Eating Crow and Learning to Like It: New Insights about the Partners in Health/Fonkoze Relationship
I can’t satisfactorily explain the ambivalence I felt (until quite recently) towards Partners in Health (PIH) and its founder, Paul Farmer. Perhaps it was the fact that someone close to me who is an international health professional had some philosophical disagreements with Farmer’s approach. She shuddered at the thought of him leading USAID, where she worked, when Hillary Clinton floated the idea in 2009. Or maybe it was that Farmer/PIH, in part due to its flattering coverage in Tracy Kidder’s book Mountains beyond Mountains, had become world-renowned and a fund-raising behemoth – while Fonkoze, which does what I regard as equally important work in Haiti, has remained largely unknown and terribly under-resourced. Or the fact that Farmer’s politics, at least as articulated in his book The Uses of Haiti, are somewhat to the left of mine (and I consider myself reliably progressive). Maybe it was the experience of seeing the billionaire friend of a friend of mine instinctively give $1 million to PIH right after the 2010 earthquake, before anyone could make the case to him for giving to Fonkoze. I could go on, but, loyal blog reader, I am sensing that you get the point.
Well, as I have researched my book on Fonkoze, I have come to see PIH in a new light. PIH goes to great lengths to highlight the important role of its Haitian sister organization, Zanmi Lasante (ZL) – something I admire and believe is important. (The relationships between northern – often U.S.-based – organizations and their southern partner institutions often begin well but grow tense over time. Usually the northern “partner” comes to hold the purse strings, dominate decision-making, and hog the spotlight. With PIH/ZL, it feels to me like a true partnership.) More to the point, the PIH/ZL team in Haiti has time and again delivered for and with Fonkoze, making this alliance one of the most vibrant I have seen at the field level in any country, spanning more than two decades of work in international humanitarian affairs.
To take one case, I heard from several people last summer that Fonkoze’s CLM or “ultra poor” program chose three international NGOs to provide health care services to its destitute clients during the pilot phase. One NGO completely failed to do what it promised, another did a bit better, and (you guessed it) PIH/ZL delivered first-rate services to Fonkoze’s CLM clients (and still does). In fact, I was told that the choice of the central plateau as the region to massify CLM after the pilot phase was made in part to ensure maximum overlap with PIH/ZL’s geographic footprint.
When I travelled to the central plateau with Professor Yunus in October, I saw with my own eyes how PIH/ZL had worked to ensure easy access to financial services for its patients by hosting Fonkoze’s Boukan Kare branch on the hospital grounds – where it stands today in all of its purple and orange glory! (There is another Fonkoze branch co-located with PIH/ZL in Tomonn.)
The PIH/ZL teaching hospital under construction in Mirebalais is something to behold: a massive undertaking, done (as a matter of principle) as a joint venture with the government, ahead of schedule, and staffed by a whip-smart team. It is something that the community, including the local Fonkoze staff and clients, is very excited about and proud of. And then Farmer himself, in his nicely written book Haiti: After the Earthquake, seemed to moderate his politics a bit – surely a disappointment to some, but in a way that made his views, at least in my mind, more realistic and balanced.
When I started probing more about the PIH/Fonkoze relationship, I learned that Fonkoze’s CLM program and the “anti-poverty summit” that led to its creation were two of the things that essentially originated in a meeting Anne and Paul Farmer had some years ago. Anne had gone to show Farmer some of the Creole-language educational materials Fonkoze had developed about HIV/AIDS, but they went far beyond this narrow agenda and emerged committed to a joint initiative to attack disease and extreme poverty in Haiti. The attached logo is one of the artifacts of this collaboration, which remains very much alive today. The CLM initiative later attracted the support of CGAP, the Ford Foundation, MasterCard Foundation and others.
Farmer has been generous with his time and contacts, introducing the late Tom White – his original benefactor – to Fonkoze some years back. (This kind of sharing of fund-raising relationships happens very rarely in international humanitarian work, even when it is reasonably clear that everyone could come out ahead by doing so.) Perhaps inspired by this collaborative approach, in my capacity as president of Grameen Foundation I have been part of an effort to bring the CEOs of international microfinance networks together into an effective working group, something I have blogged and spoken about recently.
Finally, there is the issue of quality of care. When I told Carine Roenen, the director of Fonkoze who is also a medical doctor, what contingency plans I should have if one of the Yunus delegation members who had serious health issues fell ill, she did not hesitate in her response. “Figure out where the nearest Zanmi Lasante hospital is.” End of conversation.
The international humanitarian world is more “dog eat dog” than many people imagine. Active collaboration often takes a back seat to one-upmanship and zero-sum thinking. The PIH/ZL-Fonkoze alliance is not perfect, but from what I can tell it’s pretty darn close. I’ll need to find a way to tell this improbable and heartening story. Perhaps it can provide a kind of bridge between Kidder’s book and my own, enabling readers to see the people and history behind this attempt to combine quality health care with economic empowerment – an effort that might otherwise seem dry and technical. I welcome ideas and input from blog readers. In the meantime, I suppose I’ll have to get used eating a bit of crow, since I initially got this story (how shall we say?) dead wrong.