National Organization for the Advancement of Haitians

National Organization for the Advancement of Haitians

TOWARD A UNIFIED DEVELOPMENT POLICY FOR HAITI

HAITIAN-AMERICAN SUMMIT 2000

Briefing at U.S. Department of State and Georgetown University

June 30, 2000

INTRODUCTION

During the past two decades, Haiti has been caught in a political turmoil that has impeded social and economic development. While the economies of the countries in the western hemisphere have grown at a fast pace, Haiti's economy has deteriorated at an even faster pace. Hence, as we enter the 21 " Century, it is time for the sons and friends of Haiti to come together to exchange ideas that bring a unified development for Haiti. Politics alone will not save Haiti. While political stability and the installation of democracy are fundamental to improved socio-economic conditions, the improvement of the country's infrastructure; ie, commerce and industry, law and order, health care and education, is critical to improving the quality of life in Haiti. Although Haiti may be in political turmoil at this time, it is the duty of every Haitian or friend of Haiti to continue to seek measures for improving all aspects of life in Haiti. Hence, on June 30, 2000, NOAH/HHF opened its Haitian-American Summit 2000 with a briefing entitled, “U.S. Policy Toward Haiti”, sponsored by the U.S. Department of State. In the afternoon, the session continued at Georgetown University.

Ambassador Donald K. Steinberg provided the introduction to the summit with the topic: “Haiti at the Crossroads: Building Democracy and Prosperity”. The content of the briefing at U.S. Department of State included the following presentations:

* Forging Policy Formulation toward Haiti by Mr. Robert Gilchrist, Special Assistant to the Deputy Secretary of State, Ambassador Strobe Talbott;

*Business Development Policy by Mark Schalkman, White House Senior Advisor for the Americas;

* Educational Policy Reform by Rebecca Adams, Consultant, United States Agency for International Development (USAID);

* Health Care Policy by Shirley Coly, Haiti Health Program Officer USAID;

* Judicial and Security Reform by Carl Alexandre, Director, Overseas Prosecutorial Development Assistance and Training Office (OPDAT), Department of Justice.

The Luncheon Speaker held at the State Department was Dr. Robert Bach, Deputy Director Rockefeller Foundation.

CONTENTS OF BRIEFING AT U.S. DEPARTMENT OF STATE

1. Haiti at the Crossroads: Building Democracy and Prosperity by Ambassador

Donald K. Steinberg

Ambassador Steinberg stressed that NOAH has been an important force working for democracy, enhanced trade and investment, cultural awareness, improved health care and education, and other positive changes. Due to these efforts, U.S. and Haitian citizens have an opportunity to discuss issues ranging from how to promote new trade and investment; to efforts to rebuild basic institutions of education, health and justice; to the common goal of enhancing cultural ties between the United States and Haiti in the political, economic, and social spheres. Further, these efforts have created dialogue regarding problems and challenges facing Haiti and US-Haitian relations.

Since last fall, on assuming the position of U.S. Special Haiti Coordinator, Ambassador Steinberg has met extensively with representatives of the Haitian-American community, and has been moved by their spirit of generosity-not only in giving of resources and time, but in their willingness to share advice, wisdom and institutional memory. From these meetings he has learned of the great diversity of the Haitian-American community. There is no single viewpoint on the great political, social and economic issues facing the United States and Haiti. Rather, it often appears that the only thread binding the Haitian-American community is a common love for the United States and Haiti, as well as a desire to share, with their Haitian brethren, a larger vision of societal and social interaction.

Of the ten times that Ambassador Steinberg has visited Haiti since last November, he has met with Haitians from all walks of life. They told him, “they wanted a government and society guided by the principles of human dignity, justice, rule of law, and democracy. They seek responsive leadership dedicated to alleviating Haiti's profound poverty, overcoming hunger, illiteracy, social division, and unemployment, and supporting equitable development and lasting reconciliation. They demand a society where individuals enjoy personal safety, opportunity, and the freedom to build a better life for themselves and their families.”

Haitians are looking to their friends abroad to provide special insights to ensure that these simple principles can guide Haiti and U.S.-Haitian relations over the next years of rapid transformation. Ambassador Steinberg indicated that during the afternoon symposium at Georgetown University, he would elaborate on the role of business and business leaders and investment in promoting this vision. Further, he expressed his anticipation of an open dialogue with the participants of HAITI SUMMIT 2000 about what the U.S. Government can do to increase its promotion of mutually beneficial trade and investment.

