Who ‘does’ development?

Where to start with the piece by new Minister for International Development, Priti Patel, in the Daily Mail this week? Her assertions that too often aid doesn’t get through to the people who need it most, whether because the EU has squandered it (Patel was a prominent Brexit campaigner) or because of corruption (evidence for the extent of which she was unable to provide for her appearance before a parliamentary committee)? Or claiming that the focus of UK aid is simultaneously the world’s poorest, to reduce the pressure for mass migration to Europe, and to ‘help build the UK’s trading partners of tomorrow’ (the latter two foci, critics might suggest, reflect the interests of the UK, not the world’s poorest)? Her priorities seem clear. In the accompanying interview, Patel makes it clear that the £12 billion aid budget needs to ‘deliver for our national interests’ (code for stopping immigration and linking development to national security).

The new minister has been taken to task for many of these assertions, especially by NGOs who see her vague, Daily Mail-friendly soundbites (there is remarkably little content or depth to any of the statements of intent) as further proof of the redirection of DFID away from its explicit focus on the poorest of the poor, towards boosting trade and investment as the solution for poverty (conveniently ignoring evidence gathered over the almost 90 years since the UK’s first overseas aid act, the 1929 Colonial Development Fund, showing that the rising tide of economic development not only doesn’t lift all boats, but leaves many stuck in the mud as the water rises above them).

Here, I want to explore her assertion that ‘wealth is ultimately created by people, not by the state …  that we need to empower the poorest to work and trade their way out of poverty, not treat them as passive recipients of our support’.

In the global health literature, there has been an argument between those who posit the ‘wealthier is healthier’ argument of, amongst others, Lant Pritchett and Lawrence Summers; and the opposing ‘healthier is wealthier’ argument of their critics. Sure, health is not a proxy for development in its entirety, but I think it has some useful ideas for us to look at.

In their famous 1996 article, Pritchett and Summers argued that, using infant mortality and life expectancy as markers for improvements in health, the data shows that health improves as countries get richer (the article is behind a paywall, you can access the original working paper here). They write:

Since rising income causes improved health (most likely through increased public and private spending on goods that directly or indirectly improve health), raising per capita incomes will be an important component of any country’s health strategy.The estimates imply that if income were 1 percent higher in the developing countries, as many as 33,000 infant and 53,000 child deaths would be averted annually.

This would seem to give support for Patel’s arguments that investment, trade, jobs and so on are the best ways to improve social indicators such as health. And if you believe that economic development is best delivered by the market, then that would suggest that states, as Patel suggests, do not create wealth. And wealth, once created, reduces poverty and the impact of poverty.

But actually the evidence on ‘wealthier is healthier’ is much more murky than its advocates allow for. The evidence that most draw upon seeming to link life expectancy and national income per capita is demonstrated in what is known as the Preston Curve, which does indeed show a correlation between increased GDP and increased life expectancy. Unfortunately for the wealthier is healthier advocates, Preston himself questions the assumptions taken from that curve, arguing public health is the key to improved health outcomes; and improved wealth may actually flow from improved health. In other words, states do create development.

Take the UK for example. Mortality began to fall throughout the nineteenth century, reflecting the discoveries of germ theory, the importance of hygiene in child-birth, and so on. But it is from around 1900 that it begins to fall more steadily. But was it economic development that fueled this drop in mortality? Far from it: there was no great or rapid increase in income per capita that preceded, or even accompanied, the shifts in health in the first half of the twentieth century.

So what was happening? There was a massive increase in state intervention in health and health-related areas: the adoption of compulsory, free education by 1899; local councils made responsible for the compulsory provision of children with free school meals in 1914; the establishment of the official state birth register in 1907; the introduction of a tax allowance to assist the poor in 1909, the first attempts the following year to introduce a redistributive tax system, and the creation of the National Insurance system the next year; and free medical treatment for poor children in 1912. Thirty years later came the construction of the welfare state: compulsory free education, family allowances, unemployment support, the construction of council houses and the responsibility placed upon councils for the provision of adequate housing and care for children; and the creation in 1948 of the NHS, still one of the most important achievements of any British government.

