Friday, 15 September 2017

Making aid work

In 1990, one in four children in Malawi died before the age of five. By 2016, the proportion had fallen to one in 16.

I was totally unprepared for that astonishing statistic, quoted by Melinda Gates in her article on progress against the Sustainable Development Goals. In Ethiopia, deaths under five dropped by a half in just eight years. Across the world, since 1990, the lives of six million under fives have been saved, the equivalent to the whole population of children in France.

How did this happen? Through:
  • implementing vaccination programmes against polio, measles and so on;
  • distributing bed nets to guard against malaria;
  • providing better access to family planning which enables mothers to have fewer children to whom they give better parenting and care; and
  • preventing and dealing with ordinary, but potentially lethal, childhood illnesses like diarrhoea. 
Not 'rocket science', as they say.

In Ethiopia, between 2011 and 2016, the proportion of women giving birth in health facilities rather than at home increased from 20% to 73%. Fewer maternal deaths results in fewer orphaned and neglected children, and fewer babies and toddlers being suddenly denied the breast milk essential for survival.

In Senegal, only 3% of women had access to contraception in 2011 . Today, the figure is 15%, nowhere near high enough but a huge improvement over five years.

In India and Kenya, microfinance provided direct to women themselves, often through mobile phone technology, has helped many to enter the labour market for the first time (not work, women have always worked). Women with their own earnings spend them on food, healthcare and education for their children.

Across the whole world, the proportion of people living in poverty has halved since 1990. In 1990, 35% of the world's population lived in 'extreme poverty' (on less than $1.9 per day). Today the figure is 9%.

How did these extraordinary improvements come about?

Well, some of the developments which contributed to these impressive results have been initiated by national governments. Countries such as China have made enormous strides. In 1990 two thirds of its population lived in extreme poverty; today just 2% do. While China has achieved this success largely through its own sometimes ruthless policy decisions, other developing countries have been more dependent on outside sources. Development aid has been provided by governments like our own, for instance, through DfID/UKAID or USAID. Aid has also come from the European Union, the United Nations and the World Bank. It has come from large charities and non-governmental organisations (NGOs), such as Oxfam and Christian Aid, from Foundations like the one established by Bill and Melinda Gates and from partnerships like the Global Fund.And many smaller NGOs and charities, both local and international, have made their own contributions.

Put more simply: the taxes which you and I pay and the pennies we contribute to collection boxes have saved the lives of millions of children and enabled countless men and women to provide more effectively for their families.

And yet, despite the acknowledged successes of international aid, its existence can still give rise to passionate, entrenched and conflicting views. And there is good reason for this.

Last year, the Economist published an interesting analysis of aid distribution, entitled Misplaced Charity. Just as the positive article by Melinda Gates started off with reference to Malawi, so did the Economist's rather less positive piece. It opens with reference to the enormous amount of aid which Malawi has received over the years.

"In 2012 Western countries showered $1.17 billion on it, and foreign aid accounted for 28% of gross national income."

The article goes on to state:

"The following year corrupt officials, businessmen and politicians pinched at least $30m from the Malawian treasury. A bureaucrat investigating the thefts was shot three times (he survived, somehow). Germany said it would help pay for an investigation; later, burglars raided the home of a German official and stole documents relating to the scandal. Malawi is no longer a donor darling. It now resembles a clingy lover, which would be dumped were it not so needy. It still gets a lot of foreign aid ($930m in 2014), but donors try to keep the cash out of the government’s hands."

The Economist makes the point that aid is more likely to be effective if it is given to well governed countries, not countries like Malawi. And yet, it is in countries like Malawi that the need is greatest, if only because of the impact of political and social dysfunction on ordinary families. Nevertheless, as the first sentence of this post demonstrated, aid has significantly improved life for the citizens of Malawi, despite the extreme levels of corruption. The issue is not easily resolved. After all, it can be our money which is stolen, though not exclusively.

I spent the month of August working in Malawi. These are some of the stories I picked up from newspapers at the time. Some are about theft, some about incompetence and poor management. All are about the inability (or reluctance) of the government at national and local level, its key national agencies and individual institutions to provide efficient and effective public services for its citizens.

1. The Public Accounts Committee is to set up a forensic audit of ESCOM (the Electricity Supply Cooperation of Malawi), MACRA (the Malawi Communications Regulatory Authority) and other public bodies, because of the 'plundering' of resources, the audit to be carried out by donor countries. Malawi already suffers from power shortages caused by the impact of reduced rainfall on hydroelectric plants. Only about 9% of residential housing has acces to electricity. The effect of outages on public services and business can be little short of catastrophic. Mzuzu's Central Hospital has had prolonged blackouts and, with no backup generator, staff are concerned about the bodies in the morgue. In many health centres, it is common for midwives to deliver babies by the light of their mobile phones. It is not only public services which are affected. Malawi's precious fledging industries find it difficult to operate consistently and their machinery keeps breaking down because of the insecure power supply.