He indicated a personal bias towards the vital role of business in his presentation. This bias stems from his 24 years of Foreign Service assignments working to promote economic development in South Africa, Malaysia, Brazil, Angola, as well as, other countries facing similar challenges of transition as those faced by Haiti over the next decade. Based on these experiences, he firmly believes that business leaders cannot afford to sit on the sidelines while the game of politics takes place on the field. Indeed, politics is too important to be left to the politicians and democracy is not a spectator sport.

In conclusion, the United States will continue to stand shoulder-to-shoulder with Haitians, standing up for democracy, human rights, and development. In option papers going to senior officials in our Government, he assured the attendees that "disengagement" is never an option. America’s national interest in Haiti is too great.

Ambassador Steinberg stated that the success of the coming months in Haiti can prove to be a stern rebuke to the cynics of the world if everyone can resist the easy solace of fatigue, cynicism and frustration. If all can work together and keep their eyes on the prize, future generations will look back on the year 2000 as the period during which the roots of democracy, national reconciliation, and development finally took hold in Haiti. Future generations deserve nothing less.

Foreign Policy Formulation Toward Haiti by Robert Gilchrist, Special Assistant to the Deputy Secretary of State, Ambassador Strobe Talbott.

Mr. Gilchrist emphasized that Haiti has remained a priority for the Clinton Administration in the western hemisphere that predates the military intervention of September 1994. Since that time, U.S.-Haiti relations have been characterized by a high level of engagement as evidenced by bilateral diplomatic efforts (direct U.S. dialogue with the Haitian government); the continued presence of U.S. troops in Port-au-Prince thru March 2000; high levels of developmental assistance; and U.S. efforts to maintain the engagement of the international community, such as the UN, OAS, World Bank, International Monetary Fund, Inter-American Development Bank, and many other institutional organizations.

The goals of the U.S. have included strengthening democratic institutions and civil society; helping alleviate poverty and promoting sustainable economic growth; encouraging improved respect for human rights; stemming the tide of narcotics trafficking and illegal migration; and reversing severe environmental degradation. While there have been mixed results and even some setbacks, Mr. Gilchrist made assurances that the U.S. government remains very interested in Haiti and is committed to helping Haitians advance the cause of Hatian society.

Mr. Gilchrist clarified what is meant by the term, "U.S. Government." While the State Department served a central coordinating role, particularly through the U.S. Embassy in

Port-au-Prince and in Washington, (through the Haiti Working Group under Ambassador Steinberg's leadership), Mr. Gilchrist stated it was impossible to point to one person, office or agency, as the sole solution in developing U.S. Policy. However, he stated that in addition to the State Department, other U.S. entities remain keenly interested in Haiti.

He cited the "White House”, emphasizing the National Security Council and the Special Envoy for the Americas, as critical and ‘hands-on players’in relation to Haiti, more than for other countries. The 1994 U.S. military-led intervention was directed from the top, and key policy makers, particularly those who were involved in 1994, remain interested, such as the Department of Defense, its’ Washington and Miami-based Southern Command. Also, a U.S. military training exercise continues in the Haitian countryside on a regular basis. The U.S. Coast Guard is training Haiti's nascent Coast Guard and, obviously, continues interdiction efforts throughout the Caribbean. The Department of Commerce maintains an office in Port-auPrince and helps potential U.S. investors in an otherwise complex business environment. The Department of Justice (DOJ), which includes the Drug Enforcement Agency (DEA) and the Immigration and Naturalization Service (INS), maintains a strong presence. DOJ conducts training programs in the law enforcement and justice sectors. USAID has overseen over $ 100 million worth of programs annually throughout Haiti over the past five years.

Mr. Gilchrist stated there are additional entities within the State Department concerned with Haiti. The Bureau of Western Hemispheric Affairs takes the lead on Haiti, (Ambassador Steinberg's office is part of that Bureau). In addition, input is provided by the following Bureaus: International Narcotics and Law Enforcement Affairs, Democracy, Human Rights and Labor; International Organizations; and of Economic and Business Affairs. He added that his boss, Deputy Secretary Talbott, and Secretary of State Albright are also interested. Among the U.S. Congress, the Congressional Black Caucus led by Representative John Conyers of Michigan, is a group that has expressed interested in Haiti.

