• TABLE OF CONTENTS
HIDE
 Front Cover
 Title Page
 Table of Contents
 Foreword
 Acknowledgement
 Summary
 Glossary
 Project data sheet
 Map
 Introduction and project setti...
 Project description
 Project impacts: Findings...
 Conclusions and lessons learne...
 Appendix A. Evaluation scope and...
 Appendix B. Rural community development...
 Appendix C. HACHO and the agricultural...
 Appendix D. HACHO's health program:...
 Appendix E. Additional discussion...
 Appendix F. Persons contacted
 Appendix G. Photographs
 Bibliography
 A. I. D. evaluation publicatio...














Group Title: A.I.D. program evaluation report
Title: Haiti
CITATION THUMBNAILS PAGE IMAGE ZOOMABLE
Full Citation
STANDARD VIEW MARC VIEW
Permanent Link: http://ufdc.ufl.edu/UF00087117/00001
 Material Information
Title: Haiti Hacho rural community development
Series Title: A.I.D. program evaluation report
Physical Description: 69 p. : ; 29 cm.
Language: English
Creator: Brinkerhoff, D.W
Fotzo, P.T
Ormond, B.J
Publisher: A.I.D.
Place of Publication: Washington
Publication Date: 1983
 Subjects
Genre: non-fiction   ( marcgt )
Spatial Coverage: Haiti
 Notes
Statement of Responsibility: by Derick W. Brinkerhoff, Pascal T. Fotzo and Barbara J. Ormond.
 Record Information
Bibliographic ID: UF00087117
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: oclc - 67384348
clc - 000198735

Table of Contents
    Front Cover
        Front Cover 1
        Front Cover 2
    Title Page
        Page i
        Page ii
    Table of Contents
        Page iii
        Page iv
    Foreword
        Page v
    Acknowledgement
        Page vi
    Summary
        Page vii
        Page viii
        Page ix
    Glossary
        Page x
        Page xi
    Project data sheet
        Page xii
    Map
        Page xiii
        Page xiv
    Introduction and project setting
        Page 1
        Page 2
    Project description
        Page 3
        Page 4
        Page 5
        Page 6
        Page 7
        Page 8
        Page 9
    Project impacts: Findings and analyses
        Page 10
        Page 11
        Page 12
        Page 13
        Page 14
        Page 15
        Page 16
        Page 17
        Page 18
        Page 19
        Page 20
        Page 21
        Page 22
        Page 23
        Page 24
        Page 25
    Conclusions and lessons learned
        Page 26
        Page 27
        Page 28
        Page 29
        Page 30
    Appendix A. Evaluation scope and methodology
        Page A
        Page A-i
        Page A-1
        Page A-2
        Page A-3
        Page A-4
    Appendix B. Rural community development (HACHO) final logical framework, 1977 project paper
        Page B
        Page B-i
        Page B-1
        Page B-2
    Appendix C. HACHO and the agricultural development of Northwest Haiti
        Page C
        Page C-i
        Page C-1
        Page C-2
        Page C-3
        Page C-4
        Page C-5
        Page C-6
        Page C-7
        Page C-8
        Page C-9
        Page C-10
        Page C-11
        Page C-12
        Page C-13
        Page C-14
    Appendix D. HACHO's health program: History and impact assessment
        Page D
        Page D-i
        Page D-1
        Page D-2
        Page D-3
        Page D-4
        Page D-5
        Page D-6
        Page D-7
        Page D-8
        Page D-9
        Page D-10
        Page D-11
        Page D-12
        Page D-13
        Page D-14
        Page D-15
        Page D-16
    Appendix E. Additional discussion of community councils
        Page E
        Page E-i
        Page E-1
        Page E-2
        Page E-3
        Page E-4
        Page E-5
        Page E-6
    Appendix F. Persons contacted
        Page F
        Page F-i
        Page F-1
        Page F-2
        Page F-3
        Page F-4
    Appendix G. Photographs
        Page G
        Page G-i
        Page G-1
        Page G-2
        Page G-3
        Page G-4
    Bibliography
        Ref
        Page Ref-i
        Page Ref-1
        Page Ref-2
        Page Ref-3
        Page Ref-4
    A. I. D. evaluation publications
        Ad-1
        Ad-2
        Ad-3
        Ad-4
        Ad-5
        Ad-6
        Ad-7
        Ad-8
        Ad-9
        Ad-10
Full Text





A.I.D. Project Impact Evaluation Report No.49

HAITI: Hacho Rural Community Development


November 1983



U,S. Agency for International Development (AID)


PN-AAL-025












HAITI: HACHO Rural Community Development


A.I.D. Project Impact Evaluation Report No. 49






by

Derick W. Brinkerhoff, Team Leader
Management Specialist
(Bureau for Science and Technology, A.I.D.)


Pascal T. Fotzo, Agricultural Economist
(Michigan State University)

Barbara J. Ormond, Public Health Specialist
(Bureau for the Near East, A.I.D.)






U.S. Agency for International Development




November 1983






The views and interpretations expressed in this report are
those of the authors and should not be attributed to the Agency
for International Development.































A.I.D. EVALUATION PUBLICATIONS


A complete list of reports issued in the A.I.D. Evaluation
Publication series is included in the back of this document,
together with information for ordering reports.










TABLE OF CONTENTS


Page

Foreword ...................................................... v

Acknowledgments.............................................. vi

Summary...................................................... vii

Glossary ......................................................x

Project Data Sheet...........................................xii

Map........................................................ xiii

I. Introduction and Project Setting........................1

II. Project Description..................................... 3

A. Evolution of Purpose and Objectives................. 4
B. Project Implementation.............................5

III. Project Impacts: Findings and Analyses................10

A. Health Program Impacts.............................10
B. Agricultural Program Impacts.......................12
1. Soil Conservation and Reforestation............12
2. Irrigated Agricultural Production..............13
3. Rainfed Agriculture............................14
4. Livestock/Animal Husbandry..................... 15
5. Off-Farm Enterprise: Handicrafts.............. 15
C. Infrastructure Impacts.............................17
1. Roads .......................................... 17
2. Potable Water and Sanitation...................19
D. Institutional Impacts ..............................21
1. Local Organizations..... .......................21
2. HACHO and Organizational Performance...........22

IV. Conclusions and Lessons Learned........................26

A. Conclusions......................................... 26
B. Lessons Learned.................................... 28











TABLE OF CONTENTS



Appendixes

A. Evaluation Scope and Methodology
B. Rural Community Development (HACHO) Final Logical
Framework, 1977 Project Paper
C. HACHO and the Agricultural Development of Northwest
Haiti
D. HACHO's Health Program: History and Impact
Assessment
E. Additional Discussion of Community Councils
F. Persons Contacted
G. Photographs

Bibliography





-V-


FOREWORD



In October 1979, the Administrator of the Agency for
International Development (AID) initiated an Agency-wide
ex-post evaluation system focusing on the impact of AID-funded
projects. These impact evaluations are concentrated in partic-
ular substantive areas as determined by AID's senior executives.
The evaluations are to be performed largely by Agency personnel
and result in a series of studies which, by virtue of their
comparability in scope, will ensure cumulative findings of use
to the Agency and the larger development community. This study
of the impact of the HACHO Rural Community Development project
in Haiti was conducted in November 1982 as part of this effort.
A final evaluation report will summarize and analyze the results
of all of the studies in this sector and relate them to program,
policy, and design requirements.

The team leader participated in this study as a Development
Management Specialist from the Office of Multisectoral Development
in the Science and Technology Bureau. He is currently resident
advisor on monitoring and evaluation to the Haitian Ministry of
Planning through a joint arrangement with USAID/Port-au-Prince
and S&T/MD's Performance Management Project.






-vi-

ACKNOWLEDGMENTS


In order to be done effectively, field research requires
assistance and support from a variety of sources. Such support
is all the more crucial when available time is short and the
task broad. The team appreciated the efforts on its behalf of
USAID/Haiti and would like to thank Stacy Rhodes and Joel
Cotten in particular for their help. Also deserving to be men-
tioned are the many HACHO staff members both in Port-au-Prince
and the field who took the time to make themselves available to
answer our questions, provide documents, and discuss their
work. Finally, we would like to thank Pierre Yves Lubin, our
research assistant and Creole interpreter.





-vii-


SUMMARY


Haiti's Northwest region is resource poor, sparsely popu-
lated, and possessed of minimal infrastructure and services.
The Haitian-American Community Help Organization (HACHO; in
1979 the name was changed to Harmonisation de l'Action des
Communautes Haitiennes Organisees) was established in 1966
through a grant to CARE to undertake health services provision
and community development in the region. For 13 of its 16
years, HACHO received Agency for International Development
(AID) funding for a total of $5.1 million, in addition to sub-
stantial quantities of PL 480 commodities. It also received
$1.5 million from the West German Government.

The focus of HACHO's activities changed substantially
during the project's lifetime. HACHO began by providing health
services in one small town, but soon expanded both geographi-
cally, to reach other parts of the Northwest, and sectorally,
by moving into community organization and road construction,
and later into agricultural extension, irrigation, potable
water, and handicrafts. The lack of a government presence in
the region and the extreme paucity of basic services and infra-
structure meant that HACHO, as one of the few organizations
operating in the Northwest at the time, became the focal point
for local residents seeking help and for donors looking for a
vehicle to provide assistance. In short, HACHO became a kind
of quasi-government for the Northwest, funded by outside donors
with technical assistance provided by CARE.

Periodically called upon to coordinate donor response to
natural disasters, both drought and hurricane, HACHO fluctuated
between providing emergency relief services and seeking to
build local-level development capacity. By the mid-1970s, AID
was pushing HACHO toward becoming a regional development agency
in charge of integrating and coordinating development activity
for the Northwest. At the same time, AID pressured the Govern-
ment of Haiti (GOH) to recognize HACHO officially and take over
its budgetary support. Dialogue between AID and the GOH con-
tinued without resolution until the termination of AID funding
in 1979. HACHO limped on with a much-reduced level of activity
for another three years, and was finally abolished in late
November 1982 by the GOH and replaced by the new Organization
for the Development of the Northwest (ODNO). ODNO is to absorb
HACHO's personnel and existing resources with the exception of
its top management.

The team found that HACHO's major impact lay in having
provided basic services in an area where none existed before.
Residents valued the health care HACHO provided and the road
network constructed through Food-for-Work teams managed by
HACHO and CARE. HACHO was also responsible for organizing






-viii-


community councils throughout the region. These councils were
the organizational mechanism through which donor assistance was
furnished for the self-help projects in potable water, irriga-
tion, crafts, and other areas of local concern.

The other major impact HACHO had was in disaster relief.
During the periods of drought, famine, and hurricanes that
struck the region, HACHO's ability to respond and deliver donor
assistance where it was needed proved invaluable to area resi-
dents. For the Northwest, this role was especially important
given the absence of a government network of services.

These two major sets of impacts in the case of the HACHO
project were not complementary, but rather the tension between
HACHO's relief programs and its development objectives skewed
its development efforts toward nonsustainable programs requiring
outside subsidies to keep them operating. Relief activities led
to a concentration on service provision with no attendant con-
cern for local-level capacity-building or sustainability. The
project's design in the later years tried to shift emphasis
toward production-oriented programs in agriculture and handi-
crafts, while building semi-autonomous local organizations.
However, HACHO's leadership, having its primary training in
health, was slow to move the organization toward agriculture.
The major impetus in that direction came from the German Gov-
ernment with the beginning of assistance that was earmarked for
agriculture. The community council movement organized by HACHO
was fraught with contradictions, as expectations regarding
council roles shifted back and forth between relief recipients
and self-help organizers. Councils were expected to serve as
conduits for Food-for-Work by engaging in self-help projects
and eventually to become effective mobilize-rs of local re-
sources for autonomous development. The dependency created by
the PL 480 commodities, the ambiguities around community versus
HACHO initiation of self-help activities, and the political
implications of true local-level autonomy led to the truncation
of the capacity-building objectives of the project.

HACHO also suffered from serious organizational and mana-
gerial weaknesses in spite of technical assistance from CARE in
these areas. With headquarters in the capital many hours from
the project site, a centralized decision-making structure, and
a totally inadequate information system, HACHO lacked an effec-
tive guidance mechanism. HACHO had little capacity to identify
in any systematic way where it had been, what it had done, and
where it should go. Other than on an ad hoc, intermittent
basis there was no planning, reporting, monitoring, or evalu-
ation system for HACHO. Emphasis was put on inputs and activi-
ties, not on results. Programs lacked continuity, and failed
to respond to changing circumstances. The health and agri-
culture technical packages used by HACHO remained basically
unchanged over the 16-year life of the project.






-ix-


Several lessons emerge from the HACHO project:

-In modifying project purposes, interactive effects
emerging from the changes must be attended to. Most
importantly, it is difficult to achieve development
and relief objectives within the same project.

-Development organizations in less developed countries
(LDC) tend to replicate the pattern of priorities of
their funders. Donors periodically treated HACHO as a
conduit for injecting resources into the region, and
HACHO treated the community councils the same way.

Sustainable development activities must reflect their
true costs and benefits. Unless this is done, pro-
grams will wither away once outside support is with-
drawn.

-Developing an indigenous organizational capacity re-
quires long-term attention to management improvement.
It also requires an organization that is receptive to
improvement.

SInstitutionalizing an effective organization is a
long-term process. Donor impatience and premature
termination of support lead to weak organizations that
rarely become effective. The length of time required
for institutionalization depends on the characteris-
tics of the organization involved and the social and
political climate in which it operates.

Integrated rural development projects, because of
their complexity, are particularly vulnerable to
external, macro-level constraints. Project selection
and design must be done carefully in order not to
overload a project with too many components that de-
pend for success upon systemic changes in the project
environment.









GLOSSARY


Animation French-style community development, a guided self-
Rurale help process

AFVP Association Francaise des Volontaires du Progres,
roughly the French equivalent of the Peace Corps

CANO Cooperative Artisanale du Nord-Ouest; Northwest
Artisans Cooperative, CARE/HACHO-sponsored crafts
program in the Northwest

CARE Originally, Cooperative for American Relief Every-
where, Inc.; currently known only by its acronym

DARNDR Departement de l'Agriculture, des Ressources Natu-
rels, et du Developpement Rural; Haitian Department
of Agriculture, Natural Resources, and Rural
Development

DSPP Departement de la Sante Publique et de la Population;
Haitian Department of Public Health and Population

FFW Food-for-Work, mechanism whereby laborers are given
quantities of PL 480 commodities while participating
in community projects

Fonds German-sponsored agricultural program implemented
Agricole through HACHO

GOH Government of Haiti

ha Hectare

HACHO Originally, Haitian-American Community Help Organi-
zation; currently, Harmonisation de l'Action des
Communautes Haitiennes Organisees

IHS Institut Haitien de la Statistique; Haitian Insti-
tute of Statistics

LDC Less developed country

mt Metric ton

ODNO Organisation pour le Developpement du Nord-Ouest;
Organization for the Development of the Northwest

ONAAC Office National pour 1'Alphabetisation et 1'Action
Communautaire; National Office of Literacy and
Community Action






-xi-


OPG Operational Program Grant; a form of AID funding

PDAI Projet de Developpement Agricole Integre; Integrated
Agricultural Development Project, an AID-funded
project

PL 480 Public Law 480, provides for the distribution over-
seas of surplus U.S. agricultural commodities

PVO Private voluntary organization

SEP Secretariat d'Etat du Plan; Ministry of Planning

SEPRRN Service d'Entretien Permanent du Reseau Routier
National; Haitian National Road Maintenance Service,
funded by AID for nine years and currently totally
funded by the GOH; recognized as a highly successful
AID project and one of the GOH's most reliable and
effective services


United Nations Children's Fund


UNICEF






-xii-


PROJECT DATA SHEET


1. Country: Haiti

2. Project Title: Rural Community Development (HACHO)

3. Project Number: 521-0061

4. Project Authorization/Completion Dates:

June 1966-December 1979

5. Project Funding 1966-1979:

USAID $5,130,0001
GOH 900,000
Other Donors 1,500,000

Total $7,530,000

6. Major Types of Activities Undertaken:

Health and Nutrition
Community Organization
Road Construction
Potable Water
Irrigation
Agricultural Extension
Crafts

















1Does not include the value of the substantial amounts of
PL 480 commodities distributed through HACHO.





Map 11-1
Haiti and its Position in the Antilles


Legend:
SHACHO Headquarters
(Capital)
@ HACHO Offices
HACHO Area
Other Cities
Major Roads
---- Regional Divisions

0 10 20 30 40 Miles
0 10 20 30 40 Kilometers


NORTH


L'ARTIBONITE











I. INTRODUCTION AND PROJECT SETTING


Haiti is recognized as the poorest country in the western
hemisphere and among the poorest in the world. Living stand-
ards of the population are very low as illustrated by a high
infant mortality rate of approximately 130 per thousand live
births, an average life expectancy of about 45 years, chronic
nutritional deficits (nationwide severe malnutrition in chil-
dren under five is estimated at 27.3 percent), and adult liter-
acy of between 10 and 20 percent. The 1980 gross national
product per capital was $260. Although predominantly rural and
agricultural, Haiti's agricultural production has been declin-
ing over the past decade (with an average annual decrease of
negative 2.5 percent for the period 1970-1979). Its per hec-
tare yields rank among the lowest worldwide.

Northwest Haiti is both the least densely populated and
and least resource-endowed region of the country. Because of
its dry climate, thin soils, and environmental degradation due
to erosion and desertification, this peninsula could be charac-
terized as the Haitian equivalent of the African Sahel. The
driest sections receive less than 400 millimeters (mm) of rain
annually, with the rest of the area receiving less than
1,000 mm. There is no consistent pattern of dry and wet sea-
sons, but rather one of severe fluctuations (see Table 1). The
region is also one of striking ecological contrasts within
short distances: arid coastal zones containing salt flats and
cactus; steep hills leading to the relatively moist, tropical
plateau around Bombardopolis; and, further to the east, the
more fertile highlands of Terre Neuve.

