Haiti's health gains at risk without ongoing assistance from Canada

The hospital in Gonaves feels like it's sitting in the middle of a desert, even though the community is on Haiti's west coast. It's hard to see anything but dull beige sand and the muted brown hills beyond as the sun bakes it all dry and dusty.

The hospital is well-designed: Canada contributed $29 million so it could be built to withstand earthquakes and hurricanes. The green and white facility lets air and light flow through to keep energy costs low. Mexico and the U.S. kicked in an additional US$6.1 million for equipment, including solar panels, and management costs.

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The hospital is at about 35 to 40 per cent of capacity, with a plan to gradually ramp up over the next two years, says Jean-Franois Laurent, director of the health unit for the UN's Office for Project Services in Haiti.

Laurent's role is scheduled to end next month, but that doesn't mean a clean hand-off to Haiti's health ministry, which goes by the French acronym MSPP.

"Of course once we're done, I hope it's not the end," said Laurent, a Canadian.

"The Haitian government will find other donors or support...There's a very strong will at the governmental level, at the ministry level, to make this hospital a model in the country.

"But on the other hand, there's so many variables that we cannot control."

Over the past five years, Canadian-funded programs in Haiti have helped educate people on the need for proper hygiene and clean water, trained technicians to build and fix water filters and provided money to buildanew hospital and new clinics.

But below the shiny surface of brand-new facilities lurks the shadow of uncertainty. When will the country be able to take over running the facilities and paying the salaries of the people who staff them? Will there be enough staff to put them to full use? What shape will these buildings be in five years from now? Twenty years from now?

Right now, more than 60 per cent ofHaiti'shealth budget comes fromdonors like Canada. Another29 per cent is covered by patients through user fees, and only seven per cent comes from the state.

That's barely enough for salaries.

At risk of losing ground

Haiti is an interesting place to be a Canadian. The $1billion provided to the Caribbeancountry since the 2010 earthquakegives Canada an unusually high profile. The ambassador's namecarries a lot of weight. The British have a small office inCanada's embassy,rather than the other way around.

2015 Travers Fellowship series

The CBC's Laura Payton is this year's R. James Travers Fellow. The Travers Fellowship provided $25,000 in funding for her pitch to look at whether Canada's maternal, newborn and child health program was working.Read more about the project here.

• Tuesday:Has Canada delivered on maternal health?
• Wednesday:Budgets, time crunches limit help
• Yesterday:Canada's family planning problem
• Tomorrow:What'snext?

And, local officials still talk about a suggestion two years ago by former international development minister Julian Fantino that Canada could freeze aid to Haiti.

But despite the years of co-operation and hundreds of millions of dollars invested,a recently released evaluation of Canada's work in Haiti from 2006 to 2013 found that the future could see a troubled transition.

"The almost exclusive reliance on executing agencies (the United Nations, the private sector, universities, NGOs, and so on), meant the opportunity to strengthen government systems was missed," said the external report prepared for the Canadian government.

The evaluation found several reasons to praise Canada, including for improving co-ordination between donors to eliminate duplicated efforts and helping more people castballots in elections.

But it warned Haiti's health sector might not be able to take on the management and staffing of new infrastructure.

"The MSPP lacks both the resources (funding, staff, medication, equipment, etc.) and the management capacity to support existing programs, even in the capital region... Canada should carefully consider whether to contribute to the further expansion of infrastructure and health programs, and what the capacity constraints of doing so might be."

It also foundproblems related to Canada's development workand emergency humanitarian assistance:

• Several programs, especially in health and education, were at risk of "not sustaining results" because of insufficient funding from the Haitian government.
• The lack of a proper strategy for transferring knowledge and skills to Haitians, which diminished the prospects for sustainability.
• And agencies providing assistance programs offered salaries and working conditions the government of Haiti couldn't match, "robbing the civil service of staff."

'Come a long way'

Paula Caldwell St-Onge, Canada's ambassador to Haiti, exudes warmth across a boardroom table at the embassy in Port-au-Prince. She's popular in the community of non-governmental organizations in Haiti and seems to have a close relationship with the country's health minister.

But Caldwell St-Onge is clear: the embassywon't simply hand overcheques, even though the external evaluation found Canada is losing a chance to build local expertise when it doesn't let Haiti itself handle donor funds for development.

"We [are helping] them create better management structures and better strategic plans with a budget attached to it, which is not the case right now," Caldwell said.

"So I think when we get to that point and we can see some transparency with the strategic plans and where we're going, that will be for the Canadian government to decide when that time comes."

CaldwellSt-Onge, who previously worked in Brazil and Mexico, knows Haiti well: she partly grew up there while her father worked for the Royal Bank. She says the earthquake set back the country dramatically, with nearly one fifth of the civil service killed that day.

"People are always saying 'geez, there's so much more left to do.' But the thing is we've come a long way, so yeah, I think there is a difference. It's not like we've stayed at zero and not gone forward. So I think all of that gives us hope for the future."

'Keep being positive'

International development is complex. Issues intermingle.

Canada is focusing on maternal, newborn and child health. That ties into economic development because poor families need jobs to pay for food, and it ties into governancebecause countries losing money to corruption can't provideservices.

Haiti's health ministry has plans to cut corruption by introducing standard accounting practices and to increase revenue by opening up hospitals to doctors performing private services.

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But HealthMinisterFlorenceDupervalGuillaume admits she can't imagine a day when Haiti won't need Canada, though she hopes to move beyond the basic assistance that sees NGOsinstructing people on the need to wash their hands or use a toilet instead of defecating near water sources.

"We need to get rid of this type of package of assistance one day and to have really a partnership for development where we can decrease poverty everywhere, [where] we can also give technical assistance one day to some other countries," she said.

"I'm a very positive person and I keep being positive."