Blood and Milk

(photo credit: dlisbona)

Right now, when donor governments give foreign aid, they do so on the basis of friendship and altruism. While that is certainly one reason, it’s not the whole story. Focusing only on that motivation leaves our partners filling in the gap with their own often destructive theories. In most cases, a powerful motivation for supporting development aid is the desire to live in a safer world. Helping other countries grow healthy and prosperous will makes us all safer. That is a perfectly acceptable reason to give aid.

If we speak honestly about the role of self-interest in international development, it would help us do our work better. It would empower host countries, reduce the idea that aid is basically a bribe to get something from the developing country, and improve community acceptance.

Empowering Host Countries

If we’re giving assistance for no reason other than the kindness of our hearts it puts us in a superior position. We’re the wealthy generous people, helping the poor who need our help. It is inherently disempowering to the people we work with – governments, communities, and individuals.

But, if we both have something to offer and something to gain – that is a partnership. Example: Haiti needs peace and prosperity. The US needs Haiti to stop exporting refugees and start buying the stuff we make. We can work together to make that happen. I think this explains, to a large degree, the success of social entrepreneurship. If you take generosity out of the equation, everyone is equal. And equality is a much better place to start.

Changing the Government View of Foreign Aid

Many, many, many foreign leaders see the world from a pure cold war realpolitik perspective. They assume that development aid is a quid pro quo and it’s given to win their geopolitical support. They genuinely don’t believe that aid could be given for another reason.

If development aid is just barter for geopolitical support, then it doesn’t matter if the aid projects are effective. It doesn’t matter what kind of work is supported. In fact, it doesn’t need to be development aid at all. It could just as easily be helicopters, weapons, or a new set of gold toilets for the dictator’s palace. Especially in countries where top-level leadership is corrupt, this doesn’t lead to host country support for development efforts.

While increased GDP and national prosperity benefits everyone, plenty of the short term efforts needed to bring that about have losers. Corrupt elites in particular tend to suffer, and they can and will oppose development projects for that reason. Strong support is needed from the host country is required to push past that. Knowing that the donor country values successful development efforts because it’s also dependent on the outcome helps to generate that support.

A caveat. Making donor interest in development clear could also lead to host government efforts to hold aid impact hostage. “If you care so much about regulatory reform, we’ll keep it from happening until you buy seven gold toilets.” But even that kind of gamesmanship is a game that takes impacts seriously, and is a form of empowerment, however unpleasant. And a donor can take the long view and refuse to play.

Community Acceptance

In my own career, I have been asked over and over by community leaders, local government officials, and plenty of other people why the US is funding the project I work for. They are curious, and they’re suspicious. They’ve seen enough American movies not to think Americans are saintly and loving. We must have a reason for doing something so good. But what is it? Having no clear answer makes us look suspicious.

Think of the famous case of the Nigerian religious leaders who refused polio vaccines. I strongly suspect that one reason they refused was that were looking for ulterior motives. Why would Americans want to send vaccines for Nigerian kids? Altruism alone didn’t make sense as an explanation, so they found another – the vaccines causes AIDS and sterility. They had also already been mistreated once by the international pharmaceutical industry, deepening their doubts. What if we’d said in the first place “We want your kids to grow up strong and healthy so that they work hard, get rich, buy American products and don’t become terrorists.” That’s an ulterior motive that makes sense.

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I was recently contacted by someone asking me to help in their campaign to get the MCC to reverse their decision on suspending funding to Nicaragua. I declined, and I thought my logic might be useful to other people.

The Millennium Challenge Corporation was specifically designed as a funding agency that would provide support to countries that adhere to certain standards of good governance. Its purpose was to set high governance standards, reward the countries that achieved them, and suspend funding for the countries that did not. From their website “MCC is based on the principle that aid is most effective when it reinforces good governance, economic freedom and investments in people.” Biased municipal elections legitimately qualify as “A significant policy decline or policy reversal,” in the MCC criteria for suspension of funds.

You can object to the establishment of the MCC, and argue that all US funding for international development should go through USAID, which makes an effort to support development over political pressure, although it is not always allowed to do so. You can also, as I suggested on the SGHE blog, advocate for giving USAID more autonomy and immunity from political pressure.