The Northwest is much less densely populated than the rest
of rural Haiti and contains an estimated 150,000 people. Re-
gional income per capital is approximately 57 percent of rural
income nationwide (see Table 2). Survival strategies are as
varied as the terrain, with an emphasis on risk minimization
through multiple activities. Depending upon location, resi-
dents of the Northwest engage in various combinations of fish-
ing, salt-mining, irrigated and non-irrigated agriculture,
animal husbandry, charcoal production, and handicrafts. Pover-
ty, however, is not consistent in the region; the towns, par-
ticularly Anse Rouge and Jean-Rabel, contain a small merchant
class, and a few families have relatively large landholdings.
Average holding per household is slightly more than six acres,
divided among an average of three parcels of land. Land dis-
tribution is relatively equitable, with most peasant households
holding title to at least one plot of land, however small.










Table 1. Northwest Region of Haiti, Occurrences of
Anomalous Climate and Related Food Shortages


Event


1947-1948

1957-1959

1965-1968

1974-1977

1978-1979

1979


Source:


Drought and Food Shortages

Drought and Widespread Food Shortages

Persistent Drought and Major Food Shortages

Severe Drought and Famine

Moderate Drought and Food Shortages

Hurricane David in September


Compiled from information contained in Steyaert, Louis
T. et al., An Early Warning Assessment Program for
Drought/Subsistence Food Shortages in the Caribbean
Basin and Sub-Saharan Africa: Final Report on Test
and Evaluation. Columbia, Missouri: National Oceanic
and Atmospheric Administration and University of Mis-
souri-Columbia. Report prepared for AID, Office of
Foreign Disaster Assistance, December 1980.


Table 2. Per Capita Income Differentials, 1975


Category Amount

National Average $162
Urban Areas 385
Rural Areas 96
Northwest 55


Source: Zuvekas, "Agricultural Development in
Haiti," May 1978; and Pfrommer et al.,
"Evaluation of HACHO: Phase II,"
October 1976.


Year









The Northwest is linked through a network of unpaved
roads; some are capable of supporting medium truck traffic,
others are suitable only for jeeps and light trucks. Prior to
1966, the area had but a few trails accessible only by jeep and
one road passable only in the dry season, linking Jean-Rabel to
Port-de-Paix. During wet seasons, many communities were com-
pletely isolated for months at a time. Despite improvements in
recent years, the area continues to be relatively cut off from
the rest of the country.

The Government of Haiti (GOH) in the Duvalier era has
practiced a policy of centralization of all Government func-
tions in order to concentrate authority in Port-au-Prince and
to minimize the possibility of opposition arising from regional
strengths or independence. As a result, government services
are attenuated throughout all Haiti outside of Port-au-Prince
and are close to nonexistent in the Northwest. A variety of
private voluntary organizations (PVOs), most of them religious,
are active primarily in the health and education sectors.
Other usually private services such as banks and gas stations
are lacking as well, forcing the region to depend on the near-
est urban center, Gonaives, for most of its needs in these
areas. As in most of the rest of rural Haiti, even a govern-
mental administrative presence in the region has been minimal
(though increasing in recent years due to the relatively more
relaxed policies of the younger Duvalier), lending credence to
the statement that, "To the vast majority of the Haitian
masses, the notion of the state is an abstraction..." (Lundhal
1979:345).

In the environment briefly described above, the challenges
to carrying out a development program are many. It is in this
setting that HACHO operated from 1966 to 1982.


II. PROJECT DESCRIPTION


Applying to HACHO the concept of a project as the term is
usually defined (that is, a set of activities undertaken to
achieve an objective in a specified timeframe witl a limited
set of resources) must be done with some caution. Almost all



1HACHO originally stood for Haitian-American Community Help
Organization. In 1979 the name was changed to Harmonisation de
1'Action des Communautes Haitiennes Organisees. The organiza-
tion is almost universally referred to by its acronym, however,
and apart from HACHO staff, the new name has yet to take hold
in the minds of Northwest residents familiar with its activi-
ties. Several signs in the area still carry the old name.










projects diverge from their original design; this is the nature
of implementation. However, in HACHO's case these divergences
took the form of significant evolutionary shifts in purpose,
objectives, and scope. The original Project Paper underwent
five major revisions (July 1970, October 1973, November 1974,
December 1975, and April 1977). The following description
summarizes HACHO's evolution over its 16-year life, during 13
of which it received AID support.


A. Evolution of Purpose and Objectives


HACHO was established in the summer of 1966 as a community
development program for the Northwest, to be administered by
the Cooperative for American Relief Everywhere, Inc. (CARE).
It was organized as an autonomous agency headed by a Haitian
technical director. Article 2 of the original enabling agree-
ment between CARE and the GOH stated that:

The purpose of this community development program is
to help the development of the communities in the
areas of health, education, nutrition, and agricul-
tural production with the active participation of the
interested population. The objective of this program
is to encourage self-help and community organization
for the betterment of each community and all its
individuals.

Project activities were authorized in three departments--
the Northwest, the North, and the Artibonite. It was agreed
that initial activity would be confined to the Northwest, with
future expansion to the other two departments implied. The
agreements specified that the Haitian director be both a public
health and a community development specialist. A Haitian phy-
sician, Dr. Carlos Boulos, who had been instrumental in devel-
oping the original project concept, became HACHO's first direc-
tor. Boulos had done relief work in the Jean-Rabel area in
1958. On the basis of this experience, he chose Jean-Rabel as
HACHO's first field site. A health team arrived there in
November 1966, and a second team was placed in Anse Rouge in
early 1967. The teams focused on the provision of health care,
but did undertake some community organization through the es-
tablishment of community councils.

The first shift in project emphasis came in 1968. Con-
tinued drought in the Northwest provoked increasingly severe
food shortages. AID responded through CARE with PL 480 Food-
for-Work (FFW) commodities to be delivered by HACHO. These
resources moved HACHO to focus on labor-intensive public works
in the form of road construction, a central need of the infra-
structure-poor area. Because of the FFW requirement that









commodities be distributed to local organizations, HACHO accel-
erated the formation of community councils.

Thus began the blending of relief and development objec-
tives that characterized HACHO throughout its life. By this
time, the general pattern of HACHO objectives had become es-
tablished: first priority on health care, followed by a mix of
road construction, community organizing, school construction,
and minor initiatives in agriculture. This pattern remained
the same as HACHO increased its area of operations in 1971 to
cover Terre Neuve, Gros Morne, and St. Michel de 1'Attalaye.

The second shift in HACHO's mix of objectives came in
1972. Within the health sector there was a new emphasis on
nutrition with the naming of Dr. William Fougere, an inter-
nationally known nutritionist, as the new HACHO director. At
the same time, AID began to push to move HACHO more toward
agriculture and community development and away from its primary
concern with health. AID also wanted HACHO to address the
issue of its ultimate role vis-a-vis the GOH, and urged inte-
gration of field activities with GOH agencies and the gradual
provision of GOH funding for HACHO. As a result of these pres-
sures, HACHO's objectives reflected an explicit focus on build-
ing the organization into a regional development agency as part
of Haiti's overall development effort. The 1974 Project Paper
revision stated the project's purpose as follows: "to
strengthen the framework for development in the rural Northwest
through the use of an intermediary organization, HACHO, and to
turn over progressively financial and directional responsibili-
ty for HACHO to the GOH."

Another modification of HACHO's objectives came in the
period 1976-1977. In 1976, the German Government set up a col-
laborative entity, Fonds Agricole, to work with HACHO and to
provide funding for agricultural activities in the Northwest.
In 1977, AID again revised the Project Paper, changing the
purpose to the development of self-sustaining community coun-
cils capable of implementing projects in agriculture, health,
and rural infrastructure (see Appendix B). HACHO was once
again pushed toward according a higher priority to agriculture
and toward building organizational capacity at the local level.
In spite of this pressure, program emphasis continued to be in
the area of health and nutrition.


B. Project Implementation


From its inception, HACHO interpreted its mandate to in-
clude a major focus on health and health-related activities,
such as providing potable water and nutrition education.
HACHO's first field units in Jean-Rabel and Anse Rouge were






-6-


medical teams. In 1976, 92 percent of HACHO program staff were
in the health sector (see Table 3). Following the establish-
ment of fixed health facilities at these two sites, HACHO
instituted mobile clinics to extend its curative outreach capa-
bility and to undertake preventive care, mainly through vacci-
nation campaigns. This pattern of fixed facilities plus outreach
was replicated at each field unit as HACHO expanded to Gros Morne,
St. Michel de 1'Attalaye, Terre Neuve, and Bombardopolis (see
Figure 1, HACHO organizational structure). In 1972, HACHO
began setting up nutrition centers designed to recuperate mal-
nourished children and teach mothers the basics of nutrition.
Family planning and counseling and provision of services were
also started early in the program.

Water projects and latrine construction were carried out
through community councils. Most water projects consisted of
capping natural springs with concrete and pipe in order to
prevent contamination of the water. Several town systems were
also constructed, most notably the one in Anse Rouge, which
provides household connections for the majority of residents.

HACHO's road construction effort evolved in response to
(1) the need for improved access to and within the region, and
(2) the availability of PL 480 FFW commodities for emergency
relief. These two factors combined to make the construction
and maintenance of roads a major component of HACHO's pro-
gram. The entire network in the region was either improved or,
more frequently, built by labor-intensive FFW crews organized
by HACHO in tandem with community councils.

HACHO's approach to implementing the community development
component of its mandate derived from the French-inspired ani-
mation rurale. This involved a guided self-help process where-
by HACHO community workers facilitated discussions of felt
needs among area residents, organized residents into communal
units (community councils), and orchestrated monetary or in-
kind contributions to projects addressing priority needs. As
mentioned above, the force that pushed HACHO ahead so swiftly
in setting up community councils was the humanitarian objective
of getting food to needy people during the drought in the
Northwest. HACHO's charter prohibited it from acting as a
charitable organization, requiring it to solicit some tangible
contribution from its beneficiaries. Food-for-Work offered the
ideal mechanism.

Once these community councils were in place, they became
the major mechanism through which HACHO sought to operate in
all its sectoral development activities. Besides health care,
other service sector activities undertaken were school cons-
truction, latrine building, the formation of home economics
training centers, and the establishment of youth groups.







Table 3. Changes in Mix of HACHO Program Staff by Sector


1966 1972 1976 1977 1982
Sector Number Percent Number Percent Number Percent Number Percent Number Percent


Health 24 92.3 112 57.7 86 61.9 41 51.1 32 40.5

Agriculture 1 3.8 28 14.4 16 11.5 16 17.4 17 21.5

Community
Development 1 3.8 54 27.8 37 26.6 29 31.5 30 37.9


Total 26 99.9 194 99.9 139 100.0 92 100.0 79 99.9



IIncludes engineers and road construction personnel, crafts staff, and bee-keeping personnel.

Source: Pfrommer et al., "Evaluation of the Haitian-American Community Help Organization: Phase II,"
USAID/Haiti, October 1976; Smucker and Smucker, "HACHO and the Community Council Movement," USAID/
Haiti, January 1980; and HACHO payroll, September 1982.








Figure 1. HACHO Organizational Structure


Central Office
Port-au-Prince


St. Michel
de l'Attalaye
1971 to 1974


Field Units






-9-


In the area of agriculture and other production-oriented
activities, HACHO carried out some soil conservation and irri-
gation projects prior to 1975 using FFW teams. Stimulated by
the establishment of Fonds Agricole by the Germans and by AID
pressure to devote more attention to production and income-
generation, HACHO undertook small projects in vegetable grow-
ing, staple crops production, coffee regeneration, crop stor-
age, credit (mainly in the form of seeds), farming and fishing
cooperatives, bee keeping, demonstration farms, reforestation,
crafts cooperatives and marketing, and crop production for
crafts (cotton, bamboo, sisal, and latanier palm). Each field
unit was characterized by various combinations of these activi-
ties, depending upon resource endowment and availability, com-
munity interest, and HACHO staff competence and interest. All
of these tended to fluctuate greatly over time, with resulting
shifts in local program mix.

Establishing itself as a regional development agency and
integrating itself into the GOH development framework for the
area became HACHO's purpose in the mid-1970s. Prior to that
time, HACHO had served as a quasi-governmental service provider
for the Northwest, a region in which the GOH had practically no
presence. Prodded by AID, the GOH began financial support to
HACHO and began discussions to accord the organization official
recognition as a semi-autonomous agency. Some integration was
achieved through secondment of GOH sectoral technicians to
HACHO and through the fact that some staff held joint GOH-HACHO
appointments, e.g., Dr. Fougere was concurrently HACHO director
and head of the Health Ministry's Bureau of Nutrition. Because
of HACHO's continuous presence in the region, it became an um-
brella for other organizations working there. Fonds Agricole,
CARE, Volontaires du Progres (French Government), UNICEF, and
various Christian missions have all collaborated with and
worked through HACHO. With a slowly growing GOH presence,
HACHO began to come more in contact with field personnel of the
Ministry of Health (DSPP), Ministry of Agriculture (DARNDR),
the National Office of Literacy and Community Action (ONAAC),
and the National Road Maintenance Service (SEPRRN).

In late November 1982, the GOH made a surprise announce-
ment abolishing HACHO and incorporating its functions and ac-
tivities into the newly formed organization for the Development
of the Northwest, ODNO. With this change, HACHO officially
came to an end, though its 16-year legacy has been passed on to
its successor.





-10-


III. PROJECT IMPACTS: FINDINGS AND ANALYSES


A. Health Program Impacts


Despite the fact that HACHO was founded as a community
development project, it has been primarily identified with the
provision of health care. Its initial programs in Jean-Rabel
and Anse Rouge focused on providing medical care first and
community development after. Expansion to other parts of the
Northwest replicated these priorities. As shown in Table 3
above, in the early years health sector personnel represented
an overwhelming majority of program staff and even at the time
of this evaluation remained the largest single category, though
falling below 50 percent after AID support ended in 1979.

HACHO's health program contained three major elements:
(1) fixed facilities providing curative services, (2) mobile
clinics for outreach, and (3) nutrition centers. These latter
were instituted when HACHO's directorship changed in 1972.
Other activities included dental services (mainly extractions),
vaccination of schoolchildren, latrine promotion, and family
planning services. Program content remained relatively fixed
over the life of the project, changing little in response to
new developments in the rural health care delivery field. In
1977, though, there was a slight, temporary shift toward pre-
ventive care in reaction to reduced resources.

Starting in the early 1970s, AID pushed HACHO to move
toward more of a balance between the health sector and other,
more production-oriented activities. HACHO documents speak of
increased emphasis on agriculture, but budget analysis by the
1976 evaluation team found that health continued to consume the
bulk of HACHO expenditures. HACHO's response in the health
sector to shrinking funds was to cut back the level of activi-
ties while trying to provide the same range of services.

At the time of the team's visit, health personnel in the
field had frustratingly few supplies at their disposal. Be-
cause curative care had continued to dominate health activi-
ties, staff were not well practiced in preventive techniques
although they reportedly had been trained in prevention. Most
health personnel interviewed expressed a sense of helplessness,
sitting in their dispensaries surrounded by empty medicine
cabinets waiting for the small trickle of patients who fre-
quented the facilities. The exception to this pattern was in
Jean-Rabel, where HACHO staff were working with and were subsi-
dized by the Haitian Department of Public Health (DSPP). The
number of patients per day at HACHO facilities in 1982 averaged
about 8, compared with 14 in 1976 and in contrast to 55 pa-
tients per day at Government facilities. Mobile clinics,





-11-


recognized for their potentially large contribution to rural
health, were operating erratically due to vehicle breakdowns
and lack of fuel allotments. The nutrition component of the
health program was diminished as well, in terms of number of
rehabilitation centers. However, those centers that remained
were still active because they depend not on direct HACHO bud-
get support but on PL 480 commodities provided through CARE.
The nutrition program strategy was modified in response to
diminished resources and to changing GOH policy from one of
recuperation to one of surveillance and supplementation.

Despite HACHO's high priority on health, the organization
apparently kept no data on health impact. To the best of the
team's knowledge, no baseline surveys or health censuses were
ever conducted nor were efforts made to identify particular
disease patterns specific to the different zones of the North-
west. Those data that are available are frequently incomplete,
inconsistent, or inappropriate, consisting almost entirely of a
catalog of services provided without reference to need or to
outcome. Therefore, the team was unable to substantiate that
HACHO-provided health services led to improvement in the health
status of the people in the Northwest, although it seems likely
that some improvement did occur, given that essentially no ser-
vices were available prior to HACHO's arrival.

Residents interviewed invariably mentioned the presence of
HACHO's health care facilities as beneficial, though many com-
plained that free medicines were no longer available, only
prescriptions. Thus, there appears to be a perception of im-
pact; and given that, especially in the early years, HACHO was
the major provider of the few health services present in the
region, it is not surprising that respondents identified health
as a significant project benefit.

In terms of nutritional impact, HACHO staff cited figures
showing that nutritional status in the Northwest is slightly
better than the national rural average, implying that the HACHO
nutrition program has been the major contributing factor.
While the contribution of the nutrition program cannot be over-
looked, it is likely that the substantial infusion of PL 480
commodities through various FFW projects and the resultant
increased availability of food have also been a factor in im-
proving nutritional status. HACHO was not the sole distributor
of FFW; CARE, Fonds Agricole, and various religious missions
also use food to encourage local participation.

The team's conclusion on HACHO's health impact is that it
is probable that its programs have provided benefits in the
form of medical, nutritional, and some dental and family plan-
ning services which have improved the quality of life for re-
cipients. Most people value health care highly, and the resi-
dents of the Northwest are no exception. It is also probable






-12-


that HACHO's relief efforts in the form of food distribution
have had an impact on the health status of the area's resi-
dents. Available data allow no determination of magnitude,
distribution, or spillover effects of that impact. Because the
overall amount of money spent for health by HACHO, spread over
the 13 AID-funded years, is small relative to health needs, the
team hypothesizes that resulting impact must be quite modest.
Certainly, HACHO's 1982 level of health activity was unlikely
to show measurable results. Appendix D contains more details
and analysis of HACHO's health program.


