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The War of the Causes in Aid

The development industry seems to be riddled with people whose main job is to divert money to their good cause. The advocates are united by a strong belief in the priority that should be given to their sector (education, water, AIDS etc). They convince themselves that they are speaking for real interests of the poor… Within many aid agencies there is a permanent state of low intensity bureaucratic warfare for resources…{staff} fight to defend and expand funding for the causes they work on. They deliberately stoke up pressure in private alliances with civil society organisations – many of whom they fund – to raise the political stakes through conferences, international declarations, and publications with the aim of committing funders to spend a larger share of aid resources on their issue.  ….But for the aid budget as a whole these are zero sum games, and everyone would be better off – and many lives would be saved – if it stopped.

This quote comes from a blog post by Owen Barder which is now several months old. For some reason we’re just seeing it now, but thought it was still worth sharing with our readers too.

He gives AIDS in Ethiopia as an uncomfortable example of this kind of advocacy distorting aid:

According to the World Health Organisation (WHO), in Ethiopia about 65% of the population (52 million people) live in areas at risk of malaria. Malaria is the leading cause of health problems, responsible for about 27% of deaths; and malaria epidemics are increasing. The HIV/AIDS prevalence rate among adults is 2.1% (2007) – that’s about 1.6 million people living with HIV.

Of $5.15 per head provided in aid for health to Ethiopia in 2007, about $3.18 per head was earmarked for HIV  while about $0.26 cents per head was allocated to malaria control.  Given the relatively low burden of HIV, earmarking 60% of health aid for HIV is excessive relative to other needs for health spending.

Of course it is right that we should try to make sure that everybody with HIV has access to medicines to keep them healthy, and … to prevent spread of the disease. But we should also make sure that people have bednets and drugs to stop malaria, provide childhood vaccination to prevent easily preventable diseases, ensure access to contraception and safe abortions, and, above all, enough funding to provide basic health services that would save thousands of lives and suffering.  Yet we are not willing to provide enough money to do all of this.  It is in this context that it is damaging to earmark 60% of health aid to HIV.

Owen is equally blunt about the way forward:

we should, as a development community, heap scorn and opprobrium on anyone caught advocating for more resources in their sector.  We need stronger social norms in development that frown upon this kind of anti-social behaviour.

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14 Comments

  1. Justin Kraus wrote:

    Here is another example of this problem.
    http://anthropologyworks.com/?p=1357
    To summarize, recently there has been a small movement towards developing aid projects that focus specifically on helping young males. This move has been regarded very skeptically by those who have traditionally supported aid projects focused exclusively on helping women.
    Such petty zero-sum thinking should, as Owen says, be met with heaps of “scorn and opprobrium.”

    Posted March 2, 2010 at 9:15 am | Permalink
  2. butters wrote:

    Let me preface this by saying I don’t now and never have worked in aid, and I don’t work for a government department, although I used to. I have no personal stake in this argument though, in terms of convincing myself of anything. I only mention this because he talks about people who are convincing themselves they are doing good. That doesn’t apply to everyone who may disagree with him.

    The heroic assumption here, of course, is that ‘bureaucratic warfare’ is a zero sum game. The whole argument falls apart otherwise. He recognizes this with his very brief hand waving on the point, but really, it’s too important to hand-wave away given that the entire argument rests on it. His treatment of this makes me feel like he’s trying to pull a fast one on me.

    Is there any real empirical work on this to back up the claim? I assume he would have cited if so, but I just want to confirm with those more in the know.

    THAT would be interesting and would be quite surprising (to me anyway) if true. If it could be convincingly shown, it would certainly move my priors on the whole issue.

    The first one to think of a good instrument for bureaucratic warfare gets a publishable paper….redy-set-GO!

    Posted March 2, 2010 at 9:23 am | Permalink
  3. didier wrote:

    It’s interesting that he states the problem as one of bureaucrats within agencies fighting for their piece of the pie (which is pretty much what happens in any large institution that becomes departmentalized). My experience is that its the “private alliances” and “civil society organizations” who bring the pressure to allocate more resources to their sector when they believe those agencies to be unresponsive to what they perceive to be teh important issues of the day (I would add legislators and the earmarking process as the key allies for those groups).

    The intensity of those battles won’t diminsh given that it is not only a zero-sum game (with regard to public funds) but often one of declining foreign aid budgets.

    Still one wonders if this is not just one of the manisfestations of an open society that allows for various ideas and issues to compete through the mediating institutions of the foreign aid process. What would Barder prefer to do…dictate where the resources should go?