However, I don’t think it is fair, or a good use of time and energy, to lobby MCC to go against its own stated policies. I don‘t think they will do it, and I don’t think we should ask them to. If you want aid with this kind of conditionality, I suggest you lobby congress for the end of the MCC. They could easily move the Millennium Challenge Account funds to USAID, and have them take over current projects and select future ones.

I myself don’t object to the MCC. I wouldn’t want to see all US foreign assistance subject to this kind of process, because there are many countries with restrictive, undemocratic governments with people who need and deserve development assistance. However, as an experiment with its own separate funding stream, I think MCC is doing some things we could learn from.

We’re seeing a lot of discussion right now about aid conditionality. A decent summary of the arguments is here. I’ve seen some interesting reports that say it does lead to good governance, and some convincing papers that it does not. MCC’s obsessive focus on indicator tracking could actually give us some definitive answers on whether a big chunk of governance-conditional aid actually affects things.

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I’m going to start with #9, because a lot of you asked about it. And I don’t want people thinking I was suggesting we convert people to, well, anything. No pith helmets, bibles, Korans, or books of Mormon here.

But missionaries do have a model we can learn from, at least the ones that I have met. They come into a country with a long-term commitment. They don’t just want immediate results; they want souls. Missionaries bring their families and children with them, and those children go to local schools. They live in houses that are nice by local standards, but not in the expat palaces your average foreigner lives in. They bring their stuff with them in suitcases, not container ships.

Missionaries don’t try to do any soul-saving at first, spending a minimum of six months learning local language and culture. Mormons are renowned for their language skills. And once they have learned it, they stick around, spending years or even decades in country. They devote themselves to work in one particular place.

Compare that to your average expatriate working in development, for a donor or implementing a project. The expat lives in a little bubble of fake-home, cushioned by consumable shipments, huge shipping allowances, and hardship pay. With air conditioning and heating to ensure they’re even in a different climate. And they stay in once place for approximately 35 seconds.

Good people don’t have time to get great, and average people don’t even have time to get good. Complicated programs suffer as a result, and funding is biased toward things that are easy to implement and understand. No one has time to learn local context.

Donor governments rarely have people in place for longer than five years. In some cases, it’s not even allowed. Implementers are the same way. Three to five years, on average. The incentives are to keep moving from place to place. If you get a job in, say, Hanoi, while you’re already living in Hanoi, do you get housing and shipping and expat allowances? No. You get brought on as a local hire, and whatever salary they think you’ll settle for. If you want the big package, you apply for a job somewhere else.

And the ambitious, hard-working people who are good at running programs are usually chasing that big package. Think of the one guy you know who’s been in country for ten years, taking jobs with different projects as he can find them. Is he full of useful his skills and local knowledge? No, mostly he’s just a loser. Usually he doesn’t even have language skills to show for his decade of residence. If you set things up so that the ambitious people need to hop, then they will hop. The only ones who stay in place will be the people without the ability to move on. That doesn’t support good program management.

It’s even more painful with the donor types. At least program staff are bound by the specific terms of their grant or contract. An incompetent or philosophically opposed country director can only do so much damage. Every two or three years, someone brand new comes in, with the authority to radically alter all current programs. There’s a six month learning curve while they sort out their job and get some clue about the country. Then a nice two years, at best, of reasonably competent donor oversight, and then they’re emotionally checked out and focused on the next posting.

I’ve seen USAID country directors come in and kill programs that they thought weren’t working. And they were, but they were also hard to understand. Too hard to figure out in a couple weeks of reading reports.

Host country donor staff make a major difference in institutional competence, but it’s a rare donor who lets national staff run their programs. The fear is corruption, mostly, but there is also a capacity problem. The people with the education and skills to really run a donor program aren’t working for USAID, World Bank, or CIDA salaries.

Two years of reasonably competent donor oversight is a depressing best case scenario. When you have a really good donor representative, they are like an extra brain for your efforts. They can help you dodge problems, adapt quickly to challenges, and negotiate different government relationships. It’s a synergy that can make all the difference.

And it pretty much never happens. More often than not, your funder’s representative doesn’t speak the local language and doesn’t even know the nation’s major cities before they land. No matter how smart or committed you are, you don’t have time in a few years to get up to speed enough to be really useful. One of the very few things we know about what works in development is that your interventions need to be precisely targeted to the local context. We can’t do that if nobody knows enough about the local context to make that happen. And how do you take a long view on development when no one stays for enough time to think that way?

