title: The socioeconomic impact of international aid: a qualitative study of healthcare recovery in post-earthquake Haiti and implications for future disaster relief.
abstract: We assessed healthcare provider perspectives of international aid four years after the Haiti Earthquake to better understand the impact of aid on the Haitian healthcare system and learn best practices for recovery in future disaster contexts. We conducted 22 semi-structured interviews with the directors of local, collaborative, and aid-funded healthcare facilities in Leogane, Haiti. We coded and analysed the interviews using an iterative method based on a grounded theory approach of data analysis. Healthcare providers identified positive aspects of aid, including acute emergency relief, long-term improved healthcare access, and increased ease of referrals for low-income patients. However, they also identified negative impacts of international aid, including episodes of poor quality care, internal brain drain, competition across facilities, decrease in patient flow to local facilities, and emigration of Haitian doctors to abroad. As Haiti continues to recover, it is imperative for aid institutions and local healthcare facilities to develop a more collaborative relationship to transition acute relief to sustainable capacity building. In future disaster contexts, aid institutions should specifically utilise quality of care metrics, NGO Codes of Conduct, Master Health Facility Lists, and sliding scale payment systems to improve disaster response.
authors.affiliation: a School of Medicine , Stanford University , Stanford , CA , USA.|b Family Health Ministries , Durham , NC , USA.
authors.forename: Maxwell
authors.initials: M
authors.lastname: Kligerman
authors.affiliation: b Family Health Ministries , Durham , NC , USA.|c Global Health Institute , Duke University , Durham , NC , USA.
authors.forename: David
authors.initials: D
authors.lastname: Walmer
authors.affiliation: d Department of Medicine , Stanford University , Stanford , CA , USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Bereknyei Merrell
mesh_terms: D057191:Capacity Building; D004190:Disasters; D055866:Earthquakes; D005260:Female; D006205:Haiti; D006282:Health Personnel / Q000523:psychology; D006285:Health Planning; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007391:International Cooperation; D007407:Interviews as Topic; D008297:Male; D036301:Qualitative Research; D012066:Relief Work / Q000191:economics / Q000458:organization & administration; D012959:Socioeconomic Factors
keywords: Haiti; earthquake; global health; internal brain drain; international aid