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Poaching local health workers: the case of Haiti

March 20, 2011

By Fiorenzo Conte

In writing of the challenges faced by the global health community, professor Garret denounced the risk of creating alternative health services that compete with rather than complement the national public health system. If this tendency can be explained in view of the need of NGOs to hire local employees to run their programs it presents challenges in the long term. More particularly, the author condemns the practice of international NGOs and organizations to outcompete the national health system when it comes to hiring local staff. In her words :

“Pepfar-funded programs, un  agencies, other rich-country government agencies, and ngos routinely augment the base salaries of local staff with benefits such as housing and education subsidies, frequently bringing their employees’ effective wages to a hundred times what they could earn at government-run clinics.”

In the aftermath of the earthquake in Haiti the local newspaper Le Nouvelliste denounces that a similar problem is emerging on the island. As the island is turning in a “republic of NGOs”, the international NGOs offered free health care services and hired local staff that was previously employed in the Haitian health system. On the other hand, the Haitian hospitals damaged by the quake were excluded by the big part of the international donations. In the short term the gains are evident: professionals are able to actually treat and cure patients, which would have been impossible in the current dismayed Haitian hospitals. And people can receive treatment for free. But what about the long term outlook? NGOs operate without any coordination on the behalf of the government and therefore there is no long term planning for reconstruction. Furthermore, recent years have shown how the presence of NGOs on the island is volatile given its reliance on donors funding (see here). This situation, according to the newspaper, bears the question: what will it happen when NGOs pull out as another emergency will call them? A question that need to be asked and answered by the key players if to the emergency response is to follow a long-term reconstruction.


4 Comments leave one →
  1. stef d permalink
    March 20, 2011 8:41 pm

    Putting myself in the shoes of the beneficiaries, health provision today is what matters the most. I might not even be able to survive the long term it would take to develop a competent state system if substitute service providers were not operating in the field right now.
    That being said, there is for sure a need for NGOs to coordinate among each other and integrate with the national plan, if not help it develop altogether. I do believe (from personal contacts there) that that is exactly the intent of international organisations such as who/paho, now that they emergency state has passed (that from the earthquake but also the following one from the cholera outburst).
    To what extent those objectives are being met is probably questionable. But I just think we’re always a bit too quick to judge people that are trying to really act on something as opposed to making plans. Specially when governments lack so much in capacity, capability and trust.

  2. Nina permalink
    March 22, 2011 7:20 am

    Nice post. Another prime example of how the deontelogical “save as many lives as possible now” approach of humanitarian relief can lead to the formation of a more permanent state of emergency. A little strategic thinking around longer term consequences wouldn’t go amiss here.

  3. Fiorenzo permalink
    March 23, 2011 3:09 pm

    Thanks for the comments
    @Stef: in the post I do not want to express a judgment about people that are involved on the ground. I thought it was important to voice the concerns and issues raised by a local newspaper. The question that follows for me is why then there is a gap between the intentions of the international community involved in the emergency relief and the perception of such intentions by the local civil society.

  4. eve permalink
    October 6, 2011 3:10 pm

    Does anyone know the base salary for Haitian health worker?

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