By Jake Johnston & Kira Pauleman, Center for Economic & Policy Research (CEPR), March 27, 2020
On March 19, Haitian president Jovenel Moïse confirmed the first two cases of the novel coronavirus in Haiti. The number has since increased to eight. In response, the president has declared a state of emergency and ordered schools, factories, and religious entities to close; established a curfew; and closed the country’s borders. The government announced the new policies after previously suspending air travel from most countries.
The initial reported cases both related to individuals who had traveled internationally. There has, however, only been limited local testing. As of March 25, 58 tests had been administered nationwide, according to the latest epidemiological update. The Ministry of Health has outlined a plan to combat the pandemic in Haiti, estimating a budget of $37.2 million. Already, international and local organizations have been meeting to coordinate the response.
After nearly two years of sustained protests and government inaction, the economic situation in Haiti has already made life exceedingly difficult for the vast majority of the population. The currency has rapidly depreciated, inflation has remained elevated, and the government has been unable to increase revenues domestically or through international assistance. The Haitian government has few fiscal resources to draw upon in responding to the coronavirus pandemic, and Haitian families, many already pushed to the edge, are facing an increasingly perilous future.
There are multiple complementary aspects of the response to this virus in Haiti. One centers on the health care system and the ability to adequately detect, treat, and contain the virus. The other relates to the government’s ability to establish and enforce policies that encourage physical distancing. In addressing the latter, it is important to consider how the Haitian population interacts, lives, and survives in order to implement effective policies to contain the virus, protect the population, and ensure access to essential goods.
The cases reported have so far been marked as imported, but with the difficulties of enforcing a sustained national quarantine, Haiti is facing the very real risk of COVID-19 spreading locally. While declaring a state of emergency nationwide was a necessary step, it needs to be boosted by provisions for workers and the poor, and allocations for the health care system. The international community must also play a role, with the World Bank, IMF, and other multilateral development organizations immediately freeing up resources for Haiti and other developing nations to respond to the pandemic.
The Health Care System
Prior to the onset of the coronavirus pandemic, Haiti’s health care system faced many challenges. According to a 2019 study by the Research and Education consortium for Acute Care in Haiti (REACH), Haiti only has an estimated 124 ICU beds and 64 ventilators for a population of more than 11 million. Other public health experts have put those figures even lower. This is a serious concern, especially given the relatively high proportion of the population considered to be at an elevated risk.
Already, there have been reports from the State University Hospital (HUEH) of inadequate preparation and supplies of protective equipment, which has led to some health professionals refusing to work. The HUEH was one of the marquee post-quake international reconstruction projects, but, more than ten years later, those plans remain mostly unrealized.
Haiti’s health care system overall is extremely reliant on private actors, including foreign assistance and NGOs. Dr. Youri Louis told the Haitian Times that, as of 2013, 64 percent of Haiti’s health budget derived from international assistance. In many parts of the country, access to health care is only provided by nonstate actors.
In such a fragmented system, coordination will be critical. In this regard, it is positive that national and international organizations are already meeting and discussing coordinated response mechanisms. Health actors in Haiti can draw upon their experiences combatting the cholera epidemic, which spread in Haiti after its introduction by United Nations troops in 2010. While the response to cholera was woefully inadequate, more coordinated and concerted efforts in recent years have led to some positive developments. As Sandra Wisner of the Institute for Justice and Democracy in Haiti told the Haitian Times, empowering communities must be a key aspect of any successful response:
This includes access and ensuring services are available to communities ― so having available where people are, tracing, treatment; health facilities resources with the necessary supplies, and ensuring front line workers have the resources and tools they need to provide safe and effective care and treatment for patients.
Since the 2010 earthquake, the Haitian Ministry of Health has been one of the only government institutions that has received direct donor support. Nevertheless, a significant portion of foreign assistance bypasses national health systems. It is vitally important that efforts to respond to the current pandemic also focus on strengthening the government’s health care infrastructure. Though some improvements have been evident over the previous decade, national health spending remains woefully inadequate and has actually decreased in recent years.
The government has also appealed to Cuba for assistance in fighting the pandemic. The government announced there were 348 Cuban health professionals in the country to respond, many of whom were already in the country as part of Cuba’s decades-long assistance in providing health care in Haiti.