B. Agricultural Program Impacts


Prior to 1977 and the beginning of collaboration with
Fonds Agricole, HACHO activities in the agriculture sector were
restricted to a few irrigation and soil conservation projects
carried out by FFW crews. The major focus of the team's atten-
tion was what HACHO had accomplished in collaboration with
Fonds Agricole from 1977 to late 1982, the time of this evalua-
tion. Five major program areas were identified: soil conser-
vation and restoration, irrigated agricultural production,
rainfed agriculture, livestock/animal husbandry, and off-farm
enterprise/crafts.


1. Soil Conservation and Reforestation


Recognizing the severe soil erosion problems of this pre-
dominantly mountainous region, HACHO, through community council
work crews, built about 600 kilometers of rock walls and con-
tour ditches in Anse Rouge, Bombardopolis, and Jean-Rabel. As-
sisted by Fonds Agricole, HACHO planted, between 1978 and 1982,
1,150 hectares (ha) with trees.

Assessing the impact of these programs on the area's soil
and water resource base was not possible. Perceptions of
impact by local residents focused on the food received in
exchange for labor, rather than on potential reversal of the
depletion of critical natural resources. Indeed, even in the
minds of some HACHO staff, the purpose of these activities was
relief, with soil conservation as the means to that end. In
the team's view, this bodes ill for self-sustaining changes un-
less greater attention is given to integrating soil conserva-
tion measures into local residents' survival strategies.





-13-


2. Irrigated Agricultural Production


HACHO/Fonds Agricole2 constructed approximately 19
kilometers (km) of concrete irrigation canals. Forty-two
percent of the total is located in 1'Etang and Petite Place,
within HACHO's Anse Rouge unit. By late 1982, 545 ha were
under irrigation, representing about 67 percent of the planned
target. Around 1,650 households cultivate crops on this land
(61 percent of intended beneficiaries). In addition, storage
capacity of 750 metric tons (mt) was constructed.

Between 1977 and 1980, HACHO/Fonds Agricole set up nine
demonstration centers, of which five now function. Crops grown
in the centers include corn, beans, millet, tomatoes, shallots,
and cabbage. During approximately this same period, 1976-1979,
948 farmers participated in the credit program (credit was in
the form of local variety seeds: corn, peanuts, beans, and
Irish potatoes), for a total value distributed of $63,689. The
repayment rate was claimed to vary between 65 and 98 percent,
depending upon year and locale.

The major impacts of this irrigation program have been
changes in crop mix and increased security of obtaining a mini-
mally sufficient crop yield. Farmers are now growing maize,
beans, bananas, shallots, onions, and garlic. According to
farmers interviewed, these latter vegetables are highly profit-
able crops; however, it should be noted that in the case of the
irrigation system at 1'Etang, the diesel pump is subsidized by
Fonds Agricole at 65 percent of operating cost. The magnitude
of this subsidy raises the issue of the possibility of sustain-
ing benefits once outside funding is withdrawn.

Additional program benefits include the increased year-
round use of available family labor. The presence of irriga-
tion has generated a high demand for rural labor, with the pri-
mary source of supply being the family. The 1980 evaluation
also cites the increased use of migrant labor. Crop husbandry
practices have also improved, particularly in corn production.
HACHO extension agents at the demonstration centers have shown
farmers new techniques of seed-spacing. According to the farm-
ers interviewed, this practice is now widespread and leads to
better yields.




2Since, in practice, the HACHO agricultural program was the
Fonds Agricole program, the two are considered as one in this
section. As one area resident put it, "HACHO is the envelope;
Fonds Agricole is the reality."





-14-


The intensity of land use has also increased. The irriga-
tion systems have intensified the use of land already under
cultivation and have brought new lands into use. Land values
have climbed as a result of the installation of these systems,
and in 1'Etang, land tenure issues have surfaced. The commun-
ity council did not have clear title to all the land irrigated
by the system; and once the system was in place, disputes
emerged, some of which have yet to be resolved. Finally, stor-
age facilities have been constructed for use by program partic-
ipants.

The team could not verify the number of farmers or exten-
sion agents trained in HACHO demonstration centers. However,
the apparent inactivity of the centers visited left a rather
pessimistic impression about their impact on agricultural pro-
duction. Most storage facilities visited were empty, and in
the absence of any data, the team could not assess the claims
of informants that these facilities had helped to stabilize
commodity prices.

One constraining factor on production in the Northwest has
been the unavailability of seeds at planting time. The seed
credit component of the program assures a supply of seeds at
the appropriate time. It appears to have increased production
by allowing farmers to bring under cultivation acreage formerly
left unplanted for lack of seed. Nevertheless, the full poten-
tial of this activity has not been realized. Because the seeds
distributed were the same low-yield local varieties tradition-
ally used, it is doubtful that there has been any impact on
productivity. Rough calculations of crop budgets for corn and
beans show that low yields in addition to the high cost of
water result in very low returns to land, family labor, and
capital per hectare of irrigated land (see Appendix C).


3. Rainfed Agriculture


Between 1977 and 1979, HACHO/Fonds Agricole established
coffee nurseries in Cote-de-Fer and Mole St. Nicolas. No rec-
ords were available on total number of plants in existing nur-
series or on relative percentages of Typica (local variety) vs.
Catura (high-yield variety) coffee planted. The team was told
that a large proportion of the nurseries is planted in Typica.
Therefore, expectations for future impact on increased coffee
production should not be too high. Given that the nurseries
are relatively young it is premature to look for impact of any
magnitude at present.

Apparently no targets were set and no specific production
records kept for activities in cotton, sisal, bamboo, and
latanier palm production. Between 1978 and 1979 cotton






-15-


production in the zone increased from 176 mt to 290 mt. Though
it is plausible that increased production was stimulated by
HACHO's crafts program, the linkage cannot be substantiated.


4. Livestock/Animal Husbandry


HACHO attempted several minor initiatives in this area.
Improvement in cattle stock with an imported breeding bull was
tried in Jean-Rabel, as was rabbit raising in Bombardopolis.
Both efforts were classified as failures with no further de-
tails provided.

More recently (1978-1982), HACHO implemented a bee-keeping
effort with AID funding. Based in Jean-Rabel, this program
trained 30 farmers in honey production and generated an esti-
mated $78 of additional income per producer per year. The
honey produced is of good quality, and the team was told that a
firm in Port-au-Prince has contracted with HACHO to purchase
the program's output on a regular basis. The program's admin-
istrative and training costs are subsidized by CARE, which
raises the sustainability issue discussed below in relation to
crafts.


5. Off-Farm Enterprise: Handicrafts


HACHO, in collaboration with CARE, started a crafts pro-
gram (CANO) in 1976 as a means of increasing rural incomes by
creating employment during slack periods of the agricultural
season. Participants in the program were trained in hand pro-
duction of crafts made of cotton, sisal, bamboo, latanier palm,
and clay. Fifteen craft centers were established, each spe-
cializing in the use of particular materials. Three centers
focused on cotton products such as hammocks, pillows, blankets,
and rugs; three centers concentrated on baskets of latanier
palm, and two on sisal containers; four centers produced bamboo
furniture; and one center each specialized in woven placemats,
woven bags, and ceramics.

Though 12 centers were officially considered in operation,
the team found only five that were actually active. These in-
cluded three cotton centers (Sources Chaudes, 1'Arbre, and
Petit Carenage) employing 105 artisans among them; one bamboo
center (Savane Carree) with 12 artisans; and one center for
woven placemats (Mare Rouge). The other centers were either
closed or producing at very low levels because of lack of
demand for their products. The U.S. market for baskets, where
CARE had been concentrating its efforts to sell the Haitian-
produced crafts, is dominated by mainland China. As a






-16-


CARE-financed market study revealed, the Haitian crafts are not
competitive in either design or price. In addition, the ceram-
ics center at Morne Massacre was temporarily closed due to
repair and fuel costs for the kiln.

With guidance from CARE, HACHO decided to concentrate its
crafts effort on cotton products. Available data indicate that
for the 105 artisans employed by the three cotton centers,
average monthly income per artisan is $6.89 in Source Chaudes,
$13.35 in Petit Carenage, and $19.48 in l'Arbre. Besides gen-
erating employment and income for artisans, other benefits men-
tioned in interviews included a variety of forward and backward
linkages: (1) building of traditional skills, (2) stimulating
cotton production (some informants claimed there was a cotton
shortage in the area), and (3) employment and added income for
cotton spinners. In addition, several informants said that due
to increased income from a stable source, artisans now had eas-
ier access to local credit.

These impacts must, however, be assessed in light of the
costs involved. Though no precise figures were cited, program
administrators estimated that it cost roughly five dollars for
every dollar of artisan income generated. Training and admin-
istrative costs are absorbed by CARE and the French Volontaires
du Progres (AFVP). The crafts program is clearly not sustain-
able in its present form without substantial external resources.
CARE and HACHO at the time of the evaluation were rethinking the
crafts strategy in terms of product lines, pricing, and producer
organization. Another outside factor destined to affect the
program is the recent devaluation of the Mexican peso, which
makes Mexican cotton goods three times cheaper than those cur-
rently produced by the CANO artisans.

The experience with the crafts program reflects again the
tension between HACHO's historical relief orientation and its
professed development objectives. The relief perspective
emphasizes getting benefits to people in need, in this case
increasing people's off-farm income through employment genera-
tion, with less attention to costs. The development perspec-
tive focuses on sustainability, both in terms of resources
required, and skills and attitudes. While the artisans inter-
viewed by the team said that they had benefited from the income
obtained, they nonetheless would not continue producing crafts
should CANO cease its orders. In areas where crafts centers
had closed, many expressed dismay that they were no longer
"employed," reflecting a wage labor mentality rather than the
private sector entrepreneurial spirit that the program's coop-
erative structure seeks to build. One CARE staff member summed
up the dilemma by saying, "this has been a good program but a
lousy business."





-17-


C. Infrastructure Impacts


1. Roads


The road network in the Northwest that was built and main-
tained by HACHO encompasses a total of 375 miles (600 km) of
unpaved roads and jeep trails. Providing the means to travel
both within the area and between it and the rest of Haiti is
regarded by many as HACHO's major accomplishment. Practically
everyone interviewed mentioned the presence of the roads as a
plus.

Perceptions by beneficiaries of positive impacts of the
roads include the ability to evacuate sick and injured people
to health care facilities, the ability to transport produce to
markets and transport points, the availability of manufactured
goods in areas where they had previously been scarce or avail-
able only from monopoly sellers, and the availability of truck
or tap-tap (bush taxi) service for personal travel. In the
absence of quantitative data, impacts could only be substanti-
ated through the anecdotes of area residents. What was re-
ported, however, supported the findings of the 1976 and 1980
project evaluations.

When HACHO arrived in the Northwest, the existing road
system was a set of donkey paths or, at best, jeep trails. The
only passable road was between Jean-Rabel and Port-de-Paix, and
that one only in the dry season. The HACHO coordinators quickly
saw that, if they were to bring any services to the region, im-
proved access would be the first action required.

Despite the major achievements of HACHO in this area,
further improvements are still needed. Community council mem-
bers in two of the more isolated areas, Bombardopolis and Terre
Neuve, indicated that improving the roads was their highest
priority, and complained that too few truckers were willing to
risk their vehicles on the roads, given the roads' current
state. The team could empathize with both the area residents
and the truckers on the basis of direct experience. Given the
continuing difficulties with many area roads, much transport is
still by donkey, horse, or human carrier.

An additional benefit of the roads construction has been
increased accessibility to the region for other service provid-
ers besides HACHO. Several informants reported that the roads
opened up the Northwest for GOH sectoral ministries such as
Health (DSPP) and Agriculture (DARNDR) to begin service provi-
sion. Recently both DSPP and DARNDR have begun moving slowly
to decentralize technical services into the region. While
their presence is currently limited, GOH officials stated that
it was their intent to continue the expansion of coverage.






-18-


One negative impact that flows from increased transport
capability relates to the brisk charcoal industry in the North-
west. We were told that the roads have contributed to the de-
forestation and erosion problem by making it easier and more
profitable to produce charcoal. Though no figures were avail-
able, the quantity of stacked bags of charcoal awaiting pickup
and the several large, bag-loaded trucks passed on the road
attested to the importance of the industry in the region. How-
ever, it was not possible to substantiate the link between road
construction and increases in charcoal production. In fact,
some analysts maintain that most charcoal was shipped from the
Northwest by boat (Pfrommer et al., 1976), and so would be
little influenced by improved roads.

The HACHO roads were constructed by labor-intensive work
crews supported with PL 480 commodities. The nutrition and
income effects of this mechanism are apparent. An unintended
and less visible consequence of the FFW mechanism, however, has
been the undermining of local initiative by making community
councils reluctant to furnish labor to self-help projects un-
less remunerated by FFW. This impact was recognized during the
heyday of FFW projects pnd is reflected in the distinction made
between konsey mange (community councils formed just to obtain
food) and konsey serye (serious councils, i.e., those inter-
ested in autonomous development). The dependency issue has
been widely discussed in AID (e.g., Smucker et al., 1979),
CARE, and HACHO with no agreed-upon resolution. It was often
raised during the team's interviews; and in the minds of many,
"the damage has already been done," manifesting itself in
spread effects to other projects with community-contribution
components. A case in point is the AID/CARE agro-forestry
project in the Northwest, where local residents in some areas
have refused to plant trees unless provided with FFW.

This situation reflects again the relief vs. development
dilemma that HACHO has faced throughout its life. The humani-
tarian objectives that were fulfilled by distributing food via
the FFW mechanism worked at cross-purposes with the community
development objectives that stressed self-help and voluntary
participation. HACHO was, on occasion, placed in a no-win sit-
uation, criticized for distributing food and thereby corrupting
the independent initiative of rural communities, while at the
same time being relied upon by external donors as the primary
organization for relief during the frequent droughts and hurri-
canes which plague the region. Furthermore, when relief food
was found being sold on the market, generally by legitimate
recipients, HACHO took the blame for its supposedly inadequate
control system. The importance of these criticisms depends to
some extent on HACHO's and its donors' objectives, definitions
of development, and definitions of voluntary participation.






-19-


2. Potable Water and Sanitation


Potable water and sanitation projects were recognized by
HACHO as necessary complements to the health program. One of
HACHO's best known achievements, the Anse Rouge water system,
was in the area of potable water; one of its least successful
ventures was in sanitation.

HACHO constructed, with community council help, three
major potable water systems, one in each of the three larger
towns--Mole St. Nicolas, Jean-Rabel, and Anse Rouge. All three
are still functioning satisfactorily and, by all accounts, have
made a major contribution to the well-being of the residents.
HACHO was also responsible for several smaller potable water
systems, usually capped springs, in various localities. The
Anse Rouge system has rightly been touted as an example of what
a well-organized community development structure can ac-
complish.

The Anse Rouge system consists of a capped spring, 17 km
of pipe leading from the spring to a reservoir on a hill just
above the town, and household connections for most of the resi-
dents. Public fountains in outlying areas were built later as
the town expanded. The system is well-maintained and highly
valued by the townspeople.

Originally, interest in the project was generated through
the local community. When the magnitude of the intervention
required became clear, HACHO solicited and received support
from several external donors including the French and American
Embassies. According to the engineering reports, the entire
project cost about $84,000, of which the community contribution,
exclusive of labor, was 10 percent.

The HACHO unit coordinator noted several problems that
have arisen lately due to the continuing expansion of the town
and outlined HACHO's response to these problems. The current
system is too small to provide adequate quantities of water to
the growing population. The public fountains need float valves
to decrease water wastage and eliminate the standing pools sur-
rounding the fountains that serve as breeding sites for mosqui-
toes. Obviously, the water needs of future population growth
cannot be met by this system. To relieve the growing pressure
on the original system, HACHO was in the process of developing
groundwater sources with windmill pumps for the new communities
developing on the town's northern edge. In summary, the
project was well-designed, well-maintained, and continues to
evolve to meet the changing needs of the community.

The systems in Mole and Jean-Rabel are also still func-
tioning but have had somewhat more problems than the Anse Rouge





-20-


system. The Mole system suffered damage in the recent hurri-
cane and has had to have substantial repairs. The Jean-Rabel
system suffers from a leaky reservoir, causing wastage of water
and drainage problems which may exacerbate health problems such
as malaria.

AID also provided funding for three potable water projects
in the Northwest in. which HACHO participated but which were
distinct from the general HACHO project. The first two proj-
ects were supposed to be joint HACHO/CARE initiatives; the
third is currently in progress under OPG funding to CARE with-
out HACHO. Reportedly, however, even in the second project,
HACHO was only nominally involved.

Despite HACHO's low level of past involvement and its
current lack of formal involvement, CARE has continued to use
HACHO facilities when necessary to accomplish project goals.
These facilities include the guest houses, garages, and some
personnel. HACHO has not formally been a partner, but the
infrastructure it maintains in the area greatly facilitates
project achievement.

Just prior to the termination of AID funding in 1979,
HACHO commissioned a study of groundwater resources in the
Plaine de 1'Arbre, a barren stretch between Gonaives and Anse
Rouge. Test wells were dug and potentially productive sites
were mapped. With AID funding ending and no GOH monies forth-
coming to fill the gap, HACHO was not in a position to capital-
ize on the results of the study. Instead, a private commercial
interest in Port-au-Prince received permission to develop the
site which eventually led to expropriation of some peasants'
lands. Employment generation provided partial compensation.

HACHO's planned potable water initiatives were more cir-
cumscribed. HACHO expressed the intention to concentrate on
maintenance of existing systems rather than construction of new
systems. Given the state of many of the systems visited by the
team, this course of action seems a wise one.

