Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Some Reflections on Working in Haiti
and Working with Timmy
Dionissi Aliprantis
INURED and Cleveland Fed
Timmy Global Health
Student Leadership Conference
September 7, 2013
The research reported here was supported by the Inter-American Development Bank. The opinions expressed here
are those of the author alone and do not represent the views of INURED, the IDB, Haiti Outreach, the Federal
Reserve Bank of Cleveland, or the Board of Governors of the Federal Reserve System.
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Louisiana Purchase
Simón Bolívar
Greece in 1821
Debt - today ≈ $21B
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Louisiana Purchase
Simón Bolívar
Greece in 1821
Debt - today ≈ $21B
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Today has very weak public sector
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Today has very weak public sector
NGOs provide most public goods/services
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Today has very weak public sector
NGOs provide most public goods/services
NGOs provide 70% of health care in Haiti’s rural areas
(World Bank (2006))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Today has very weak public sector
NGOs provide most public goods/services
NGOs provide 70% of health care in Haiti’s rural areas
(World Bank (2006))
Public schools are able to accommodate only 10% of
school age children (World Bank (2006))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Haiti
The first free country in the western hemisphere
Today has very weak public sector
NGOs provide most public goods/services
NGOs provide 70% of health care in Haiti’s rural areas
(World Bank (2006))
Public schools are able to accommodate only 10% of
school age children (World Bank (2006))
Donors have pledged $11 billion for reconstruction (As of
June 2, 2010 – HRF (2010))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
1) How can NGOs most effectively perform their own work?
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
1) How can NGOs most effectively perform their own work?
Provision of safe water in rural areas
community-level water infrastructure
home water treatment
sanitation
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
1) How can NGOs most effectively perform their own work?
Provision of safe water in rural areas
community-level water infrastructure
home water treatment
sanitation
No consensus on best approach to maintaining wells
(Ahuja et al. (2010), Zwane and Kremer (2007))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
2) How can NGOs integrate their efforts into larger, coordinated
efforts (ie, those of the public sector)?
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
2) How can NGOs integrate their efforts into larger, coordinated
efforts (ie, those of the public sector)?
Issue of sovereignty
All of USAID’s funding for Haiti during FY 2007-2008 ($300
million) was allocated to foreign NGOs (USIP (2010))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
2) How can NGOs integrate their efforts into larger, coordinated
efforts (ie, those of the public sector)?
Issue of sovereignty
All of USAID’s funding for Haiti during FY 2007-2008 ($300
million) was allocated to foreign NGOs (USIP (2010))
Following a 2009 donors’ conference “donors provided
only $40 to $70 million of the more than $350 million in
pledges and continued to direct assistance through NGOs
rather than the government” (USIP (2010))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
2) How can NGOs integrate their efforts into larger, coordinated
efforts (ie, those of the public sector)?
Issue of sovereignty
All of USAID’s funding for Haiti during FY 2007-2008 ($300
million) was allocated to foreign NGOs (USIP (2010))
Following a 2009 donors’ conference “donors provided
only $40 to $70 million of the more than $350 million in
pledges and continued to direct assistance through NGOs
rather than the government” (USIP (2010))
Of $194 million in US gov post-earthquake contracts until
April 2011, 2.5% awarded to Haitian firms (CEPR (2011),
Dupuy (2010))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Research Questions
2) How can NGOs integrate their efforts into larger, coordinated
efforts (ie, those of the public sector)?
Issue of time
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Access to Safe Water
Worldwide
884 million people only have access to unimproved water
sources (WHO (2008))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Access to Safe Water
Worldwide
884 million people only have access to unimproved water
sources (WHO (2008))
84% of people using unimproved sources of drinking water
in rural areas (WHO (2008))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Access to Safe Water
Worldwide
884 million people only have access to unimproved water
sources (WHO (2008))
84% of people using unimproved sources of drinking water
in rural areas (WHO (2008))
2.2 million children 0-14 die every year from unsafe
drinking-water, inadequate sanitation or insufficient hygiene
(WHO (2010))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Access to Safe Water
Worldwide
884 million people only have access to unimproved water
sources (WHO (2008))
84% of people using unimproved sources of drinking water
in rural areas (WHO (2008))
2.2 million children 0-14 die every year from unsafe
drinking-water, inadequate sanitation or insufficient hygiene
(WHO (2010))
Haiti
49% (27%) of rural (urban) population still does not have
access to water from an improved source (World Bank
(2010), Varma et al. (2009))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Access to Safe Water
Worldwide
884 million people only have access to unimproved water
sources (WHO (2008))
84% of people using unimproved sources of drinking water
in rural areas (WHO (2008))
2.2 million children 0-14 die every year from unsafe
drinking-water, inadequate sanitation or insufficient hygiene
(WHO (2010))
Haiti
49% (27%) of rural (urban) population still does not have
access to water from an improved source (World Bank
(2010), Varma et al. (2009))
140 out of 140 countries according to one water poverty
index (Lawrence et al. (2002))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Access to Safe Water
Worldwide
884 million people only have access to unimproved water
sources (WHO (2008))
84% of people using unimproved sources of drinking water
in rural areas (WHO (2008))
2.2 million children 0-14 die every year from unsafe
drinking-water, inadequate sanitation or insufficient hygiene
(WHO (2010))
Haiti
49% (27%) of rural (urban) population still does not have
access to water from an improved source (World Bank
(2010), Varma et al. (2009))
140 out of 140 countries according to one water poverty
index (Lawrence et al. (2002))
International aid for water infrastructure disrupted for
political purposes (Varma et al. (2009))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Alternative Approaches in Rural Areas
Water Quality Improvements: Household Water Treatment
(HWT)
Point of use filtration, chlorination, solar disinfection, etc.