So that’s what we can learn from missionaries. Stick around until you know what you’re doing. Project managers, and donor representatives, should have regional knowledge and language skills. They should be deeply steeped in local culture. We need incentives to get good people to stay in one place and become experts at it. Well, first we need it to be permitted. Then we need incentives.

If we’re uncomfortable keeping country directors around for the long haul because of corruption concerns, then we could keep other people in country instead. Technical people, for example. You could have some just-rotated-in manager making the final decisions, guided by a team who’s been working in this context long enough to know what works. You also need host country nationals in as many positions of authority as possible. Get past those corruption fears with good financial controls, ethics training, and employee mentoring. (Yes, it’s an incomplete solution, but so is rotating people constantly to keep them from getting attached.)

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Photo credit: bp6316
Chosen because they look exactly like the missionary kids I see in Tajikistan.

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This is the heart of whatever it is I am writing - my ten core principles for improving the provision of international aid and the implmnetation of development projects. I have decided to just keep writing while I figure out what form this document takes - white paper, article, book. For now, I offer you the skeleton. I’ll expand on each of these ten in future posts.

I realize there isn’t a whole lot to comment on, or for that matter, read, here, but I’d love any comments you have on my basics here.

1. Evidence-based development
2. Fund people, not concepts
3. More, smaller programs, more flexibility to change.
4. Longer funding cycles.
5. Focus on self-interest in international development.
6. Get real about donor coordination; it occurs primarily through individual relationships.
7. Recognize not all governments have the best interests of their populations at heart. You can’t have general policies for host country collaboration.
8. Tags, not categories.
9. Forget the private sector; learn from missionaries. Cultivate regional and technical expertise.
10. Kill off the development studies programs.

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photo credit: perpetualplum
Chosen because it was going to have to be either a skeleton or a big 10.

Technorati Profile

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Some time ago, in a time and place I’m not going to specify, a middle-aged woman brought me a human uterus in a jar. She was a pathologist, and she’d stolen it from her place of work. It was a healthy uterus, she said, with a healthy fetus inside, that had been removed by a gynecologist under pressure from the government to keep birth rates down.

Needless to say, my project could do nothing to help her. We didn’t even know where to begin. We weren’t a human rights project, or even a reproductive health project. We didn’t have the contacts with the government to make them stop this kind of behavior. I thanked her for her honesty and passion, and gave her the contact information for Human Rights Watch.

Until today, that was the worst story anyone had ever trusted me with. I’d heard worse things in the media, of course. But that was the worst story some had asked me to help with.

What really got to me was that it wasn’t her uterus she was carrying around. (And, it turned out, she took it everywhere, for fear the government would steal it and she’d lose her evidence.) It belonged to a stranger. But this pathologist saw a systemic wrong, and she wanted to change that.

I don’t think anything has changed in that country. I think she is still carrying that uterus in her purse.

That woman is my hero. She’s more than a little bit nuts at this point. She sleeps with a human organ under her bed. She’s Don Quixote with a scalpel and a supply of formaldehyde. But she’s not complacent.

And that’s why I’d like to slap both Bill Easterly and Jeff Sachs upside the head. There are human lives at stake here. There are people suffering and dying and risking their lives to help others. And nothing the big guys are saying right now is useful to me.

I want to know how to do my work better. I want to know whether it’s useful to have the EU pull its funding from the country whose name I won’t mention or if it’s more effective to keep pushing small changes and hope they add up. I want to know if supporting democratic institutions actually leads to democracy.

The high level debates about theory and the middle-aged guys mud-wrestling about African aid do nothing for me. You are very, very smart. You know more about aid than just about anybody. Please, give me something useful.

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photo credit: caro’s lines
Chosen because the jar is somehow sad.

Tags: rants
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This one’s for Glenna.

There are lots of ways you can prevent or cure malnutrition. They come down to emergency feeding, supplementation, fortification, and changing food behaviors. Here’s a high-speed tour, in order of speed of impact and sexiness to donors.

Therapeutic foods come in two forms: powders that are mixed with clean water to become nutritional formulas, and ready-to-use therapeutic foods. Both are used as emergency measures, the tools of last resort to prevent death. You need to target them in a very specific way to use them well. Formulas are starting to be supplanted by the very trendy plumpy’nut, which can be used without a doctor’s attention once distributed. Some malnourished people are still so bad off that they need formula, though.