Even before the arrival of the novel coronavirus, the Haitian economy was projected to shrink by 1 percent on a per capita basis in 2019. The government’s directive to close businesses will bring additional economic hardship. Remittances, on which the Haitian economy relies, may also see a reduction as diaspora communities struggle in their own communities with quarantines and business closures.
Haitians’ reliance on the informal economy will make responding to the crisis even more difficult. Some 60 percent of the population lives on less than $2 a day. Though the government has directed businesses to close, the reality is that many rely on the informal economy to survive.
In this regard, despite the government’s announcements, public markets and public transportation continue to operate. Local journalists have raised concerns about the lack of guidelines for drivers and passengers. While the public might be aware of the virus, most people still depend on public transportation and public markets to survive and get around. Unions have taken the lead by recommending a reduction in the number of passengers allowed on taxis and buses, but there has yet to be any clear initiative from the state to enforce the unions’ recommendations and regulate transportation.
While the government has ordered factories closed, it is unclear what, if any, financial support from the government will go to impacted workers. Antèn Ouvriye, an organization representing factory subcontractors, has criticized the government for not ensuring salaries will continue to be paid during closures. On March 25, de facto prime minister Joseph Jouthe announced that public workers and those working in the textile industry would receive one month of wages; however, it remains unclear exactly when that would take place and how much the government will be able to afford.
In order to ensure communities are able to take action to protect themselves and are able to stay at home, the government must act to provide the resources necessary to sustain people’s livelihoods, including access to food and water. Some countries have acted to reinforce and increase government spending on essential services and social safety net policies. Some have prioritized subsidizing revenue by ensuring salaries are maintained, while others are providing meals to those who rely on daily activities for their basic needs. Although Haiti’s resources are limited, the government response needs to incorporate economic relief for the population, especially for street vendors, factory workers, and small business owners, many of whom rely on the informal economy to make a living.
The government, however, has thus far relied on monetary policy ― increasing access to credit through the central bank and relaxing repayment schedules. This, however, is likely to have only a limited impact for the vast majority of Haitians. Without greater international assistance, it is unlikely the government will have the fiscal resources available to properly support the population throughout the crisis.
Price gouging has already started, putting a strain on an already fragile population. This is partly due to the fact that the Haitian food supply depends largely on imports, which are likely to decline during the current situation. While the government has announced measures to ensure food distribution, it must make a priority of protecting consumers from price spikes. This also presents an opportunity to invest in and expand the agricultural sector, which could provide stability for farmers and sellers, and increase national production.
It is imperative to recognize that the Haitian state’s inability to adequately respond to the crisis is tied to a legacy of foreign domination, occupation, and exploitation, and to decades of foreign aid policies that have eroded the state’s capacity. Nevertheless, it is increasingly clear, as with the 2010 earthquake, that the Haitian government will not be able to adequately respond to the current crisis without increased support from the international community.
The IMF and the World Bank have issued a statement urging “all official bilateral creditors to suspend debt payments from IDA countries that request forbearance.” Though most of Haiti’s debt is concessional (loans provided at very low or even zero interest rates), bilateral and multilateral donors should immediately suspend any debt servicing requirements for the duration of the pandemic. The Inter-American Development Bank has also announced a special lending facility for countries impacted by the coronavirus pandemic.
The IMF could also provide an unprecedented influx of reserve assets to developing countries, including Haiti, through a Special Drawing Rights allocation. The IMF is reportedly considering this. With its dwindling reserves and reliance on the importation of goods, such a boost would be extremely valuable to Haiti.
It is also likely that a prolonged crisis will exacerbate an already fragile food security situation in much of the country. Many children rely on school feeding programs, which are often funded by international organizations. International assistance will be key in ensuring the government is able to reach the most vulnerable in responding to the pandemic, but international actors must be wary of repeating past mistakes. Food assistance should be designed to ensure local procurement of available goods, and to support investment in national production.
The onset of the coronavirus pandemic in Haiti requires immediate and concerted action by local and international actors; but in a country where the failures of international assistance and intervention are so readily apparent, those involved in the response must make every effort to ensure a more sustainable future.
Posted April 2, 2020