It was public policy that led to improved health outcomes. Incomes did not start to rise rapidly in the UK until after the 1960s, after the health improvements had been secured. And the UK is not the only example which can be brought against the wealthier is healthier hypothesis. In India and China, there appears to be a negative correlation between economic growth rates and infant mortality rates. Even in the US itself, the biggest falls in mortality occurred after 1970, when real income growth was stagnant. Cuba, of course, is the example most often used to show the problems of linking national income levels to health outcomes, with its higher life expectancy than the US. This suggests that far from impeding economic development, public policy and public investments in key social infrastructure areas are essential for it. For healthier people are more productive, can work more, can earn more. Just as a better educated population can do more, achieve more, make better use of existing and new opportunities.

Even more importantly, the evidence seems to be clear that inequality is the key factor in health outcomes (even in countries such as the UK where, in theory, health services are provided equally to all, regardless of wealth). The poor, everywhere, tend to die earlier. And economic growth which does not reduce the inequality gap does not reduce these inequalities in health outcomes. Wealthier nations does not create healthier people, unless inequality is reduced alongside. And this is a task that only the state can address through public policy.

There is something of a tradition where people grow into their role at DFID, as they begin to see the day-to-day realities of the difficulties and challenges of the development task. Patel may find her current views challenged by the evidence, as others have before her. But starting your tenure repeating the uninformed, un-evidenced and vague criticisms of the Daily Mail and some of her Tory backbench colleagues is not the best start. Now it’s time to move to listening and learning mode.

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Buerk’s Law: celebrities, poverty and infantile caring

In a recent article in The Radio Times, former I’m a Celebrity … Get Me Out of Here! contestant Michael Buerk criticised National Treasures Benedict Cumberbatch and Emma Thompson. Their crime? “…[P]ratting around among the world’s victims.” The journalist who made his reputation through his reporting of the Ethiopia famine in 1984 (ironically helping mobilise the tradition of celebrity engagement in world issues that he so despises) has singled out the two for failing to have an understanding of the underlying issues and the realities of war, poverty and disaster:

“I hate it when feather-bedded thesps pay flying visits to the desperate to parade their bleeding hearts and trumpet their infantile ideas on what ‘must be done’.”

Now I’m torn on this one. As someone whose job it is to teach, write and talk about these issues, I’m liable to be a bit disgruntled that someone who gets a quick briefing, a quick tour of a disaster zone, is then treated by the media as the Oracle of Truth about this famine, that conflict, this refugee crisis and so on.

But my own thwarted desires for global fame and recognition aside, there is an argument that the complexity of global issues of this type (whether famine, war, the mass movement of desperate peoples across borders, or natural disaster) are not dealt with well by the use of celebrities-as-messengers. The reliance on ‘goodwill ambassadors’ and such-like serve to push out the political, social and economic background to a story in favour of the easily digestible, more visually stunning, and more easily solvable version of the narrative.

But is this the fault of the celebrities, or (a) the media, with its obsession towards simplifying the story, and being oh-so-more eager to report when That-Woman-Off-That-Thing is the headline; (b) the NGOs and other organisations who seek to get media attention for their view and analysis through such relationships, at the expense of nuance; and (c) us, who let’s face it, probably do pay more attention when That-Bloke-Who-Sang-That-Song-I-Quite-Liked is the main focus of the piece. The reality is that celebrities are used by NGOs and international organisations because they make it much easier to garner media interest for that particular issue or crisis. This blog, for example, is pretty much whistling in the wind in terms of its reach. But if it was guest written by Taylor Swift, Beyoncé, or Leonardo DiCaprio, then even its most trite ideas might be considered newsworthy. Whether we like it or not, Famous Person Says Thing has been standard fare for generating interest since, well, since there has been such a thing as a Famous Person.

I find the idea of actors, musicians and so on having an interest in the world actually quite reassuring. And if they get their views publicised more so than others who lack fame, well so be it (us mortals have Twitter). Yes, views might be simplistic, but being involved and caring is surely better than not being so? Most of the time, they are drawing attention to an issue; and where a ‘policy’ or solution is advocated, it is more than likely one suggested to them by an organisation seeking to use their status to push their idea.

Far more problematic, perhaps, is when celebrities seek to use their influence not just to draw attention to issues that might otherwise be neglected, or to voice their own responses to the world they see around them, but to directly push, influence and lobby for policy responses, imposing their own world-view. The well-funded celebrity foundation, for example, which attempts to directly influence policy (based on limited, or certainly partial advice from those they surround themselves with). Those who use their global status to directly meet and engage with leaders and bypass democratic, transparent and accountable systems. Those who use their fame to lambast critics who possess much less capital within the media to get their views listened to and reported fairly; or use their reputation and wealth to take to court those who dare question whether their proclaimed successes really were that successful.

