Escaping the realities of the health care system – at your expense.

There’s nothing like allowances for representatives of national assemblies to really get people fired up. Annoyed as people get about MPs salaries, it’s the perks that lurk below the headline wage that cause righteous spluttering and indignation. The UK’s parliamentary expenses scandal that erupted in 2009 resulted in resignations, de-selections, and even jail sentences for those MPs unable to come up with even the barest semblance of a plausible reason as to why they should pay rent to their partner, have their hedges trimmed, or buy new toilet seats or duck houses with public money (OK, the duck house claim was actually rejected – but the picture of some hapless MP trying to argue it was legitimate is too good not to mention).

The salaries and benefits of MPs in Tanzania and Kenya have in recent years come under fire. In Tanzania, reports over the past few months – denied by government – that MPs have received increases to their salaries and benefits (including a grant of $98,000 when they leave parliament, and a 285% increase in sitting allowances) has caused a scandal. In Kenya, Kibaki may have vetoed a planned pay rise that would have made Kenyan MPs the highest paid in the world, but in 2012 MPs quietly voted substantial increases in benefits packages.

But it’s not all about the monetary benefits. Less often commented upon, but equally (or perhaps even more) pernicious, are the health benefits that accrue to those with power. For legislators, it seems, health care in Europe’s finest hospitals and clinics is one such perk. In Tanzania, MPs, their spouse and up to four children under the age of 18 are provided with medical insurance that will cover ‘treatment within the United Republic and abroad‘ (my emphasis). Up until last year, Kenya was more generous in the scope of its coverage, allowing for up to two spouses and eight children. Changes in 2013 mean one spouse and four children up to the age of twenty-five can be treated in US or European hospitals, as well as in private wards of local hospitals, with cover worth up to $115,000 for in-patient procedures (as well as support for outpatient treatment, maternity, dental and optical support).

Now there’s nothing wrong with the principle that health insurance should be part of the benefits package of MPs. But paying for treatment abroad might be. Isn’t it a bit of a problem if they don’t have to come into contact with the same conditions politicians are ultimately responsible for ensuring government provide to the rest of their compatriots? If MPs are not subject to the same problems, delays and difficulties in accessing decent health care, where is their incentive to improve it (or their ability to really understand the nature of the challenges?).

In the UK, the annual September hunt for the cabinet minister who sends their child to a private school is a long tradition. What kind of vote of confidence is it, critics ask, if government members won’t send their kids to the type of establishment the rest of us use for ours? The difference is that this is not subsidised by the public purse: if you think your child will only reach their potential in the rarefied corridors of Eton or St Paul’s, you have to pay from your own salary. Similarly, if you want to be treated by a Harley Street doctor rather than go to the local NHS hospital, you need to fork out yourself.

Of course, one could hope that MPs can and will champion issues they have no direct experience of. You don’t have to have been a victim of domestic violence to realise its horrific impact and push for reforms to end it and provide support for those in fear. And, in Tanzania and Kenya as elsewhere, many do act on such principles. But giving people the opportunity to escape from the realities of poorly functioning services can have dangerous consequences. There’s nothing like knowing your health and wellbeing depends on a broken system to provide an incentive to make sure it is fixed. And if the state cannot stop the rich escaping such perennial pressures of everyday life, it certainly should not be subsidising them. If the elite want to make use of the private clinics of Europe, North America and elsewhere, let them pay for it themselves out of their (already generous) salaries.

An aside: Tellingly, perhaps, the Tanzanian act, outlining the benefits package to MPs, writes of the “Member of Parliament … [and] his family”. I haven’t read through the entire text of the Kenyan equivalent, but on first glance couldn’t see any similar assumptions as to the sex of the MP.

Posted in Uncategorized | Tagged , , , , , | 3 Comments

Museveni, the Anti-Homosexuality Law, and the politics of the succession

So Uganda’s Anti-Homosexuality Bill has finally been passed, after years of ‘will it, won’t it’ to-ing and fro-ing, signed by President Museveni at the end of February. The law has been modified from its original iteration – the death penalty for so-called ‘aggravated homosexuality’ was dropped a while back, and the clause which criminalised those who failed to report LGBTs has similarly been taken out – but it is still a virulent and horrific attack on the rights of LGBTs in a country in which homosexuality was already illegal, and those believed to be gay subject to intimidation and attack.

