Paul Farmer’s compelling new book, “Haiti: After the Earthquake,” suggests that international aid to Haiti, while providing relief from suffering during the worst of times, including in the aftermath of the January 12, 2010, earthquake, has for the most part failed to help Haiti build capacity in its own public institutions, including its public health and education sectors.

A capable, responsive and accountable public sector is essential to helping Haiti become a healthy, productive and ultimately resilient society—one better able to cope with the destructive forces of inevitable natural disasters such as hurricanes and earthquakes. Moreover, Farmer argues that meddling by the West in Haiti’s internal politics has contributed to the country’s chronic political instability. Periodic withholding by the U.S. of direct assistance to the Haitian governments—including democratically elected but leftist governments—and U.S. vetoes of initiatives by international organizations to channel aid directly through the Haitian government, have steadily eroded the capacity of the Haitian public sector to provide basic social services.

In testimony to the U.S. Senate Foreign Relations Committee in 2003, Farmer called for an end to the de facto prohibitions of development aid to the government of Haiti that the US promoted in forums in which it held influence, including the Inter-American Development Bank. “At the time [of the testimony], influential American institutions were effectively blocking four loans to Haiti from the Inter-American Development Bank—for primary health care, education, potable water, and road improvement—because they didn’t condone the outcome of Haiti’s 2000 elections, which brought the left-leaning Aristide back to power.” (p. 97)

U.S. aid did flow to Haiti during times when Washington was displeased with the country’s political leadership, but not to the Haitian government. Instead of aiding Haitian government organizations such as the ministries of health and education, aid was channeled to international non-governmental organizations (INGOs). INGOs set up their own health, water, education and agricultural programs, with little reference to Haitian government oversight, needs or priorities. Funding channeled through international NGOs failed to help build the capacity of Haitian public institutions that must provide health, education and other essential public services to poor Haitians over the long term. “Without real and sustained commitment to strengthening the public sector—including its capacity to monitor and coordinate services offered by NGOs—who would make sure development funds were being used efficiently.” (p. 97.) At the time of the January 2010 earthquake, 80 percent of all aid to Haiti and 90 percent of all U.S. aid was channeled through NGOs and contractors.

Haiti by the time of the earthquake had become known in humanitarian aid circles as “the Republic of NGOs,” with more NGOs per capita than any developing country apart from India, according to Farmer (p. 99). The U.S. reliance on INGO-managed assistance was to a considerable degree a direct consequence of U.S. laws that prohibited direct U.S. aid to Haiti’s public sector. “Post-earthquake Haiti needed many of the foreign contractors and NGOs because its [public sector] implementation capacity has long been weakened.” (p. 99). Ultimately, only 0.3 percent of all Haitian quake relief was channeled through Haiti’s public sector. (p. 102)

Farmer was back at the Senate Foreign Relations Committee on January 27, 2010, less than two weeks after the earthquake. Six months previously he had been appointed UN deputy special envoy for Haiti under the special envoy, President Clinton. Tasked with mobilizing international relief support for Haiti and recognizing that it is poverty that makes people most vulnerable to natural disasters, he argued that greater amounts of aid for reconstruction be channeled through Haiti’s public sector. Better education and public health care systems would over the long term bring greater prosperity, and in turn would reduce the loss of life and destruction of property and livelihoods in the aftermath of natural disasters.

There is an opportunity not only to build Haiti back better, but to build a more functional and ultimately beneficial arrangement for aid delivery. Over the past two decades, U.S. aid policies have seesawed between embargoes and efforts to bypass governments, including elected ones not to Washington’s taste. Neither the international community nor the United States provided credible, long-term, financial investment in Haiti. Restructuring foreign aid and forgiving Haiti’s crippling debts are essential to helping the country recover. U.S. laws, including the Foreign Assistance Act of 1961 and its later revisions, prevent direct investment in the public sector; we will need to revisit these policies.