Buerks Law Cartoon

Finally, as for the charge that celebrities such as Cumberbatch and Thompson present infantile analyses of the situation and possible solutions, let us not forget that Buerk himself has received substantial criticism for the tone of his reporting of the 1984/85 famine. Yes, he raised awareness of what was going on, and in doing so mobilised a huge response. And as a 13 year old at the time, I can remember the genuinely powerful emotional response that it generated (if pushed, I can still quote the opening lines). But his narrative was not just simplistic (the charge against Thompson and Cumberbatch), it was potentially misleading. It was presented as a famine caused by natural disaster, the result of drought and failed harvests. Yet even as this narrative was being broadcast, it was widely known that the Ethiopian famine of 1984/85 was the result less of drought (a factor though this was) than the war being prosecuted by the government against the rebels in the north of the country, and its deliberate policy of seeking to use hunger as a weapon of war. Subsequent coverage of the massive global effort by the media of North America and Europe focused on Live Aid, the NGOs, the figure of Bob Geldof haranguing politicians, striding up and down mountains and visiting camps set up to deliver food aid; and the generosity of the public response to appeals from celebrities and NGOs. The politics of that humanitarian response, the flaws, mistakes, bad judgements and sometimes terrible outcomes were sacrificed for the simplistic (I’ll be charitable and not use the ‘infantile’ word) narrative of charity saving lives.

Perhaps we can all agree that disasters, crises and human tragedies need to be reported in their full complexity. But also that, sometimes, the natural response of wanting to do something, anything, of wishing we could cut through that complexity to just help those in dire need, is a sign of our humanity. If that basic human response is infantile, then I for one choose to be an infant.

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Should humanitarian agencies be a foreign country?

In the 1960s , a residential college was established by a lay-Dutch Catholic order in Tanzania. It offered scholarships for young women from low-income rural households to be trained as community development workers. Whilst it was initially supported by NGOs and the government, there was a sense by the early 1970s that the ‘expatriate stranglehold’ of an all Dutch teaching and management team was generating hostility within the government, and looking increasingly out-of-step with the commitment to Africanisation of professional positions within the country. No doubt the belief of the Dutch staff that they could do a better job than anyone who might replace them contributed to the strained relationships with local and central government. Whilst recognising the good work being done, one of the NGOs funding the college questioned ‘whether an all European staff can really be the best people to know (with all the will in the world) the needs of an African country.’

I was reminded of this when reading about the controversy generated by South Sudanese efforts to regulate NGOs in that country. The President of South Sudan has signed into law the NGOs Bill, passed by parliament a week ago. The bill establishes the regulatory framework for NGOs working in the country: all NGOs need to be registered; government monitoring and oversight mechanisms have been established; and foreign NGOs are required to obtain a ‘country agreement’ with the government before being able to operate in South Sudan.

However, amidst the fairly standard requirements on NGOs to be registered and subject themselves to government regulation, there are a number of controversial measures. NGOs are required to use South Sudanese banks; they can be fined around £8,000 for publishing ‘false statements’ about the bill (probably code for presenting the bill as a means for the state to exert political control over civil society and limit critical voices); and – what has most caught the attention of the international community – limiting the number of foreign aid workers to no more than one-fifth of the national workforce. Moreover, the bill insists that the requirement for 80% staffing by South Sudanese nationals operates at all levels of an organisation, including national managerial staff.

In a country in which around three million people are facing severe food insecurity, and 1.7 million people have been displaced through conflict, this is being seen by many humanitarian organisations as an attack on their neutrality and freedom, limiting their ability to meet the needs of those who require humanitarian aid. The EU Delegation, the Heads of Mission in South Sudan of Denmark, Germany, Italy, Netherlands, Spain, Sweden, UK), along with the Heads of Mission of Canada, Japan, Norway and Switzerland have criticised the potential impact of the NGOs Bill, warning:

In their current form these bills could restrict the operation of NGOs who are providing life-saving services to the people of South Sudan. Restricting the work of NGOs could have a significant negative impact on the people of South Sudan.

David Miliband, head of the International Rescue Committee, has also criticised the bill for its potential ‘negative impact on humanitarian operations at a time of great need.