Evidence of effectiveness, also evidence could be from bias
(Schmidt and Cairncross (2009))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Alternative Approaches in Rural Areas
Water Quality Improvements: Household Water Treatment
(HWT)
Point of use filtration, chlorination, solar disinfection, etc.
Evidence of effectiveness, also evidence could be from bias
(Schmidt and Cairncross (2009))
Hygiene/Sanitation:
Handwashing, Latrines, etc.
Evidence of effectiveness (Curtis and Cairncross (2003))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Alternative Approaches in Rural Areas
Water Quality Improvements: Household Water Treatment
(HWT)
Point of use filtration, chlorination, solar disinfection, etc.
Evidence of effectiveness, also evidence could be from bias
(Schmidt and Cairncross (2009))
Hygiene/Sanitation:
Handwashing, Latrines, etc.
Evidence of effectiveness (Curtis and Cairncross (2003))
Infrastructure Improvements: Wells and Capped-Springs
Typically at community-level due to costs
Evidence of effectiveness (Parker and Skytta (2000)), but
do not address transportation/storage (Wright et al. (2004))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Most Effective Type of Intervention?
“Consensus” has changed
1970s – ?: Infrastructure (Parker and Skytta (2000))
? – Present: Water quality and sanitation (Waddington and
Snilstveit (2009))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Most Effective Type of Intervention?
“Consensus” has changed
1970s – ?: Infrastructure (Parker and Skytta (2000))
? – Present: Water quality and sanitation (Waddington and
Snilstveit (2009))
Should funding for infrastructure continue to receive priority
over alternative interventions (Zwane and Kremer (2007))?
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Most Effective Type of Intervention?
“Consensus” has changed
1970s – ?: Infrastructure (Parker and Skytta (2000))
? – Present: Water quality and sanitation (Waddington and
Snilstveit (2009))
Should funding for infrastructure continue to receive priority
over alternative interventions (Zwane and Kremer (2007))?
Need better evidence on approaches to maintaining wells
(Zwane and Kremer (2007))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Most Effective Type of Intervention?
“Consensus” has changed
1970s – ?: Infrastructure (Parker and Skytta (2000))
? – Present: Water quality and sanitation (Waddington and
Snilstveit (2009))
Should funding for infrastructure continue to receive priority
over alternative interventions (Zwane and Kremer (2007))?
Need better evidence on approaches to maintaining wells
(Zwane and Kremer (2007))
Measures of outcomes must include time dimension –
water-person-years (Koestler et al. (2009))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Top-down:
Government utility responsible for infrastructure
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Top-down:
Government utility responsible for infrastructure
Community-based:
Organization of local water committees
Committees responsible for collecting funding for
operations and maintenance
Construction and hardware typically subsidized by
government/NGO
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Top-down:
Government utility responsible for infrastructure
Community-based:
Organization of local water committees
Committees responsible for collecting funding for
operations and maintenance
Construction and hardware typically subsidized by
government/NGO
Effectiveness of community-based approach
Côte d’Ivoire: breakdown rate from 50 to 11% at 1/3 cost of
top-down approach (at 13,500 water points – World Bank
(1996))
Positive evidence from Pakistan (Khwaja (2009)), India and
Sri Lanka (Isham and Kähkönen (2002))
Strength of committees determines success (Parker and
Skytta (2000))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Maintaining Infrastructure
Maintenance can increase access
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Maintenance can increase access
$12 billion in maintenance could have prevented $45 billion
in road reconstruction in Africa during the 1990s (World
Bank (1996))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Maintenance can increase access
$12 billion in maintenance could have prevented $45 billion
in road reconstruction in Africa during the 1990s (World
Bank (1996))
User fees to fund maintenance can decrease access
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Maintenance can increase access
$12 billion in maintenance could have prevented $45 billion
in road reconstruction in Africa during the 1990s (World
Bank (1996))
User fees to fund maintenance can decrease access
80 percentage point decrease of uptake of deworming drug
in Kenya (Kremer and Miguel (2007))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Maintaining Infrastructure
Maintenance can increase access
$12 billion in maintenance could have prevented $45 billion
in road reconstruction in Africa during the 1990s (World
Bank (1996))
User fees to fund maintenance can decrease access
80 percentage point decrease of uptake of deworming drug
in Kenya (Kremer and Miguel (2007))
60 percentage point decrease in uptake of ITNs in Kenya
(Cohen and Dupas (2010))
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Subscription Fees
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Percent Subscribing
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Percent Subscribing and Subscription Fees
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Timmy
Descriptive Statistics
Sample
Leogane
Haiti Outreach
n
127
21
Functioning
116 (91.34%)
21 (100%)
Broken
11 (8.66%)
0 (0.00%)
n Unobserved
24
1
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Standard intervention ⇔ θ > θ∗ = 0.516
Community-based intervention ⇔ θ < θ∗ = 0.516
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Members have worked on development projects in Haiti since
the 1980s