2. Dishonesty may also be a problem. Staff at Queen Elizabeth Central Hospital in Blantyre have been charging patients for free services such as blood transfusions and surgery, and pocketing the money.

3. Fractured sewage and water pipes which were due to be replaced long ago contaminated the water supply and flooded Area 18 in Lilongwe, the capital. Burst pipes happen in every country. The issue, however, is how long it took Lilongwe City Council and Lilongwe Water Board (LWB) to do anything about it: more than a month. Eventually, the Parliamentary Committee on Agriculture, Irrigation, Natural Resources and Climate Change gave the Malawi Housing Corporation four days to sort the problem out. In the meantime, local residents either had to use filthy water or pay for prohibitively expensive bottled supplies. Both ESCOM and LWB have continued to provide illegal connections for houses built in contravention of planning guidelines. Sewage pipes, including those from hospitals and industrial sites, empty directly into the rivers from which people collect water and in which they do their laundry and bathe, contaminating the water with pathogens and poisonous metals. About 50% of urban families use untreated sewage to grow their crops. Some of the manure from sewage is illegally sold to farmers as fertiliser by water board staff, leading to warnings about eating salad crops.

4. The Central Internal Audit Unit of the Ministry of Finance, Economic Planning and Development has stated that district councils have abused 21% of their development budgets. Abuse includes misappropriation of funds, poor value for money in procurement and district commissioners who, when caught stealing funds, are simply moved to other districts.

5. The ruling Democratic Progressive Party (DPP) has been holding 'Blue Nights' to which they invite state companies. Each of the guests 'voluntarily' donates large sums of money. Among the guests was the LWB, who handed over K5 million  (£5,200) of public funds despite being unable to provide an essential public service to its customers in Area 18. (The rumour is that LWB was actually asked for K10 million). Blantyre City Council donated K5 million of its taxpayers' money to the DPP while the poorest city council, Mzuzu, paid over K3.5 million. Civil Society Organisations have challenged the DPP about these payments.

6. The Minister for Health and Population announced that an independent study had shown that 30% of the country's publicly-funded drugs are stolen before they reach healthcare professionals. They are then sold back to health centres.

7. Dowa District Hospital, which serves a population of 800,000 people, has had no running water or toilets, though the problem seems eventually to have been fixed. However, similar problems have affected other health centres.

8. The Anti-Corruption Bureau and Fiscal Police have launched an investigation into 250 missing passport books, a situation in which immigration officials working at the highest levels have been accused of selling them for over K10 million each. Some passports have been found in the hands of foreigners. The newspaper article from which I took this information concluded, without irony, "The Malawian passport is highly preferred as Malawians are viewed by many outsiders as trustworthy and unable to commit fraud or terrorist attacks." The bit about terrorism is almost certainly true.

9. MANEB (Malawi's Examination Board) has withheld examination results from 250 secondary schools which failed to send it the fees they had already collected from candidates (K30,000 or £31 pounds for each pupil - a lot of money.) Last year, when the same thing happened, school directors were arrested for embezzlement. It was doubtful whether the unfortunate students would be issued with the certificates essential for their future careers.

10. The Ministry of Foreign Affairs and International Affairs has told the Public Accounts Committee that officers at the Malawi Embassy in Ethiopia syphoned off K293 million and paid it into personal bank accounts. Overall K538 million was mismanaged.

And so it goes on: endemic corruption at all levels, including at the very top of government. The notorious Cashgate scandal to which the Economist's article refers, drained K236 billion of public funds, and was already underway in 2009, long before the years 2012-2014 to which the legal charges refer. Bingu Mutharika, previous President and brother of the current President, declared assets valued at K150 million when he assumed office in 2004. He amassed wealth valued at K61 billion during the eight years he was in power. Such plundering of the public coffers does not just affect the obvious victims. International donors contributed to Malawi's national budget using taxes collected from their own people.

And there are other forms of dishonest practice which affect the work of development agencies at far lower levels. One that I find immensely frustrating is the 'allowance' culture. In most countries, civil servants are paid a salary and expected to carry out their assigned tasks without further payment. In Malawi, in contrast, civil servants receive salaries but expect to be paid additional money for every meeting they attend or visit they make. If you submit a paper for discussion, there is an immediate request for payment to 'facilitate' discussion and comment.

