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The long-term ramifications of the earthquake in Haiti, already the poorest country in the western hemisphere by a wide margin, are staggering. One month following the devastation, PIH began to move beyond the acute phase of response in order to formulate and execute medium and long-term plans for the rebuilding of lives and livelihoods, communities, and the public health system. Though we are sure our plans will continue to develop as the needs on the ground evolve, on February 12, 2010, PIH launched a Fund for Building Back Better in Haiti to support a three-year recovery and rebuilding plan with an initial budget of $125 million.

Below we have outlined the current projected activities and efforts that the Fund will support with the knowledge that the scope of our interventions, and therefore the size of the Fund, may grow in the months to come.

Medium-Term Activities (1-6 months)

1. Continue urgent medical and surgical care operations for earthquake survivors.

PIH/ZL will sustain our expanded volunteer deployment, logistics, warehousing and distribution system in support of the increased demand for medicines, medical and surgical supplies and equipment and the need for specialized surgical and medical teams to reinforce and help train our existing staff. These efforts will continue to serve patients in Port-au-Prince at the University Hospital (HUEH) and at PIH/ZL facilities in the Central Plateau and Artibonite Departments.

2. Sustain community-based care and mobile clinic outreach within Port-au-Prince.

PIH will operate mobile clinics serving between 80,000 and 100,000 displaced people within five or six communities in Port-au-Prince to provide comprehensive primary health care, reproductive health services, treatment of pediatric malnutrition, HIV testing and referrals, and disease treatment and prevention.

3. Provide assistance to displaced people and affected households in PIH/ZL's catchment area.

In collaboration with partner organizations and through our existing community-based social and economic support initiatives, PIH/ZL will help strengthen food & agriculture, housing, safe water, education, and income generation programs for the most vulnerable people in the areas we serve.

4. Build capacity for acute trauma counseling and overall mental health services within our sites.

With key partners, PIH/ZL is conducting an initial needs assessment at our sites and in the spontaneous camps. The assessment is particularly focused on identifying consultation psychiatry needs, developing a training plan for staff and community health workers, outlining additional medicine requirements, and defining key psychosocial support activities.

5. Support the social and economic needs of Zanmi Lasante's more than 4,000 staff.

Almost all our Haitian staff have lost family members in the earthquake and are taking in relatives who have nowhere to go. To ensure these front-line workers, the majority of whom are medical personnel and community health workers, can continue to perform their jobs over the long-term, PIH/ZL is distributing financial assistance to staff to help them with basics during this very difficult time.

Long-Term Initiatives (2-3 years)

1. Expand capacity for specialty clinical services needed to care for earthquake survivors.

PIH/ZL will develop new facility and community-based capacity for post-operative care, rehabilitation and physical therapy, and mental health services by forging strategic partnerships, recruiting additional expertise, and conducting extensive training. Surgical care will be greatly strengthened at all of our facilities in the Central Plateau and Artibonite, with higher-level surgery available at five hospitals and capacity for emergency obstetrical care available at all sites.

2. Strengthen our clinical operations and the public health system.

In partnership with the Haitian Ministry of Health, PIH/ZL will strengthen our network of community health workers as well as the clinical operations at 12-15 hospitals and health centers that provide comprehensive health care to our catchment area in the Central Plateau and Artibonite Departments, which together may grow from 1.2 million to 1.7 million people.

3. Build and renovate public health infrastructure.

Construction and renovation projects, in the form of new hospitals, training centers, pharmacy/warehousing buildings, surgical suites, outpatient clinics, and inpatient wards, will take place at six sites already identified.

4. Strengthen the public medical and nursing education system in Haiti.

A new hospital and teaching center will be constructed in the town of Mirebalais, which is estimated to serve roughly 450 patients per day. The Mirebalais facility will serve as one of Haiti's national teaching hospitals, with PIH/MSPP facilities in the Central Plateau and Artibonite serving as satellite teaching sites.

5. Expand PIH/ZL's programs for social support, community development, and poverty alleviation.

Roughly 2,000 additional community health workers will be hired and trained to work in tandem with mobile clinics, health centers, and hospitals to expand the reach of services.

Funding Need

On February 11, 2010, Dr. Paul Farmer articulated his view on the crisis and need in Haiti: "We are in uncharted territory here, and a certain humility about diagnoses, prescription, and prognosis is surely warranted...So what is to be done? ... Might addressing the acute needs of the displaced and injured afford us a chance to address the underlying chronic condition?" After some reflection, he summarized, "So the diagnosis is: natural disaster in a setting of great and longstanding privation... Haiti needs to build back better and stronger than before. This, then, should be the treatment plan."

While PIH/ZL's role in building back better is only a small piece of Haiti's overall plan, our vision of accompanying Haiti has resounding effects in the small country and beyond. As of February 12, 2010, we have raised roughly $57 million toward our $125 million plan to build back better. Our expectation is that $15 million will be spent before July 1, 2010, and an estimated $110 million in the two to three years that follow. We welcome and encourage both longstanding and new partners to contribute to the STAND WITH HAITI Fund as a way to engage in sustained, long-term recovery to rebuild lives, livelihoods, and communities. Thank you for your consideration and hope that you will join us now.

For more information on the Fund, please contact Ariana Watson at or 617-998-8927.