Choreographing Chaos in Haiti: Strategic Narratives and the Pursuit of Maternal Healthcare.

Large projects often stall because uncertainty accumulates faster than decisions can be made. Ambiguous conditions allow for multiple options, making operational misalignment and thus a loss of momentum likely. Rebuilding momentum becomes the central leadership challenge. My recent experience in Haiti shows that strategic narratives are among the most effective tools in such situations. However, building strategic narratives is not always straightforward and often involves a paradox in which initial buy-in requires initial success.

Since 2021, Haiti has fallen into a whirlwind of gang-related violence. This violence has engulfed much of the capital, Port-au-Prince, and is today spreading to the rural areas of Artibonite. Unsurprisingly, this context is destructive to healthcare services and infrastructure, leading to poor sanitary conditions. It is in this environment that the organisation that I have been supporting is working to reopen a maternity hospital. This is a bold and worthy objective, due to Haiti’s poor maternal healthcare outcomes, including maternal mortality. However, the challenging security environment and a new relationship with the Ministry of Health (MoH) hospital direction created uncertainty, while the difficulty of finding and retaining qualified staff in such a setting had slowed program implementation. 

This is why, when I arrived in early 2026, project activities, including a major rehabilitation effort, had effectively wound down to a standstill. This was due in large part to coercion by local armed actors and some internal HR gaps and mismatches. The organisation had tried to resolve some of the issues by adding time, effort, and energy, but a clear missing element was a shared understanding of success and a path-of-least-resistance approach to getting there.

Often, large organisations, when adding additional resources and focus to important or troubled projects, achieve the counter-intuitive effect of muddying the waters. More people with more ideas, and probably good ones, do not make decision-making easier. After all, one bad plan agreed upon by everyone is more effective than multiple good plans that elude agreement.

On top of this is the reality that every organisation has a political fabric. Certain decisions are likely to be accepted if they move forward in a particular way. We must understand the relative weight of decision-makers within the bureaucracy to reach positive outcomes. Understanding the process, listening, and gaining buy-in are key elements in laying the groundwork for progress. Negotiating these internal blockages requires clarity and conviction. These were all key points to be considered before decisive action could be taken.

The objective was to rebuild momentum by focusing on key priorities, and as such, we needed a strategic narrative to align all relevant stakeholders. By strategic narrative, I mean a shared story that shapes how people understand their objectives, capabilities, and the environment around them. These narratives build consensus around a common understanding of the problem at stake and the direction of travel towards a solution.  A strong, strategic narrative allows all actors to take the path of least resistance whilst remaining within the domain of acceptable action. 

Our strategic narrative framed the project as a partnership. It emphasised sustained collaboration, deliberate communication and a willingness to make pragmatic compromises to improve patient care. Instead of positional arguments, we sought to discuss the different paths of action logically under this common understanding. However, work was required to gain enough trust to successfully sell the strategic narrative. To do so, three key interventions were identified: break the organisation's internal inertia to deliver on our obligations, build trust with all actors by redefining our relationships with them, and institutionalise systemic improvement to prevent future slippage.

The most visible measure of progress was the construction program. This meant pressing on with the work already decided, as renegotiating the organisation's internal plans would lead to further uncertainty. Remaining on the same operational pathway is often the goal, but teams with frequent changeovers inherently review and reshape their planning. Renewed violence was also a risk. However, waiting for prime conditions in Haiti is like waiting to win the lottery. Initial success was achieved by rapidly renegotiating contracts without altering structural or operational planning, which allowed us to restart and accelerate the program after a forced halt due to violence. Visible delivery gave the MoH confidence that the partnership could succeed and gave weight to our strategic narrative.

Simultaneously, the medical team worked to create a new culture of engagement with the MoH. We needed to analyse islands of agreement, points of tension, battles we needed to win now and battles that could be fought later. We needed to show humility and understanding. To rapidly build trust and rekindle momentum, we capitalised on the activities we could deliver to open discussions on further points of improvement that sat on islands of agreement, taking the path of least resistance. By changing our approach to the partnership, consciously being less confrontational and referring to the logic of our narrative created space for discussion, predictability in behaviour and ultimately stronger collaborative outcomes.

We also needed to look inwards at the organisation's internal bureaucratic systems to create institutional space to begin meeting the MoH on requests that made sense for patient care. In part, this meant expanding our staffing to deliver on our medical commitments. Creating a shared idea of collaboration with the MoH and the results such a collaboration would bring, as well as the limits of our compromises, allowed us to expand our budgets and hire more critical staff. In doing so, we were able to keep the surgical theatre functional, raising our credibility with the local community and the MoH. These elements allowed us to build trust and ensured the incremental acceptance of our narrative amongst internal and external actors.

These three elements interwove to rekindle the priority activities. Showing progress brought trust and encouraged collaboration. We saw first-hand how success breeds further success. It is difficult to maintain a credible negotiating position if your ability to deliver is in doubt, though perceptions of that ability grow with each successful delivery. As such, it was unlikely that we could form a strategic narrative for the relevant stakeholders to rally around if our initial commitment was stalled. Gaining early wins allowed momentum to build.

However, momentum does not run on inertia. Continuous energy inputs are needed, and this is one of the difficulties in maintaining forward movement in large, ambitious projects. It also means institutionalising certain changes. In the case of Haiti, it meant fostering a culture of collaboration, starting with headquarters-level briefings, position papers and continual reinforcement at project level. It also meant developing creative HR solutions to encourage key players to remain engaged with the project and foster a sense of cultural continuity.

The experience reinforced a lesson I have seen repeatedly across humanitarian operations. Momentum is rarely restored through perfect plans or additional analysis. It is restored through shared direction, deliberate prioritisation, and visible progress. Strategic narratives are powerful because they transform uncertainty into shared direction. If your organisation is facing similar issues, it is critical that someone be purposefully tasked with fostering and maintaining this change. In uncertain environments, leadership is often less about finding certainty and more about creating enough clarity for people to keep moving forward.

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