By Sakuntala Narasimhan
The World Health Organisation (WHO) notes in a publication released earlier this month that a “huge amount of new financial commitment, worth over $40 billion,” has been pledged by a collective of global agencies, towards maternal and child health projects in developing countries. The strategies that these projects will focus on include “innovative approaches” like the use of mobile phones “to create awareness and promote health” so that individuals and communities can have the information they need to make decisions about their health. Although the publication mentions the need to “address structural barriers to health,” the assumption is that lack of information and knowledge is the limiting factor. This assumption shows a woeful ignorance of the socio-cultural complexities that make up the local matrices within which “development” work has to be undertaken, which is why in spite of the hundreds of billions of dollars that have been poured into developing countries as aid in the last five decades, there has been no commensurate improvement in the social sector parameters in terms of adequate food, shelter, access to healthcare and education.
Poverty persists in the developing regions; the gap between the haves and the have-nots has in fact widened in the wake of globalisation over the last two decades. Despite substantial growth in GDP, those on the lower economic rungs in these nations (India, Bangladesh, Pakistan, and many countries of Africa and South America) have seen their lifestyle parameters worsen. Maternal mortality is still unacceptably high in these regions (the Asian subcontinent accounts for a quarter of global maternal deaths). Infants are dying in unacceptably large numbers, of illnesses that are preventable. So why haven’t the massive doses of aid from overseas succeeded in delivering what they set out to address?
A candid answer to that question can be found in a new publication, titled So Much Aid, So Little Development: Stories from Pakistan (Johns Hopkins University Press, ISBN 978-1-4214-0137-9) written by Samia Waheed Altaf, a Pakistani specialist in public health who was a member of an international team that oversaw the Social Action Programme (SAP) in Pakistan during the ‘90s. She has observed and chronicled the way decisions are made in disbursing aid from multilateral agencies. Using real life stories of aid recipients and beneficiaries, the book describes how giving and receiving aid has become an end in itself – the donor agencies have the satisfaction of putting on record that so many millions were spent on such-and-such projects, while the receiving country pats itself on its back on the inflow. Invariably, however, the American or European “experts” who fly in to devise, and advise on, health projects, have no idea of the local constraints, and come up with strategies that guarantee failure in terms of real improvements in ground realities.
Young girls are recruited for stipends, for instance, and given training in creating awareness on family planning or contraception. The girls enroll because they need the money, but once the training is over, there is no way their families are going to allow them to go from door to door “creating awareness” about contraception (or even about general health issues for that matter) because young women do not wander around like that, unaccompanied, to address strangers. Not done, certainly not in the rural Asian context. The “experts” who fly back with a report about the completion of the project, have no idea why the training doesn’t result in better community health indices. As for awareness, the lowliest among illiterate villagers knows of course, that it is inadvisable to drink polluted water – but what options do they have, when the factory set up (in the name of development) discharges toxic effluents into the river that is the source of water for the community? Or when water bodies dry up? Pregnant women do not deliver their babies at the hospital, not because they are ignorant but because they do not have the money to get to the nearest hospital, or there are no roads connecting the village to the city, or for a dozen other reasons. Women have multiple pregnancies not because they do not know any better, but because of son preference, which has nothing to do with foreign aid but decides how effective a project for limiting families will be. The western “consultant” who wonders why a woman does not walk out of a marriage where she is not permitted to go out and get involved in community work, is no different from the infamous French queen who wondered why the poor protesting about lack of bread could not eat cake.
The foreign experts stay at five star hotels, hire air-conditioned cars and go shopping for exotic handicrafts to take back as “bargain buys” (just $45 per cushion cover that would cost four times that much, in New York). Nearly 40 per cent of aid money goes back to the donor countries, as consultants’ fees (one of the conditions governing aid is that consultants from the donor country should be hired) and incidental expenses (hiring a fleet of vehicles, staff, field helpers, interpreters, meetings, daily or deputation allowances, publishing a glossy report with a liberal sprinkling of appropriate buzz words and highfalutin phrases).The human dimension gets completely ignored, in the pursuit of paper projections and academic analyses.
Samia Altaf gives you hilarious accounts of how advisors from overseas go about implementing their “projects.” The epilogue, where she voices her concern about the way the West “aids” the poorer countries with scant regard for the appropriateness of their strategies under local conditions, is alone worth its weight in gold. How many at the World Bank, IMF and WHO have read this account of how aid actually works? How many high level bureaucrats with policy making powers at these agencies, will make the effort, or learn from these observations?
Sakuntala Narasimhan is an award winning Indian journalist and author specialising in gender and development. This op-ed appeared in Dawn, Karachi, on October18, 2011 and is reproduced here with permission of the author.