In the area of sanitation, HACHO's efforts had had minimal
impact, and a rethinking of strategy was under way in late
1982. In an effort to encourage local initiatives in sanita-
tion, HACHO provided cement and roofing to any family who ex-
pressed an interest in building a latrine. Predictably, the
materials were put to other and, from the families' perspec-
tive, more practical uses such as upgrading residences.
HACHO's revised strategy was to offer ready-built latrine
platforms and frames to families willing to dig the pit and
weave matting for the walls. HACHO hoped that this strategy,
coupled with community education, would be more successful.






-21-


D. Institutional Impacts


1. Local Organizations


HACHO was instrumental in the formation of community coun-
cils in the Northwest and, from its inception in 1966, worked
through the council structure. By the mid to late 1970s, there
were 212 councils in the region. However, this proved to be an
unwieldy number, and it was gradually reduced to the present
108 through the consolidation of smaller councils.

As a community development organization, HACHO was commit-
ted to establishing a mechanism for local action and community
participation. As a relief organization distributing PL 480
Title II commodities, HACHO needed a local-level network to get
food to those in need. HACHO field staff sought to achieve
both sets of objectives through community councils. Apart from
the provision of health services, practically all of HACHO's
activities were undertaken in collaboration with community
councils using the small-project mode of operations. In the
area of health, councils were used to motivate the population
for outreach activities. Impacts resulting from many of the
HACHO interventions cited above can in part be attributed to
community councils.

The salient issue concerning the institutional impacts of
HACHO's work with the councils revolves less around what they
actually accomplished than around differing perceptions of
their purpose. Analysis of local organizations worldwide
points out that they can serve three basic rural development
functions (Esman and Uphoff, 1982). First is the facilitation
of public service delivery. By furnishing service providers
with information on local needs, priorities, and capabilities,
local organizations can help to tailor services to fit the
locality. Second, they provide for the activation of collec-
tive self-help. They can mobilize local resources to fulfill
development needs. Third, they can empower the local people to
make effective demands on government and others who control
resources.

The team findings confirmed what other, more in-depth
analyses (Pfrommer et al., 1976; Smucker and Smucker, 1980)
have revealed. Basically, community councils in the Northwest
have been effective in facilitating service delivery and mobil-
izing local resource contributions. They have had less impact
on the empowerment dimension and have tended to reflect rather
than to change substantially the existing sociopolitical struc-
ture. Interviews with community council officers and members
revealed that self-perceptions of councils emphasized their
role as a channel for outside development assistance. They






-22-


indicated that council members were ready and willing to under-
take development projects; all that was needed were some exter-
nal resources.

Whether or not the community councils set up and supported
by HACHO represent an appropriate or successful response to the
region's needs depends upon which of HACHO's objectives are
seen as paramount, and upon what working definition of develop-
ment is chosen. The relief vs. development dichotomy emerges
as important, given that the use of councils as relief vehicles
has in the minds of many reduced their capacity to serve devel-
opment purposes. It should not be forgotten, however, that
prior to HACHO there were no local organizational mechanisms
available in the Northwest for any purpose.

The team found some evidence of impact on the empowerment
dimension. Informants reported that some councils, dissatis-
fied with HACHO's slow project-approval process and lack of
resources, have begun to bypass HACHO and request resources
directly from other donors, e.g., CARE and USAID/Haiti. On a
more speculative note, it is possible that the recent move by
the GOH to consolidate councils into hierarchies of federations
and to limit the number of official councils to two per rural
section indicates that community councils are perceived as a
nascent political force that must be controlled. Paradoxically,
this could be taken as a measure of success in empowerment and,
thus, in the Haitian context, could presage further restric-
tions. Additional discussion of community councils is con-
tained in Appendix E.


2. HACHO and Organizational Performance


With the modifications in project purpose over the life of
the project, more emphasis was placed on developing the organi-
zational capacity of HACHO itself. AID wanted to see HACHO be-
come a regional agency that could undertake integrated rural
development in the Northwest. Through the AID contract with
CARE,, management advisors were provided as technical assis-
tants. Their main function, however, was almost purely admin-
istrative; they were charged with overseeing the distribution
of PL 480 commodities in accordance with U.S. regulations and
with countersigning vouchers and checks. Any influence on
HACHO's internal management depended upon the relationship be-
tween a particular CARE advisor and HACHO's leadership. The
advisors' leverage apparently declined in proportion to the
decreases in funding that required their signatures for dis-
bursement.

Despite the various statements of purpose in successive
project documents concerning the intent to build HACHO into an





-23-


effective rural development organization, the project itself
had no specific set of activities that focused on improving
HACHO's management performance. The 1976 evaluation contained
a section on organizational improvements, including a proposed
restructuring to reduce excessive centralization and opera-
tional bottlenecks, plus recommendations for a monitoring and
evaluation system. The team could find no evidence that any of
these suggestions had resulted in changes in HACHO's managerial
structure or practices.

Over the life of the project, HACHO's structure remained
practically the same. Headquarters were in Port-au-Prince,
with a regional office in Gonaives in charge of operations and
maintenance, and a field office located in each of HACHO's
zones of activity in the Northwest. By 1982, these field
offices numbered four, down from a maximum of six in 1974.
HACHO began with a small staff, which grew to 246 employees at
its height in the mid 1970s, declined to 165 by 1980, and to
159 by 1982. Table 4 shows the distribution of staff by cate-
gory and location at the time of the evaluation.

The team found the organization to be highly centralized;
expenditure, project technical review, and project approval au-
thority were located in Gonaives and Port-au-Prince. Reporting
systems were inconsistent and idiosyncratic, preventing any
comparisons over time in terms of projects planned, in prog-
ress, or completed. Emphasis was on inputs and activities
rather than on outputs and results. Field staff were strongly
process-oriented, a characteristic of HACHO's animation rurale
operating style, and saw their role as facilitating the
peasant's emergence from his cocoon of traditional fatalism and
ignorance. The view of rural people as rational actors had yet
to be accepted. Sectoral goals, planning targets, or local
project selection criteria were not in evidence. Isolated
planning documents exist, but seemed to bear little relation to
what had been done or to future intent.

HACHO's physical plant and its fleet of approximately 15
vehicles were deteriorating due to age and lack of funds for
maintenance or repair. Monthly allocations of fuel were insuf-
ficient to allow field staff to visit project sites or to per-
mit adequate personnel supervision.

The overall impression was of an organization in decline
or in a state of suspension. HACHO's strategy after the
termination of AID support seems to have been to retain as much
of its staff as possible, cutting back its operating budget in
anticipation of receiving either increased GOH or renewed donor
funding. Staff in the field who were interviewed appeared to
have little to do and pleaded a lack of resources. The activi-
ties that HACHO was engaged in resulted from collaboration with
other entities such as CARE, Fonds Agricole, and the DSPP.






-24-


Table 4. Distribution of HACHO Personnel by Category
and Location, 1982


Port-
Jean- Anse Bombard- Terre au- Totals
Category Rabel1 Rouge opolis Neuve Gonaives Prince No. %


Administration
General 9 4 3 4 10 3 33
Vehicles 1 1 1 1 28 1 33
Foreman 3 1 1 1 1 7
Service 4 3 2 1 3 1 14 55

Engineers,
Surveyors,
Assistants 5 5 3

Community
Development
(Animation
Rurale) 2 1 1 1 5 3

Agriculture 2 2 2 11 17 11

Health and
Nutrition 93 113 3 63 3 32 20

Crafts 2 5 4 2 13 8

Total

Number 30 28 17 16 63 5 159 -
Percent 19 18 11 10 40 3 1004


1Includes staff of AID-supported bee-keeping project: 5


Admin-General, 1 Foreman,


1 CD agent (CD agents in Bombardopolis and Terre Neuve also are on bee-keeping
project).

2Refers to drivers, driver assistants, mechanics, and other garage workers.

3Includes dentists (dentist-trainee in Terre Neuve).

4Figures may not add due to rounding.


Source: HACHO payroll, September 1982.





-25-


HACHO's administrative structure was still in place with
its links to rural communities through the councils; this was
perceived as an asset from the point of view of outside funding
agencies. Though HACHO's 1982 state approached the moribund,
this should not overshadow its past organizational achieve-
ments. The Northwest had no administrative infrastructure
worthy of the name before HACHO. Establishing a regional orga-
nization capable of placing and sustaining resident technical
staff in a remote, rural area is a feat in itself. Any assess-
ment of HACHO's organizational performance must be seen in
light of Haiti's physical and politico-administrative environ-
ment (on the latter, see Brinkerhoff et al., 1981).

One important unintended impact stemming from HACHO as an
organization is that other agencies have gained well-trained
staff with experience in rural development. As HACHO reduced
its personnel, these people came onto the job market, and other
organizations, both GOH and international, hired them. Accord-
ing to the team's information, many of these were HACHO's best
staff members. Informants familiar with HACHO now and earlier
stated that, on the average, the present caliber of staff is
lower than it used to be.

In terms of the project's success in building an organiza-
tion capable of sustained, independent action, the verdict is
mixed. HACHO no longer exists, having been replaced by ODNO.
However, the GOH plans for ODNO to absorb HACHO's personnel,
programs, and physical assets minus its top management group.
Thus while HACHO qua HACHO was unable to institutionalize it-
self, the organization did succeed in sustaining its essential
elements until they could be incorporated into its successor.
The extent to which those elements can become an asset to ODNO
depends largely upon the level of resources that are made
available to the new organization plus some careful attention
to improved management.

The project's relatively low achievement in the realm of
institution-building results from a combination of internal and
external factors. Internal to the project was the lack of
explicit attention to building appropriate management systems,
as mentioned above. HACHO's leadership, in addition, was
trained in medicine and community development, not management;
thus, there was little internal expertise in organizational
capacity-building.

Several causal factors were external to the project.
First, GOH policy toward HACHO remained ambivalent and unclari-
fied, despite years of discussion. While official status did
not appear to be needed for day-to-day operation--witness the
years HACHO worked in the Northwest without it--the uncertainty
that the lack of status engendered did influence HACHO's abil-
ity to attract outside resources, retain staff, and play a more
effective, integrative role in the region's development.






-26-


Second, donor ambivalence about what HACHO's primary pur-
pose should be affected institutionalization. AID could not
decide whether it wanted to build an organization with develop-
ment capacity for the Northwest or merely establish a conduit
to funnel outside resources into the region. Trying to have
both hindered the capacity-building objectives.

Third, donor impatience with the slow institutionalization
process affected HACHO's ability to perform as a development
organization. AID began in the early 1970s to urge that HACHO
be incorporated into the GOH and that AID's support be with-
drawn. The target date for termination of technical assistance
and funding was 1978. If the time spent doing relief is sub-
tracted, this left HACHO a relatively short period to become
institutionalized and self-sustaining. Experience with other
efforts shows that the process is a long one, and insistence
that it take place within AID's five-year project framework
practically guarantees failure.


IV. CONCLUSIONS AND LESSONS LEARNED


A. Conclusions


The team reached the following conclusions regarding
HACHO's experience with rural development:

1. Given the challenge of tackling delivery of services
in a remote area of one of the poorest countries in the world,
HACHO's success in providing needed services where none existed
before is an achievement that should be recognized. Expecta-
tions for levels of achievement must take into account the
difficulties of working in Haiti and the relatively low level
of funding provided by AID. Many familiar with the experience
of other development projects in the country have the impres-
sion that, in comparing results with total level of inputs,
HACHO can be deemed a success.

2. The above notwithstanding, there were significant
weaknesses in the HACHO project in the following areas: (a) the
balance among sectoral interventions: overemphasis on service
provision, and attendant underemphasis on support for produc-
tion-oriented activities; (b) the content of sectoral technical
interventions: in health a substantially curative-oriented
program failed to recognize intraregional health differences
and was basically unchanged from its inception, and in agri-
culture the package offered was not financially profitable to
farmers; and (c) management structure and procedures: HACHO's
organization received inadequate attention during project





-27-


implementation, and no formal monitoring and evaluation system
was established as an integral part of the project.

3. Related to the management issue raised in 2(c) above,
HACHO's weaknesses in planning, monitoring, reporting, and
evaluating created an organization that was basically without a
guidance mechanism. Except in the most general of terms, HACHO
could not analyze what it had done, what worked and what did
not, or where it should go. Indeed, HACHO failed even to re-
cognize that a self-evaluative approach was necessary for ef-
fective organizational functioning. The organization had few
built-in mechanisms to learn from what it did and improve its
performance; people working in HACHO learned, but the organiza-
tion remained relatively untouched by that learning.

4. HACHO's community development orientation, springing
from the animation rurale tradition, focused chiefly on group
process and attitude change and ignored economic and political
constraints facing the rural poor. This strategy was func-
tional for HACHO in the sense that if the organization accepted
such structural constraints as a major factor in improving the
well-being of the poor and recognized these contraints as be-
yond the organization's control, then it would be difficult to
justify its activities. Defining the Haitian peasants' prob-
lems in terms of inappropriate attitudes allowed HACHO commun-
ity workers to concentrate on re-education and motivation.
There is, however, a growing body of experience indicating that
effective local development must address structural questions
and that there are workable methodologies to do this that can
achieve some success, despite structural constraints.

5. The tension between relief and development objectives
that characterized HACHO's life had a major influence on the
project's outcomes. The achievement of relief objectives
diminished HACHO's ability to promote the establishment of
self-sustaining development capacity at the local level. In
terms of impact on beneficiaries, the relief orientation pushed
HACHO to engage in development activities that ultimately were
unsustainable without continued outside subsidies, e.g., irri-
gated agriculture or crafts. In terms of impact on HACHO's
organizational capacity, the humanitarian focus provided little
incentive to manage for results because by definition, relief
means "doing good," and questioning costs or effectiveness is
seen as mean-spirited. (This is an issue for U.S. PVO effec-
tiveness as well.)

6. HACHO's role in regional development in the Northwest
was as a kind of precursor to Government, providing essential
services in the absence of GOH activity there. While it is
possible that its operations influenced the GOH's political
will to bring services to the Northwest sooner than if HACHO
had not been there, it is likely that HACHO's achievements in






-28-


physical infrastructure were an even more significant factor in
facilitating increased GOH service provision in the region. In
terms of integrated rural development, HACHO's major function
was to coordinate external assistance from various donors, such
as Fonds Agricole, AID, CARE, some missionary groups, and the
abortive UNICEF project, PIRNO. As the GOH establishes more of
a sectoral presence in the Northwest, HACHO's successor, ODNO,
should target its interventions more narrowly toward areas not
covered by GOH activities, focusing particularly on opportuni-
ties for productive investment. With the present DSPP plan for
expansion of health services in the region, ODNO should phase
itself out of the health sector altogether, with the possible
exception of dental services.

7. Some of the responsibility for HACHO's fate lies with
AID. Though aware of the relief vs. development conflict, AID
continued to push HACHO to do both even after the Project Paper
had been amended to emphasize the development purposes. Given
the frequency of natural disasters in the region and the fact
that HACHO was, for a long time, the sole organization in
place, it is easy to see why AID allowed this dichotomy to
persist. Nevertheless, even at the times when there was an
opportunity to push for change--following the 1976 evaluation,
for example--AID failed to insist on modification as a requi-
site for continuing support. Instead, in its impatience to
declare HACHO institutionalized, AID put all of its efforts
into the push to have the GOH assume responsibility for HACHO,
leaving aside the issue of needed organizational changes. The
GOH was at that time unwilling or unable to accept HACHO as its
own. AID's leverage was lost when its funding ended, and HACHO
became an organization with no clear purpose or institutional
identity. Thus, AID set up an organization and then set it
adrift, officially unrecognized by the GOH. Perceiving that
AID did not intend to commit further resources to HACHO and
being unwilling to support it without outside contributions,
the GOH chose to abolish HACHO.


B. Lessons Learned


There are a number of lessons to be learned from the HACHO
project:

1. In modifying project purposes, attention needs to be
paid to possible interactive effects arising from the proposed
changes. This is especially true when mixing relief and devel-
opment objectives, where the risk is high that development
activities will be skewed away from interventions with self-
sustaining potential in the effort to provide rapid response to
a disaster.






-29-


2. LDC development organizations have a tendency in their
relations with client groups to replicate the pattern of prior-
ities of their funders. Donors periodically treated HACHO as a
conduit for injecting resources into the Northwest, and HACHO
treated the community councils the same way.

3. Sustainable development activities must reflect their
true costs and benefits. Programs requiring continuous flows
of external resources constitute relief, not development, and
it is ultimately a disservice to the rural poor to pretend
otherwise.

4. Developing an indigenous organizational capacity for
management requires long-term attention to management improve-
ment. Technical assistance personnel whose role is, or is
allowed to become, performance of staff tasks for an LDC agency
cannot help that organization build the capability to carry out
such tasks on its own. Technical assistance demands a mobil-
izer's role that combines transfer of appropriate skills to
others with the encouragement necessary for getting them to do
things differently.

5. Institutionalizing an effective, capable organization
in any LDC environment is a long process; certainly longer than
most donor agencies' project timetables. Prematurely abandon-
ing organizations with little provision for the future is ulti-
mately self-defeating. While many donors use termination of
support as a means to press LDCs to take over the care and
feeding of these organizations, most host country governments
are skilled enough in the art of donor management to see this
tactic for what it is--a bargaining ploy. In order to avoid
littering the development landscape with inadequately institu-
tionalized organizations, donors should target their
institution-building efforts on high-potential organizations
and stick with them. That this is possible even in Haiti
(where several informants told the team that few things suc-
ceed) is illustrated by AID's experience with SEPRRN. On the
other hand, AID needs to recognize which organizations are
unlikely ever to become adequately institutionalized and
should, at that point, learn to cut its losses.