I’ve spent the past six or seven years following the unfolding story of the rise in homophobia (a word that doesn’t really do justice to the absolute hatred towards LGBTS held by many) in Uganda. Much has been written about the role of foreign and local Christian organisations, the incitement to intimidation that has been the very public ‘outings’ undertaken by certain Ugandan newspapers, and the potential impact of the various clauses of the new law.

What I am more interested in here is why Museveni has so publicly signed the bill now, risking his reputation with donors and setting up an inevitable confrontation with the US and the EU.

Since the 1990s, Museveni has been one of the most successful of African leaders in promoting himself as a vital and strategic ally to western powers, and a staunch supporter (and promoter) of economic reforms pushed by various donors and international finance organisations. He has done this by manipulating conflict in northern Uganda, the existence of various rebel groups (some of which appear to rest more in Ugandan government rhetoric than in reality) in neighbouring countries, and the attacks by Islamic militants in the country linked to Uganda’s involvement in Somalia. Through these, it has been able to define itself to western government audiences as both a victim of terror, and a vital ally in the Global War on Terror that begun in the early 2000s. Allying this with just enough verbal (if not necessarily actual) commitment to economic reform, it has done a very clever job in muting criticism of its governance record, of the rampant Third Termism, of which Museveni was a prime example, or of escalating military expenditure (defended as needed to counter domestic and international security threats which would also affect western strategic interests).

At the same time, Museveni has been manoeuvring within Ugandan politics to ensure he is seen as the indispensable leader – the only one who can protect Uganda against security threats from terrorists, and challenges to Ugandan independence from donors. Over the past decade he has done all he can to undermine political opponents (whether branding them as traitors or terrorists, or banning marches and media criticism). He secured his third term as president, following the now traditional route of constitutional change. And he has presented himself to Ugandans as a nationalist leader at his prime.

On the broader East African stage, Museveni’s regional ambitions have seen him described as ‘the Napoleon of Africa’ (I can’t remember who by, I’m afraid, but interestingly it echoes a longer-standing nickname of his, albeit for different reasons). So alongside Uganda’s presence in Somalia, and involvement in South Sudan, we also see Kikwete rapidly written out of the story of efforts to reconcile Odinga and Kibaki during the post-election violence in 2007-08. Museveni is determined that he personally is seen as the regional leader to whom others turn for advice, support and mediation.

I think it is within this context that we need to see the vacillations of Museveni over the Anti-Homosexuality Bill. Since the bill was first introduced as a private members bill back in October 2009, it has been delayed, promised rapid action, delayed again, as Museveni has alternatively assured he would, then would not sign any bill passed by parliament. He has been seeking to address two different constituencies: donors, with his promises to water down, or even reject the bill, designed to show them that in Ugandan politics they cannot do without him to defend their interests as well as those of political and economic reform; and Ugandan citizens, to whom he casts himself as the protector of Ugandan values and independence against donors who would seek to enforce alien values (an image of the strong nationalist which also plays neatly into his regional ambitions). His actions also undermine the opposition: should they support the bill (which clearly resonates with much, but by no means all, opinion), risking making themselves look irrelevant and giving tacit support to Museveni’s claims to be defender of Ugandan autonomy; or should they garner the support of donors by rejecting it, but potentially undermining their credibility within Uganda?

This strategy has been highly successful over the past four or so years. Museveni has faced criticism from donors, but little that has seriously challenged his political hegemony. So why has he signed the bill now? Presumably the balance between donors and internal politics has shifted to the latter, and Museveni sees more political capital to be made from being seen as supporter of the bill and defiant against the donors. Perhaps the calculation has taken on board that donors have been reluctant to challenge seriously the regime over long-standing accusations of illegal detention, torture and even extra-judicial killings of opposition leaders and supporters, so why would it start taking notice now over a bill that targets LGBTs (a reading that may prove wrong, but probably not – donor indignation tends to be short-lived and short-sighted). Aid levels (and hence dependency) has been falling since 2009, which may have further tipped the scales in the calculation, and in any case some donors are already up in arms about corruption allegations. So how much is there to lose from angering this particular audience?

But underpinning the strategy must be thoughts as to his own political future and succession, especially with reports and rumours of internal divisions and disarray amongst the inner circle. Right now, to secure that future, Museveni needs to burnish his nationalist (rather than donor darling) credentials. And if, as previously in Uganda, in Kenya, and countless other examples, donor outrage soon peaks, Museveni’s gamble will look as if it has paid off.

