NEAL CONAN, HOST:
There's definite progress in Haiti. Two years after the earthquake, the number of displaced residents in the tent towns is down by two-thirds, but that still leaves half a million people in often squalid circumstances. More than half of the 10 million tons of rubble has been removed from the streets, but only a little more than half. A less ambiguous improvement: More people have access to clean water now than before the disaster. Even so, hundreds of Haitians contract cholera every day, though a new vaccination project could reduce fatalities.
If you've been to Haiti in the past year, what's the most important priority now? 800-989-8255. Email: firstname.lastname@example.org. You can also join the conversation on our website. Go to npr.org. Click on TALK OF THE NATION. Rajiv Shah is administrator for the U.S. Agency for International Development. He joined us a year ago to talk about distribution of relief aid. He's joined us again today here in Studio 3A. Nice to have you back with us.
DR. RAJIV SHAH: Thank you. It's nice to be here.
CONAN: And what worked, and what hasn't?
SHAH: Well, you know, it is always important to note that on this anniversary of an incredibly tragic event, that more than 250,000 people lost their lives. And the challenge that that has posed for a country that had difficulties to begin with are really extraordinary. But in the context of that, over the last two years, we've seen real signs of hope. A number of things have worked. Partners and the Haitian government and Haitian leaders have done things differently so that today, as you point out, more people have access to clean water and safe sanitation in Port-au-Prince than the day before the earthquake.
Health services are broadly available to a broad range of the population. A quarter of a million kids are now back in school and getting an effective education. And importantly, the economy is actually on the move - 5.6 percent GDP growth. And we've seen real areas of hope in areas like the banking and mobile money system, as well as in agriculture and food security, which continues to be where 60 percent of Haitians are employed. So there are challenges. This is tough. This is a long-term program of leadership for the Haitians and for their partners. But we have seen important concrete results that give us hope for the future.
CONAN: And I'm sure we'll have many questions about the challenges. I did want to ask you, though, about one of the projects that does seem to be succeeding. You wrote an op-ed in the Miami Herald, which we just took a look at, and there is a project to help farmers in Haiti - 60 percent of the workforce in Haiti are famers - to increase their yields, particularly of rice.
SHAH: Absolutely. You know, Haitians have been importing rice and buying imported grains, like rice and wheat and other products, when they have the potential to have a very vibrant economy in the agriculture sector. We've seen a specific partnership between the University of Florida and the people and farmers of Haiti result in their getting access to better technologies in areas like corn or maize, where we've seen more than 300 percent improvements in yield.
In rice, they're using a system called the system of rice intensification, which allows them to use less water, less fertilizer, more safe inputs. And they're seeing a big increase, doubling or tripling of yields, and a 75 percent increase in farm incomes because of that program, which has now reached almost 10,000 farm households, and we believe will reach 125,000 over time. So those are the types of concrete results that will help Haiti develop a stronger economy, reduce poverty and reduce the kind of chronic hunger and malnutrition that has held back so many Haitian children unfairly.
CONAN: The United States is the largest donor to Haiti, yet there are many others, and there are commitments, I think, through 2020. But I wanted to read you this quote: "It is not realistic to expect the international community to continue to direct foreign assistance money indefinitely toward this country, as it has for so many years." The source is U.S. Ambassador Kenneth Merten. It seems some people are beginning to lose some patience.
SHAH: Well, Ken has been a - Ambassador Merten has been a stalwart supporter of Haiti and the Haitian people and has fought through very difficult circumstances to do that. President Obama and Secretary Clinton have made clear that we will have a long-term and firm commitment to the people of Haiti. We did before the earthquake. We did in the tremendous relief effort immediately following the earthquake that saved tens of thousands of lives, and we will continue to in the future. But what is true is that we need to do things differently. We have to invest in Haitian institutions, work with Haitian partners so that they can lead their own country's future and they can develop strong government institutions, strong NGOs, strong private companies.
And we're starting to see that. We saw Marriott and Digicel make an announcement about a major new hotel investment in Port-au-Prince. We see that we're working today, USAID is working with 500 Haitian organizations after a real intensive effort to go out there and meet these groups and make sure we work directly with them, so that they develop the capabilities and capacity to rebuild their own country and to do it to a higher level of excellence than had been done previously.
CONAN: You talk about Haitian partners, and a lot of those are NGOs. It's fair to describe the government as having itself been shattered by the earthquake. There has been an election, the presidential election, since. There is a new president. Yet, we still read descriptions of the Haitian government as dysfunctional.
