Even before this month's earthquake, Haiti was living on a huge transfusion of outside aid.
It came from mega-donors like the U.S. government, which has spent $2.6 billion since 1990 on ambitious programs to create a stable democracy.
And it came from small groups like parishioners of St. Petersburg's Holy Family Church, who donated $6,300 to build a clinic in a town so remote it's reachable only by mule and foot.
Yet for all the help, three-quarters of Haiti's 9 million people live on less than $2 a day. Half have no access to clean drinking water. One-third have no sanitary facilities. Only 10 percent have electrical service.
"After consuming billions in foreign aid over three decades, Haiti remains politically dysfunctional and impoverished,'' concluded a 2006 U.S. report "Why Foreign Aid to Haiti Has Failed."
Few would criticize the outpouring of help after the earthquake, which killed as many as 200,000, left thousands maimed and destroyed much of the capital, Port-au-Prince. But Haiti has long depended on aid and remittances from Haitians overseas — including at least 400,000 in the United States — to sustain itself.
In 2003, per capita aid to Haiti was $23.70, more than twice the amount for Latin America and the Caribbean as a whole. Private organizations deliver four-fifths of Haiti's public services.
A key reason for Haiti's reliance on aid — and its negligible impact — lies in a series of corrupt, inept governments. International donors found it nearly impossible to work with a country whose civil service was packed with thousands of "phantom" employees who collected paychecks but never showed up for work.
To help strengthen Haiti's public sector — its courts, its police, its government agencies — the United States and other countries launched dozens of good-governance programs.
"This type of project has admittedly been the one to yield the most disappointing results — the main reasons being the Haitian government's lack of political will and flagrant lack of cooperation,'' according to Canada's aid agency, which poured $273 million into Haiti between 1994 and 2002.
The aid flow has not been constant. As Haiti struggled through coups and other turmoil, donors periodically suspended assistance. That caused its own problems.
"Programs in place suddenly terminated when aid stopped, unraveling many positive benefits,'' the U.S. report said. "Once aid started up again, programs had to regain what was lost before they could move forward.''
Other aid projects have been poorly designed and produced unintended results.
Starting in 1994, as part of an effort to prevent future coups, the United States spent $8.7 million to demobilize the Haitian army. Thousands of soldiers were trained as mechanics and carpenters so they could return to civilian life.
But dissolving the army left Haiti without its own security forces since the army had also served as the national police. Building a new Haitian police force "proved difficult and time-consuming,'' the report said.
Moreover, few of the former soldiers found work; businesses were loath to hire them because they had once terrorized the population. And because most soldiers were anti-Aristide, his government wouldn't employ them as civil servants.
In 2004, ex-soldiers overthrew Aristide a second time.
In recent years, the United States has funded many projects through nongovernmental organizations like Save the Children.
These organizations, along with charities, church groups and missionaries, undoubtedly have helped thousands of individual Haitians. But in doing so much they let Haiti's government get away with doing so little.
"Operating parallel service delivery systems eroded the legitimacy of government, which already had demonstrated it would not serve the people,'' the U.S. report said.
The number of outsiders doing humanitarian work in Haiti is staggering. GuideStar, which compiles data on U.S. nonprofit organizations, lists nearly 1,000 that have "Haiti'' in their name or Haiti as their mission. And that doesn't include countless groups like Holy Family Church.
Last year, members helped build a new clinic in Beau Sejour, a mountaintop town of 22,000 ravaged by four tropical storms that hit Haiti in 2008. Until the clinic was destroyed in the earthquake, Holy Family was sending a monthly stipend while a church in Hamilton, Ontario, paid for visits by a doctor and dentists.
"They were the first dentists ever seen,'' said Karen Jensen of Holy Family, which is collecting donations to rebuild the clinic. "One man had 24 teeth they had to fill or pull. The family said it was the first time their father was without pain in years.''
The St. Petersburg and Canadian churches partner with a Catholic parish in Beau Sejour under a program called Parish Twinning of the Americas. Since 1978, it has spent $24 million in Haiti building schools, clinics, roads — all services that governments are supposed to provide.
Haiti's "government has had lots of problems — you can't overlook that — but we're hoping that maybe now this catastrophe will have some positive outcome,'' said Fran Rajotte, development director for Parish Twinning's clinics in Haiti. "As Christians, we can't worry about what other people should or shouldn't do. We have to do what the Lord calls us to do.''
Another organization, Florida-based Hope for Haiti, supports schools, orphanages and children's health programs. Asked whether such work undermines the Haitian government, executive director Elizabeth Davison had a terse reply:
Aid can still work
Since the earthquake, charities have raised more than $335 million for emergency relief. To help Haiti recover, the U.S. government has pledged $100 million on top of the nearly $300 million already requested for 2010; other countries are kicking in millions.
Can anything be done to make sure all that money produces substantial, lasting results?
Though many aid organizations refuse to work with Haitian authorities because of the notorious corruption, "all the more reason, indeed, to work with the government,'' author Tracy Kidder wrote in the New York Times. "The ultimate goal of all aid to Haiti ought to be the strengthening of Haitian institutions, infrastructure and expertise.''
Kidder is on the development committee of Partners in Health, which operates 10 rural hospitals — all still intact — in tandem with the Haitian Ministry of Health. The Boston-based program "offers a solid model for independence — a model where only a handful of Americans are involved in day-to-day operations and Haitians run the show,'' Kidder wrote.
The U.S. report agrees that a top priority should be building a stronger, more stable Haitian government. One way is to crack down on the corruption "because the more corruption, the less aid effectiveness.''
Another is better coordination between international donors.
Aid programs "may conflict or be duplicative of that from other countries,'' the report said. "In Haiti, without exception, every major donor worked on democratization and yet Haitian democracy was nowhere to be found.''
The report also suggests that the United States let other nations take the lead in democratization, given that "many Haitians believe the United States meddles in their country, taking sides and imposing its will. And the United States has done so for over a century.''
Aid would be more effective if donors undertook only projects that are self-sustaining after the funding stops — perhaps building an irrigation system for crops, the sale of which would give farmers money to maintain the system.
Too often, the report said, projects that made little difference were described as successful.
"USAID's Strategic Plan for Haiti 1999-2004 was merely a listing of projects under way with the annotation that there were 'accomplishments.' Yet the policy areas — environment, privatization, justice, security, fiscal and monetary management, elections — were disasters with billions spent and adverse results produced.''
Susan Taylor Martin can be contacted at firstname.lastname@example.org.