Whatever the reasons, the result is that life for LGBTs and organisations set up to defend their rights, will become harder. LGBTs have long faced serious intimidation, violence and the threat of death in Uganda, especially since the late 2000s when attitudes and hatreds significantly worsened. But for the political elite, the law, homosexuality, and LGBTs have become pawns to be used to further personal and party ambitions. Will donors make a difference, when they have so spectacularly failed to do so in other instances of gross violations of rights? Let’s see.

Posted in Uncategorized | Tagged , , , , | 1 Comment

NGOs, Journalists and the media: because even NGOs have PR teams

When I read a review of a hotel in the travel section of my favourite newspaper, the fact of who has paid for the accommodation is usually stated somewhere at the bottom: accommodation was provided by a travel company / the hotel, etc. In the Observer restaurant review, Jay Raynor pays for his food himself, and actively resists the freebies that might accrue from a chef desperate to curry favour. In refereed journals, published research should as a matter of course identify the funding which supported the work.

Different examples, but one common theme: I want to know whether the review I am reading might possibly be coloured by a complimentary bottle of Petrus or a freely-provided suite. And I especially want to know whether research that tells me how good ACME Cure-fast is for healing all ills has been funded by the ‘independent’ ACME Foundation for Encouraging Tame Researchers to Say What We Want Them To. The same applies to stories on the news: have they been ‘placed’ by a PR company, ‘spun’ by the spokesperson of a government department, and who has written the narrative – the journalist or someone else?

This week George Alagiah was presenting a number of pieces on South Sudan across the BBC news platforms. They were interesting and good reports. One was on maternal and child health care services, and the tragedy of the number of newborns who die within 24 hours of birth. The interviews with mothers who had recently lost their children were sensitively done for the most part.

But in this report, a few things stood out. The health clinic with whom the reporter was travelling was, we were told, supported by Save the Children. Save the Children logos on the clothes of those being filmed, and on the cars George and his team were travelling in, were prominent. The story was linked to a report and campaign being launched by the NGO, and its Chief Executive Justin Forsyth spoke from South Sudan to BBC Radio 4’s Today Programme.

Now of course, there is nothing wrong with this campaign, nor with its being reported. But it is a reminder of how many news stories across much of sub-Saharan Africa are driven (and the narrative shaped and controlled) by NGOs. This is by no means an egregious example – this is certainly not the mess of media reporting that was Goma in the late 1990s.

Nevertheless, it is quite clear that Save the Children, from ensuring its branding is on display, and being identified as the sole supporter of the hospital at Nimule, is in the driving seat. At one point it was reported that ‘according to Save the Children’, around 4,100 children die within their first 24 hours of life. But this isn’t a figure that comes from the NGO. It comes from WHO statistics. It may seem a rather petty thing to be concerned with, given the tragedy and horror that statistic points underscores, but surely responsible reporting should be going to the source (I would, for example, expect my students to go to the original source)

There is widespread concern that too many media stories are driven by NGOs who provide not only access, transport, and ‘facts’, but more worryingly, the narrative as well. Indeed, I have heard George Alagiah himself voice concern on this precise issue. This is not to say NGOs should not get their campaigns, findings or concerns on the news; nor that journalists should not engage with NGOs. But more care needs to be taken to both assert media independence and provide full transparency. Where reporters are given access via an NGO, use their transport, are taken to particular areas or facilities by an organisation, this needs to be clearly stated during the report. Surely no-one believes any more than just because the organisation is a humanitarian one, it is free from questions of self-interest in the shaping of narratives?

NGOs have private interests, as much as altruistic humanitarian objectives. Just as we should be careful of the PR experts who spin government stories, and rightly mock the shambles of Mastercard’s PR company trying to dictate what journalists should say in return for tickets to the Brits, we also need the media to ensure full and open independence from even those organisations whose humanitarian motives would seem to be honourable and decent. Above all, let’s not forget that NGOs have increasing numbers of very professional, very skilled PR teams whose job is to raise the profile of the organisation and its campaigns. And the job of journalists should be to make use of, but not be driven by, those PR teams, no matter what kind of organisation they work for.