Jehane Sedsky, a colleague of Farmer’s at the UN special envoy’s office, in a concluding chapter entitled “Building Back Better, provides a thoughtful discussion of why the efforts of not-for-profit community in Haiti before the earthquake often did not contribute to lasting change in Haiti or, in many cases, to even help Haitians.

• The work of not-for profits was uncoordinated and did little to reinforce the priorities of the Haitian government.

• International NGOs expended great effort determining ways to address problems they saw, but often they did not include Haitians in meaningful ways as they developed their plans.

• International NGOs are accountable to their international donors—not to the disenfranchised communities they are trying to serve.

• Often they deliver goods and services but less often pay local salaries; creating a culture of dependency rather than self-sufficiency.

• Many years of effort by NGOs has served to only weaken the already weak government, which did not, even before the earthquake, have the resources to pay its employees.

• As a result, public health and education officials are paid intermittently, hospitals lack basic medicines and supplies, and schools are 90 percent privately owned and unregulated. (p. 357)

International humanitarian NGOs do not deploy their resources or staff to work within national institutional frameworks as partners—as part of the fabric of Haitian health and education organizations. Many find it inconvenient to do so, but many of their objections to working as authentic partners, dedicated to rebuilding Haitian capacity at its core, must be answered and overcome.

Farmer and his co-authors offer a persuasive critique of the failures of international aid to engage with Haitian public sector institutions in ways that would better serve Haiti over the long term. But they don’t in my view offer enough in the way of concrete proposals for forging a new kind of relationship between donors, international NGOs, and the Haitian government. I want to offer below a few ideas, principles really, for a new kind of aid relationship.

• A considerable portion of international development and humanitarian funding should be directed to building the capacity of the public health, public education and water sectors, sectors essential to poverty alleviation and economic growth. What’s an appropriate portion of all aid? I don’t know, but for purposes of discussion, let’s consider what it would take to get 50 percent of all aid disbursements channeled through the Haitian government as general budgetary support or through projects that are administered jointly by the Haitian government and INGOs and/or contractors by 2015.

• International technical advisors and professionals—health care workers, teachers, health and education administrators, civil engineers—should in much greater number than is currently the case be seconded from aid agencies, including from the staffs of International NGOs, to Haitian ministries and agencies, filling established posts. This would mean, for instance, that Haitian health care not be augmented by building new non-profit hospitals, staffed at the top by foreigners, and drawing talented Haitian away from public institutions with better, but ultimately uncompetitive salaries. Rather, funds should be directed to building better Haitian public hospitals, and international medical staff would take up positions at the side of their Haitian colleagues.

• In addition to providing technical assistance in their respective fields, international staff will be expected to provide management expertise, including skills in financial management, reporting and program auditing. (I’ve written in a previous blog about how Botswana’s insistence that all international advisors hold established Botswana government positions left a template of good management practice that endures long after the departure of expatriates).

• Effective public service delivery in Haiti will ultimately be provided by a growing Haitian economy, capable of financing to a much greater degree than is the case today its own public services. Considerable financial aid and technical assistance should be directed toward sectors of the government and the economy responsible for promoting joint public-private investment projects, generating employment growth, and better managing public finances. Partnerships between U.S. and Haitian universities and the Haitian ministry of finance supporting training in public finance and administration of top Haitian graduates should be designed and generously funded.

• The US should consider Haiti as a partner for Millennium Challenge Corporation funding for key sectors, such as health, education and agriculture, and provide aggressive support for USAID management development projects that would help Haiti meet the pre-conditions for MCC sector funding (as is currently being done for Liberia).

Haitians deserve a better deal from their own government and from international aid organizations. The current aid system does not help deliver the kind of systemic improvements in Haiti’s public service sectors for which it is capable. It’s past time to leave behind the litany of excuses that stand in the way of helping Haiti build back better.