    Posted March 2, 2010 at 10:25 am | Permalink
  4. Ari wrote:

    I’m just not sure how this is any different than *any* segment of the government budget. In fact, that’s exactly what the political process is in any healthy country: an open competition for government resources, or “low intensity bureaucratic warfare”, as Barder calls it. Every sector makes its arguments to be prioritized – depending on the persuasiveness of the arguments, they might win or lose. How else is a democracy supposed to work?

    Are you arguing instead for one benevolent aid-dictator to survey the field and divide up the pie as he/she sees fit, just assuming this person has perfect access to completely objective information about everything?

    Barder says “lives would be saved – if it stopped”…and what?? Not sure what the alternative is.

    Posted March 2, 2010 at 10:33 am | Permalink
  5. Jim wrote:

    Aid funding is less like a centrally planned economy and more like a free market. It’s not like everyone involved in aid all over the world get together and know exactly what problems are out there, exactly what their solutions are, and exactly how much money there is – and then plan accordingly for world betterment. In the absence of central planning and regular resources, you do get competition. Sometimes among agencies, sometimes within. Of course it’s ironic. But I’m sure there is an invisible hand somewhere in there…. ;)

    The whole situation is a bit like a Quentin Tarantino movie – he usually begins with some absurd-seeming scenario and then he works backwards to show his viewers how this absurd scenario actually came about – he shows all the inter-playing factors at work. Unlike a good Tarantino movie, a lot of aid criticism just stops at the first scene – leaving viewers with a bewildering final impression but without unravelling for them how this all comes to be. At this point, all kinds of wrong assumptions are made, and self-righteous positions taken.

    Of course the voices that are silent here are the people engaging in this metaphorical warfare – I bet if we hear their daily accounts of decisions being made – we’d get a very different picture. However, they have neither the time nor interest to sit around and write blogs bc they are busy on the frontlines dealing with reality instead of just writing about it from a safe distance.

    I’d like to set up a reality-tv show – let’s call it Critical Aid – where smug aid critics have their confidence tested in the thick of things. Let’s put them in charge of mid-size aid projects and see how they perform. Each episode can be based on them facing one of their main aid critiques and we can see if they really can do any better. We can also follow their emotional development throughout as they see themselves, aid, and colleagues in new light. I see some episodes of emotional breakdown, fallen pride, and finally rebirth. It would make for really good viewing.

    Then they could write the types of books that people will read 100 years from now.

    Posted March 2, 2010 at 11:04 am | Permalink
  6. Owen Barder wrote:

    Thanks for picking this up.

    A couple of the commenters have asked what the alternative is. One says: “[is this] just one of the manisfestations of an open society that allows for various ideas and issues to compete through the mediating institutions of the foreign aid process. What would Barder prefer to do…dictate where the resources should go?”

    The answer to this is definitely “no”, I don’t think the decision should be determined by bureaucrats, however well-intentioned. I am in favour of a competition of ideas and diversity of approaches. But evolution needs both variation and selection, and while we have quite a lot of variation, we almost completely lack mechanisms for selection in the development sector. Competition among bureaucrats and special interests is unlikely to be effective unless it is in the context of institutions that generate greater accountability. I’ve tried to set my thinking as coherently as I can in this CGD Working Paper: Beyond Planning: Markets and Networks for Better Aid (pdf) (I apologise in advance that the paper is rather long and indigestible).

    Owen

    Posted March 2, 2010 at 12:28 pm | Permalink
  7. Dan Kyba wrote:

    Great post.

    The difference in resource allocation, as demonstrated by Owen, between HIV/AIDS and malaria also reflects the example of how priorities can be driven by the home country and funding source of the NGO rather than then needs of the host country when being an NGO becomes a business for well-placed individuals within it. In this case, HIV is a also a donor country issue whereas malaria is not, therefore HIV will receive the lion’s share of donor resources and media attention in the home country.

    The saddest part of this ABC split between donors (A), providers (B) and recipients (C) is how some NGOs in their drive for self-sustaining funding and volunteer support will deliberately perpetuate within A existing mythologies for their purpose, rather than honestly educate funding groups and perspective volunteers.

    Another problem with this split comes with the evaluations. If NGO (B) is funding and providing assistance to a local CSO (B1) then there is added another layer between donor (A) and recipient (C), that is if, in such cases, there will even be a C. With A, B and B1, regardless of whether there is a C, there comes a closed and self fulfilling feedback loop.