Posted in Uncategorized | Tagged , , , , | 2 Comments

A nudge, a shove, but little respect

It used to be an old joke that sociology was the study of people in rich industrialised countries, and anthropology the study of the poor in poor countries. All very unfair, but I was reminded of it when hearing the news about a trial project in the UK offering money to women who continue to breastfeed their babies for up 6 months. Described by various newspapers and broadcasters as the politics of the nudge (offering incentives of various kinds to encourage healthy behaviour), it would be known as a conditional cash transfer were such a scheme to operate in Africa, Asia or Latin America. Those of us in the global north need to be nudged to be virtuous, those in the global south, bribed.

The scheme, which is being trialled in ‘deprived’ areas of South Yorkshire and Derbyshire before being rolled out as a national pilot (if successful) will give women up to £200 in shopping vouchers if they breastfeed for the first six months of their child’s life. According to those running the scheme, the vouchers will act as incentives to promote behaviour that is seen as providing better health outcomes for children (and for mothers too).

The politics of the nudge may have a fancy name, may be seen as the gentle, encouraging look of the nanny state (rather than its punitive, “I’m very disappointed with you” variant). But it is, of course, nothing new (calling something a new name doesn’t suddenly give it a different provenance). Conditional cash transfers (CCTs) act in precisely the same way: offering cash provided the established conditions are met, be it children attending school, taken for their vaccinations, etc.

It may be that it works, but as with the underlying premise behind CCTs, it does rest upon a set of assumptions that are problematic at best. It assumes that the key reason women do not breastfeed for six months (surveys suggest that around 55% of women are still breastfeeding at eight weeks, although that falls to a quarter in more economically deprived areas) is economic. Or rather, that economic incentives will be enough to overcome other barriers. But of course (and whilst I can claim no direct knowledge of this, I do remember my wife’s experiences with our first born) breastfeeding is hard. My wife was lucky: she had excellent support in the midwife-led maternity unit, and attended a friendly breastfeeding support group. But not all new mothers are lucky enough to receive this support. Decent structures being put in place, rather than resorting to bribery, would be a far better use of resources. Explaining the benefits of breastfeeding, and accepting that some (perhaps for good reason, perhaps not) will not follow that behaviour, rather than castigating those who fail to live up to the expected standards, is surely a better idea.

There is a second problem with the politics of the nudge / CCTs. As Jishnu Das writes in his blog, both assume that the outcome is better. But they do not say better for whom, or for what. Attaching conditions to cash transfers, or seeking to bribe, sorry, nudge, people into good behaviour assumes that there is broad agreement on what constitutes ‘good’ behaviour. But more than that, it implies that behaviour or activities that do not accord with this are implicitly bad, something to be changed. In doing so, it not only denies agency to individuals, but sets up unhelpful distinctions between good and bad behaviour, and from that good and bad people. And how long do nudges need to be ignored before the temptation starts to start shoving a little harder? As Das notes, there is a big difference between children being sent to school, and children actually learning.

Won’t somebody think of the children!
Of course, in the case of CCTs (and in the case of nudging towards breastfeeding, if the pilot does appear to raise rates), the cry will go up that even if we think people should be able to make decisions about their own behaviour and life more widely, what about the children who may be denied school, denied the health benefits of breastfeeding, etc. as a result of ‘selfish’ (or ‘bad’) decisions made by their parent(s), and it’s a fair point. The state does have a responsibility to step in when children are being denied services to which they are entitled (or which carers are legally required to provide). But unless actual harm is being done, surely we have to respect the decisions of individuals? And don’t the poor have as much right to make decisions as the rich (who aren’t targeted by CCTs or shopping vouchers)? Apparently not: in publicly funded schools in the UK, parents can no longer take children out of school for holidays, or even family weddings. Such restrictions don’t apply to the privately-schooled (not by government regulation, in any case).

One could also say that governments nudge all the time: by taxing cigarettes to discourage smoking; taxing fuel or cars with heavy emissions, for environmental reasons, etc. But shopping vouchers is on a different scale. The pilot may succeed in increasing breastfeeding rates. But whether this is the best way to achieve that, on a sustainable basis, and for more than a relatively small number of mothers and children, is questionable. And whilst some may see this as a rigorous test of the viability of the scheme, it is nothing of the sort: why not try another pilot alongside, say increasing welfare support for the most deprived, coupled with investment in post-birth support for new mothers, and see what difference that makes. Testing one scheme may show an increase. But it certainly won’t show whether it is the best approach.