Steven Lawry is a Senior Research Fellow at the Hauser Center for Nonprofit Oganizations at Harvard University.

I recently had the chance to witness Haiti’s ongoing recovery efforts first-hand over the course of two weeks this past January.  I was working with Haiti Outreach an NGO which builds wells, water-systems and schools throughout the country.  During my time with Haiti Outreach, I was exposed to a variety of faith-based organizations (FBOs) and this has me contemplating the role of FBOs in Haiti’s recovery process.

The international community has played an important, and well documented, role in Haiti’s post-quake reconstruction efforts.  Foreign governments to date have pledged over $5.3 billion dollars in the form of humanitarian aid and debt forgiveness.  UN Security Council resolution 1927 authorized the United Nations Stabilization Mission in Haiti (MINUSTAH) and has committed approximately 12,000 uniformed personnel to maintaining peace and security throughout the country.

The role of non-profits in Haiti’s reconstruction efforts has been heavily publicized.  The traditional players – Oxfam, Red Cross, Médecins Sans Frontières (MSF), Save the Children, etc. – have been actively involved in reconstruction efforts.  Less publicized, however, has been the significant role of FBOs in Haiti’s ongoing recovery process.

A recent article in USA Today is one of the few media pieces to recognize the important role FBOs are playing in Haiti.  Some summary statistics:

• Over $300 million dollars has been raised by FBOs for Haiti to date
• Thousands of volunteers have traveled to Haiti through FBOs
• From the US Catholic community alone, over 500 catholic institutions and parishes have sent volunteers andor aid

In terms of traditional criteria—cash and manpower—these numbers are impressive.  The more interesting question to me, however, is this: what is the distinctive value-add of FBOs in the reconstruction effort?  What are the unique strengths (and potential weaknesses) of FBOs which other non-faith based NGOs, as well as foreign governments, may lack?

Three possibilities come to mind:

Mission — FBOs, by definition, are distinctive in that faith or religion is at the core of their missions. This may allow FBOs to raise funds and manpower from people not inclined to support governmental or secular NGO efforts.

Support Network — Many FBOs are able to call upon the support of churches, parishes, clergy and their constituents.  These are wide and diffuse constituent bases united by a singular theme—faith.  As such, in times of humanitarian crisis, FBOs have a strong connection to a broad base of support which governments and non-faith based NGOs may lack.

Service Delivery — By virtue of their faith based identity, FBOs may have the potential for enhanced service delivery to their targeted aid recipients.  Haiti’s unique history of unrest and foreign intervention has led to a prevalent distrust of foreign governments and NGOs.  Approximately 80 percent of Haitians identify themselves as Christian and/or Catholic.  Catholic and Christian FBOs, by virtue of their faith based identity, have the chance to deeply connect with these Haitian people based upon shared faith and values.  When successful service delivery requires constituent “buy-in” (educational efforts on effective cholera prevention, for example), FBOs may have an advantage compared to their governmental and secular counterparts.

One year post-quake, over one million Haitian citizens live in tent camps.  Only approximately 5 percent of the rubble has been cleared.  Reported cholera cases number a quarter of a million, with approximately 5,000 fatalities.  Haiti is still in dire need of continued international assistance. FBOs, in tandem with international governments and other NGOs, have an important role to play in Haiti’s continuing reconstruction efforts.

Jesse Wallin is a first-year Master in Public Policy candidate at the Harvard Kennedy School. He is a student fellow at the Hauser Center for Nonprofit Organizations.

The session is titled “The Challenges of Haiti: A Critical Test for International NGOs.”  Peter Bell, Senior Research Fellow at the Hauser Center for Nonprofit Organizations and former President & CEO of CARE USA will lead this session. He will discuss what international NGOs might learn from their mixed record in Haiti and how they can seize the opportunity to do things differently (and better).  Peter will also speak to the specific pressures that international NGOs are coming under, given the magnitude of resources raised for Haiti, and the opportunity to “build back better” including building local capacity and better governance.

