Making dollars count in Haiti

IN EVERY country, every day, a lot of money is spent by various governments and agencies with the intention of making life better for citizens.

In Boston, priorities are set by City Hall, the state, and the federal government — along with a host of privately controlled philanthropic organizations. Just like everywhere, these decisions are driven by both political realities and personal preferences.

Funds are limited and no dollar can be spent twice, so money tends to go to causes that have well-organized and vocal campaigners. Relatively short election cycles make it more rare for politicians to invest in long-term investments that would not generate benefits — or votes — for decades to come.

The same situation occurs in the world’s most impoverished places, but the stakes are higher. Consider Haiti. A country of 10 million people, it has a total annual national budget of only around $3 billion — the same size as that of the City of Boston. Another $1 billion is spent by aid organizations.

Haiti tends to receive attention only when it is hit by a national disaster or goes through electoral tumult. Unemployment is high, much of the country does not have reliable access to electricity, one-third of households are not eating enough to be considered “food secure,” fewer than 6 out of 10 children reach the last grade of primary school, and free ambulances attend just 2 percent of accidents and emergencies.

In a nation beset by challenges and undermined by structural weaknesses, it is challenging to know where to start. If you had an extra dollar to spend making Haiti stronger and more resilient, where should it go?

A new project at the Copenhagen Consensus Center called Haiti Priorise could help provide a solid foundation to answer this question. Funded by the Canadian government, Haiti Priorise first worked with all stakeholders — including Haitian officials, businesses, civil society, thought leaders, donors, academics, and sector experts — to list the biggest challenges facing the nation, and identify the most effective solutions. Whittling down an initial list of more than 800 solutions, they settled on 84 of the most promising ideas.

In more than 40 new research papers, Haitian and international researchers have covered everything from improving broadband access, rebuilding the electricity network, and creating an electronic voting system, to linking Haitian farmers to international carbon markets.

Crucially, all the papers use cost-benefit analysis to make investments comparable. They estimate the costs as well as the social, environmental, and economic benefits, expressed in dollars.

Magdine Flore Rozier Baldé, an economist at Haiti’s Ministry of Planning and External Cooperation, has studied the costs and benefits of expanding immunization coverage. Currently, fewer than half of Haitian children receive every shot that they should. While infant mortality has been cut significantly, Haiti still has the highest infant death rate in the Caribbean. About 2 child deaths in 10 are caused by diseases that could be prevented by vaccines.

Rozier Baldé finds that gradually raising immunization coverage to reach 90 percent by 2020 would cost just $78 per child, for a total investment of around $35 million. By 2025, more than 16,000 lives would be saved. Furthermore, the investment would save parents income that they would have lost by caring for sick children, and it would create savings for the health system.

Rozier Baldé concludes that every dollar spent on this initiative would achieve $13 in benefits to society.

Another study looks at scholarships to keep girls in school. Across the country, attendance is higher for boys than for girls. This has real costs, including lifelong impacts on health and income, which also negatively affects the next generation.

In Bangladesh, Kenya, Brazil, and Nicaragua, scholarships have helped girls stay in school, encouraged academic success, and delayed early marriage.

Mélissa Torchenaud, an economist and project analyst at the Ministry of Planning and External Cooperation, finds that a four-year scholarship would cost around $1,000 per child. The wage increase from each additional year of schooling will add up to nearly $4,000 across each girl’s lifetime. Each additional year in school also reduces the risk of a girl’s own, future children dying early by almost 10 percent. More education will cut HIV, teen pregnancy, and maternal mortality rates, as well as improve nutrition in the next generation.

Adding up all these health and economic effects, every dollar spent on a scholarship initiative would generate nearly $5 worth of benefits.

Alongside these two studies, other researchers are studying things like improving Haitian rice production, building stronger infrastructure, boosting early childhood education, and teaching in the local language of Creole alongside French.

Taken together, the research papers provide a dispassionate, data-driven way to answer the vital question: With so much need, where can we achieve the most good?

In May, a panel of top Haitian economists and development experts, along with Nobel laureate economist Vernon Smith, will study the research and identify effective priorities. A forum of youths from across Haiti will do the same.

The new data can be utilized by the new Haitian government to inform priorities. It can be used by Haitian civil society to advance the case for overlooked investments with phenomenal benefits. And it can help outsiders like America’s own aid agency, USAID, to parse different spending options.

In Haiti — as in anywhere on earth — there are many ways where money can improve lives. By focusing on data and analysis, we can find ways to make every dollar achieve the biggest impact possible.

Bjorn Lomborg is president and founder of the Copenhagen Consensus Center and a visiting professor at Copenhagen Business School.