The socioeconomic impact of international aid: a qualitative study of healthcare recovery in post-earthquake Haiti and implications for future disaster relief

ABSTRACT

We assessed healthcare provider perspectives of international aid four years after the Haiti Earthquake to better understand the impact of aid on the Haitian healthcare system and learn best practices for recovery in future disaster contexts. We conducted 22 semi-structured interviews with the directors of local, collaborative, and aid-funded healthcare facilities in Leogane, Haiti. We coded and analysed the interviews using an iterative method based on a grounded theory approach of data analysis. Healthcare providers identified positive aspects of aid, including acute emergency relief, long-term improved healthcare access, and increased ease of referrals for low-income patients. However, they also identified negative impacts of international aid, including episodes of poor quality care, internal brain drain, competition across facilities, decrease in patient flow to local facilities, and emigration of Haitian doctors to abroad. As Haiti continues to recover, it is imperative for aid institutions and local healthcare facilities to develop a more collaborative relationship to transition acute relief to sustainable capacity building. In future disaster contexts, aid institutions should specifically utilise quality of care metrics, NGO Codes of Conduct, Master Health Facility Lists, and sliding scale payment systems to improve disaster response.

KEYWORDS:

• Haiti
• international aid
• earthquake
• global health
• internal brain drain

Acknowledgements

We acknowledge the contribution of Lydia Maurer (LM), who helped significantly with the coding process. We also acknowledge the help of our expert consultants, Michaela Kiernan (MKN), Katherine Gilbert (KG), Nicole Tinfo (NT), and Johan Guillaume (JG). We also thank our Creole Interpreters and community guides, Robinson Pierre (RP) and Florian Caan (FC). We also acknowledge the help of our colleagues at Family Health Ministries, especially Kathy Walmer who made this project possible. We also thank Dr. Michelle Barry, Dr. Eran Ben David, and Janine Bruce who were indispensible mentors for the lead author.

Author Contributions: MK contributed to the research idea, study design, literature search, data collection, data analysis, interpretation, and manuscript writing. DW contributed to the research idea, study design, data interpretation, and manuscript writing. SB contributed to data analysis, data interpretation, and manuscript writing. No authors were paid for writing this article. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Additional information

Funding

Research grants were provided by Family Health Ministries, Stanford University School of Medicine, and Duke University.

Role of the funding organisation or sponsor: Family Health Ministries helped generate the initial idea for the study, helped design the methodology, and provided the infrastructure in Haiti to make the project possible.