When you need therapeutic foods, something has already gone wrong. They are a patch for a broken system. A clear example of a downstream solution. Quick to get started, rapid results, no real long term impact. Very very sexy to donors, since feeding starving children is exactly the thing people think about when they picture aid work and projects get going fast.

Vitamin supplements don’t need to be heavily targeted, but you can’t just give them out to everyone. Different categories of people - children, pregnant women, and so on - need different nutritional supplements. Not a ton of supervision is needed, but some. In addition to targeting, someone has to physically give them out. Supplements need a health system, or at least a logistical system, behind them. Somewhat exciting for donors, since programs gear up fast and little children line up adorably to get their vitamins.

Food fortification doesn’t need a logistical system or medical support. If you get iron and folic acid into the flour, iodine into the salt, and vitamin E into the oil, you can improve the nutritional status of an entire population. But you end up supplementing a whole lot of people who don’t need it. It’s effective, but it’s not efficient. You also need a government capable of enforcing fortification, so it’s an upstream solution. And we’re starting to see some evidence that some kinds of fortification, like folic acid, can increase some kinds of cancer, so they are not an unqualified good. Fortification is boring for donors. They details and politics of fortification are honestly pretty boring for nutrition experts, let alone people trying to decide where to give their twenty bucks or overworked government types.

Lastly, changing food behavior involves teaching people how to eat in a way that meets their nutritional needs. The classic examples are not selling home grown vegetables and using the money to buy processed foods, and increasing the consumption of legumes, especially in combination with leafy greens. So many things affect individual eating behavior that this is an upstream and a downstream solution. It’s about what is available to eat, and what people choose from that. Changing nutrition behaviors is very, very hard. It takes a long time and shows its impact slowly. It’s downright repulsive to donors, because it reminds everyone of all the vegetables they ought to be eating themselves.

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Photo credit: mashnicaragua

Chosen for reasons I hope are obvious.

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flat tire

The most recent installment of the Notes from the Field series on the Aid Watch blog was written by a “veteran NGO leader” from Nepal, Scott MacLennan. In it, he decries the absentee management and outright deceptions of large NGOs, arguing that “Only small NGOs it seems are able to actually get out in the field and get their hands dirty making things happen.”

I disagree. I disagree passionately. Only competent, well-run NGOs are able to make things happen, and those factors are unrelated to size. It comes down to the skills and qualities of the people running the NGO. An organization can influence this by the way it selects people. This is wholly unrelated to size.

To further argue my point, I’ve made a handy list of the pros and cons of small and large NGOs:

Large NGOs:

Pros

1. Have a certain base level of competence because of their broader experience.

2. They can more easily expand or supplicate successful projects.

3. They usually have enough staff that if a country director in Nepal leaves they can pull someone from, say, Sri Lanka rather than leave the post vacant while they hire.

4. They are used to the requirements and mechanics of donor bureaucracy, and that lets them get started more quickly and not be bogged down in paperwork.

5. They generally have more experience with financial controls and are usually better at it.

6. They may have enough different projects to leverage their presence. For example, I once threatened a local official that we’d cancel laboratory skills trainings if they didn’t allow a child health campaign.

Cons

1. They can be inflexible.

2. They can have a lot of bureaucracy that stifles change.

3. They may lose their personal touch - it’s just work to them.

4. They generally have a higher percentage of funding from government donoirs, which limits their programmatic options.

Small NGOs:

Pro

1. They tend to be more flexible and able to change directions quickly.

2. They tend to be emotionally committed to their work.

3. They are generally funded by small private donors, which means they have many more choices of how to use their money.

4. They are often very connected to the communities they serve.

5. They can be more innovative.

Cons

1. May be short on technical background, or have more good intentions than useful knowledge.

2. They may not have enough experience to realize they are reinventing the wheel, or worse yet, reinventing a flat tire.

3. May not have dedicated finance and administrative staff, which means financial accountability is weaker.

4. If a staff member leaves, they have to advertise and hire to replace them - no pool of people to draw on.

That list makes it pretty clear that it’s not the size of the NGO that matters. Different kinds of organizations have different strengths. What matters is now an organzation uses those strengths and overcomes its weaknesses. Size, in this case, doesn’t matter.

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Photo credit: Austin Tolin

Chosen because, well, it was pretty. And this is a hard concept to illustrate.

