Month: May 2009

A Request for Useful Information

By Alanna Shaikh | | 15 Comments |

empty jar

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.

Nutrition and Malnutrition

By Alanna Shaikh | | 4 Comments |

 

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.

Why size doesn’t matter

By Alanna Shaikh | | 7 Comments |
flat tire
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:

Pros

  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. They 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. They 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.

Making Mistakes

By Alanna Shaikh | | 8 Comments |
overturned SUV
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.

International Development – a bibliography

By Alanna Shaikh | | 4 Comments |

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, 2001.

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

Does poverty make people cruel?

By Alanna Shaikh | | 5 Comments |

A Tajik colleague told me, quite a while ago, that poverty makes 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.