Ill. Education in Haiti and the Role of the USAID Program by Dr. Rebecca Adams.

Ms. Adams stated the challenge of the USAID education program has been to establish a system for helping Haitian schools to improve because Haiti is a country without a national education system. It remains the weakest in the western hemisphere with an adult literacy rate of thirty-five percent. Thirty-three percent of school age children in Haiti receive no education. And of those who attend school, two-out-of-every-three drop out before completion and more than half of those remaining will repeat at least one grade before passing the six-year exam. Further, the public schools serve only fifteen-twenty percent of the children being educated in the country. The rest are enrolled in private schools, sectarian and nonsectarian. However, whether public or private, no school in Haiti is regularly supported

in its quest to maintain minimal quality, and no community is systematically helped to share in the education of its children.

The USAID Program - Ed 2004 is an $18 million four-year project that supports development of quality education networks that bring together public and private schools to jointly undertake teacher training, participate in distance~ leaming programs, and encourage greater parental involvement in the education process. The goal of this support is to improve the quality of instruction and administrative efficiency in primary schools serving rural and depressed urban areas, and to help develop a sustainable primary education system in Haiti. Ed 2004 provides interactive radio instruction in 2nd and 3rd grade with Creole and Math in 394 schools. Altogether, 113,000 students are receiving improved instruction in these core subjects for the early primary grades.

Secondly, the project is helping schools that are located in close proximity to form support clusters. To date 65 clusters have been formed. These schools, previously divided by their affiliations: catholic, protestant, public or private, are now collaborating regularly to improve the quality of instruction.

Thirdly, the project supports 2,600 teachers and 370 school directors through extensive inservice training. Finally, Ed 2004 includes a policy reform component. USAID continues to support Haiti's National Plan for Education and Training, by supporting the consultative process between the public and private sectors. Currently, 10 local and U.S. sponsors ranging from the Haitian Foundation for Private Education (FONHEP) to CARE and Catholic Relief Services, provide field staff that regularly meet with and support teachers, school directors and parents.

Among Ed 2004's achievements is the creation of support service networks and structures. As a result, there are changes in: student learning, school organization, and the degree and quality of community participation. Ms. Adams stated that assessments indicate that children participating in Ed 2004 schools had leaming gains in math that were double those of students not receiving the support of Ed 2004. In Creole, the leaming gains of students in project schools were forty-percent higher than the control group. Leaming gains were equally demonstrated for both boys and girls.

Ms. Adams stated that results like these indicate that more children will successfully complete their six years of primary education. In terms of community participation, 40 of the cluster schools have functioning parent organizations with democratically chosen representation that meets periodically.

These community-school organizations have resulted in additional benefits such as: one cluster of five schools created a cooperative for teachers where they can exchange their pay checks and borrow money at reasonable rates. This arrangement saves the teachers one day's pay because it eliminates travel to Les Cayes for checkcashing. Another school cluster built and equipped a small training center for school activities; and others have made physical improvements to their community schools.

Despite the challenges presented by Haiti, there have been important achievements in the policy reform arena. In USAID's previous education program, support was provided for the development of the National Plan for Education. Emphasis remains focused on decentralization, primary school accreditation, licensure of teachers and financial transparency. To date more than half of the cluster schools have made application for licensing. Ms. Adams stated that of most importance is the emergence of public-private partnerships among institutions active in the education sector. The Ministry of Education has established its first Partnership Commission to set a policy reform agenda for the country's education system, Ed 2004 has become widely recognized, even in the remotest areas, as a model worthy of replication: e.g., the World Bank has incorporated the cluster school model into its education loan package.

Haitian families care very much about education. Household expenditure surveys report that the typical Haitian family spends upwards of 16% of their household income on education - making it the second ‘only’ to the largest household expenditure, with food being the greatest. Education is so important to Haiti's long-term development because in the absence of education and subsequent literacy, democracy is unsustainable .