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Members have worked on development projects in Haiti since
the 1980s
Concluded from honest, critical self-reflection
communities still dependent on outside interventions for
clean water even after working in those communities
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Members have worked on development projects in Haiti since
the 1980s
Concluded from honest, critical self-reflection
communities still dependent on outside interventions for
clean water even after working in those communities
Experimented with alternative approaches to maintainence
Train community-member how to repair wells, assign them
responsibility for group of wells
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Members have worked on development projects in Haiti since
the 1980s
Concluded from honest, critical self-reflection
communities still dependent on outside interventions for
clean water even after working in those communities
Experimented with alternative approaches to maintainence
Train community-member how to repair wells, assign them
responsibility for group of wells
Hire someone, provide them with ATV
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Members have worked on development projects in Haiti since
the 1980s
Concluded from honest, critical self-reflection
communities still dependent on outside interventions for
clean water even after working in those communities
Experimented with alternative approaches to maintainence
Train community-member how to repair wells, assign them
responsibility for group of wells
Hire someone, provide them with ATV
Checklist complete - community-based interventions on paper
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Evolution of Haiti Outreach
Shift of focus to management training
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Evolution of Haiti Outreach
Shift of focus to management training
Experimented with user fees
Controversial
Only to fund extra wells
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Shift of focus to management training
Experimented with user fees
Controversial
Only to fund extra wells
Experience with user fees
Communities more engaged
Avg annual cost of maintaining handpump ≈ $25
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Evolution of Haiti Outreach
Shift of focus to management training
Experimented with user fees
Controversial
Only to fund extra wells
Experience with user fees
Communities more engaged
Avg annual cost of maintaining handpump ≈ $25
Data Collection and Analysis
Patterns when plotting wells on Google Earth
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Animator
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Some Broader Issues
Importance of Skills
Roll Call
Is Algebra Necessary?
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Some Broader Issues
Importance of Skills
Roll Call
Is Algebra Necessary?
Agency
Who are you empowering with your actions?
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Some Broader Issues
Importance of Skills
Roll Call
Is Algebra Necessary?
Agency
Who are you empowering with your actions?
Building institutions that respond to need
Takes time - relief v. development
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Some Broader Issues
Importance of Skills
Roll Call
Is Algebra Necessary?
Agency
Who are you empowering with your actions?
Building institutions that respond to need
Takes time - relief v. development
You get what you pay for
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Resources
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
March 2000
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
My Experience with Timmy
Trips to Haiti, Cuba, Honduras, and Ecuador
Involved with IU Chapter
Kept up on events in Haiti, returned in 2009, 2010, 2011
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
My Experience with Timmy
Trips to Haiti, Cuba, Honduras, and Ecuador
Involved with IU Chapter
Kept up on events in Haiti, returned in 2009, 2010, 2011
Math Corps
“It All Adds Up”
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
My Experience with Timmy
Trips to Haiti, Cuba, Honduras, and Ecuador
Involved with IU Chapter
Kept up on events in Haiti, returned in 2009, 2010, 2011
Math Corps
“It All Adds Up”
“Instead of thinking of improving the world let us concentrate on
self-improvement. We can scarcely find out if the world is on
the right or wrong path. But if we take the straight and narrow
path we shall find all taking it too or discover the method of
inducing them to take it. . . ”
-Gandhi
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
My Experience with Timmy
Big Issues
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
My Experience with Timmy
Percent Seen Someone Shot or Shot at (in NLSY97)
Black
White
Before Age 12
26
8
Between 12 and 18
29
10
Cumulative by 18
43
16
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
“Advice” to a Current College Student
What is power?
Satyagraha
Be genuine and humble
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
“Advice” to a Current College Student
What is power?
Satyagraha
Be genuine and humble
Find something you love
Might take time (the wisdom of George W. Bush)
Always judge yourself by your definition of success
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
“Advice” to a Current College Student
What is power?
Satyagraha
Be genuine and humble
Find something you love
Might take time (the wisdom of George W. Bush)
Always judge yourself by your definition of success
Devote yourself to it and work hard
Timmy
Intro
Rural Water
Data and Results
Haiti Outreach
Big Issues
“Advice” to a Current College Student
What is power?
Satyagraha
Be genuine and humble
Find something you love
Might take time (the wisdom of George W. Bush)
Always judge yourself by your definition of success
Devote yourself to it and work hard
Timmy