Peter Bell is a Senior Research Fellow at the Hauser Center for Nonprofit Organizations at Harvard University and chairs the facilitation group of the NGO Leaders Forum. Before joining the Hauser Center, he was a visiting fellow at the Carter Center. Previously, Peter served as president of CARE USA for ten years. He has also been president of the Edna McConnell Clark Foundation, senior associate of the Carnegie Endowment for International Peace, president of the Inter-American Foundation, and Deputy Under Secretary of the U.S. Department of Health, Education and Welfare. At the outset of his career, he worked for 12 years with the Ford Foundation, including ten years with its Latin American program. Peter’s volunteer positions include being chairman emeritus of the Inter-American Dialogue, vice chair of the Bernard Van Leer Foundation, a director of the Global Water Challenge, a director of Transparency International USA and a trustee of the World Peace Foundation. He is a graduate of Yale College and holds a master’s degree in public affairs from the Woodrow Wilson School at Princeton University.

More About the Study Group

The Study Group on NGOs and Development is organized by the Humanitarian & Development NGOs Domain of the Hauser Center for Nonprofit Organizations at Harvard University.  The group meets biweekly to consider, discuss and debate issues related to emerging paradigms in development, evolving roles of NGOs, and specific management, leadership and governance challenges.  The study group brings together interested students, practitioners dealing with these questions in real time, and academics investigating similar questions.  The goal is to create a climate for genuine discussion and lively exchange, in which all participants come to the table with a commitment to share, listen and reflect.  The study group is a space for building relationships, exchanging ideas and connecting real-world challenges to scholarly study of NGOs and their role in development.  Guests will serve as resource people and catalysts of discussion.

In the midst of conducting research on the role of faith-based organizations (FBOs) in the nonprofit sector, I had the privilege of interviewing the inspirational Rev. Dr. Robert V. Lee, III, Chairman and CEO of Fresh Ministries, during his visit to the Hauser Center for Nonprofit Organizations at Harvard University.

Fresh Ministries is a multi-faith humanitarian organization.  It began as a local FBO in Jacksonville, Florida and grew into an international nonprofit known as Be the Change International.  Fresh Ministries employs and aids people of all faiths, and works to meet the United Nations’ Millennium Development Goals (MDG).

JM: What provoked the transition from being a domestic nonprofit to working internationally?

RL: The international work was a natural outgrowth of our domestic work.  We’ve been doing Millennium Development Goal work since before the UN called it the Millennium Development Goals (MDG).  We understand real change as holistic, and within a defined geographic area.  Usually it’s centered on children and education: raising a generation of children who have an equal chance to live healthy, happy, and productive lives.  But in order to do that they need a good education, which requires suitable schools and a stable environment.  Parents need realistic work opportunities, reliable health systems, safety in their communities, and strong family values.  For the core city neighborhoods, such as in Jacksonville, FL, this had been our focus.  Just by word of mouth and sharing practice models in Florida, things began to take shape.  Then, when President G.W. Bush started PEPFAR we were asked to get involved internationally.  We were doing some other things internationally already, but not on the MDG side.  So, we began with health-related issues, and just grew from there.

JM: What were some of the new challenges you faced in the transition from domestic to international?

RL: We realized we needed to pay attention to the context in which we were working.  Sure, you can say poverty’s poverty and you’re trying to eliminate poverty, but each people have a unique set of circumstances.  The challenge is listening, ascertaining what the problems are in that area, and redefining how you address them.  For example, in some cases gender equality is a key issue.  One MDG project we’ve started begins by building a school.  The parents know that school provides the most opportunity for their children, and will do whatever they can for them.  Our deal is if their children attend our school, parents must treat their sons and daughters equally; parents cannot pull their daughters out of school after so many years.  This is just one example; you have to pay attention to any obstacles impeding the program.  But the big challenge is simply understanding the people and combining your resources to form viable solutions.