Attendance at meetings and active partnership working are often contingent on the amount paid in allowances, not the relevance and usefulness of the support provided. You often end up doing the work on your own as your colleagues have found something more lucrative to spend their time on. It can be unnerving to have them get up and leave in the middle of a meeting because they are off to another meeting sponsored by a different organisation which provides a more generous allowance. Development partners (donors) have laid down guidelines for such payments but they are frequently ignored. Indeed, some unscrupulous agencies, including some well known NGOs and international organisations, deliberately pay inflated allowances in order to attract participants away from work initiated by other organisations.

Senior civil servants working in education are doing particularly well at the moment. They are being paid very generous allowances to 'monitor' a programme funded extremely generously by the USA. Whole sections of the education system appear to be grinding to a halt while civil servants add to their take-home pay, all in contravention of the Civil Service Code which, as in other countries, forbids civil servants from supplementing their salaries with fees from additional work for other organisations.

Yes, you can no doubt tell that I find this very irritating, and not just me. Indeed, sometimes I have seethed when, having flown half way across the world to work on a project or to carry out training, the people I am supposed to work with have disappeared off elsewhere to earn an extra bob or two.

And yet, it is not that straightforward. Salaries of even senior officers are extremely low, even taking into account the low cost of living. While this may partly be because of the lack of resources at the centre, it is also because it is a requirement of the International Monetary Fund that debt-ridden developing countries like Malawi keep the wages bill down. Remember, unlike in the UK, professionals such as teachers are deemed civil servants. Ordinary teachers may be paid as little as K40,000 per month, about £41. Primary headteachers may receive only K60,000. Even senior officers will be paid far less than is necessary for them to feed, house and educate their own children. Hence the desperate attempts to acquire extra allowances from whomever will pay them.

Even worse, officers' substantive salaries are often paid late, as happened in August. The announcement came that there had been a delay in transferring the necessary documentation between government departments, a somewhat unconvincing excuse given that this routine activity is done every month. However, then it was reported in the press that the money for salaries had been diverted to the DPP to support its campaigning in the forthcoming parliamentary and ward by-elections to be held on October 17th. The Nyasa Times claims that the government is panicking about the elections because of accusations of underperformance. This claim was denied by the Secretary to the Treasury. Still, it is an interesting perception.

A senior accountant in one of the departments claimed that all paperwork had been submitted on time, but that the money was, in fact, diverted to pay striking teachers. They were striking because yet again their salaries hadn't been paid.

He went on to say, “We are also reliably informed that some money has been used to pay outstanding payments to DPP functionaries who do business with government to enable them comfortably help the party in the by-elections.

The paper concludes the article with the following statement, "Due to lack of fiscal discipline, Government has of late been caught failing to fund essential activities such as health and education while a number of its ministries, notably the Ministry of Education (teachers), have been failing to pay their employees on time."
And so it goes on. The impact of government dysfunction on education is irrefutable. While these days more children are being kept alive in Malawi, as the Gates Foundation's figures show, the education they receive is pretty dreadful and has been getting worse. Here are a few facts and figures published by the Borgen Project.
  • Only 35% of children finish primary school and only 8% finish secondary school.
  • The teacher-pupil ratio in Standard 1 is 1:130.
  • 83% of learners in Standard 1 are unable to read a single syllable, and 92% cannot read a single word. 
  • Malawi is ranked the weakest for its performance in English reading and second weakest for mathematics against other southern African countries. (Southern and East African Consortium for Measurement of Educational Quality - SAQMEQ)
  • Pre-school education is run mostly by unpaid volunteers and most centres are unregistered. 44% of pre-schoolers are undernourished.
In the past, international donors provided 40% of Malawi's expenditure on education, but since the Cashgate thefts, have suspended their contributions. They may now support individual projects but they no longer pay into the country's coffers to support public services as such.

The Malawi government currently allocates 18% of its budget to education, more than most other African countries. This figure is encouraging as at least it demonstrates that the country values education and recognises its essential contribution to improving most other aspects of life for its citizens, for example, health, agriculture, industry, business, farming and the ability to combat climate change.

The Borgen Project article concludes, "However, when comparing the educational quality with other countries, it can be noted that Malawi does not allocate its funds efficiently."

Indeed.

Many a time I have come to the end of my stint in Malawi utterly convinced that the only solution is for development aid to be withdrawn from the country and for the people and their country to accept and take responsibility for their own future. I know I am not alone in thinking this. I have often heard resentment expressed in the African media and, sometimes in my presence, of the continued involvement of ex-colonial countries like our own in providing aid and other forms of support. There can be a feeling that developing countries are being bullied and manipulated into taking action which they would not themselves choose.

People may question why consultants like me are being paid generous fees to do work which local people could do. This does, of course beg several questions. Sometimes people whose only experience is from within their own setting may not know what they don't know. Often what is needed are new ideas not more of the same. People may also be unaware that fees which seem so generous compared with their own salaries are sometimes well below what consultants might receive working for commercial organisations or even other development agencies.