SHAH: Well, it's important to put this in context and understand the progress they've made. President Martelly was elected, and then there was a peaceful transition of power in a democratic circumstance with the partnership of the international community. That was an important achievement. President Martelly then went on to build his Cabinet and fill out his government, which has taken some time but is now complete. And the Haitian institutions, ministries are taking leadership of their own future.
So the Ministry of Health has designed a health plan that the United States and a number of other international partners are now lining up behind in trying to help them implement. The Haitian Ministry of Education have been implementing President Martelly's commitment to get every Haitian child into schools. And we're working with them to help them set standards and meet some of the innovators in American education so that we can learn from each other as we go forward.
That's the kind of leadership we want to see from our Haitian partners, and we are ready to be good partners behind their leadership because, ultimately, it's those actions that will create the conditions where aid is no longer needed in the future.
CONAN: Rajiv Shah is the administrator of the U.S. Agency for International Development, joining us, again, a year anniversary of the earthquake in Haiti that devastated the capital, Port-au-Prince, and, as he mentioned, killed so many people and left millions homeless. 800-989-8255. If you've been to Haiti over the past year, what is the priority now? Or you can email us: email@example.com. Let's start with Mario. Mario with us from West Palm Beach in Florida.
MARIO: The priority would be to create structures. Haiti doesn't even have a capitol after two years after the earthquake. And there is no movement to our structural capital with modern buildings. There's no movement of that. If you go to Haiti today, it's like the earthquake just happened. But people are talking about progress that they are making, and we have a lot of people under the tents still after two years. And I just came from Haiti. I'm asking myself, where that money has gone? Because I haven't seen it. I haven't seen it.
CONAN: The presidential palace, as Mario referenced...
MARIO: Still a mess.
CONAN: ...still a mess. That's exactly right, Rajiv Shah.
SHAH: Well, it is. It is important to note that the Haitian leadership has put forth their own development plan. And their priorities have included education, have included energy, agriculture, rebuilding their economy and providing health and education services to their people. And they prioritized that over some other potential investments like the reconstruction of that particular palace. But it is important to note, I was in Haiti recently, and you see - visit the camps and, of course, there are still 500,000 people in that setting.
In that environment, it's hard to recognize, but it's important to note that there used to be 1.5 million in that neighborhood. And we moved - in partnership with the Haitians, moved those people into appropriate housing, often by reconstructing homes that had been damaged and reconstructing them to a higher level of earthquake protection than before.
In many cases, there are major new home construction sites, like the 1,500 homes that are going in in the north around this major new industrial park that's an investment with the South Korean textile manufacturer that will initially create 20,000 jobs that might, over time, create 60 or 65,000 jobs. Those are the kinds of large-scale transformational programs and results that will help Haiti become a vibrant, self-sustaining economy over time.
And, you know, I applaud the Haitian government for making some tough choices in terms of setting priorities. I know this is going to be a long road ahead, but we have reason to be optimistic, and we have to be vigilant about tracking where the money is going to making - so that we make sure we deliver more of these results.
CONAN: You trumpet it and for good cause. There are more people getting clean water today in Port-au-Prince than they were the day before the earthquake. I'm sure that's correct, and I'm sure that's very important. Nevertheless, cholera, a disease that is spread and caused by poor sanitation and dirty water, 300 people a day come in with new cases of cholera. This is an improvement too. That's down from 500 a day. This was brought in by the United Nations, troops. Everybody believes, and this is a cause of great resentment.
SHAH: Well, the cholera outbreak was an extraordinary setback to a country that was just trying to climb out and recover from a tremendous tragedy to begin with. The initial case fatality rate was more than 9 percent, and that's incredibly high, and that means we lost far more children than ever should've been the case. The United States, working through the Centers for Disease Control and other partners, really sent our best, most capable disease control experts to Haiti to help, work with them, to bring down that case - fatality rate. The global goal went - in cholera epidemics is about 1 percent. Today, that case fatality rate is 0.56 percent. And so, the goal is to really save as many lives as is possible and to try to keep cholera under control, and that has largely been achieved. We have to keep at it and keep focused at it. And, hopefully, there'll be some new tools like vaccines and other strategies that can help eliminate the problem all together in the near future.
CONAN: USAID Administrator Rajiv Shah. You're listening to TALK OF THE NATION from NPR News.
Let's go next to Megan(ph), Megan with us from Stillwater, Minnesota.