    The final issue comes from my field observation that especially now with the internet, the lowered transaction costs have made it is easier and more lucrative to form a local CSO and ally oneself with a foreign NGO then it is to form and operate locally a real MSME business. So long as the money keeps coming in through the NGO and exacerbated by the broken A B C feedback loop, the CSO can stay in business a long time. Since the money is not earned, but rather collected from government and donors, this does become somewhat of a zero-sum game as one NGO’s gain can become another NGO’s loss. Be this as it may, it is this final point, relative ease of creation coupled by a relative lack of market and donor accountability that is fuelling the rapid increase in the number of NGOs and their local CSO partnerships.

    Posted March 2, 2010 at 12:33 pm | Permalink
  8. Michael wrote:

    It’s hard not to agree with the general point. But the examples miss an important point. AIDS really is different from most diseases. Societies have sustained themselves through many generations of high child mortality. AIDS, on the other hand, has in some places killed enough of the young adult population to destroy a whole community.

    Malaria mortality is about twice as high in children as in adults, and for the childhood vaccination comparison the point is obvious.

    It may be that the flow of aid dollars is driven partly by what you see when you look right at a village, rather than at statistics, and in this case the less direct view may be the better guide.

    Posted March 2, 2010 at 5:43 pm | Permalink
  9. Mark Rutherford wrote:

    Despite Owen’s disclaimer, I don’t see how he can avoid claiming the authority of a tyrant who can adjudicate the proper claims of the advocates for one disease, one sex, one age group over another. Moreover, how could that tyrant be certain that he or she was correct in the adjudication? Owen is complaining about the state of nature. More good than harm has been done by letting a thousand advocates advocate – and more harm than good has been done by the top-down imposition of a single answer to all problems. And temporary misallocations are both inevitable, and temporary, as fallible humanity goes forward.
    Owen should just grow up.

    Posted March 2, 2010 at 9:44 pm | Permalink
  10. geckonomist wrote:

    Well, the aid community wastes aid money “on behalf of the poor”, and Owen Barder wastes foundation money on “writing long and indigestable working papers”.
    I can’t spot the difference. The result for the poor is the same, isn’t it.

    Producing self repeating papers with a message that he himself does not even believe in, for which he doen not want to held accountable, he just wants “to provoke discussion”. (just read §95. if you don’t believe me).

    No poor man has ever benefited from such “work”.

    Posted March 3, 2010 at 4:10 am | Permalink
  11. Owen Barder wrote:

    @geckonomist – With respect, no foundation (or anybody else) paid me a dime for writing that working paper.

    Posted March 3, 2010 at 11:24 am | Permalink
  12. Sam Gardner wrote:

    Indeed, the core of the problem is the lack of good systems for allocating resources in aid. meanwhile, it seems to me however that the political process, through advocating for a sexy cause, has some advantages compared to the current bureaucratic, where the discarded Dollar-Burnside study still dictates how countries get funded.

    A better solution would be to eliminate all proxy indicators for “good aid”, going for direct indicators and rigorous evaluation and evidence basis.

    Posted March 3, 2010 at 5:17 pm | Permalink
  13. Raphael wrote:

    Free market competition for allocation of aid dollars is not what led to the disproportionate allocation of money to one epidemic. It was, in large part, due to a choice by the Bush administration – it was his development priority, for better or worse. The Obama administration is doing the same with Agriculture and Health, it seems. So it really was a top down process that resulted in the Ethiopia problem – not a bottom up fight for limited resources.

    However, the solution is NOT a bottom up approach of NGOs fighting for a finite pie. The political process is about power and those with more money and connections (not those with the best evidence) will get funded in any darwinian struggle.

    What is needed, instead, is a change in norms where govts start funding what works based on evidence. (And thank good USAID is finally investing in M&E and learning after a long dry spell.) So proven interventions should be prioritized – ala Copenhagen Consensus. ROI should be measured. RCT and qualitative research should be used in evaluating effectiveness and determine future funding.

    Fund what works rather than whoever has the loudest voice …. My $0.02.

    Posted March 4, 2010 at 2:45 pm | Permalink
  14. Oftentimes the real purpose and direction of aid programs are drowned by donor policies and politics. There is need for reality check as to what programs must receive bigger allocation. It’s frustrating to know that HIV programs received the bigger aid slice when people, especially children are dying of diseases like malaria. Also, it is not enough to assume that channeling funds through NGOs/civil societies alone would ensure aid delivery. It must be a tripartite effort among NGO-Govt.-Donor and the sincere commitment to really make a difference in the lives of our suffering brethren.

    London Office Property

    Posted March 6, 2010 at 9:45 am | Permalink

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