Increased levels of education are associated with higher individual incomes, better employment opportunities, increased agricultural production, improved health standards, lower fertility, and a greater sense of empowerment, leading to participation in the democratic processes. Research suggests that at least 80% of the population must achieve literacy for sustainable development to occur. Increased levels of education reduce poverty by mitigating its effects on population, health and nutrition, and by increasing the value and efficiency of the labor offered by the poor. Education is the great equalizer. No other process has reduced the differences between the haves and the have-nots more than education.

The single greatest political tool a government has to effect change is that of education. Better schools are crucial to generating economic growth, promoting equity and sustaining democratic government. The key to Haiti's future is the reformation of the Haitian education ystem.Therefore, it must remain our priority to ensure that all children have access to quality primary schooling.

IV. Health Care Policy by Shirley Coly, Haiti Health Program Officer, USAID

Ms. Coly began by citing some general trends with important implications for health care delivery. As a country of 8 million people with a current total fertility rate of 4.8, it is estimated that, at this rate, Haiti's population will double by the year 2027. Haiti's growing population suffers the worst poverty in the western hemisphere with over 80% of rural and 50% of urban people living below the poverty level ($220 US per capita per year). Moreover, fewer than 75% of school-aged children are enrolled in school and the adult literacy rate is only 35%. An ever-increasing number of Haitians are seeking better economic opportunities in the already over-crowded urban area of Port-au-Prince, which has an estimated 3 million inhabitants.

Chronic instability is a significant barrier to the development of an effective public health sector. Other important trends include the low socioeconomic status of women, despite their roles as primary caregivers in most families. A nationwide lack of adequate sanitation facilities has an obvious and adverse impact on public health efforts, especially regarding infectious diseases such as diarrhea. The structure of the health sector in Haiti also presents notable challenges. The vast majority of trained health care providers such as doctors and nurses are located in the Port-au-Prince area, leaving large rural regions underserved. A variety of health care facilities are located throughout Haiti, including dispensaries, health centers, and hospitals with in-patient services. Ownership and operation of these facilities is divided almost equally among private entities, (predominantly NGO's, but also including a small number of private practitioners), the public sector, (the MSPP - Ministere de Sante Publique et Population), and a combination of public and private partnerships.

The following are some of the key health status indicators for Haiti comparable to countries of similar size and development in the Latin American region (LAC):

I . The Total Fertility Rate (TFR) at 4.8 is higher in Haiti than in most

comparable LAC countries.'

2. Haiti has a very low usage rate of modem contraceptives --- only 13%

nationwide in the 1994/95 DHS.

3. The Infant Mortality Rate is 74, intermediate levels of other LAC

countries and Francophone Africa.

4. Haiti has the largest Maternal Mortality Rate (MMR) in the western

hemisphere, estimated at 1000 per 100,000 births.

5. Another significant threat to the health of the Haitian people is the AIDS

epidemic. It is estimated that 6% of the adult Haitian population is

infected with HIV, the highest rate in the Western Hemisphere. 2

6. Voluntary testing and counseling is rare, as is awareness of the risk

factors associated with HIV transmission. For example, in the 1995 DHS,

90% of 14 - 49 year olds surveyed believed themselves to be at minimal

risk for HIV although 50% of males report having multiple partners and

only 10% of sexually-active adults use condoms.

7. HIV carries a damaging social stigma and is equated with death. The

social consequences and the challenges for the health care system can be

severe.

Health indicators taken from 1994/95 Demographic Health Surveys (DHS). 'All HIV/AIDS statistics cited here are from Impact du SIDA, POLICY Proj ect/GHESKIO 1998, unless otherwise noted.

While discussing the practical lessons learned from Phase I, Ms. Coly also discussed the USAID/Haiti Country Strategy for 1999 - 2004. The overall strategic goal of the USAID Mission in Haiti is the Reduction of Poverty in a Democratic Society. The Health program's strategic objective, "Healthier Families of Desired Size", feeds into this overall strategic goal.

The history of USAID's health sector work began in 1991. From 1991 through 1994, Haiti was under a UN embargo and USAID activities were extremely curtailed. Prohibited from direct interaction with the military government, USAID continued to support health services by managing multiple agreements with the private sector, namely, a variety of US-based PVO's and Haitian NGO's. Meanwhile, the public sector underwent a marked deterioration in its ability to provide health care services and in its infrastructure. The MSPP and its departmental counterparts remain weak institutions even until the present time.

