental or otherwise. Governmental institutions in resource poor contexts such as Haiti have little if any sources of internal revenue. They are in turn supported by groups such as the USAID, UNDP, WHO etc. But the point is that when local departments of health begin maintaining simple, easy to maintain health records, through constant and consistent training and capacity-building, there emerges a hint of the larger picture -health workers encouraging behavior change at the community level, families empowered by health workers and by the capacity-building to make the right decisions, and a public health system that tracks the progress initiated by the behavior change and the improved decision-making.
An investment in training farmers and providing them with seed capital will, with the benefit of an improved public health system that supports health workers and tracks health indicators lead to improved food security. Yes, this is a simple argument, but an argument nevertheless for investing not just in nutrition, or agriculture or public health but in all aspects of development, at the community-level so that gains in one sector will translate to gains in another sector for that community and can then be replicated elsewhere.
I hope that I've given you a snap shot of the mechanics of integrated development and how it could work and more importantly, why it should work. Drop us a line here if you’d like to continue this conversation, and thanks!