6. A development project is a resource-limited, time-
bounded intervention. It is dependent for success on a
combination of factors, some of which it can control or do
something about, but many of which are beyond its sphere of
influence. Integrated rural development projects are particu-
larly sensitive to these external factors because of their
mandate to intervene on several sectoral fronts, either in
sequence or simultaneously. Macro-level constraints--such as
agricultural pricing policies, public sector personnel poli-
cies, and host government regional priorities--need to be taken
into account in project selection, design, and implementation.

































APPENDIX A

EVALUATION SCOPE AND METHODOLOGY






A-i


I. TEAM COMPOSITION


The HACHO impact evaluation team had the following
members:

-Derick W. Brinkerhoff, team leader, a development man-
agement specialist from AID/Washington's Office of
Multisectoral Development with short-term experience
in Haiti in the areas of administrative reform and
decentralization.

Pascal T. Fotzo, an agricultural economist from
Michigan State University with long-term experience in
Cameroon and Upper Volta with the farming-systems ap-
proach to rural development.

Barbara J. Ormond, a public health specialist from
AID/Washington's Near East Bureau with long-term ex-
perience in Haiti in the areas of health, population,
and nutrition.


II. SCOPE AND GENERAL APPROACH


In carrying out an assessment of HACHO under AID's Impact
Evaluation Series, the team was charged with the task of fer-
reting out the results of HACHO's activities as they affected
the population in Northwest Haiti and of evaluating the impact
of those results. To account for these results and impacts,
the evaluation entailed an effort to test the validity of the
development hypotheses upon which the project was designed and
implemented.

In seeking to discover what works in socioeconomic devel-
opment, simplicity--or its obverse, complexity--is in the eye
of the beholder. Some observers claim that attempts to eval-
uate project impacts are ultimately fruitless undertakings,
given the plethora of intervening factors that could lead to
any number of alternative explanations of what happened and why
in a given development project. As an additional nail in the
coffin of feasibility, these observers add that the state-of-
the-art in social science methodology is inadequate to measure
impact even if plausible cause and effect linkages are assumed.

The team recognized the difficulties inherent in its task
and sought to follow a simple--but not simplistic--approach
that is appropriate to time, data, and methodological con-
straints. The team viewed the HACHO evaluation not as an
exercise in which it could "prove" what impact HACHO had, but
rather as a retrospective look at the HACHO case informed by






A-2


the perspectives of various actors knowledgeable about HACHO
either from inside or outside the project. The organizing
principle used for presenting what was discovered is that
employed by the Impact Evaluation Series: What are the lessons
learned from the case that may be of use to project designers,
implementers, and policymakers? Thus, the team's approach
flowed from that of Rein (1976), who sees evaluation as the
telling of policy-relevant stories. This report tells the
story of HACHO.


III. METHODOLOGY


The team employed a mix of rapid reconnaissance techniques
to information collection that included the following: docu-
ment and report examination, key informant interviews, site
visits, and direct observation. The team began its work with a
one-day session in Washington to discuss the scope and method-
ology, to collect available documents, and to speak with one of
the former AID project officers for HACHO. The team leader
took a trip to New York City to interview CARE officials, in-
cluding one of the management advisers to HACHO.

The various team members arrived in-country between
October 22 and October 26, and spent the first week gathering
additional documents, meeting with USAID staff, and making
contact with HACHO central office personnel, other GOH offi-
cials, and other donor organizations. (Appendix F provides a
complete list of all persons contacted in the course of the
evaluation.) Plans were made for site visits to HACHO's
regional office in Gonaives and to the Northwest, including
Terre Neuve, Anse Rouge, Bombardopolis, and Jean-Rabel, HACHO's
field units (see map).

Over the weekend of October 30-November 1, the team re-
vised its research strategy in light of the paucity of baseline
data; the difficulty in obtaining records from files that had
been retired, lost, or destroyed; the idiosyncratic nature of
project reporting formats; and the modifications of project
purpose over the 13-year period during which HACHO received AID
funding. The team spent the period November 2-12 in the field,
visiting HACHO offices, current and former project sites, com-
munity councils, and small settlements in the Northwest. The
team traveled 277 miles (443 kms) of HACHO-constructed and
-maintained roads.

The fact that HACHO collected no systematic data on out-
puts or even on inputs prevented the team from undertaking much
quantitative analysis, even apart from the problem of the lack
of baseline data. The quantitative analyses that appear in the
evaluation reflect the ingenuity of various team members in






A-3



working with whatever numbers could be gleaned from HACHO files
and documents. They are presented surrounded by caveats and
should be considered as indicative at best.

Upon returning to Port-au-Prince, the team prepared a
draft impact evaluation report, conducted several followup
interviews with HACHO and GOH personnel, and gave debriefing
sessions for USAID. A copy of the report was left with the
Mission for comments. The team left Haiti on November 20.
final revisions were made by the team in Washington.
































APPENDIX B

RURAL COMMUNITY DEVELOPMENT (HACHO)
FINAL LOGICAL FRAMEWORK, 1977 PROJECT PAPER










PRTOBCT DESIGN SUUARY
LOGICAL FRAMENIRK


Life of Project
From FY 1966 to FY 1979
Total U.S. Funding
Date Prepared: March 1977


Project Title and Number: Rural Community Development (HACHO) 521-0061


Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions


Program or Sector Goal (the broader
objective to which this project con-
tributes):

To improve the quality of life of an
estimated 150,000 inhabitants of
Northwest Haiti.


Project Purpose:

To develop community councils that
are practicing self-help techniques
in implementing agricultural,
health, community development, and
road maintenance projects.


Measures of Goal Achievement:

Decrease in Third-Degree
Malnutrition

Increase in Caloric Intake From
1,500 per Day in 1976

Decrease in Number of Communicable
Diseases From 47% of Cases Diag-
nosed in 1976

Increase in Number of Women Partici-
pating in Family Planning Programs
From 600 in 1976


FY 77 FY 78 FY 79


10% 20% 30%


6% 12% 20%




10% 20% 30%




10% 20% 30%


of project status):

The community council contributes 50% of total project
costs. Soil conservation completed on 3,500 ha.

A minimum of 60% of council members regularly attend
meetings, pay dues, and participate in projects.

Community councils continue to maintain infrastructure
projects that they have completed.

At least 50% of community councils continue to seek further
Information on self-help community development techniques.

A minimum of 20 community councils with $300 in treasury.

50% of community councils meet criteria of effectiveness
described in Attachment 10.


Hospital and clinic records

MACHO staff surveys

Annual evaluation


Community councils' records
and accounts

HACHO's quarterly reports and
staff surveys

Final evaluation


A _ _ __ _ _ __ _ _ __ _ _


Assumptions for Achieving Goal Tar-
gets,

Ministries agree to assume responsi-
bility for some of HACHO's activi-
ties.

People accept instruction on nutri-
tion, health, new farming practices
introduced by community councils and
HACHO.

Successful completion of community
self-help projects motivate further
participation when new projects are
proposed.



Assumptions for Achieving Purpose:

Community councils are receptive to
self-help community development
approach

HACHO offices are moved to the
Northwest, and staff receives salary
incentive for living there.

HACHO is able to respond positively
to community council requests.

Successful completion of projects
motivates community council members
to formulate and undertake new
projects.


Conditions That W d


n--~1L1^-- ~L-L Y~l


r-l~^-L^ n------- I-^ n^^- ILi-..-~ I-_~


Ien11











PROJECT DESIGN SUMMARY
LOGICAL FRAMEWORK
(Continued )


Life of Project
From FY 1966 to FY 1979
Total U.S. Funding
Date Prepared: March 1977


Project Title and Number: Rural Community Development (HACHO) 521-0061


Narrative Summary Objectively Verifiable Indicators Means of Verification Important Assumptions


Outputs: Magnitude of Outputs: HACHO staff surveys and Assumptions for Achieving Outputs:
reports
Self-help community development projects: FY 77 FY 78 FY 79 HACHO's managerial and technical
Annual evaluation ability continues to improve.
To increase agricultural productivity 1,000 3,000 5,700
Hectares under cultivation 11,400 13,350 15,500 Local community councils continue to
Participants in agricultural projects 2,000 3,475 3,950 support HACHO's efforts.
Charm club members 300 600 1,000
Trained agricultural assistance 5 11 16 Reorganization of community councils
Irrigation systems 2 5 9 will result in greater effectiveness
Cooperatives 15 50 75 and fiscal responsibility.
17 20 28
To increase potable water supply systems 223 250. 275

To provide basic health services
Nutrition Centers

To improve and maintain roads (mi)



Inputs: Implementation Target (type and quantity): Assumptions for Providing Inputs:

AID See budget tables for financial plan. GOH agrees to increase its financial
CARE advisers contribution.
Medical supplies
Vehicles and other commodities PL 480 continues to be available
Operational expenses through CARE.
Research and evaluation
The Fonds Agricole and other donors
GOH continue their contributions to
Operational expenses MACHO.
Equipment and staff

Other Donors
Federal Republic of Germany

CARE
































APPENDIX C

HACHO AND THE AGRICULTURAL DEVELOPMENT
OF NORTHWEST HAITI









C-1


I. BACKGROUND


This appendix provides a brief description of the agricul-
tural program of HACHO from 1966 to 1982 with the goals of con-
tributing to the definition of a new strategy for AID invest-
ment in that sector and of providing a basis for dialogue with
the GOH concerning its agricultural policies. The major empha-
sis of the discussion is on preliminary ideas on alternatives
for promoting agricultural production and nonfarm rural enter-
prises, and the strengths and weaknesses of HACHO in supporting
these alternatives.

Following Smucker and Smucker (1980:15-17), HACHO's stated
goal was "to improve the living conditions of the population in
its zone of action." It was established primarily as a relief
organization. With time, however, HACHO's mandate was broad-
ened to include "(1) the provision of preventive and curative
medical care through stationary and mobile health units;
(2) nutritional assistance and education; (3) road construction
and maintenance; (4) agricultural development; and (5) a wide
variety of community development activities including the pro-
vision of potable water to communities, the formation of com-
munity councils, the construction of schools and latrines, and
instruction in crafts and domestic arts" (Pfrommer et al.,
1976:4).

The economic analysis of HACHO's agricultural activities
and related crafts projects was seriously constrained by three
main factors. First, evaluating the impact of an agency with
changing priorities (health vs. agricultural priorities) is a
difficult task, particularly when the review of project docu-
ments and earlier evaluations does not reveal a particular,
concise, measurable set of purpose and goal statements. Sec-
ond, the team's knowledge and understanding of HACHO's programs
were limited by the lack of monitoring and evaluation compo-
nents in the project. While many rural development project
plans include overambitious monitoring and evaluation schemes
that are then only partially implemented, HACHO's files lack
even a framework for monitoring and evaluating its activi-
ties. As pointed out by Pfrommer (1976:98), "there is no
assessment of the project's final impact on the area." Fin-
ally, the limited duration of the evaluation team's stay in
Haiti (30 days, 4 of which were national holidays) precluded
the use of benefit-cost analysis of HACHO's agricultural and






C-2


crafts programs. As an alternative, the "SONDEO"1 approach was
used to elicit some estimates of the dollar costs and returns
of some selected agricultural and crafts programs as well as
their impact on production, income, and employment. It should
be kept in mind, however, that data on Northwest Haiti are both
limited and of poor quality. Estimates included herein are
offered as orders of magnitude relevant to the assessment of
HACHO's activities rather than absolute or precise estimates.
Informants used by the evaluation team included HACHO's per-
sonnel, other government officials assigned to the Northwest,
PVO staff in the project area, and farmers (participants and
nonparticipants whenever possible).


II. HACHO'S AGRICULTURAL PROGRAM AND ITS PERFORMANCE


Theoretically, income from agriculture can be increased in
at least three ways: (a) mobilization of more resources (labor,
land, water, and capital); (b) introduction of new, complemen-
tary inputs, including better cultivation practices to raise
the value of output obtained from given resources; or (c) a
change in the crop mix to raise the value of output obtained
from existing resources. In practice, Northwest Haiti's agri-
culture is severely constrained on all three fronts. The issue
is: how did HACHO address these constraints through its agri-
cultural programs?

Four different agricultural programs can be identified
throughout the life of the project (1966-1982) with various
purposes and objectives--soil conservation and restoration,
irrigation and agricultural production, improvement of rainfed
agriculture, and livestock. A brief overview of the objectives
of each program was undertaken in order to establish a basis
for evaluating outcomes and results.

It should be noted at the onset that despite the fact that
HACHO was initiated in 1966, agricultural projects did not
begin until 1972. Between 1972 and 1975 agricultural projects
received about $43,000 in direct financial support from HACHO,
exclusive of salaries, administrative costs, and other expenses
(Pfrommer, 1976:13). In 1976, agricultural activities received
a major boost from Fonds Agricole funded by the Federal


1SONDEO methodology is a quick but clean method of rapid rural
appraisal. It is a quick and cost-effective method in the
tradeoffs between quantity, accuracy, relevance, timeliness,
and actual use of information. For more details, see Hilde-
brand, Peter E., "Summary of the SONDEO Methodology Used by
ICTA."






C-3


Republic of Germany. Between 1976 and 1982, Fonds Agricole
spent about $5.7 million in direct development expenditures on
agricultural projects, exclusive of salaries, administrative
costs, and other expenditures.


A. Soil Conservation and Reforestation


Soil conservation and reforestation was the only major
agricultural program which existed prior to 1976. It is cur-
rently being sponsored by Fonds Agricole. The objectives of
this program include the recuperation of 1,500 ha of land which
otherwise would not be suitable for agriculture, protection of
the watershed in the Bombardopolis and Jean-Rabel areas, and
improvement of soil fertility. These objectives were to be at-
tained through the construction of drywalls and contour canals
and the development of seven nurseries for forest (e.g., Neem,
Leucaena) and fruit trees (avocados, mangoes, cashew nuts, and
citrus) using PL 480 commodities to provide food and employment
for 2,600 households.

During the team's tour of the project area, the lack of
familiarity of agricultural personnel with completed and on-
going projects, coupled with a filing system which was either
nonexistent or without any information relevant to the evalua-
tion process, precluded any quantitative assessment of the im-
pact of this program. Nevertheless, several kilometers of
drywalls and contour canals were seen in Anse Rouge, Bombard-
opolis, and Jean-Rabel. No trace of soil conservation was seen
in Terre-Neuve, where the slope of the mountains is much
greater than in the other areas. Fonds Agricole files show
that between 1978 and June 1982, 1,500 ha of trees were planted
throughout the Northwest.

It was too early to assess the impact of this program on
soil and water conservation. It can be said, however, that
this soil conservation program does not seem to have engendered
a positive attitude toward forestry and the environment among
farmers, a prerequisite for long-term success and sustainabil-
ity. Farmers interviewed indicated that there would be no soil
conservation without Food-for-Work (FFW). This attitude is
quite understandable since local communities often became in-
volved only as a means to get food. The soil conservation
program was, in practice, more a hunger relief program than an
agricultural development program aimed at reversing the trend
toward depletion of the area's major resource base--its soil
and water. As a result, the major impact, in the short run at


2This remark is true for most of the other programs as well.






C-4


least, was the temporary provision of food and employment to
households that participated in project implementation through
labor commitment. The main problem with such projects, where
project intent and benefits are perceived differently by the
planners and the target population, is that the project will
have no chance of achieving the planners' purpose once the flow
of benefits valued by the target population stops. This is
what happened to HACHO's soil conservation and reforestation
program.

Since the soil conservation and reforestation program was
funded mostly in kind using FFW, one may legitimately ask, what
has been the impact of FFW on domestic agricultural production?
Based on the findings contained in Smucker et al. (1979:4-5),
no special attention was paid by the team to the impact of FFW
on domestic agricultural production. The findings of the
above-mentioned report can be summarized as follows: (1) ris-
ing cereals imports (commercial and concessionary) have not
prevented rising prices for domestic cereals; (2) FFW programs
have generally contributed only a third of all food aid; any
disincentive effect assigned to FFW would, thus, appear to
grossly exaggerate its impact on domestic production; and
(3) market incentives actually favor increased domestic food
production despite food imports (domestic maize being the main
beneficiary).


B. Irrigation and Agricultural Production Program


HACHO's irrigation program started effectively only in
1976 under the sponsorship of Fonds Agricole. Its objective
was to increase food crop production (cereals, beans, bananas,
sweet potatoes, peanuts, and other vegetables), mainly through
the use of 813 ha of irrigated land to be cultivated by 2,680
households. These production goals were to be met by making
seeds available to farmers through a well-coordinated credit
program, building storage facilities of a total capacity of 800
tons throughout the project area, and training a total of 340
farmers and extension agents in demonstration centers scattered
throughout the project area.

The team found that 19 km of irrigation canals have been
built to date; only 545 ha of land are currently under irri-
gation (see Table C-l). This represents 67 percent of the
target which was set at 813 ha. According to Fonds Agricole
personnel, each household cultivates about one-third ha of
irrigated land; this means that about 1,650 households are
currently benefiting from this program, which is only about 61
percent of the total number of households which were expected
to benefit. A total storage capacity of 750 metric tons (which
is about 94 percent of expected target) has been built and is
distributed as shown in Table C-2.






C-5


Table C-l. Distribution of Irrigation Canals and Irrigated
Area Throughout the Project Area, 1982



Length of Canal Irrigated Area
Location (meters) (hectares)


Ramonaise 2,000 20
Fond Ramadou 1,650 25
Baie-de-Henne 660 20
Petite Place 2,860 60
1'Etang 5,360 80
Ka-Philippe 1,710 90
Lavalletiere 2,642 75
Hatte-Dimanche 1,000 40
Nan Saut 1,100 75
Sauval 30 60



Source: Fonds Agricole Report, May 1982.



Of the nine demonstration centers which were built between
1977 and 1980 by the Fonds Agricole, only five are currently
functioning: Etang, Petite Place, Bayonnais, Hatte Dimanche,
and Ka-Philippe. These centers cover on the average 0.5 ha,
and crops grown in these centers include corn, beans, millet,
tomatoes, and other vegetables (shallots, cabbage, etc.). It
was not possible for the team to assess how many farmers or
extension agents were trained in these centers. However, the
state of the demonstration centers visited by the team left the
team rather pessimistic about the impact of such centers on
agricultural production.

