When Bureaucratic Inefficiency Means Life or Death

Nearly two years after the catastrophic earthquake, about 500,000 Haitians are still living in tents. Compounding this tragedy, inadequate shelter has provided ideal conditions for cholera to spread when contaminated water floods tents and homes. Haiti’s Health Ministry has confirmed 7,040 cases of cholera fatalities so far, and the rainy season will likely renew the spread of the disease this spring and summer.

NPR reports that life-saving vaccines are already available along with medical staff trained to administer them, but the vaccination process is being held up by bureaucratic red tape:

Initially it was opposed by a previous Haitian government, in part because international agencies such as the World Health Organization and Pan American Health Organization were against it. Officials at the U.S. Centers for Disease Control and Prevention also opposed it privately.

But the WHO last November approved the dollar-a-dose vaccine that is ready to be used in Haiti, the PAHO now favors the project, and the current government of Michel Martelly indicated approval in December. The CDC representative in Haiti says it’s supportive and interested in the outcome.

Now the project is awaiting approval from a national ethics committee, which wants assurance that the vaccine is no longer considered experimental.

A common pitfall of international aid is that foreigners seeking to provide help misunderstand local institutions and local needs. They can cause more harm than good by subsidizing detrimental policies or providing in-kind aid that takes away opportunities for local entrepreneurs. The cholera vaccination program seems to not suffer from these failings, though, as the program has broad support from Haitian people and just needs permission to go forward from their government. The NPR story continues:

Almost everybody contacted by GHESKIO workers in a door-to-door campaign has said they want the vaccine. Their names, ages and addresses have been entered into smartphones and uploaded into a master data file. (First, the health workers had to paint house numbers next to each doorway, because there were no addresses.)

One of the groups working to provide cholera vaccinations along with GHESIKO is Partners in Health. Among international aid organizations, PIH stands out as exceptionally adept at employing local knowledge, hiring employees from the countries where they are working rather than bringing in foreigners to administer programs. Paul Farmer, the founder of PIH, has dedicated his life to understanding the unique challenges in the countries where he works. William Easterly, a critic of many international aid efforts from a Hayekian perspective, supports Paul Farmer’s work, if not PIH’s institutional philosophy.

Their use of local knowledge is exemplified in the cholera vaccine program where PIH employs local Haitian health workers to provide vaccinations. These are the people who have the tacit knowledge necessary to carry out the vaccine program effectively in a country with many infrastructure challenges. The cholera program would be tracked using technology that can be relied upon in Haiti rather than attempting to import methods from the United States.

While PIH’s model represents some of the best practices in embracing local knowledge and has helped reshape the model of global infectious disease prevention, the difficulties in administering the cholera vaccines in Haiti underscore the institutional challenges that the country faces. The combination of complex bureaucracies and a weak state contribute to making it the poorest country in the western hemisphere, and depressingly, no amount of foreign aid can help change the institutions that prevent Haitian entrepreneurs from contributing to economic growth.