MEGAN: Yeah. Hi. I was in Haiti recently with the Tallahassee Haiti Medical Organization, and I just think, in general, that Haitians need basic access to health care. There's such an inequity in health care there and just lack of clean water. And, I mean, we gave out 650 bars of soap in three days of (unintelligible) because the people just lack the basic necessities like that.
CONAN: And one of the problems there, Rajiv Shah, as you know well, has been the lack of facilities to train health care professionals in Haiti, including doctors. Has there been progress there?
SHAH: There has, but I'm so glad the caller mentioned the distribution of soap and efforts to really promote basic sanitation practices to prevent disease in the first place. That's an area where we've seen a lot of progress compared to pre-earthquake statistics. There's also a challenge about building a vibrant and integrated health system. You know, for too long, Haitian NGOs and international NGOs, as well-meaning as they were, would go out and try and solve one disease or provide services in one area somewhat disconnected from each other.
In the reconstruction, they decided to do things differently, and the Haitian government put forth a single plan for an integrated health system. We are working with them and other partners to make sure there's a reference hospital system so that clinics can be connected to reference hospitals so that if people need a higher level of care, they can be send back to that high level of care. And we're building out the university hospital in the center of Port-au-Prince that can also serve as a training site to address some of the human resource shortages and needs.
Please keep in mind, before the earthquake, the level of chronic child malnutrition was almost 50 percent in Haiti, and so that's a basic health indicator that demonstrates that conditions were very bad. I think we've seen that number come down significantly recently, and we'll expect to continue to see progress as we continue to expand vaccinations, access to basic maternal health and access to basic child health services throughout the country.
CONAN: Megan, I'm sorry. I heard you trying to get back in. I think she has left us. I apologize. Anyway, as you look ahead, the question about wastage of funds, have you been able to account for all of the money that the United States has sent into Haiti and make sure that it has gone to useful causes?
SHAH: Well, the United States has spent in the immediate humanitarian aid, in the first few months after the earthquake, nearly $1.3 billion in an effort to do everything from health and education, protection, and you remember those urban search and rescue teams that were out there saving lives. At that point in time, the goal is to spend the money very, very quickly and save as many lives as is possible. Since then, the United States has committed an additional $1.8 billion. And the goal of the reconstruction resources are to make sure the money is spent effectively to do the extra hard work to invest in local Haitian institutions so that they can build up their own institutions. And there's an exit strategy over time for donors and partners.
And in that context, people sometimes note that, well, not all the money has been spent. Only about 44 percent of that has been spent. But that's actually the - that's the consequence of taking extra measures to make sure that we're safeguarding and protecting resources, taking extra time to work with local entities and local organizations, spending the time coordinating with other donors so that things are not haphazard and uncoordinated, and then measuring concrete results, which is why we can quote to you today the yield performance in the rice project or the percentage of children that are getting vaccinated. Those things take extra time and effort, but it's worth taking that time in order to get it right.
CONAN: Let's see if we can get Maurice(ph) on the line from St. Louis. Maurice, we just have a few seconds.
MAURICE: Yes. Basically, I wanted to talk about how Haiti, I think, should have a plan as far as agriculture and biomass for electricity production. I'm a graduate student in sustainability, and I've actually come across some USAID documents where USAID has provided funding for creosote projects so people can use less charcoal and in turn, you know, reduce the need for charcoal in Haiti. But I think one of the main problems to - for my main point is that...
CONAN: Very quickly, please.
MAURICE: ...basically, Haiti needs to get away from charcoal. People need to have...
CONAN: I'm afraid we're going to leave it there to give Rajiv Shah a chance to respond. Get away from charcoal.
SHAH: Well, you're right. And at the end of the day, we have tried to prioritize science, technology and innovation. I'm so glad the question came from a graduate student because it shows that American students, American universities have so much to offer in terms of moving forward the science and technology to make new things possible. Helping to transition people to better cook stoves has been a major priority for Secretary Clinton and will help reduce health consequences. Building a mobile money system so that cell phones can be use as banks is a different way of thinking about building a financial system so that you don't have to rebuild a traditional banking structure that didn't reach as many Haitians. And there are an infinite number of examples of creative ideas that can be brought to Haiti and can emanate from Haiti to help create a better future for the Haitian people.
CONAN: Rajiv Shah, thanks very much for your time.
SHAH: Thank you.
CONAN: Rajiv Shah, administrator of the U.S. Agency for International Development. You're listening to TALK OF THE NATION, from NPR News. Transcript provided by NPR, Copyright National Public Radio.