After the restoration of democratic rule to Haiti in 1994, USAID began redesigning its PHN program. A ten-year strategy, "Health Systems 2004", was envisioned as a two-phase process, beginning with a shift away from crisis management towards long-term sustainable development in the PHN sector. Phase I began in 1995 and featured three components. Unlike PHN programs in many other countries, USAID/Haiti supports direct health care services. In Phase I, the Mission had two different contracts, one with the US-based Management Sciences for Health (MSH), and another with the Association des Organisations de Population et Sant6 (AOPS), an umbrella group of Haitian NGO's. MSH had a dual role to sub-contract with other NGO's to provide private sector health care services, and to provide technical assistance and training to public sector MSPP managers and staff. Other Phase I activities included support services such as social marketing and operations research.

Despite the many challenges of providing health care in Haiti, Phase I partners were able to document some important improvements in health status indicators in their service areas compared with national baseline from the 1994/5 DHS. Beginning with a national modern contraceptive prevalence rate of 13% in 1994/5, the USAID-funded regions have documented a significant increase to 25% in just three years. The target level for FY2000

is 26.9.

Although data aggregation differed between the baseline DHS (2 - 3 prenatal visits) and subsequent annual program evaluations (4+ prenatal visits in 1997 survey; > 3 prenatal visits in 1998 and 1999), the general trend shows a clear increase in the number of prenatal visits for pregnant women in the USAID service populations. This is an important factor in improving child survival outcomes. Phase I partners have also demonstrated an increase in the number of births attended by medically trained personnel. Hopefully, interventions such as this will begin to have an impact in reducing

the matemal mortality rate.

3 HS2004 results from MSH, December 1999. 4 Health indicators taken from 1994/95 Demographic Health Surveys (DHS).

An overall upward trend shows improvement in immunization status. In 1999, 56% of young children in USAID-funded service areas had received BCGG (for tuberculosis) and were fully immunized against polio, diphtheria, tetanus, Whooping Cough (pertussis) and measles. Another significant result has been the steady decline in malnourishment among children under five years of age. A child is classified as being malnourished if he/she has a height-for-age ratio more than two standard deviations below the normal average.

The second phase of HS2004 has just been launched. With a projected total budget of approximately $70 million over its five-year duration, Phase Il has three components: (1) Private Sector Support through Management Sciences for Health and their NGO network; (2) Public Sector Support for MSPP capacity-building; and (3) Field Support. Although the ftmding level is significantly less than that provided to the private sector, maintaining a viable working relationship with the MSPP is essential for long-term sustainability of USAID activities and results. Approximately $1 - 2 million annually is planned for inclusion in a SOAG with the Government of Haiti. The purpose of the ftinded activities is to strengthen the management capacity of the MSPP and of its departments, especially in view of the Government's movement toward decentralization of services.

The third component of HS-2004 is the use of Field Support funds to purchase specialized technical assistance and expertise to support USAID activities in Haiti. Field Support funds are used for a variety of activities, including:

· Training

· Operations Research

· PHN Staff

· Demographic Health Survey (DHS)

A. STI/HIV/AIDS: Next Segment of Ms. Coly's Presentation of the situation in Haiti.

It has been almost 20 years since the first case of HIV was reported in Haiti. Today, the

estimated national HIV prevalence rate is 6.6%.5 Widely recognized estimates for

STI/HIV/AIDS include the following:

Urban rate is 9.29%, rural 4% 300,000 people living with HIV and AIDS, half of whom are estimated to be living in Port-au-Prince; the same number have died from the disease. By 2010, estimated deaths attributed to the disease reach as high as I million. The grand majority of the affected are between 15-49 years old - the group that comprises Haiti's labor force.

5 All HIV/AIDS statistics cited here are from Impact du SIDA, POLICY Project/GHESKIO 1998, unless otherwise noted.

0 The number of AIDS orphans is estimated to be between 160,000 and 190,000. (There are 150 orphanages in the country, but only one will accept HIV+ children, their maximum capacity is 24.)

