Paul Farmer

The co-founder of Partners in Health on PEPFAR and Haiti
Harvard Political Review: The organization you helped found, Partners in Health, has had a lot of success in the countries you’ve worked in. But what could you be doing better?
Paul Farmer: First, when you grow and try to reach more people, there’s often a sacrifice in terms of the quality of service. PIH works in 12 countries and probably has 13,000 employees. If we’re going to see a couple million ambulatory patients every year, what about the diagnostic work that gets done for those patients? What are they getting prescribed? Are we following up? We don’t really know. There are so many people providing these services, who haven’t all had the same amount of time to learn.
What about the quality of the facilities we’re running? What’s infection control like in one of our hospitals? How good are we at using green sources of energy to power these hospitals and clinics? There’s just lots of work that needs to be done. But there are good examples, too. For example, after the earthquake, rates of completion in Haiti of the HPV vaccine series were higher than the average in the United States. So even though I’m concerned with quality, the apparatus of community-based care tends to be effective.
HPR: What do you think about President Obama’s failure to expand funding for the President’s Emergency Plan for AIDS Relief (PEPFAR)?
PF: It’s not just Obama’s failure, it’s our failure. He’s not an individual agent either. Watching how Congress can slow things down or block things has been instructive to me.
It will hardly surprise you to learn that I’m an advocate of more investment. But I also think we need to do better with the resources we have and attend to quality and local capacity-building. A lot of U.S. federal funding goes into the field through contractors and non-governmental organizations. I’m not opposed to that. I just think we need tougher metrics regarding how much of that money gets to the people for whom it is intended and how we can move from a reliance on contractors and NGOs, even like Partners in Health, and towards strengthening public health systems.
HPR: Over the 25 years you’ve been involved in Haiti, the country has seen several coups, a large number of natural disasters, and a series of unfavorable trade and aid policies. What’s the future of Haiti?
PF: Haiti has some enormous human resources. They’ve been involved in this struggle now for a couple of centuries to promote basic rights and freedoms, like freedom from want. So that heritage in and of itself is really important. It’s part of the answer.
But the other answer you already got to. We have to stop abusing our neighbor. You mentioned unfair trade policies. I was living in Haiti at a time when, in the course of two or three years, unfair trade arrangements destroyed the local rice production. So, that has to stop. We have to concert our efforts to help Haiti rebuild with autonomy, assistance, and accompaniment. Do I think this can still happen at this late stage? Yes, I do.
Lily Ostrer ’14 is a Staff Writer. This interview has been edited and condensed.