In response to the scarcity of seeds during the planting
season, the credit program was launched mainly to make seeds
(local varieties) available to farmers. Table C-3 illustrates
the cost side of the credit activities as well as the number of
farmers reached by the credit program.






C-6


Table C-2. Distribution of Storage Facilities1
Throughout the Project Area, 1982


Location HACHO Unit Date of Completion


Lavalletiere Bombardopolis Dec. 1977
Baie-de-Henne Bombardopolis Dec. 1977
Ka-Philippe Terre-Neuve Dec. 1977
1'Etang Anse Rouge Dec. 1977
Ti-Riviere Anse Rouge Dec. 1977
Petite Place Anse Rouge June 1979
Sauval Jean-Rabel May 1981
Hatte-Dimanche Anse Rouge Nov. 1981


lEach facility has a capacity of about 100 mt.

Source: Fonds Agricole Report, May 1982.



The major impact of the irrigation program was in terms of
change in the crop mix and a reduction in the risk of crop
failure. Without the irrigation system, it had been impossible
to grow maize, beans, bananas, and other vegetables such as
shallots and onions. For instance, before the irrigation sys-
tem was built in 1'Etang, the only crops grown in the area were
millet and cotton. This situation prevailed in other zones of
the project area as well.

Other impacts of this program include the better use of
available family labor all year round. The irrigation scheme
has generated high demands for rural labor and the primary
source of labor supply is, of course, the family. No data were
available, however, to allow assessment of the increase in
labor requirements due to the project and its impact on the
rural labor market. In addition, the program led to improved
crop husbandry, particularly in the case of maize. In the dem-
onstration centers, one technique taught to farmers was the
spacing of seeds--in the case of corn production, 80 cm apart
on the line and 40 cm between the lines--in order to achieve
about 50,000 plants per hectare. According to HACHO's exten-
sion agents, this practice is now widespread among the farm-
ers. Finally, the program allowed increased land use inten-
sity; irrigated agriculture is always an intensive form of
farming and usually does increase land values, as was evidenced
in the project area.














Table C-3. HACHO Credit Activities, 1976-1979


1976 1977 1978 1979

Total Total Total Total
No. of Costs No. of Costs No. of Costs No. of Costs
Crop Ha Farmers ($) Ha Farmers ($) Ha Farmers ($) Ha Farmers ($)


1,574

190


Corn

Peanuts

Beans

Irish Potatoes


5,635

189

3,040


70

52

150


3,488

2,000

10,260


6,522

1,902 o

24,689 1

4,200


Source: Fonds Agricole Report, May 1982.






C-8


An attempt to derive crop budgets to assess the cost
effectiveness of the irrigation system was made difficult by
the fact that no records on crop yields were kept at the
project level. Estimates used in calculations here follow
Fougere (1979:6), which cites yields achieved in Northwest
Haiti of 450-500 kg/ha for corn and 500-600 kg/ha for beans.
In the crop budgets, 475 kg/ha and 550 kg/ha are used for corn
and beans, respectively. Two sets of estimates are presented,
based on the type of irrigation system, one for pump irrigation
and one for gravity irrigation (see Table C-4).


Table C-4. Costs and Return Per Hectare of Corn
and Beans, 1979 (pump irrigation)



Item Corn Beans


1. Annual Cost of Irrigation Canall $125 $125
2. Pump Operation Costs2 80 64
3. Seed Cost 42 111
4. Total Cost 247 300
5. Gross Returns3 355 484
6. Net Returns to Land, Family Labor,
and Capital 108 184


It is assumed that with proper maintenance, an irrigation
canal will last 10 years.

2Farmers in the irrigation area pay $4 per hour of irriga-
tion. It was estimated that 1 ha of corn will need about 20
hours of irrigation during the cropping season, while 1 ha of
beans will only require 16 hours of irrigation; the $4 per hour
of irrigation is currently being subsidized at the rate of 65
percent by the Fonds Agricoles.

3Gross returns are obtained by multiplying the average yield
per hectare by the unit price of corn and beans ($0.34/lb and
$0.40/lb), respectively.






C-9


In the case of gravity irrigation, the net returns to
land, family labor, and capital per hectare are be $188 for
corn and $248 for beans. Under both systems of irrigation,
the returns per hectare seem low, particularly when one con-
siders that, on the average, there are 2.4 participants (or
households) per hectare of irrigated land. If we assume that,
on the average, there are 4.5 active workers per household, in
the case of gravity irrigation, net returns per active worker
are $17 for corn and $23 for beans. So the impact of an irri-
gation scheme on agricultural productivity remains minimal, and
the current attempt to introduce new vegetable crops such as
shallots, carrots, and garlic in the project area to improve
net returns per hectare of irrigated land is commendable. How-
ever, this action must be coupled with programs to improve
farmers' access to markets and market information.

The irrigation program, however, remains very vulnerable
to a host of external and internal economic, agronomic, and
random factors. Economic factors include access to markets and
agricultural pricing policy. Land tenure is becoming an issue,
given increasing land values. The cost of pump irrigation is
prohibitive and raises the question of the sustainability of
such a production model. Agronomic factors include the lack of
an improved and proven technical package (improved seeds,
adequate fertilizer rates, better cultural practices) which
raises a serious question about the long-term returns to the
irrigation scheme. Finally, the area is subject to random
factors. Northwest Haiti is very vulnerable to natural disas-
ters such as hurricanes and droughts. For instance, farmers in
Baie-de-Henne are still struggling with the replacement of
aqueducts lost to Hurricane David in September 1980, including
those built in concrete.


C. Improvement of Rainfed Agriculture


This program, which only started in 1976, has two major
components. First, it sought to increase production of cotton,
sisal, bamboo, and latanier palm (used in handicraft produc-
tion), and to introduce these crops in new areas. In addition,
it aimed at increased coffee production through the regenera-
tion of 400 ha of coffee plantations.

During the team visit to the project area, the lack of
familiarity of HACHO personnel (in Bombardopolis and Jean-
Rabel, principal sites of the coffee project) with the coffee



3These figures were obtained by adding item 6 and item 2 of
Table C-4.






C-10


project precluded the assessment of the impact of this project.
Through discussion with the extension agent based in Cote-de-
Fer, it was found that the coffee nurseries in his area were
based on the local variety (Typica) which has a very low yield
potential. Furthermore, a review of documents available from
the Department of Agriculture and National Resources (DARNDR)
showed that in the Northwest, coffee production decreased from
19,810 mt to 19,214 mt between 1978 and 1979 (DARNDR, 1980b:18).

Given that the coffee nurseries are relatively young (less
than five years), it is too early to assess their impact on
coffee production, and under no circumstances can the decline
of coffee production in the Northwest be attributed to this
program. Given that the nurseries contain a good proportion of
Typica, however, expectations of the future impact of this pro-
gram on coffee production should not be too high.

It was also impossible to evaluate the first component of
the rainfed agricultural program because of the lack of pro-
duction targets and production records. In the case of cotton,
however, it was found that for the Northwest as a whole the
production of cotton increased from 176 mt to 290 mt between
1978 and 1979 (DARNDR, 1980b:18). Even though cotton produc-
tion increased from 176 mt to 290 mt between 1978 and 1979, we
could not attribute this entirely to the project because of
nonproject changes over time. It is quite plausible that this
increased production might have been stimulated by the crafts
project.


D. Livestock Program


This program, which was scheduled to start in 1977, sought
to increase meat production in order to improve the nutritional
status of the population in the project area and to provide an
additional source of income to farmers. These objectives were
to be attained through the promotion of pig production, rabbit
production, bee production, and the construction of a demon-
stration center in Nan-Vincent for the training of farmers in
basic animal husbandry practices.

The team visit to the project area revealed that (a) no
demonstration center had been built (lack of personnel and/or
funds was claimed to be the major cause of this situation); (b)
rabbit production had never gotten off the ground, although a
small pilot project was tried in Bombardopolis and classified
as a failure; (c) pig production was crushed in the second year
of the project by the arrival of African Swine Fever from the
neighboring Dominican Republic; and (d) farmers are currently
being given cash incentives to exterminate their pigs.






C-1


As a result, the only livestock activity functioning in
the project area now is bee production. Although it has a very
limited direct impact on the nutritional status of the popula-
tion in the project area (most sales are made in Port-au-
Prince), it does provide employment to about 340 farmers. The
farmers were trained in the honey-making process by HACHO and
now earn an additional gross revenue of $78 per farmer per year
(HACHO Report, 1981). Data on the cost of production were not
available to allow computation of net returns. The major con-
straint of this enterprise as evidenced from the HACHO reports
was the climate prevailing in Jean-Rabel which limits the flow-
ering of plants and, hence, bee production.


III. HACHO'S RURAL OFF-FARM ENTERPRISES: ASSESSMENT AND
PROSPECTS


In addition to the low productivity of agriculture, North-
west Haiti also faces underemployment. In an attempt to solve
the underemployment problem, HACHO has been promoting a range
of employment- and income-generating activities among which is
CANO, the crafts project.

CANO was started in 1976 as a means of raising the income
of the participants and creating employment during the slack
periods of the agricultural season. People in this project
were trained in the hand production of crafts made from cotton,
latanier palm, bamboo, sisal, and clay. As of June 1982, 15
craft centers were identified as active in the Northwest:
three centers in which 105 artisans were producing cotton goods
such as hammocks, pillows, blankets, and rugs; one center in
which 15 artisans were producing table mats; three centers in
which 115 artisans were producing baskets using latanier palm;
one center in which 50 artisans were producing bags using
latanier palm; two centers in which 100 artisans were producing
sisal containers; four centers producing furniture using bam-
boo; and one center in which 6 artisans were producing pottery
using clay.

During the team visit to the project area, only 12 crafts
centers were active or semi-active. Three of the bamboo cen-
ters had closed their doors during the previous five months.
All six latanier centers were still open, but production levels
were very low due to low demand for such baskets. (The basket
market in the United States is dominated today by products made
in the People's Republic of China to such an extent that tradi-
tional sources of baskets have been relegated to positions of
minor importance.) The clay center in Morne Massacre was tem-
porarily closed because the artisans were unable to keep the
kiln running because of high repair and fuel costs. So actual-
ly, only five centers are now active: the three cotton centers






C-12


in Sources Chaudes, l'Arbre, and Petit Carenage; the center for
table mats in Mare Rouge; and the bamboo center in Savane
Carree.

A closer look at the cotton centers for which data were
available, and which now constitute the area of emphasis of
HACHO/CARE in the crafts program, revealed that these centers
provide employment to about 105 artisans and an average monthly
income per artisan of $6.89 in Sources Chaudes, $13.35 in
Petit-Carenage, and $19.48 in 1'Arbre. The cost of training
artisans as well as other administrative costs are absorbed by
CARE and 1'Association Francaise du Volontaires du Progres
(AFVP).

CARE has supported the crafts project until now because it
uses local materials, builds on traditional skills, and pro-
vides people with jobs and income which they badly need. Other
impacts of the cotton centers resulting from their forward and
backward linkages include stimulation of cotton production (it
was claimed by some informants that there is currently a cotton
shortage in the project area); provision of jobs and incomes to
spinners; improved credit ratings for the artisans (it was
claimed by some respondents that because of the additional in-
come source, artisans have an easier access to credit in their
local communities); and improved habitat.

In spite of these benefits, given the host of problems
facing the crafts project, the phase II evaluation of HACHO
(Pfrommer et al. 1976) recommended that crafts projects be min-
imized due to the highly competitive market in this field. In
the basketry area, for example, Chinese baskets available today
in U.S. markets are characterized by clearly defined utilitar-
ian items, such as bread baskets and waste baskets, whereas the
HACHO line of baskets lack such basic, utilitarian items. In
addition, Haitian baskets are relatively more expensive. The
best selling Chinese items retail for $.50 in the United
States, whereas CANO baskets retail for $.60 in Port-au-Prince.

This leaves only cotton in which CANO can theoretically be
competitive. Recent events in Mexico, however, (devaluation of
the peso) make Mexican woven cotton goods three times cheaper
than cotton goods made by CANO.

In view of these findings and events, the team concurs
with the recommendations of the phase II evaluation and finds
it commendable that CARE is taking steps to create new product
lines both in basketry and in cottonry, and to revise the pric-
ing structure for handicrafts. Furthermore, if the United
States is to be the primary market for these products, it would
be helpful to revise the gourde/dollar exchange rate.






C-13


Another area which requires some re-thinking is the "coop-
erative" basis on which the project was originally designed.
As a supervisor of one of the craft centers put it, "We are
very far away from the possibility of a real cooperative--
personal interests are still dominant." This is quite under-
standable because cooperatives are best formed when they start
at the grass-roots level, build a solid base, and expand as
they work through their problems, developing insight and under-
standing along the way as well as technical and management
skills. It is difficult to see how this is going to happen in
the near future, given that the already existing structure and
administration have more of a wage-labor orientation than a
cooperative orientation.


IV. CONCLUSIONS AND RECOMMENDED FUTURE AGRICULTURAL ACTIVITIES
FOR HACHO AND POSSIBLE AID INTERVENTIONS


1. The soil conservation and reforestation program was a
desirable program, but faces some serious difficulties because
of the differences in view between project planners and project
beneficiaries about what the benefits of the project are or
ought to be. Food-for-Work, which was justified at the begin-
ning of the project because people in the Northwest were at the
brink of starvation, has turned out to be a contributing factor
to the current failure of this program. It should be noted
here that the soil conservation and reforestation programs were
not tied in with any agricultural production. It is recom-
mended that if this program is to be continued and is to have a
chance at succeeding on a significant scale, it should be
coupled with an agricultural production program which can pro-
vide immediate returns, even if they are low, to the farmers
involved in these programs.

2. The economic analysis of the irrigation schemes sug-
gests that the cost of pump irrigation is prohibitive and
should be discontinued. There is no adequate technical envi-
ronment to support pump irrigation in the project area. Re-
turns from crop sales even with gravity-fed irrigation are
currently too low to make the scheme economically viable. It
is recommended, therefore, that steps be taken to increase the
productivity of crops currently being grown on irrigated areas,
while also attempting to produce some highly remunerative crops
such as onions, garlic, or shallots. In order to reap the full
benefits from these packages or even to make the package suffi-
ciently attractive to farmers, access to markets should be im-
proved through better feeder roads, storage facilities, and a
better information network. Thus, the key policy issue to be
addressed here is the problem of rural infrastructure.






C-14


3. Dryland agriculture and livestock has received very
little impetus from the HACHO administration due either to a
lack of executive capacity to plan and carry out activities in
these sectors or to the priorities as perceived by the current
HACHO personnel. Most coffee nurseries are still planted in
Typica which has a very low yield potential. It is recommended
that such nurseries be discontinued and that nurseries with
Catura or other high-yielding varieties be expanded. A regen-
eration of old coffee plantations should go beyond a nursery
program and include training in coffee husbandry practices such
as pruning, pest and disease control, and fertilization; devel-
opment of marketing channels; and analysis of pricing policy
and other incentives to encourage new plantations.

Other dryland crops, such as cotton, should receive more
than lip service from HACHO if they are to play an important
role in the craft sector. Cultivation needs of staple crops
such as sorghum and millet should be addressed through the
introduction of drought-resistant varieties. The experiences
gained by the Texas A&M team in the PDAI project may be a
valuable resource in this initiative.

Livestock activities should be expanded beyond bee produc-
tion to embrace broiler and egg production, as well as small
ruminants. It would be advisable to test these activities
first as pilot projects. HACHO's personnel structure should be
thoroughly reviewed to ensure staff capability in these areas.

4. CARE has been the primary supporter of the crafts
project until now. The crafts project is currently facing
tough competition in the U.S. market from the People's Republic
of China in basketry and from Mexico in cotton goods. The
economic analysis of the crafts project suggests that the cost
of generating one dollar of income is too high (it takes five
dollars to generate one dollar of income). It is recommended,
therefore, that CARE take steps to investigate new markets
(other than the United States) where Chinese and Mexican crafts
have not yet entered (e.g., other Caribbean countries), to
create new product lines in basketry and cotton goods, and to
revamp their price structure to make the craft project not only
a "good" project, but a good business as well, or to discon-
tinue the craft production if economic losses are inevitable.

































APPENDIX D

HACHO'S HEALTH PROGRAM: HISTORY
AND IMPACT ASSESSMENT





D-l


I. INTRODUCTION


In the original HACHO grant signed in 1966, HACHO's pri-
mary purpose was stated as the formation and support of commun-
ity action groups. Within a year, however, that grant had been
amended and the purpose changed to the provision of rural and
mobile health and family planning services, with other activi-
ties clearly subordinated to health. A core of medical person-
nel and services was quickly established. By late 1966, a
mobile health team was already working out of a former Depart-
ment of Public Health (DSPP) dispensary in Jean-Rabel. Within
a year teams were also working out of Anse Rouge and Bombardo-
polis. No program changes occurred until 1972 when several
nutritional rehabilitation centers were opened. This addition
completed the package of nutrition and health services, includ-
ing dentistry and family planning, that formed the basic struc-
ture of the HACHO health program until HACHO's termination in
December 1982.

There was confusion over HACHO's identity throughout its
life: whether it was primarily a health organization, a commu-
nity development organization, or a relief agency. In the
confusion, health consistently emerged as the primary program
component for many reasons. First, both of HACHO's directors
were medical doctors, although each had also had substantial
experience in community development and the related areas of
education, agriculture, and rural infrastructure. Neverthe-
less, it is hard for a doctor not to see the problems of a
region, first and foremost, in terms of health. Good health is
seen as necessary for progress in other areas, giving the popu-
lation the strength and time to participate in other activi-
ties, such as agriculture and infrastructure development.