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overturned SUV

(photo credit: Kim Scarborough)

1. In Tajikistan, where I currently live, and in Central Asia in general, married women wear scarves on their heads. So do unmarried women older than about 25. It’s not a religious thing at all. It’s just what women do. Visitors often come to Tajikistan for a week and leave thinking that it’s a deeply religious country because of all the women wearing hijab. If you either a) asked someone or b) knew enough about Islam to know what a hijab has to cover, you wouldn’t make that mistake. But people don’t know, and they don’t ask. They walk around, they make assumptions, they go home and share their misinformation.

2. In order to graduate from my alma mater, Georgetown’s School of Foreign Service, you have to be proficient in a foreign language. My roommate and I both chose French. In the weeks leading up to our proficiency exams, we spoke French to each other at all times to practice. Once, I heard someone comment as we walked by “That’s why I love Georgetown – the constant exposure to other cultures.”

That’s my convoluted way of saying we get things wrong all the time. Sometimes our science is bad, sometimes we haven’t bridged the culture gap as securely as we’d like, sometimes we’ve made so many compromises that we ended up somewhere we don’t belong. Some of that we can prevent. Both of my examples above could be prevented through spending more time and doing more research.

We can’t prevent all of it. As long as our programs are designed and run by human beings rather than infallible robots, mistakes will happen.

We do, however, need a resilient system to catch our mistakes and a corporate culture that lets us make changes when we realize we’ve screwed up. We can catch our mistakes through monitoring and evaluation. That means not just collecting data, but looking at it, thinking about what it means, and using that meaning to guide program decisions. And we can keep our errors to a minimum by cultivating an atmosphere where people are encouraged to admit their mistakes. If you maternal and child health director realizes that the patient education classes aren’t doing anything, she needs to be free to re-design the curriculum or cancel the activity and spend the money on childbirth kits.

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Here’s my bibliography for learning about international development. It’s not exhaustive - more the very basics as a starting point. Overall, I like books for theory and background, articles for technical information and detail, and blogs for the on the ground perspective and a peek into the industry of development. I don’t think theory helps with a sense of how development work actually gets done (that’s my major critique of Easterly, in fact) and I don’t think you can actually do this work well without some kind of background on the picture of what development is and what its goals are.

Books

William Easterly,  The Elusive Quest for Growth: Economists’ Adventures and Misadventures in the Tropics. Cambridge: MIT Press. 

Ruth Levine,  Millions Saved: Proven Successes in Global Health.  Washington: Center for Global Development, 2004 

Carol Lancaster,  Foreign Aid: Diplomacy, Development, Domestic Politics.  Chicago: University of Chicago Press, 2006. 

Amartya Sen. Development as Freedom. New York: Anchor, 2000.

Articles

JR McNeil, “The World According to Jared Diamond”

Roger Bate “The Trouble with USAID” American Enterprise Institute. May 23, 2006.

USAID White paper

Brian Atwood, Peter McPherson, and Andrew Natsios, Arrested Development

Blogs

Chris Blattman’s Blog

From Poverty to Power

Center for Global Development Blogs

World Bank Private Sector Development Blog

Owen Barder

The Bottom Billion Blog

Aid Watch

Tags: basics
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A Tajik colleague told me, quite a while ago, that poverty make people cruel. It stuck in my mind. The way she said it, as an absolute truism, resonated and reminded me of the cruel things I have seen poor people do. Mothers who sell their daughters in sex slavery, for example, or the horrors exerted on child laborers in Bangladesh. Or even, on a level down, the awful treatment of animals in many developing countries.

It seems impossible to argue that poverty leads to cruel things. Not really an interesting or disputed point. The real question, I suppose, is whether wealth also leads to cruelty. When you consider systemic cruelty, the answer is yes. The factory owner who benefits from child labor is as culpable as the parents who give their children to the factory. Probably more culpable, since the factory owner could make money in another way.

I posed the question of poverty and cruelty on Twitter, and I think that Ian Thorpe gave me the best answer. He suggested that inequality makes people cruel. That explains the people on the bottom end of the pyramid forced into cruel actions and cruel choices, and the people on the top end, so far from poverty that poor people and their problems no longer seem real to them. It’s easy to be cruel when you can’t see your victims. Or when you think their problems are inevitable and can’t be solved. Or when you think poor people make themselves poor or even aren’t quite human. Inequality creates the kind of distance that makes that happen.

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(photo credit: myradphotos)

Chosen because it shows one of the cruelest forms of child labor.

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