Presented in the light of South Sudan’s ongoing humanitarian crisis, the new bill looks ill-timed at least, malicious at worst. If millions are reliant upon international aid, and the international aid organisations who deliver it, then anything that might hamper those efforts cannot be supported. The most pressing problem is the underfunding of the Humanitarian Response Plan for South Sudan (with currently only around 2% of the required $220m secured). Concern over fraud, mismanagement and corruption within South Sudan’s banking sector raises fears that any money kept in the country will be siphoned off, further worsening conditions for those in dire need of humanitarian aid. NGOs say they do not object in principle to the call for more national staff across all levels, but in a new country, with serious deficits in people with appropriate skills (and competition for those that exist with government, international organisation and private sector employers) it is simply impractical to rapidly move to the 80% figure.

Perhaps the bill and its provisions should simply be shelved until the current crisis is over. Does it really matter of foreign NGOs ship in their aid workers? After all, they are keeping people alive in the now, and that has to be more important. As I am frequently told when I question the efficacy of NGOs, at least they are doing something, and something has to be done (something always ‘has to be done’, that necessity seemingly excusing all kinds of failures, mistakes, and disastrous responses).

And yet, and yet. There is something of the whiff of self-interest in all this, along with an echo of neo-colonial cant. Of course there is a crisis, and humanitarian aid is required (even if, as the work of people like Alex de Waal have long shown us, humanitarian aid is not as successful, nor as solely responsible for keeping people alive, as the myths of humanitarian action would suggest). Climate change, conflict, regional instability and the growing pains of a new nation mean that millions will continue to face food insecurity for years to come. So when, exactly, is the appropriate time to consider this?

Whilst there are problems with the bill (although are most of the provisions very different from other regional NGO regulatory regimes?) there are strong arguments why pushing for more national staff may actually be a good thing, even in the midst of humanitarian crisis. Just because a country is in need of international assistance, does that mean it can have no control over the organisations who come in, that it cedes all national sovereignty to foreign agencies who have no local accountability?

NGOs say that the skilled personnel for senior managerial positions do not exist, or not at the wage levels aid organisations can offer. It is true there are constraints, and expecting NGOs to fill those positions in a very short space of time is unrealistic. But for how long have these organisations been operating in the country (before and since its independence)? Why have they not been training up more staff over the years and years of their activities. Some have, but not enough.

This matters, because as we know from decades of experience of humanitarian disasters, interventions which do not build on (or which actively, if inadvertently, destroy) local capacity (which includes food markets and distribution networks, transport networks, local personnel, etc) create further long-term instability and insecurity, even if they resolve that particular crisis. Developing skilled national managers is not an addition to humanitarian action, it should be seen as a vital, necessary, obligatory, even, part of it. Leaving millions reliant on the vagaries of international good will and donations, on the services of international humanitarian agencies with so many other crises to attend to, is dangerous. It ensures that ‘emergencies’ never really end, as one crisis bleeds into, and feeds, the next. And it means countries can never build up the expertise and experience they need to cope if and when humanitarian agencies don’t respond as quickly as needed.

There is also something distasteful about foreign NGOs claiming they need to bring in their (well paid) foreign staff to manage programmes, employing nationals for the un- or semi-skilled (and often very dangerous) work. This is not a criticism of those foreign aid workers themselves, who in many cases take significant risks, endure significant hardships, and are motivated by values I respect and support. But it is to criticise organisations who fail to address skills deficits by not investing in training and support. The big lie of colonialism was that African peoples were not educated, not skilled, not capable enough to occupy senior government positions. Some NGOs are in danger of making similar claims to justify their organisational structure and employment. Investing in such training is not a diversion of aid, it is an essential part of it. Failure to capacity build (whether infrastructure or skills) is to fuel the crisis.

Rather than scaremonger, NGOs should take this bill as an opportunity to lay out their plans for how they will nationalise their staff, not just in South Sudan, but in all the areas in which they work. The government of South Sudan may have malign intent behind this bill as some say, but that doesn’t mean that the underlying principles in some of the controversial clauses are bad in their potential impact. Even if the purpose of the bill is not really about accountability, transparency and building national capacity, those ends could nonetheless flow from it.

Those Dutch volunteers – well-meaning, well-intentioned, good at their work – were eventually replaced, forced out by the Tanzanian government. Wouldn’t it be preferable for NGOs to manage their own succession, rather than waiting for governments to do it for them, and for less than benign reasons?

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Gates Unlocked: is the Gates Foundation really that bad?