JM: Could you explain the Fresh Ministries’ emphasis on its multi-faith quality, given its Episcopalian origins?

RL: I’m an Episcopalian priest and there are other Episcopalians that are involved in the organization.  In addition, we’ve partnered with the Anglican Communion because of its infrastructure, which is a great resource.  Some of us are affiliated with the Church, but we are very intentional about living in a multi-faith community.  We use that to springboard to a higher level, and embrace all people whoever they are.  To some people God looks like one thing, and to others another – and we respect that.  What we all have in common is a passion to help others.

JM: How is faith reflected in the Fresh Ministries community?

RL: Well, for example, we have staff of all faiths.  Within each of these faiths, we have people ranging from low key practitioners to the outspoken, who’ve just learned to respect and love each other, regardless of faith.  The common passion is helping people, and it plays out in different ways.  On Wednesdays, we get together and have services to reflect people’s spiritualities.  Sometimes it’s Episcopalian, Jewish, Quaker, or the like.  Other times it’s nondenominational or incorporates multiple faiths.

JM: What are the biggest challenges and opportunities for Fresh Ministries over the next five to ten years?

RL: The mainline faith-groups are having different conflicts.  In the Anglican Communion, people are getting caught up in issues like human sexuality.  You see a lot of people, particularly young people, who aren’t going to Church to hear more arguments.  These are the people who really care about what’s going on in the world.  They seem to appreciate and understand the interconnected nature of our global community, and they’re willing to go serve in a clinic or outreach program in Haiti or Africa in a heartbeat.  What we’re trying to do is figure out how to take advantage of this global mood to get involved, making use of our resources.  In the past we’ve worked with the President of the United States, the Archbishop of Canterbury, and major institutions.  So, the questions are, how do you triage what needs to be done, and how do you build up and ramp up the next generation to take this on?  We’re a brave band of aging preachers really, who’ve done a lot of things.  But the challenge is finding and enabling interested young people to be the people they were created to be with their own ideas and genius.  Enabling them, growing the organization, creating sustainable and efficacious partnerships, and keeping focus on what we’re already doing are our key priorities.  We’re trying to figure out how to line up all the assets and resources we have to identify and meet the challenges that are out there, and bring in young people to be the wave of tomorrow.

JM: As the founding CEO of Fresh Ministries, and in light of the economic crisis, what are you most concerned about and what are you proudest of?

RL: Given the economic crisis, a lot of nonprofits around the world are suffering.  My feeling has always been that if you’re doing the job well, there are resources out there because the job still needs to be done.  If we find ways to partner with other people for resources, and keep our focus on what we’re doing, then we will get the job done.  What I’m really proud of is that we’ve been able to do a lot of good things and help a lot of people.  It’s really gratifying when you see a family turn the key in the door of a new home, or hear about somebody who’s just gotten a job through a hospitality institute, and how it’s changed their lives.  They thank you, although you know it’s them that did it and you’re very proud of them.  Those are very gratifying moments.  I think what I’m most proud of, though, are the people who work with us.  We have a really passionate group of people who are dedicated to our mission.  My biggest concern is figuring out how to transition this into the future.  How do we find more people, and get their creativity and genius in doing all of this?  How do you promote that kind of thinking and passion?

JM: Given the recent crisis in Haiti, how has Fresh Ministries responded to the new challenges and what advice might you give to other NGOs present or on the way?

