Is it realistic for people to make headway against so many problems on their own? Several centuries of poverty would suggest the answer is no.
Would a personal assistant help? An experiment here may answer that.
Half of the commune’s 10,000 households are being assigned a “household development agent” — a neighbor who will work as a health educator, vaccinator, epidemiologist, financial analyst, social worker, scheduler and advocate all at the same time. With the agent’s help, a family will assess its needs and come up with a plan to make things better.
“The idea is to forge a relationship from the get-go,” said Maryanne Sharp, an official at the World Bank, which is overseeing the $4 million project. “We want the family to say, ‘Yes, we own the plan, and we will work on these objectives on this timetable.’ ”
The commune’s other 5,000 households will function as a control group, continuing as they have, scrounging out a living in one of Haiti’s poorest and most isolated places.
In two years, the families will be resurveyed and their children and houses reexamined. If those with agents are doing better, then the strategy of coaching people out of poverty may be expanded throughout the country.
The experiment, aided by Haiti’s health ministry and run by two charities, Zanmi Lasante and World Vision, acknowledges several realities of life here.
One is that fixing just one of a poor family’s many problems — say, access to medical care or substandard housing — may not make much difference. The second is that house calls are the most efficient way to reach people in rural areas. The third is that finding help in a place where more than 900 nongovernmental organizations operate — and provide 70 percent of the health care — can be daunting and confusing.
The all-encompassing nature of the job is not the only unusual feature of the project, which is called Kore Fanmi — “family support” in Creole. The agents will also be eligible for pay-for-performance (P4P) bonuses.
“If their families perform better, they will receive more salary,” said Francesca Lamanna, a World Bank economist who oversees the project. “This will help them do their jobs better.”
P4P is rapidly becoming a feature of American medicine, including with Medicare. But it is “kind of a new fad in global health,” said Amanda Glassman, an economist at the Center for Global Development in Washington. Evidence suggests it improves outcomes, at least for a while. Critics worry that it may lead to people gaming the system and undermine professionalism.