The organisations for which I have worked do not donate cash; they share skills. However, it is cash which sometimes seems to be valued far more highly than any knowledge or skills that people like me contribute. Yet, as soon as I start thinking in this way, usually at my lowest point when I am tired and keen to go home, something happens which contradicts that point of view. For instance, during my most recent visit, my colleague and I provided training for senior educationists which they all attended without the incentive of an extra allowance. Not only did all participants attend for the full programme, but they took active roles and were animated and enthusiastic about the workshops provided. We have good hopes that practical outcomes would result. Yes, it was definitely worth doing.

We also have to consider the real costs of even a reduction in international aid, let alone discontinuing it altogether. The Gates Foundation report notes that, "... projections for HIV suggest that a 10% cut in global donor funding for treatment—a not unduly pessimistic assumption—could lead to 5.6m more deaths by 2030 than if spending remains on track." 

Each of those unnecessary deaths is likely to be that of a parent who then leaves a family unsupported, or of a child who became HIV positive at birth through maternal transmission. In Malawi almost all treatment for HIV/AIDs is provided through American aid.

And while countries like China and India are showing significant progress in reducing poverty (though the gap between rich and poor may still be unacceptable), the continent of Africa still has major problems in achieving something similar. The birth rate in many African countries is still very high: in Nigeria each woman gives birth to an average of 6.4 children. Many of the poor in Africa exist far below even the definition of 'extreme poverty', an extraordinarily low baseline. Infectious tropical diseases such as malaria exact a huge toll from its population.

Africa has the world's youngest population. In 2015, the number of young people aged 15-24 was 226 million. This figure is expected to double by 2055. While the average age of an African president is 62, the median age of Africa's population is 19.5 - the world's largest gap between governors and governed. In 2015, 12 million young Africans entered the labour market, but only 3.1 million jobs were created. Poor education and skills development coupled with a lack of jobs threatens not only economic performance, but could almost certainly give rise to political and social unrest and increased crime. Bright young people and their parents and communities know this, of course, which is why so many are risking their lives in the Mediterranean and ending up in terrible detention centres in Libya or sleeping rough in European cities. Those who migrate are those who are seeking self-improvement - just as young European colonialists, our own ancestors, did in the nineteenth century.

So tempting though it may be to think that the days of supporting poverty-stricken countries through the provision of international aid are over, the real costs of letting down hundreds of millions of young Africans are too overwhelming to contemplate. On a practical level, well-targeted aid provided within their own countries may prevent so many of them migrating and dying.

Sadly, however, the USA under President Trump has already slashed foreign aid budgets, particularly those used for family planning. While Britain remains one of the most generous providers of aid, this status may not survive the changes in attitudes brought about by Brexit or the economic downturn which may result. Already, support for refugees in a number of countries including Britain, is being taken from the aid budget, a decision which reduces support to some desperately poor countries.

The Gates Foundation Report while recounting so many positive stories of progress supported by so much hard reliable data, also contains a plea for aid to be retained at least at the current levels. The Foundation itself has been responsible for saving so many young lives, for enabling so many women to take their futures and the futures of their children into their own hands, that we should listen to it. However frustrated transient people like me may become, they and other similar organisations are in it for the long haul. We, our fellow taxpayers and our governments shouldn't let them down, nor, above all, the people that they serve. And if that means that we have to hold our noses and stomach the greed, self-centredness and corruption of politicians and civil servants, so be it, if by that means we provide hope and sustenance for the millions of young people they are letting down.


Sources for this post

Misplaced charity, the Economist, 11 June 2016

Goalkeepers: the stories behind the data, child mortality, Melinda Gates, Bill and Melinda Gates Foundation, 13 September 2017

The 10 most important facts about education in Malawi, the Borgen Project blog, 20 August 2017

The Gates Foundation is worried about the world’s wellbeing, the Economist, 14 September 2014

Great strides have been made against disease and poverty, the Economist 14 September 2014

Africa's defining challenge, by Mohamed Yahya, the Africa Regional Programme Coordinator for the United Nations Development Programme, UNDP blog and also published in The Daily Times 7 August 2017

Articles from the following newspapers:

Weeked Nation 5 August 2017
The Nation, 7 August 2017
The Nation, 11 August 2017
The Nation 24 August 2017
The Nation 29 August 2017
The Nation 1 September 2017
Malawi News, August 5-11, 2017
Malawi News August 12-8, 2017
Malawi News, August 19-25 2017
The Daily Times August 7
The Daily Times August 11
Nyasa Times August 23
Nyasa Times August 24
Nyasa Times August 29

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