Ashlee Metcalf, MD and Natasha Ang, MD
The Case for Direct Allocation of Funds:
The comparison between the rebuilding efforts after the earthquake that devastated Haiti in 2011 and the tsumnami that destroyed Indonesia in 2004 is a great example of why foreign aide should be focuse on the community. The picture of Haiti in 2014 is only mildly different than the picture of Haiti post earthquake in 2011. Why is this you may ask? Based on UN estimates, donors chaneled $6 billion in funding to Haiti from 2010 to 2012, but less than 0.6% was invested in Haiti. Not much of the funding was given directly to the Haitian government due to concerns of disorganziation (post natural disaster), concerns of corruption, concerns of ability to mobilize material. In times of chaos, it’s important to look at the direct needs of the community and give foreign aide directly to the community. Take Indonesia for example… Efforts to rebuild were based on employing community development for rebuilding homes and local infrastructure to maximize the effectiveness of community recovery. Who knows more about the needs of a community more than the people that actually live in it? There’s a sense of ownership and value in the community. We are able to track funds more directly when we know exactly where the funds are going, instead of depending/relying on a government to disperse funds.
The Case for Strengthened Infrastructure:
80 percent of foreign aid from major donors bypasses the systems of local public institutions, going instead through US-based government contractors or numerous NGOs but there are numerous reasons we should not bypass the local government. Healthcare is not a vacuum. We need other systems in place to make it successful and when we move money through national systems, we strengthen much needed infrastructure. Think about our own US mucipal systems. Water supply, road maintenance, sanitation, regulations regarding where electrical cables can run are not privately owned for a reason. A national government may have better access to the whole nation’s resources – be it natural ones, commodities or people – to apply to a given situation. It may be able to priortize areas of need for the whole country. Paul Farmer has a great piece on this. He also discusses Haiti as an example of lack of coordination of aid and working with the national system allowed a devastating cholera outbreak to continue despite the presence of 12,000 NGOs within the nation. He also discusses how public perception of the level of corruption of foreign aid monies is vastly overestimated.