Second, it is easier to establish and operate health serv-
ices than it is to organize community development activities.
Rural communities recognize modern medical services as benefi-
cial. The need is always there, and the participation of the
target population is usually ensured. Community development,
on the other hand, requires that the highly individualistic
Haitian peasant recognize community goals and be convinced of
the benefits of working in common with other members of the
community to achieve them. Further, it is required that these
benefits be seen as substantial enough to warrant diverting
scarce time and resources from activities with a known return
to those with unproven potential.

Finally, and perhaps most important, health care is often
the expressed priority of the community. Communities without
any modern health services frequently put the construction of a
dispensary above the construction of a school or a road, and
usually far above provision of agricultural extension services





D-2



or participation in soil conservation activities. If a commu-
nity development organization is truly responsive to local
priorities, health care may well be one of the first activities
it should undertake.


II. COMPONENTS OF THE HEALTH PROGRAM


HACHO's health program has three major components: fixed
facilities for curative care, mobile clinics for curative and
preventive care, and nutrition centers. Other activities that
were included, at various times during the project, were dental
services, school vaccination programs, promotion of latrine
building, and provision of family planning services.

In 1982 the HACHO zone was structured in four units:
Jean-Rabel, Anse Rouge, Bombardopolis, and Terre Neuve. In
1974 at the height of HACHO's operations, there were six
units. The two additional units, Gros Morne and St. Michel de
1'Attalaye, operated for only a few years, and the following
discussion, therefore, focuses on the four primary operating
units.

In theory, health services in each unit were centered
around a fixed curative facility--a hospital, health center, or
dispensary--that had been built or renovated by the project. A
medical team, consisting of at least a doctor, a dentist, and a
nurse, worked at this facility one to two days a week and spent
the other days traveling with a mobile clinic to outlying areas
in the unit. At each mobile clinic site a dispensary was
staffed by an auxiliary nurse who did consultations and pro-
vided minor treatment or referral. She was also responsible
for a continuing health education program and for follow-up of
referred patients. During the weekly mobile clinic visit,
those services that the auxiliary was unable to provide were
available from the health team.

When the directorship of HACHO changed in 1972, a nutri-
tional component was added in response to the high level of
malnutrition that the medical teams were finding in the zone.
This component was based on one that had had much success at
the Albert Schweitzer Hospital in Deschappelles in central
Haiti. Nutrition centers were to be established in areas where
surveys indicated a high prevalence of second and third degree
malnutrition in children under five. These centers and their
counterparts in other parts of Haiti were internationally ac-
claimed at the time as a highly innovative and successful me-
thod of recuperating severely malnourished children. Intensive
feeding with inexpensive and locally available foods accompa-
nied by training the mother in the food preparation and feeding
techniques used was intended to provide both recuperation of






D-3


the malnourished child and, through the mother's education,
protection against relapse. When all second and third degree
malnutrition cases in the area of the nutrition center had been
treated, the center was to move to a new site. These centers
were staffed by nutrition auxiliaries.

At the height of HACHO's involvement in health care, there
were 6 unit health facilities, 17 mobile clinic posts, and 20
nutritional rehabilitation centers. The program at the time of
the team's visit was much diminished.


III. EVOLUTION OF THE HEALTH PROGRAM


Health was the explicit or implicit priority of the HACHO
program during most of its 16 years of existence. AID did not
always agree with this priority and much of HACHO's recent his-
tory shows a pattern of conflict between AID and HACHO over the
relative importance of various components of the HACHO program.
As AID began funding more comprehensive health projects within
the formal Government of Haiti (GOH) structure, it began to see
HACHO health activities as outside the mainstream of the offi-
cial program. HACHO activities threatened the goal of an inte-
grated GOH health system, and pressure began to build to
integrate HACHO activities into the GOH structure.

Beginning in 1975, AID began encouraging HACHO to turn the
medical aspects of the program over to the DSPP. At that time,
AID was funding a project to strengthen the institutional
capacity of the DSPP, the first three such projects culminating
in the current Rural Health Delivery System (RHDS) project
(521-0091). At that time, HACHO leadership felt strongly that
the DSPP was not capable of assuming full responsibility for
the provision of health care in the Northwest. There are some
indications that this judgment was probably correct and that
AID pressure for integration was premature. For example, in
early 1977, when the HACHO board met to plan future activities,
the DSPP declined to participate, saying it would go along with
HACHO's ideas. The HACHO Administrator's quarterly report for
January-March 1977 states, "GOH officials continue to indicate
that HACHO must be responsible for health activities in the
Northwest as GOH's Department of Health is not in a financial
position to take over these activities for the time being."

The AID-sponsored evaluation in 1976 noted that "HACHO's
priorities remain the provision of medical care and the con-
struction of roads (certainly worthy goals), despite increased
lip service paid to the importance of agriculture and the com-
munity development goals" (Pfrommer et al., 1976:53). The
evaluators did not agree with these priorities and recommended
that "if outside sources of funds are cut and the Haitian






D-4


Government is unable or unwilling to make up the deficit, then
the first alternative should be to eliminate the health pro-
gram" (Pfrommer, 1976:180). This recommendation coincided with
AID programming desires, and the HACHO Project Paper was
amended in 1977 to support this shift in focus. While HACHO
persisted in its assertion that the DSPP was incapable of
assuming responsibility for health care in the Northwest, it
was constrained by its lack of alternative funding sources for
health activities.

Table D-1 shows the changes in health personnel levels
over the project life.


Table D-l. Percentage of HACHO Program Staff in Health,
1967-1982


Year Percentage


1967 92.3
1972 57.7
1976 61.9
1979 51.1
1982 40.5


Although the health program was cut slightly based on the
strong recommendations of the 1976 evaluation, health personnel
still represented the majority of HACHO's program staff. It
was not until after 1979, when AID funding was terminated, that
health staff fell below 50 percent of total program staff. If
figures on expenditures by program sector were available, the
decline in health activities would be even more apparent.
Field visits suggest that staff costs consumed almost the
entire health budget, there being little material support pro-
vided to the health personnel in the form of medicines, vehi-
cles, or fuel. Programming decisions were apparently made not
on the basis of the perceived needs of the population of the
Northwest but rather on the availability of funds and the pri-
orities of the donor organizations. The transition away from a
predominant emphasis on health was made easier for HACHO by the
coming of the German Fonds Agricole project in 1977 and its
infusion of resources into HACHO's agricultural program.






D-5


In response to the slowly diminishing level of support
from AID, the health program gradually retrenched. Nutrition
centers were combined with dispensaries to save on personnel.
Deliveries of medicine and vaccines gradually declined to
almost nothing. Mobile clinic visits, never completely reli-
able, were cut back because of reduced fuel availability and
became irregular with the increasing unreliability of the aging
vehicle fleet.

The nutrition centers weathered the cuts somewhat better
since they were dependent on HACHO only for personnel and
supervision. The food used in these centers is supplied from
PL 480 commodities delivered through CARE. Modifications were,
nonetheless, made in the nutrition program. The quantity of
PL 480 foodstuffs being provided to Haiti had declined. Given
the resulting lower level of PL 480 food available to HACHO and
in keeping with changes in national policy, the centers were
changed from intensive recuperation centers to surveillance
centers with a much lower level of food distribution and more
emphasis on identification of severe or chronic nutrition prob-
lems. The total number of centers has declined from a high of
20 in the early 1970s to 6 in 1982.

The health programs at the four field units evolved quite
differently in response to budget reductions, despite their
common underlying structure. The most important factors af-
fecting program direction under the reduced budget appear to
have been the technical orientation and dynamism of the coordi-
nator of the unit and the presence or absence of other compet-
ing or collaborating health facilities. The difference in
level and composition of community health problems was not a
factor in determining program content. Although community sur-
veys to determine prevailing health needs had been suggested by
numerous advisors and evaluators, they were never carried out.

The health programs at Terre Neuve and Bombardopolis were
never very strong, in part because of the only intermittent
availability of HACHO medical personnel. Both units had prob-
lems retaining personnel because of the relative isolation
their difficult access roads enforced. Furthermore, in the
town of Bombardopolis, there are two missionary-run health
facilities (one of which was renovated partially with AID
funding) and a DSPP dispensary, all providing services similar
to those offered by the HACHO programs. There was apparently
little official cooperation among the four facilities.

In Anse Rouge and Jean-Rabel, where the unit coordinators
were usually both physicians, the health program was histori-
cally the strongest component of the HACHO program. In Anse
Rouge the 1982 program was similar in design to the original
HACHO health program although operating at a much lower level
of service. In addition to the HACHO medical team there were





D-6


also DSPP personnel working out of the HACHO health center.
The HACHO center, however, was clearly the focal point of the
program, and the HACHO physician, a very dynamic individual,
directed activities. In contrast, at Jean-Rabel the former
HACHO hospital has been officially taken over by the DSPP and
was being enlarged and renovated with funding from the German
Catholic Church. HACHO staff were, thus, working out of a
DSPP-funded and -directed facility. In the past HACHO had
often paid a salary supplement to DSPP personnel assigned to
HACHO facilities. In contrast, it was reported that 1982 HACHO
auxiliaries were receiving DSPP supplements. Medical supplies
are also provided to Jean-Rabel by the DSPP, making this unit
the most active in the HACHO program. Its strength, however,
had little to do with HACHO but was derived from its associa-
tion with and support by the DSPP.

The differences in program evolution among the various
units are instructive in understanding the varying effective-
ness of these programs during most of HACHO's life, when empha-
sis was on the health sector and adequate resources were
available. The program is currently strongest in Anse Rouge
and Jean-Rabel where the unit coordinators are both physicians.
Program levels at Terre Neuve and Bombardopolis are much lower,
reflecting the intermittent availability of a doctor in Terre
Neuve and the lack of a HACHO doctor in Bombardopolis.

Attractiveness and accessibility of the unit appear to be
important in determining the caliber of personnel willing to
accept a long-term position in a unit. Physicians are likely
to be employable elsewhere and are consequently less likely to
stay where living and working conditions are poor. Without a
physician the health program loses much of its dynamism and,
presumably, much of its effectiveness.

Thus, it appears that a committed, dynamic, and trained
medical person is required for the successful operation of the
health component at the unit level. It also appears from in-
formation in other parts of this report that medical personnel
are less capable of directing the other components of the pro-
gram. This observation should not, however, be limited to
medical personnel. At all levels the program tended to reflect
the technical bias of the person in charge, be it the local
community leader or the HACHO director in Port-au-Prince. The
wisdom of assigning the administration of an integrated program
to one technical specialist must be questioned.





D-7


IV. PROGRAM IMPACT AND ANALYSIS


A. Medical Services


In spite of the high priority given to the health sector,
there are almost no data on health impact. This deficiency
alone is grounds for strong criticism of a 16-year health pro-
gram. There are no baseline data. Other data that are avail-
able are often inappropriate, incomplete, or inconsistent.
Attention was given to the managerial task of monitoring inputs
and outputs with little mention of either expected or achieved
impact. Tables D-2 and D-3 are meant to be illustrative of
levels of HACHO health services over time. The team could not
substantiate that provision of services by HACHO had a positive
impact on the health status of residents of the Northwest or
that changes in service levels affected the magnitude of im-
pact. The figures and the years shown in the tables represent
available data and are not meant to define the level of ser-
vices or impact over time. They are representative of the
available data.

It is clear that service levels have declined drastically
between 1973 and 1982 and that at the current level of serv-
ices, no significant impact can be expected on the general
level of health of the population in the Northwest. Only at
Jean-Rabel has service delivery continued at anywhere near its
former level, and that is due to cooperation with the DSPP.
Services at Jean-Rabel actually increased between 1978 and 1982
from an estimated 3,552 patients seen and zero vaccinations
given in 1978, to an estimated 5,558 patients seen and 1,382
vaccinations given in 1982. In Jean-Rabel as elsewhere, how-
ever, services have become more concentrated at the unit head-
quarters, with infrequent mobile clinic trips because of
vehicle and fuel problems.

The reasons given by informants (both HACHO personnel and
intended beneficiaries) for the decline in services are many.
Most frequently cited was the lack of medicine at the HACHO
facilities. Patients who receive a prescription instead of
medicine often have nowhere to fill it nor the money to pay for
it if they could fill it. Service levels have also fallen off
because of the irregularity and decreased frequency of mobile
clinic visits. The unreliability of the mobile clinics was
most damaging. Patients who have walked several hours to wait
for a mobile team that fails to appear are easily discouraged.
When the team does show up, the turnout is likely to be poor.

A third reason for the declining number of patients is the
increasing availability of alternative service facilities. In
Jean-Rabel the DSPP now operates the hospital and there are two
nearby missionary clinics. In the Anse Rouge area there are





D-8


Table D-2. Level of HACHO Health Services, 1973-1982


Number Visits per Number Vaccinations
of Patients Person per of 2 per Child
Year Seen Year Vaccinations per Year


1973 58,860 0.40 50,274 2.10
1974 48,677 0.30 19,585 0.80
1978 9,692 0.06 1,271 0.05
1981 8,191 0.05 991 0.04
19823 8,724 0.06 1,381 0.06


1Population is assumed to be 150,000 with 16 percent under 5
years old. Vaccinations are listed per child under 5 although
it is likely that pregnant women were also included in vacci-
nation programs and that many of the children vaccinated were
over 5.

2No data are available on whether the complete series of any
vaccination was given to any particular patient.

3In 1982, 64 percent of patients seen and 100 percent of vacci-
nations given were at Jean-Rabel. The Jean-Rabel program is
DSPP-supplied.

Source: Data for 1973-1981 are extrapolated from William
Fougere, "Activites Sanitaires de la HACHO de 1972 a
1982," November 1982. Data for 1982 were extrapolated
from monthly medical report service statistics.


Table D-3.


Changes in HACHO Health Program Services,
Anse Rouge, 1975-1982


Apr-Sept Apr-Sept % Change Apr-Sept % Change
Category 1975 1977 from 1975 1982 from 1975


Patient Visits 2,347 1,761 -25.0 708 -69.8
Prenatal Visits 201 250 +24.4 111 -44.8
Vaccinations 1,190 0 -100.0 0 -100.0
Home Visits 572 474 -17.1 120 -79.0
Family Planning 10 24 104





D-9


two missionary clinics as well. The DSPP has opened a dispen-
sary in Bombardopolis where there is also a large missionary
hospital and clinic. The numerous missionary clinics are usu-
ally well stocked because of donations from abroad and often
charge no fee for consultation or medication. In addition, as
one HACHO doctor noted sadly, "the Haitian peasants have more
respect for foreigners than for Haitians."

The decline in resources since the termination of AID
funding was apparently not the only factor in the low utiliza-
tion of HACHO health facilities. Many of the current problems
existed even when HACHO was fully funded. The 1976 evaluation
notes that HACHO health personnel saw an average of 14 patients
a day compared to 50 per day at government facilities. Five
major reasons were given for this low utilization. First, the
quantities and variety of medicine available at HACHO health
centers was low. This was a result of both an unwieldly drug
procurement process (imposed by AID regulations but later modi-
fied) and a drug distribution system that did not take into
account the differences in disease patterns among the units.
Second, mobile clinic schedules were erratic due to poor roads
and vehicle problems. Unreliable service led to poor attend-
ance at clinic sites in the outlying areas. Third, auxiliary
nurses at dispensary sites were often inadequately supervised
so that the care provided at this level was frequently of poor
quality. Fourth, the outreach services were insufficient given
the level of education of the population and the prevalence of
disease. Finally, inadequate knowledge of prevailing disease
patterns kept personnel from being trained specifically for the
most prevalent diseases in their areas and meant that the medi-
cines provided to the dispensaries and health centers were not
always those that were most needed. This lack of knowledge is
a symptom as well as a cause of poor service; had outreach been
better and had there been greater communication between the
health providers and the target population, knowledge would
also have been better.

Some of the factors, such as poor roads and AID procure-
ment policy, were beyond HACHO's control. Others were directly
HACHO's responsibility and should have been remedied. It
should be noted that the 1976 evaluation also found that some
aspects of the HACHO health facilities were as good or better
than government facilities. HACHO clinics were open every day
and had generally lower fees than government clinics. The
coverage of rural areas provided by the mobile units was recog-
nized in the evaluation and by this team's informants as a
unique HACHO contribution.

There is some evidence that, as resources in health de-
clined, the mix of services provided changed. Table D-3 was
derived from the monthly medical reports from Anse Rouge for
the six-month period from April to September in 1975, 1977, and






D-10


1982. Although it is evident that services are declining gen-
erally, preventive services that require no resources (i.e.,
prenatal visits and home visits) either increased or declined
more slowly in 1977 than did curative services or preventive
services that require resources (e.g., vaccinations). Such a
shift in service mix is an appropriate response to declining
resources. By 1982, however, all services had declined mark-
edly, except family planning, which has shown a slow but steady
gain. The number of mobile clinic posts declined from four in
1975 and 1977 to one in 1982; the frequency of visits planned
to the remaining post had declined to only one or two per
month.

The shift in service mix in 1977 shows what appears to be
a commendable attempt at reallocation of scarce resources
toward preventive measures requiring personnel only. By 1982,
however, services had declined to the equivalent of eight
patients per day. It would seem at this point that resources
might be better allocated by reducing personnel and using the
savings to provide the remaining personnel with more of the
physical materials necessary to their work and with more train-
ing in health promotion activities requiring few resources,
such as oral rehydration or health education. It appears that
HACHO decided to maintain personnel levels at their historical
levels in anticipation of future budgetary support from either
the GOH or foreign donors. Such assistance did not materialize.

In addition to the services described above, there is evi-
dence that HACHO acted in response to extraordinary health
situations such as the typhoid epidemic in 1973. The epidemic
was reported as "controlled" in HACHO quarterly reports but no
information was given on the magnitude of the problem nor the
steps taken to contain it. This part of the program cannot,
therefore, be evaluated.


