Tuesday, August 4, 2009

The World Bank and IMF Forgave Ayiti's Billion Dollar Debt as Ayiti Struggles to Reform Public Programs and Policies

A few weeks ago the boards of the World Bank and IMF decided to approve Ayiti’s (Haiti)$1.2 billion debt relief under the enhanced HIPC (Heavily Indebted Poor Countries) Initiative and the Multilateral Debt Relief Initiative (MDRI). The interest payment on Ayiti’s loan had grown to approximately $20 million per month, which is a staggering payment for a poor island-nation with approximately $4.1 billion in GDP and $1,300 per capita.

Ayiti’s debt was relieved because Ayiti had reached the completion point under the enhanced HIPC Initiative. For Ayiti to reach the completion point, Ayiti had to make several reforms despite suffering through a series of humanitarian crises and enduring the devastating impact of four hurricanes, drastic increases in food and energy costs and challenging political conditions. A number of political leaders and organizations urged for the cancellation of Ayiti’s debt. US organizations including Jubilee USA Network, Institute for Justice and Democracy in Ayiti, TransAfrica Forum, the Quixote Center, Center for Economic and Policy Research, the Episcopal Church, and Partners in Health worked together to build the political will in the U.S. for Ayiti’s debt cancellation, in partnership with colleagues in Ayiti, throughout the Americas, across Europe and around the world. Ayiti is now under the MDRI for further debt relief from International Development Association (IDA) the Inter-American Development Bank (IADB). MDRI relief would save Ayiti US$972.7 million in debt service of which US$486.7 million owed to IDA and US$486 million to the IADB.

Several of the reforms that Ayiti has made and will continue to make as part of the debt forgiveness program, include: implementing a national poverty reduction strategy; strengthening public expenditure management; producing audited government accounts; ensuring commitment to an asset declaration law, which requires a country not to nationalize foreign assets; adopting a law on public procurement; strengthening tax and customs administration; improving debt management and financial reporting; establishing a financing mechanism to allow over 50,000 additional children to attend public school; allocating over 20 percent of recurrent spending to education; implementing a national teacher training program; approving an HIV/AIDS prevention and treatment plan; and, improving immunization rates for children under the age of eighteen.

Despite the extensive list of reforms, Ayiti’s public health law and public health program are not included as reform iniatives althougth they are in dire need of renovation. I recently joined a group of approximately 60 doctors, nurses, administrators and educators on a week-long medical relief mission to Les Cayes, Ayiti to provide medical services to residents in one of the poorest areas in Ayiti. Medical doctors came from as far as China, New York, Philadelphia, New Jersey and Florida to volunteer their services. The mission was organized by Gaskov Clergé Foundation which was developed to promote, health, sports, education and science in Ayiti. I was the only lawyer in attendance, and my involvement was originally limited to providing strategic support to the board by interviewing various parties and taking footage of the medical mission for an upcoming documentary. However, within a few hours of arriving in Ayiti, my role expanded as the need from the community extended beyond the group’s initial expectation. As word spread within the community that “doctors from America had arrived,” people came from neighboring provinces to seek free medical services. The week was intense. Each day the doctors consulted with 300-600 patients, and 2-3 surgeries were performed at the national hospital with limited surgical resources. My cutting-edge interviewing skills gave way to my language skills. I placed the camera aside, to a large extent, to fufill the more fundamental need of serving as an interpretator for the non-French speaking doctors and conducting direct patient medical history inquiries of patients who primarily spoke French and Creole.

A few observations became immediately apparent. First, poverty in Ayiti is not at all analogous to poverty in the United States. Poverty in Ayiti is brutal. The concept of health insurance, public funding for hospitals, or effective medical equipment are non-existent, therefore resident do not receive basic medical care. Second, the majority of illnesses that the doctors treated were preventable, if patients had public health information regarding the importance of washing their hands, using clean water to bathe, and drinking parasite-free water because preventive medicine is not accessible. Third, what Americans consider as "basic" necesities to maintain health such as clean water, annual medical check ups, dependable medical equipment and supplies, is not basic provisions provided by the govenment for the residents of Ayiti. Clean water and public health education is a national concern. Things that are viewed as “basic” to Americans are life-giving and extremely precious to residents of developing countries. As Ayiti struggles to reform its macro-economic policies, developed countries such as the United States should continue to encourage the government of Ayiti not to overlook the importance of public health education and the need to provide “basic” preventive care to the poorest of the poor.

Lydie Nadia Cabrera Pierre-Louis
Assistant Professor of Law
St. Thomas University School of Law

1 comment:

  1. professor pierre-louis:

    what an amazing and heartbreaking experience it must have been to visit haiti and assist in providing medical care.

    is there momentum in haiti to improve its public health education? are there any ngo's that are on site attempting to assist in this critical sharing of information?