Prevalence varies widely by region with the highest rates found in the North, West and Northwest regions. The following factors are thought to contribute to these distribution rates:

· Urban Centers (PAP, Cap Haitian) and high risk populations

· High concentrations of mobile populations (transport workers, migrant construction workers)

· Frequent cross border activities with US and DR

By 2010, it is projected that the prevalence rate will rise to 7.5%. The related illnesses of sexually transmitted infections and TB, in particular, further complicate the scenario. 6 USAID believes these are segments of the population that are particularly hard hit by the disease and its effects:

· Children: the high number of orphans due to HIV

· Youth: the majority of HIV cases are transmitted during adolescence -approximately 65% of the population is under 24.7

· Men having sex with men (MSM): Firm data is yet unknown, but recent survey indicates that MSM have extremely high risk behavior combined with a low knowledge of modes of transmission and prevention measures. The majority of MSM also have sex with women. 8

· Migrant populations: as mentioned above, the proximity to DR and the US and the risky behavior that migrant populations often practice elevate rates in some areas.

USAID has been working with several partners to curb the disease. IMPACT is USAID's primary partner in STI/HIV/AIDS programming. IMPACT is doing work in Behavior Change Communication targeting youth, men (high risk and generally) and Commercial Sex Workers. IMPACT activities include:

· The production of Creole language materials for literate and semi-literate populations

· Street theatre

· Training for Hotline counselors in reproductive health and crisis counseling

· Outreach to bar and brothel owners

6Control ofsexually transmitted diseases in Haiti: results and implications ofa baseline study among pregnant women living in Citj Soled Shantytowns. Behets FM, Desormmeaux J, Joseph D, Adrien M, Coicou G, Dallabetta G, Hamilton HA, Moeng S, Davis H, Cohen MS, et al. Journal of Infectious Disease 1995 Sep: 172(3). 7 Phone conversation with FOSREF's Annick Supplice, July 1999. 8 POZ/GRASADIS, unpublished survey fmdings, 1999.

IMPACT has also recently completed a behavioral surveillance survey - data collection and analysis to better understand the behaviors of high-risk groups including men, youth and commercial sex workers. FY2000 will serve as baseline.

In voluntary counseling and testing (VCT) IMPACT is conducting pilot activities in the Grand Anse in collaboration with CARE's pilot home-based care program. IMPACT is also working with orphans and vulnerable children, conducting a situation analysis in year one (this has recently been completed) that will be followed by appropriate community action during the next two years.

With its partner, AIDSMark, USAID is funding the social marketing of HIV prevention products - mainly male and female condoms. Feasibility studies are looking at the potential for marketing lubricants to men who have sex with men and marketing STI treatment kits.

Finally, CARE-MoRR is focusing on community care and support for people living with HIV/AIDS. CARE has launched a pilot community-based care and support project for people living with HIV and their families in Grande Anse. CARE is also exploring linkages with NGOs providing food aid, prevention, voluntary counseling, testing, and micro enterprise development.

V. Judicial and Security Reform by Carl Alexandre, Esq., Director, Overseas Prosecutorial Development Assistance and Training Office (OPDAT), Department of Justice

Reforming the criminal justice system and justice as a whole in Haiti is very important to the bilateral relationship between the United States and Haiti. In addition to the Drug and Enforcement Agency (DEA) and Department of Immigration (INS), the Department of Justice (DOJ) has two other components involved in Haiti, the International Criminal Investigation Training Program (ICITAP), as well as Mr. Alexandre's office, OPDAT. His office is not engaged in the investigation of criminal cases in Haiti. His efforts through DOJ and OPDAT are to assist the Ministry of Justice.

OPDAT's Phase I efforts have been ICITAP's Police Development Program, a multilevel program initiated in 1994 that helped define the role of the police within the context of Haitian society. OPDAT has helped train the international police force. Phase II of the efforts of OPDAT has focused on the development of a professional police force. Prior to 1994 there had never been a civilian police force in Haiti. ICITAP worked to recruit and train the civilian police force to develop structure. In Phase III, ICITAP focuses on the sustainability of the Haitian National Police (HNP). OPDAT has placed technical advisors to work in key roles of HNP. Their role is to advise the HNP on how to have a better trained, more structured and streamlined operation.

Significant accomplishments, to date, include a trained police force of 5,200; the creation of a functioning Inspector General's Office; and the training of specialized units within