B. Dental Services


Dental services were provided by a dentist resident in
Anse Rouge serving Anse Rouge and Terre Neuve and by a dentist
resident in Jean-Rabel serving Jean-Rabel and Bombardopolis.
These services, too, have shown a substantial drop in recent
years (see Table D-4). Extraction was reported as the primary
service performed; prophylaxis was a very minor part of the
program. It was not clear whether the low level of prophylaxis
provided was a result of lack of demand, which is an education
problem, or to lack of resources. Whatever its shortcomings,
supporters and detractors of the HACHO program alike recognize
the importance of HACHO's contribution in the area of dentis-
try. Northwest residents relied on HACHO for dental care,
particularly extractions, as few other dental services are





D-ll


available in the area. The overall coverage relative to the
probable level of demand, nevertheless, remained quite low.


Table D-4. Dental Services: Jean-Rabel and Anse Rouge,
1975 and 1982


April-September 1975 April-September 1982
Category Jean-Rabel Anse Rouge Jean-Rabel Anse Rouge


Patients Seen 1,219 717 994 202

Extractions 966 801 895 124

Prophylaxis
(children) 42 5 29 4




C. Nutrition Centers


Under HACHO norms, 1,800 children should have been treated
at the nutrition centers each year (six centers, each holding
three sessions per year with four groups of 25 children each).
Participation in a session entailed a mother and child pair
spending one day a week at the center for education in market-
ing, cooking, and feeding methods intended to ensure the great-
est nutritional benefit to the child. There were also biweekly
distributions of PL 480 Title II commodities. In some centers,
the recipient group included 20 children and five pregnant or
lactating women.

According to the principles of the nutrition center, 92
percent of children entering a center should be successfully
recuperated. Those not recuperating should be readmitted or,
if in a state of severe deficiency, referred to a clinic for
more intensive treatment. Therefore, each starting group of
children should consist of approximately 92 percent new cases
and 8 percent readmissions. All children should be under five
years old and be suffering from second or third degree malnu-
trition. Data from the monthly reports of the nutrition center
at Anse Rouge for the past two years reveal the participant
characteristics shown in Table D-5.

It was not clear from the monthly reports when a new group
was admitted to the center nor when any child was "graduated"
from the center. Since children are supposed to attend the
center for four months, it is possible, even probable, that any






D-12


Table D-5. Participant Characteristics, Anse Rouge
Nutrition Centers, 1980-1982
(percentages)



Nutrition Northwest National R ral
Category Center Average Average


Rural 16.3 (10.2)2 93
Urban 83.7 (89.8) 7
New Cases 45.1 (41.0)
Readmission 54.9 (59.0)

Nutritional Status3

Normal 0.7 (8.0) 25.4 24.1
1st Degree
Malnutrition 51.6 (51.6) 48.8 46.4
2nd Degree
Malnutrition 41.5 (41.6) 22.8 26.0
3rd Degree
Malnutrition 6.1 (6.1) 3.0 3.5


1Data are taken from the National


Nutrition


In April and September 1981, the prevailing pattern of mostly
urban readmission was reversed and a set of all new and all
rural children was admitted. The numbers do not appear to rep-
resent a trend since in May 1981 the figures again show a pre-
dominantly urban readmission group. The numbers in parentheses
exclude the April and September 1981 cases. Figures from
November 1981 were not used because of inconsistencies which
made the data questionable.

3Attendees over 5 years old (7.8%) were not classified by
nutritional status.


Survey.






D-13


set of monthly figures described the same set of children as
the previous month's figures. Monthly variations in the urban/
rural mix frequently support this assertion but not always.

There were no reports comparing entry and exit weights or
nutritional status. Such figures may be available in the
weekly ledgers at the centers themselves, but they were not
reported to the unit, regional, or central level for purposes
of monitoring and supervision, Nutrition center ledgers re-
viewed by the team recorded the following: entering nutri-
tional status, attendance rates, and commodities received. The
1976 evaluation found that although 60 percent of attendees
gained weight, only 25 percent of these retained the weight
gained.

The distribution of attendees by nutritional status shows
that while the centers treated malnourished children, they did
not concentrate on the most severely malnourished. Over half
of all attendees were in first degree malnutrition, even though
HACHO norms call for admission of children in second and third
degree malnutrition only. This fact suggests a problem in the
siting of the centers or in their recruitment and outreach
procedures, or both. Evidence of the magnitude of the nutri-
tional problem in the HACHO zone is found in the admission
figures for April 1981. In this month the prevailing pattern
of mostly urban readmissions was reversed and a set of all new
and all rural children was admitted. The distribution by
nutritional status of this group shows 88.2 percent in second
degree malnutrition and 11.8 percent in third degree. Clearly
there exists an unserved population of malnourished children in
the HACHO zone. These data suggest that HACHO's nutrition
program was not reaching those children most in need and should
have been modified. That this situation appears to have been
the norm suggests that supervision of the nutrition centers was
inadequate.

When the distribution by nutritional status in the North-
west is compared to the national rural average distribution,
the Northwest appears to be slightly better off despite its
assumed relative poverty. It has been suggested by the HACHO
staff that the HACHO nutrition program was a major contributing
factor to this relative well-being. It is likely that the
substantial infusion of PL 480 commodities into the region in
the form of Food-for-Work has affected the general availability
of food which might be reflected in a generally higher level of
nutritional status. Besides HACHO, both CARE and the German
Fonds Agricole distribute Food-for-Work. While the HACHO pro-
gram undoubtedly helped many who were malnourished, it is un-
likely that, given the level of effort, much of the difference
in regional nutritional status can be attributed to the HACHO
nutrition centers.






D-14


Perhaps HACHO's greatest contribution to health in the
Northwest was its quick response in the face of regional disas-
ters. HACHO was instrumental in helping to minimize the nutri-
tional consequences of the frequent droughts occurring in the
Northwest. The contribution that such relief efforts made in
times of critical nutritional need cannot be overlooked in
examining HACHO's impact on health in the region. The mobili-
zation of all available food and personnel by HACHO during the
severe 1978 drought has been cited by many as perhaps HACHO's
finest hour.


V. CONCLUSIONS


When HACHO began its activities in 1966 it filled a great
need of the local population for modern health care. If
HACHO's services were not always entirely effective, one must
consider the conditions under which HACHO had chosen to work.
It is at best difficult to provide outreach services when one
must first build the road on which one must travel.

1. HACHO's service delivery model remained static over
the life of the project. When HACHO began, the mix of services
it provided and its mode of delivery were appropriate and con-
formed to standard practices. Much of HACHO's program was
based on a successful model developed and tested elsewhere in
Haiti. Over the years, however, HACHO's program remained
static, even though other projects in the country had tested
and proved the efficacy and the cost-efficiency of certain
modifications to the original service delivery model. Except
for the severely diminished level of resources, the health
component of HACHO's program in 1982 was remarkably similar to
that of 1967.

2. HACHO's program focused too many of the available
resources on curative rather than preventive care. In spite of
numerous declarations that more attention should and would be
paid to preventive medicine, the program remained largely a
curative one. It is easy to be tempted toward curative inter-
ventions given the obvious need in the Northwest. Neverthe-
less, had more effort been directed toward designing an effec-
tive preventive strategy, perhaps the effects of the program
would have been more lasting. The shortcomings of the curative
strategy were shown quite clearly when program resources were
cut. Without the materials to support curative services most
of the personnel were idle, since they were not trained to en-
gage in preventive activities that require few or no external
resources.





D-15


3. HACHO's response to resource reductions was inappro-
priate. The program decisions made in response to declining
resources were inappropriate and reveal HACHO's perception of
itself as a conduit for external resources. When funds were
cut personnel were maintained while materials were cut back.
Personnel did not appear to have received necessary retraining
to cope with the resource scarcity. HACHO seemed to have ex-
pected future contributions from outside and apparently decided
to keep its health structure intact in anticipation of renewed
funding rather than to redesign its program to maximize effec-
tiveness in the face of reduced resources.

4. HACHO's administration was too centralized. HACHO's
program decisions were made centrally. Inadequate attention
was given to tailoring the program to meet specific community
needs. In an organization whose espoused purpose was response
to community needs, such a lapse is puzzling.

5. Overall impact of the HACHO health program is likely
to have been positive although quite small. Lacking baseline
data or even current data on relevant health indicators, it is
impossible to quantify the overall impact. The 1976 evaluation
states that health benefits were perceived to be significant.
It is likely, however, that relative to total demand for health
services in the Northwest, overall impact has been low. At the
same time, the almost total absence of alternative health ser-
vices for much of HACHO's tenure in the area and the relatively
low level of resources available to the project over its 13
AID-supported years argue that, under the circumstances, the
services provided by HACHO were welcomed by the population as
acceptable and beneficial.

In summary, the services provided by HACHO, while far from
perfect, represented an admirable attempt to provide some level
of health care in a region where little else was available.
That more could have been achieved even with HACHO's limited
resources is certainly arguable. In the face of pressure from
AID, beginning midway through the project, to cede this program
component to the GOH, HACHO continued to provide health ser-
vices because it believed, probably correctly, that the DSPP
was not then equal to the task. Now, however, a major rural
health system, the RHDS, is being established with AID/GOH
funding, and the Northwest is one of the first target zones.
While HACHO's continued insistence on the DSPP's inability to
provide adequate services in the Northwest was laudable in
1977, by 1982 it had waited too long to step aside and allow
the Government to assume the primary role as provider of health
services for the Northwest.



































APPENDIX E

ADDITIONAL DISCUSSION OF COMMUNITY COUNCILS






E-l


ADDITIONAL DISCUSSION OF COMMUNITY COUNCILS1


The following discussion is based on agency files, prior
contact with the agency and councils in Terre Neuve (see Food
Aid Report, Smucker 1979), case studies, and other experiences
with peasant communities in the region. As the case studies
demonstrate, there is considerable diversity within the move-
ment. Certain patterns emerge, however, and certain generali-
zations may be made.

1. The council model, form, and substance. All councils
are organized along similar lines. They take a democratic form
with elected officers and periodic elections. All members have
the right to vote. All residents of a locality have the right
to membership. In substance, however, the functioning of coun-
cils does not always fit the outward forms.

In principle all local residents are considered "members"
of a council but not all of these members are active, and so
there is an expressed distinction between "active" and "inac-
tive" members. As a result, "active" council members may well
not be representative of a certain locality but only of a par-
ticular faction within it.

There is also a pattern whereby a successful president is
unlikely to be challenged. In such a situation new elections
may be postponed indefinitely. Furthermore, there is a pattern
of unelected leadership in some councils, a role known as
"leader-guide." The leader-guide may be a founding president
or former president whose advice is sought by current council
leadership. In some cases the leader-guide may never have
actually held office though he may have played an influential
role in the founding of a council. He may be a rural school
teacher, an agricultural technician, or another high status
outsider with close ties to town or city. In some cases the
current council president may be little more than a spokesman
for the leader-guide. The relationship is sometimes one of ex-
ploitation, but not always. Such relationships tend to follow
traditional Haitian patterns of personal loyalties and patron-
client relationships.

Community councils commonly show a pattern of authority
and hierarchy reflected in the significant distinctions made
between the executive committee and the mass membership. There
are sometimes factions which compete for control of council



1Excerpted from Glenn R. Smucker and Jacqueline N. Smucker,
"HACHO and the Community Council Movement," USAID/Haiti,
January 1980, pp. 71-75.






E-2


leadership. Such factionalism lends itself to meddling by
outsiders, creating a phenomenon known as "elections offi-
cielles" or "elections orientes." In such cases a president or
executive committee is put into power by rigged elections or by
naked force and intimidation.

2. Social class. The membership in councils is dominated
for the most part by relatively more powerful and economically
better-off area residents. While the membership itself varies
a great deal in terms of the class question, the tendency is
for leadership to reflect the larger landed families. This
tendency is even more pronounced in the towns.

3. Localism. By virtue of both geographic dispersion and
people's orientation, there is a definite strain in favor of
local control and decentralization. This is evidenced in pat-
terns of both federation and council membership. Where the
council movement becomes a new trend as it has in the north-
west, the tendency is for every little locality to want its own
organization due to the evident link between councils and agen-
cies delivering services to rural communities. It is interest-
ing to note a counter-tendency among agencies such as HACHO and
ONAAC. Proliferation of councils is discouraged in favor of
larger population units, councils with subcouncils, subcommit-
tees, and regional federations.

4. Federations. Federations are not representative or-
ganizations. They tend to be dominated by townspeople, whereas
most of the membership is rural. The current trend toward fed-
erations strains in the direction of hierarchy, though it theo-
retically could be otherwise. Member councils are generally
reluctant to contribute funds to the federation; however, Anse
Rouge effectively elicits funds from any member councils re-
ceiving Food-for-Work. There does not appear to be a clear
rationale for the existence of federations from the point of
view of local councils nor is there a clearly enunciated policy
from within the agencies helping to organize them. At the
level of local communities there is widespread lack of under-
standing of distinctions between HACHO as an agency, the com-
munity council of the local town, and the new federations. The
structure of these relationships tends to blur into "local"
interests versus "outsiders."

5. Finances. The problem of factions and elections is
often expressed in disputes over disposition of funds. A pat-
tern of rural distrust of federations and town councils is also
linked to pressures on member councils to pay dues. Allega-
tions of "personal interest" as opposed to the interests of the
group revolve around accusations of misuse of the council or
federation treasury. A common problem reported by council
members is the difficulty of building up a treasury because of
dues payments in arrears.






E-3


6. Relief and development. Where relief goods are dis-
tributed in the context of organizing community councils, the
goal of self-sustaining local organizations is consistently
sabotaged. The earliest wave of council organization in the
region was a channel for food relief at a time of drought and
famine. In Jean-Rabel it is still unusually difficult to do
community development, in contrast to Anse Rouge. It might be
noted that councils do serve to channel food aid into rural
areas better than other means using urban brokers whose
interests and contacts do not reach so far. Such use of coun-
cils, however, should not be confused with goals of self-
sustaining "autonomy." Relief goals and development goals come
into conflict if relief is incorporated from the outset in
councils intended to be development vehicles.

7. Project orientation. The community councils are gen-
erally organized in relation to various projects. In fact it
is often the projects which shape the membership of the coun-
cil, as at 1'Etang (farmers, not fishermen), or determine
whether a council is active or inactive. Councils may exist in
name and have officers but remain inactive for years until a
viable project becomes available. Where Food-for-Work is the
type of project giving new life to a council, the distinction
between konsey serye (serious council) and konsey mange (food
council) is popularly used by local organizers. The problem
with this distinction is that it tends to camouflage the fact
that other projects besides food aid bring dormant councils to
life in a way similar to those labeled as konsey mange.

The project organization of councils is part of a larger
and more fundamental issue: pragmatism and vested interest.
Where a council is active, it is because people are getting
something out of it. This may be in the form of access to
external donors bringing jobs and construction materials or a
variety of public services such as potable water and agricul-
tural extension. It may also be local control over economic
structures perceived as useful, personally, such as an irri-
gation structure, or a council treasury with loan options to
members. Where access to benefits is perceived as tied to the
existence of a community council, a council may well spring
into existence, even without professional organizers, on the
strength of an observed link to projects. In sum, the fact
that a council is active is an inadequate measure of its quali-
ty as an independent institution.

8. Initiative. For the most part projects are initiated
by HACHO and accepted by community councils rather than the
reverse. Even though council members may have prior interest
in a project area, they usually wait to be approached by a
HACHO technician rather than initiate a request themselves.
This pattern emerges out of a close examination of project
histories. The local context is one in which there is apparent





E-4


acceptance of almost any project an agency might suggest, ex-
cept for those which visibly threaten vested interests. As a
result, HACHO is readily able to mount a series of bakery proj-
ects when it receives an unanticipated offer of flour from a
colleague agency. There is nothing wrong with bakery projects;
this simply illustrates the point that bakery projects were not
being initiated by community councils prior to the agency's
flour donation.

9. Council as channel for services. The most common role
played by community councils is that of being recipients of
agency services. This is not necessarily a passive role per
se; public services are perhaps best administered in the con-
text of grass-roots structures. Local initiative may well be a
factor in what type of services a council receives. Even in
this role, however, councils tend to take less initiative than
the agency in determining what services are provided. The
whole question of providing services must be seen in the con-
text of Haitian traditions of government in which few if any
public services are readily available to peasant farmers. In
this sense HACHO and private sector agencies provide services
that otherwise would simply not exist. Community councils are
a useful channel for agency services.

10. Council as self-sustaining institution. The rhetoric
of community development anticipates the prospect of viable
local institutions, a theme reflected in the AID grant objec-
tive, "...to develop self-sustaining community action pro-
grams." This role should be analytically separated from the
role of councils as channels for public services. Given the
fact that the very existence of councils is predicated on the
flow of projects, it is not anticipated that they would have a
"self-sustaining" capacity in the absence of agency goods and
services. The reason for this is fundamentally political.

11. The politics of community councils. There is a blur-
ring of public and private in the work of HACHO and other agen-
cies. The conseil communautaire is a law of the land but re-
mains in the private sector. HACHO functions as an autonomous
Government agency; ONAAC operates out of the Ministry of Educa-
tion but serves a "private" clientele. In the Northwest, local
government officials find it easier to seek funds for potable
water systems and other civic improvements through HACHO and
community councils rather than the official Government sector.
It is apparent that community councils and HACHO provide
"public" services that the Government, for whatever reason, is
unwilling to provide directly. It is also evident that the
political role of community councils is intentionally limited
to the private sector. It does not function as a lobby or ef-
fective pressure group in relation to the political process.
Aside from the question of local people's lack of experience or
training in doing so, a separate issue, it seems clear that the






E-5


community council is not permitted to do so. The problems of
"initiative" and of being "self-sustaining" are unlikely to be
resolved unless organizations of peasant farmers are able to
exercise a political role. Historically, Haitian peasants have
never had an institutional means of representing their inter-
ests in the political process. Community councils could con-
ceivably play such a role, but are unable to do so as presently
constituted.

































APPENDIX F

PERSONS CONTACTED




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