Nudges and CCTs have a place, and there is plenty of evidence that CCTs are linked to positive results (although here we are back to Das’ point, positive for whom?). But so have unconditional cash transfers. The lesson is perhaps we should trust people more to make decisions over their Iives, and seek to address the social, economic, political, and structural barriers that prevent them putting those decisions into effect.

Posted in Uncategorized | Tagged , , , | 1 Comment

Technology trials and ethics: is being cheaper good enough?

I was recently at a technology for health event, during which a number of designers showcased their inventions. One such project plans to use biometric data as a means of accessing patient medical records through mobile phone technology. The project has designed a biometric scanner that can link patients to their medical records. Health workers scan the fingerprints of the patient, which can then create a new unique ID for that patient, or allow the health records of existing patients to be downloaded to a phone, improving medical treatment and support. It is one of a number of similar initiatives seeking to make accessing of patient records, and identification of individual patients in remote rural areas especially, easier for health care workers.

ImageIt all looked good: a nice scanner, the (very now) linking in to mobile technology, and the understanding that difficulties in identifying patients, and in knowing their health histories, is a major problem in providing decent healthcare. But in the otherwise solid presentation, one comment stuck out. Kenya had been chosen as one area to pilot the project: in part because of the extensive use of mobile technologies in the country, in areas such as mobile banking for example; but also because Kenya’s regulations on the encryption of data are not as strict as in other countries.

Offshoring of clinical trials for new drugs, vaccines, etc, to low- and middle-income countries has long been a concern of global health governance. Pharmaceutical companies, keen to take advantage of laxer regulatory regimes, or work in areas where it is easier (quicker and cheaper) to recruit participants, have an obvious incentive to do this. In recognition of this fact, the global ethical rules governing such clinical trials attempt to set and enforce minimum standards, no matter where those trials take place.

Clinical trials must be run in accordance with the Declaration of Helsinki principles governing such trials. Physicians, pharmaceutical companies, and all those engaged in medical research involving human subjects must place “the well-being of the human subject” above “the interests of science and society.” In practical terms, research must be underpinned by basic principles designed to “protect the life, health, privacy, and dignity of the human subject”, principles that include:

  • The research must conform to accepted scientific principles.
  • All aspects of the research must have received approval from an independent ethical review committee (which has the right to monitor on-going trials).
  • Only properly qualified people must carry out the research; and only a medically qualified individual can have responsibility for the people.
  • All those involved should have been through a careful evaluation of the risk and burden from participation, as well as the potential benefit.
  • Volunteers must be informed participants, and only under very controlled circumstances can those deemed legally incapable of giving informed consent be engaged as participants (and assent must be granted by the legal representative of that individual).
  • And one principle that has relevance to the discussion of testing out biometric technology: “Every precaution should be taken to respect the privacy of the subject, the confidentiality of the patient’s information and to minimize the impact of the study on the subject’s physical and mental integrity and on the personality of the subject”.

The existence of global ethical guidelines means that, in theory, participants in a low- or middle-income country should be just as protected from unethical clinical trials as those from high-income countries. Within the European Union, for example, “Regardless of where they are conducted, all clinical trials included in applications for marketing authorisation for human medicines in the European Economic Area” must comply with EU directives on clinical trials:

Clinic trials conducted outside the EEA have to comply with ethical principles equivalent to those set out in the EEA, including adhering to international good clinical practice and the Declaration of Helsinki

So whether the participant is in Nairobi, Accra, Mumbai or Manchester, the trial should conform to the same ethical and rigorous standards.

Of course, there are a widely acknowledged failures in translating theory to practice. There are questions about whether EU regulators pay sufficient attention to the ethical underpinning of trials undertaken outside the area in their deliberations (see the report ‘Ethics for Drug Testing in Low and Middle Income Countries’, published by the Centre for Research on Multinational Corporations, for example). And there are serious concerns over the transparency of trials conducted in low- and middle-income countries.

Nonetheless, and it is an important caveat, there are global standards underpinning clinical research trials against which such trials can (and should more rigorously) be judged. What about trials for technology? Certainly there are many working on issues of ethnics in the design and use of technology. But what global ethical guidelines apply to pilot projects that test out a particular type of technology?

To return to the project that started off these thoughts: it seemed to me that the reason the project was piloting in Kenya was largely because it would be cheaper due to the more relaxed regulatory regime. Now, one obvious response is provided that the pilot accords with national laws in the country in which it is based, that should be sufficient to make it ethical.

