November 23, 2010

Cholera in Haiti: Do Aid Groups Deserve Some of the Blame?

Aid groups are scrambling to respond to the deadly cholera outbreak in Haiti—and to answer questions about whether they did enough to prevent the disease, which has claimed more than 1,100 lives.

A petition circulated last week by a group called the Disaster Accountability Project argues that if aid groups had spent more of the money they raised after the January earthquake to improve water and sanitation conditions in Haiti, the disaster might have been prevented. The petition is titled, "We Donated to Haiti Relief and We're Angry."

But others say that's simply not true. Aid groups say water and sanitation conditions in Haiti were poor before the cholera epidemic—and that it doesn't make any sense to say they should have prioritized cholera prevention over other types of assistance,  because the disease hadn't been seen in Haiti for at least half a century.

"Saying that agencies should have been prepared for this outbreak is a little bit like saying the U.S. should currently invest resources and prepare for an outbreak of bubonic plague," Jeff Wright, operations director of the aid charity World Vision, told The Chronicle.

Others say the threat of cholera was something aid groups and the United Nations did, in fact, recognize as an issue, but they didn't focus on it because the possibility of an outbreak was remote. In a paper called "The Haitian Cholera Outbreak: A Preventable Tragedy?," Joseph Crupi, a research associate at the Council on Hemispheric Affairs, concludes that aid workers "understandably focused on more pressing concerns."

But even if aid groups ought to have recognized cholera as a bigger threat, could they have prevented the disease? And does it make sense to criticize their rate of spending (many charities had spent about one-third to one-half of their earthquake donations in the first six months after the disaster) as the Disaster Accountability Projects does?

Saundra Schimmelpfennig, a former aid worker and author of the blog Good Intentions Are Not Enough, says that charities probably couldn't have prevented the cholera outbreak but that if they'd operated with greater efficiency, they might have slowed its spread.

But she told The Chronicle that the rate of charity spending is "a really meaningless way to get at what's happening."

"Just because money was spent quickly does not mean it was spent well," she writes on her blog. "Conversely, just because an organization has not spent all their money does not mean they were not operating at top efficiency given the realities on the ground."

Ben Smilowitz, who started the Disaster Accountability Project after serving as an American Red Cross volunteer following Hurricane Katrina, says that he would prefer to use additional measures of charities' performance, but they weren't available because groups don't provide them. Encouraging nonprofit groups to share more substantive information is one of his goals, he says. (He based the petition on The Chronicle's reporting of how much charities had spent six months after the Haiti earthquake).

Mr. Smilowitz's turn as a watchdog has stirred frustration and anger among some charity officials. Mr. Wright, of World Vision, says his group sees the value of greater transparency but that Disaster Accountability Project's reports are ill-informed and get information wrong. He points to other groups—Active Learning Network for Accountability and Performance, and Humanitarian Accountability Partnership International—that already serve to evaluate aid groups and also have the expertise and knowledge that Mr. Smilowitz's group lacks.

Ms. Schimmelpfennig agrees that Disaster Accountability Project's petition, which seems misinformed, raises questions about how effective the group can be in holding charities accountable. She wonders if the group talked to the informal group of charities and U.N. agencies that work on water and sanitation to learn what they'd done. (Mr. Smilowitz says he receives e-mail messages from the U.N.-organized "cluster" of charities but didn't contact the group directly).

But Ms. Schimmelpfennig is not so quick to dismiss the importance of an outside watchdog. She points out, as does Mr. Smilowitz, that Active Learning Network and Humanitarian Accountability Partnership International are supported by aid groups, so they aren't entirely independent from the charities they are evaluating. Nor do they conduct the kind of oversight that Mr. Smilowitz's group is trying to do, she says.

Mr. Smilowitz, meanwhile, says he isn't surprised by the criticism he's getting from some aid groups, but, given the cholera epidemic, "it would have been ridiculous for us to be quiet."

In a way, Mr. Smilowitz is part of a trend of "do-it-yourself" watchdogs, fueled by new technology like cellphone cameras and a growing interest on the part of donors in ensuring their money is well spent. Charities say they welcome greater scrutiny—but responding to it is posing a challenge.

World Vision's Mr. Wright says the issue is "who can and should do that scrutinizing and on what basis. We could run ourselves ragged and hurt our beneficiaries trying to respond to the demands of every start-up shop." He adds: "There have to be norms and standards."

Mr. Smilowitz says, however, that charities have public-relations employees to respond to queries like his, which he is asking in behalf of donors. His petition calls for more transparency. As an example, Mr. Smilowitz thinks charities should have a weekly update on their Web sites of exactly what they have accomplished and how much they have spent in a place like Haiti. He says that all donors get from nonprofits are happy stories—and they often contradict what is happening in the field.

As of 12:40 p.m. U.S. Eastern time on Tuesday, 369 people had signed Mr. Smilowitz's petition.

Are aid groups sharing enough information? Is it fair to blame them for the spread of the cholera epidemic? What do you think?