RL: Our international outreach NGO, Be The Change International, has been working for the past year to implement our youth HIV/AIDS prevention education curriculum in the 254 Haitian schools supported by the Episcopal Church, serving more than 80,000 children of all faiths.   Our five year strategic plan for Haiti included founding an in-country NGO, Be The Change Haiti, that would be managed by Haitian nationals and directly partner and support other in-country NGOs working toward the MDGs in Haiti.  The tragic earthquake mandated immediate expansion of our original strategic plan to include both emergency relief and long term rebuilding efforts. We have launched Be The Change Haiti, and are now fully engaged in partnerships and outreach programs to meet Haiti’s immediate needs and long-range challenges.   Only through partnering with other like-minded in-country NGOs, the Haitian government, and the Haitian people, can we truly realize a self-sustaining Haiti. The complexities of the Haitian culture and the high level of need make it impossible for one entity to make substantial change on its own. We must all work together to empower the people of Haiti with the life skills, job skills, education, entrepreneurial programs and microloans, and numerous other support programs the Haitian people need to rebuild their own country. We feel there is a huge difference between enabling aid and empowering assistance. It is the old “give a man a fish and feed him for a day — teach a man to fish and feed him for life” philosophy.  It is the responsibility of all NGOs to cooperate with one another in an effort to empower, not enable, the people of Haiti. The future of Haiti depends on it.

Julia Martin is a second year student in the Master of Theological Studies (MTS) program at the Harvard Divinity School.

It is well known that international NGOs had a huge presence in Haiti before the devastating earthquake of January 12th. Upwards of 8,000 NGOs were working in nearly every developmental and humanitarian assistance sector.  The greater portion of foreign assistance was channeled not to the Haitian government, but directly to NGOs.  Prime Minister Jean-Max Bellerive in an interview on CNN with Christiane Amanpour on January 23rd estimated that 80 percent of all development assistance to Haiti before the earthquake went to NGOs.  He added that 90 percent of US official assistance goes to NGOs. 

While some NGO recipient organizations are locally-led and governed, and international NGOs employ large numbers of Haitian staff, Haiti’s development sector is largely led and managed—effectively controlled—by international NGOs and their donors.

The important question of accountability goes a long way toward explaining how this state of affairs came to pass. International donors have lacked confidence in the ability of the Haitian government to manage development assistance in an effective, efficient and corruption-free manner.  Donors believe their funds are more likely to be used for agreed purposes and will reach intended beneficiaries if the money goes to international NGOs and contractors directly accountable to donor governments.  But Prime Minister Bellerive went on in the CNN interview to raise a fair question: how can Haiti’s government be called to account for the management of development assistance when 80 percent of funding goes directly to international organizations that are not accountable to the Haitian government itself?

While international NGOs have contributed significantly to the well-being of Haitians over the years, the near complete control they exercise over Haiti’s development sector is not without its problems.  The lack of accountability to Haiti’s government, which I have noted, is among them. Another is the missed opportunity for donors to work closely with Haitian institutions in developing Haitian capacity to manage development programs (including exercising some measure of authority over the work of international NGOs and contractors) in ways that are free of corruption and which give Haitians valuable leadership, policy and management experience. 

Harvard professor Paul Farmer and co-founder of Partners in Health, a health and human rights organization that has worked in Haiti for 20 years, spoke to the need to change the relationship among donors, the Haitian government and international NGOs in testimony before the US Senate Committee on Foreign Relations on January 27th:  “The aid machinery currently at work in Haiti keeps too much overhead for its operations and still relies overmuch on NGOs or contractors who do not observe the ground rules we would need to follow to build Haiti back better.  The fact that there are more NGOs per capita in Haiti than any other country in the hemisphere is in part a reflection of the need, but also in part a reflection of the overreliance on NGOs divorced from the public health and education sectors.”
Sentiments similar to Farmer’s have been expressed by many public figures in recent days. 

“Building back better” has become a frequently used term in the past three weeks. A return to the pre-earthquake status quo of ineffective official authority and “the Republic of NGOs” in the development sector is not acceptable. Many advocate, and I agree, that Haitians must take principal responsibility for Haiti’s reconstruction, with official aid agencies and international NGOs playing strong supporting roles.