But is that sufficient? As we have learnt over the past few months, data privacy is a real concern, and encryption of data containing personal details is tremendously important. Of course, one could argue it is for Kenyans to demand their government tighten up regulations. But is there any responsibility on those undertaking such pilot projects to conform not just to national standards, but to best practice in the countries in which they are themselves based? Would they be happy if their personal details (identification details such as fingerprints, sensitive material such as personal health records, etc) were sent between servers and devices with the same level of encryption and privacy as those taking part in the trial? Will those be taking part be informed of the potential risks of this technology (however small the designers believe those risks to be)? Would this accord with the Helsinki Declaration principle that “every precaution should be taken to respect … the confidentiality of the patient’s information”?

There is always a danger that regulatory burdens can stifle creative responses to particular needs, or make the price of testing and piloting new ideas too expensive. But for the same reason global regulations seek to protect the most vulnerable from exploitation through clinical trials (even where those participants may be the ultimate beneficiaries), so too must we take more seriously the ethical implications of pilot projects of all sorts. Doing something because it is cheap is not an ethical decision, no matter how useful or potentially ground-breaking the technology might be.

Posted in Uncategorized | Tagged , , , , | Leave a comment

NGO top salaries: mountains, molehills and interns

In response to the story in The Telegraph highlighting six-figure salaries for (a very small number of) charity bosses in the UK, I was asked to write something for The Guardian. In this piece, I was (and remain) rather unconcerned about the news that Major Organisations with budgets of over £100million and hundreds of staff pay their CEOs large salaries. There is a debate to be had about salary levels, but one that should be based on whether it is fair to have the profoundly unequal wage differentials we have in this country overall, not about the charity sector alone.

But what is clear is that a number of misapprehensions (wilful perhaps?) have been propagated by the initial newspaper reports and subsequent reactions. The fact that some (actually only two from the rather small selection investigated by The Telegraph) earn more than the Prime Minister has been held up as somehow shocking. Why? These are not public bodies (where such comparisons may have more weight). They may be non-profit organisations, but they are also private – a fact that somehow seems to escape the attention of the critics.

Another criticism is that, as organisations in receipt of public funds, NGOs have a moral obligation to rein back pay. Certainly, as organisations mostly critical of the marginalising effect of gross inequality, as organisations working with some of the world’s poorest, as well as being organisations spending public funds, there is a responsibility not to waste money. But we (or rather The Telegraph and other critics of NGO salaries) seem not to be overly concerned with salaries of chief executives of private for-profit organisations who also receive huge amounts of public funds for their work (PriceWaterhouseCooper, for-profits working in the health sector, G4S and its publicly funded (in)security work). To be fair, the salaries of top banking executives, especially bonuses despite continued poor performance, has been a target for hefty criticism. But, large though the amounts of public funding to NGOs is, it pales in comparison to funds to prop up failing banks. And there are no NGO CEOs receiving multi million pound bonuses as far as I am aware.

As I wrote in the article, should we really be judging the work of these organisations (and more specifically that of their CEOs) on the level of income they have raised? Surely we do not see the hallmark of success of Oxfam, Save the Children, Christian Aid, and the others as income? And those that do are surely missing the point. There may be reasons why some CEOs should not be seeing their incomes rising, but not on the basis of a simply profit / loss analysis.

Interestingly, the targets of the attacks on ‘charity boss excess’ are all development and humanitarian organisations, working predominantly overseas. Cancer Research UK, for example, pays two of its staff more than £200,000, and in total 35 receive more than £100,000. To be fair, last month The Telegraph did report that the RSPCA pays three senior execs more than £120,000. I don’t want to see conspiracy against charities working with poverty overseas, but the debate over the past couple of days has been rather one dimensional in terms of its targets.

But if the issue of top NGO salaries is perhaps of less significance (and something of a distraction) than the most vociferous of critics would have us believe, there is nonetheless something of an irony that many of these organisations are happy to defend senior executive pay whilst continuing to recruit unpaid volunteer interns, promising the dubious benefit of gaining valuable experience (that will hopefully one day lead to paid work). I know there’s no direct link between senior pay and internships. But can organisations who campaign against low wages, against inequality, against the exclusion of the poor from opportunities to gain experience and training, really defend internships?

If you’re looking, the Red Cross (CEO salary, £184,000) is advertising for a Health and Social Care Projects intern:

This is a very high profile project working in partnership with other voluntary organisations to create a more integrated pathway of care for our beneficiaries. There would also be opportunities to develop experience in overall project management, a scoping study and needs assessment, as well as, monitoring outcomes and impact and mapping and research of local communities.

One to two days a week for 8-12 weeks, reasonable travel and lunch expenses (well, reasonable as long as they are under £5 per day). Or how about an internship supporting the humanitarian and finance grants team at Save the Children (Chief Operating Officer salary, £168,653): again, reasonable expenses, but very definitely a voluntary position.

Anyone working in a development studies department will know of countless numbers of students who feel required to undertake unpaid internships in order to gain work experience. With so many people clamouring to work in the sector, NGOs and other development organisations can be picky, and hold all the power when it comes to maintaining the internship system.

So, perhaps we should resist the temptation to create a mountain out of the very-much-molehill that is a tiny number of people from a very selective pick of organisations earning vast sums of money. But NGOs should also think a little bit more about the message that is being sent when they defend (fairly) those salaries whilst maintaining an unequal, unfair system that does little to advance the values they seek to propagate globally.

Posted in Uncategorized | Tagged , , , , , , | Leave a comment

It takes a village…

Donors have been accused of ignoring human rights abuses linked to a villagisation programme in Ethiopia. As reported in The Guardian, The Oakland Institute has criticised UK’s Department for International Development (DFID) and USAID for failing to criticise and act upon reports of physical violence, intimidation and other abuses resulting from a forcible resettlement campaign in the Lower Omo Valley.

According to the Oakland Institute report, Ignoring Abuse in Ethiopia: DFID and USAID in the Lower Omo Valley:

Forced evictions, denial of access to  subsistence land, beatings, killings, rapes, imprisonment,  intimidation, political coercion, and the denial of  government assistance are all being used as tools of forced  resettlement

This, and the accusation of complicity and tacit support for villagisation schemes that involve forced relocation, and the abuses of human rights that are associated with such force, should come as no surprise. Donors, NGOs and other international development actors have a long track record of supporting villagisation and resettlement campaigns in the name of development, and of downplaying the violence and intimidation associated with them.

Remember Ethiopia in the mid-1980s, and disastrous attempts to resettle people from the north in the midst of famine and war? Before that, during the late 1960s and 1970s, Tanzania undertook one of the world’s largest villagisation programmes, physically resettling between 6-8 million people in the space of a decade, with much less controversy than the Derg’s efforts a decade later. As I have explored in my research on the history of NGOs, Tanzania’s villagisation programme was supported by a wide range of organisations and individuals who saw in it the potential for a brave new world for those affected.

One consultant, reporting in 1974 for Christian Aid, noted:

Stories are told of peasant huts being set on fire by the military. Doctors and nurses make no secret of  the casualties they had to deal with, including burnt babies, forgotten by terrified mothers, who ran screaming out of huts set on fire.… The most serious consequence of all this is a lack of food, as a result of which Tanzania is facing a famine… [Surrogates of the State, p.106]

Should the NGO for whom the report had been commissioned have been concerned, withdrawn its support for the programme? No. The report continued to what looks like a rather startling and unexpected conclusion:

The scene has been set for a much more comfortable life than the average African has ever known… Whatever the mistakes of 1974, in eight to ten years time, all the new villages will have the promised amenities, and this should increase considerably agricultural production. [p.108]

They didn’t, and it didn’t. Other NGOs, notably Oxfam, were also very much aware of the realities of Tanzanian villagisation. Yet they to maintained their faith in a process that would, they assumed, lead to a better life for all.

Underpinning the Planglossian faith in villagisation campaigns is a village-bias in international development policy. Since early colonial development interventions, there has been an assumption that ‘Africans’ by and large live in villages. And where they don’t, they should, because villages are best for rural development and for enabling access to services. We can see this bias today, in Ethiopia, in the underpinning logic of the Millennium Development Villages, and elsewhere outside Africa. As a result of this bias, this unchallenged assumption as to the virtue of the village, questionable methods for implementing such schemes have all too often been played down in support of the long-term objectives.

So what is happening in the Lower Omo Valley now should surprise no-one: the insistence that people move if they are to benefit from government and donor-supported development; the blind-eye (or downplaying) of compulsion and other abuses; and the inevitable plea to look to the long-term benefits.

Posted in Uncategorized | Leave a comment