Let’s consider for a moment the attributes of a post-earthquake reconstruction and development era that Haitians would be proud of and the international community would have confidence in.
Clare Lockhart is executive director of the Institute for State Effectiveness, an organization based in Washington, D.C. that specializes in the study of failing or failed states.  The Institute’s research has drawn out important lessons from the experience of recently failing or failed states that have put themselves on a path toward legitimacy, effectiveness and accountability.  In an extended interview on BBC radio on January 23rd, Lockhart shared four lessons learned from studies of  Mozambique’s and Rwanda’s recovery from failed-state status that she thought Haitian leaders, donors and international NGOs might consider carefully. These are:

•  A broadly unified and inclusive national political leadership
•  Zero-tolerance for corruption
•  Investment in human capital development, particularly in education and health
•  Heavy investment in local economic growth and especially the growth of indigenous businesses and enterprises. (Here Lockhart noted the likely enduring value to the Haitian economy of reconstruction money for roads and other infrastructure being directed to local firms as opposed to large international contractors.)

To “build Haiti back better” is in the first instance a reform agenda, requiring fundamental changes in how the Haitian government, donors and international NGOs understand their appropriate roles and their collective responsibilities to the citizens of Haiti. Lockhart’s list of lessons learned from failed states recovering from terrible traumas provides useful guideposts toward shaping that agenda.

Steven Lawry, Senior Research Fellow at the Hauser Center for Nonprofit Organizations, is currently based in Juba, Southern Sudan, where he heads a USAID-funded project assisting the Government of Southern Sudan to develop a new land policy.

Following on the heels of the catastrophic earthquake in Haiti, the editorial in The Lancet of January 23 is headlined “Growth of aid and the decline of humanitarianism”.  It acknowledges that aid agencies and humanitarian organizations “do exceptional work in difficult circumstances”.  But the editorial also asserts that the aid sector, now “an industry in its own right”, has “largely escaped public scrutiny”. 

The Lancet goes on to state that large aid organizations, in particular, have taken on the “unsavory characteristics” of many big corporations.  They can be “polluted” with internal power politics, “obsessed” with raising money, and pursue media coverage as an “end in itself”.  Worst of all, the editorial claims that relief efforts in the field are “sometimes competitive” to the detriment of collaboration that could better serve people in need.

While The Lancet offers no specific evidence for any of these allegations, I suspect that one could find instances in which all organizations of any appreciable size lose their way and need to be exposed and reprimanded.  Humanitarian NGOs should be scrutinized by outsiders, who have a right to expect them to be driven first and foremost to save lives and relieve suffering and to pursue those purposes in accord with such humanitarian principles as independence and impartiality. 

Like The Lancet, I find the competitiveness among some NGOs for the media limelight and donor contributions in the midst of humanitarian crises to be unsavory.  But The Lancet and other watch dogs need to understand that NGOs must raise money to pay for their life-saving services.  And media access has helped NGOs to transmit messages about the importance of donors giving cash rather than used clothes and other supplies that clog airports.  Media access has also helped NGOs to inform the public about the special vulnerability of poor people to so-called “natural” disasters and the need ultimately to reduce poverty if the human toll of earthquakes, hurricanes, and tsunamis is to be reduced.

Whether or not the allegations in The Lancet are well founded, I would be delighted if the response to the Haitian disaster prompted some soul-searching among NGOs that leads to serious exploration in the U.S. of a joint inter-agency appeal for private fundraising for major emergencies (in the spirit of the Disasters Emergency Committee, better known as the DEC, in the U.K.).  When a major emergency strikes, it should be easier for people who are not already donors to a particular NGO to give with confidence, without having to sort through a multitude of organizations with shared missions. 

Even more crucial, it is past time for NGOs with overlapping missions to engage in more collaborative programming in vulnerable countries not only to respond to humanitarian emergencies, as they often do, but also to prevent them. 

Peter D. Bell is a Senior Research Fellow at the Hauser Center for Nonprofit Organizations at Harvard University.