Last week, in a rare foray away from the usual Facebook fare of thoughts on the latest episode of War and Peace or sharing a delightful nugget about my children, I engaged in a Facebook conversation with a couple of colleagues about the Gates Foundation. As reported in a few newspapers (see, for example, The Independent), the campaigning organisation Global Justice has published a report (and a computer game designed to satirise Gates’ philanthropy), critical of the Gates Foundation. The report, ‘Gated Development: is the Gates Foundation always a force for good’ reiterates many of the criticisms that have been long levelled at this organisation, and which I have also been making over the past 8 years or so in my lecturing about this particular organisation and ones of a similar type. In that Facebook discussion, I found myself taking an unusual tack: seeking to defend the organisation, its work, and its impact on development. I know!

Having spent a bit more time reading the report, and looking at their publicity, I thought I would expand on some of those ideas. To make it clear, I have some problems with the Bill and Melinda Gates Foundation (BMGF), some of which tally with those identified in the report (although I think the report exaggerates and overstates many of these). But I think the report unfairly targets the BMGF, and ironically (given its own criticism of the foundation for a too-narrow focus) fails to place it in the wider context in which it exists: a context which might suggest a differently nuanced analysis.

The main charge against the BMGF is that it skews aid policies and approaches in ways that could cause substantial harm to the poorest. In part this is because of its focus on technological responses to poverty and precariousness; and by its skewing impact on priorities through control over the massive resources it wields.

The charge against skewing aid priorities is not new. Back in 2008, the WHO’s Dr Arata Kochi criticised the BMGF for, amongst other things, distorting funding to a few (externally-decided) priority areas. Kochi also suggested that because medical researchers wanted to maintain access to this large and growing source of funding, they were reluctant to criticise the work of others supported by the foundation.

This is clearly a worry. And the charge that the BMGF is part of a system that sees priorities set externally, and exerts a gravitational pull on research (in health, but also agriculture and other areas where the foundation works) related to poverty, does stick. The question is both to what extent, and why, this has arisen.

Firstly, the external setting of priorities. This is problematic, but it is symptomatic of the failings of a wider development architecture that pulls power to the global north, and away from those regions most affected by poverty and precariousness. The Millennium Development Goals are a classic example of this process: they shaped the flow, direction and use of substantially more resources than the BMGF has spent; and made it difficult, if not impossible, for most low-income countries to impose their own priorities. Secondly, why does the BMGF have so much power? Has it wrested it away from donors and international organisations as part of the neoliberal and corporate globalisation agenda? Or has it operated in an arena where donors have systematically – for their own reasons, and not for the benefit of people like the Gates’ – undermined and weakened global institutions which could – and should – take the lead. It currently spends just under $4 billion (2014) on its programmes: a huge amount for an individual organisation, and about 2.95% of total official development assistance. If donors increased their funding to the levels seen as the minimum required, this share would fall further. And of course, it does not take into account aid flows from non-official (i.e. OECD-accredited donor) sources. So yes, it is big, massive even, but about twice the size (in terms of annual spend) as one of the largest NGOs, World Vision.

Take health, for example. The BMGF probably does have a disproportionate impact on global health policies (if we assume it takes the lead in all programming, rather than responding to existing programmes or supporting those of other agencies), but this is in large part because since the 1990s the largest donors have reduced their support for the WHO’s general budget through fixed contributions and increased their extra-budgetary contributions (which they have greater control over). At the same time, the World Bank has risen as the largest and dominant funder of global health (and thereby dominated global health policy). The BMGF did not create the space in which it operates, but occupied one already shaped by donors and international organisations competing to push their own agendas, and visions and prejudices. A large part of the (real) problems of the BMGF could be addressed if governments undertook a clear, radical and principled reform of global health governance.

The report cites Bill Easterly’s criticisms of the technical-solutions approach of the BMGF, as it does Oxfam’s Duncan Green. And I agree with their criticisms. But to say that development requires more than technical fixes, whether focusing on human rights, or political and economic structures, or inequality, is not the same as saying all development organisations must focus on non-technical approaches. It would be hard to argue that the ‘technical’ approach of providing long-lasting insecticide treated bed nets (LLINs) has not had a huge impact on reducing malaria mortality. It requires other policies and approaches, but is still a major contribution (one in operation long before the BMGF emerged). Should the organisation, Focus On Vision (which provides reading glasses to those to poor or otherwise unable to access them) change its approach because this is just a technical fix (however transformative getting glasses can be)? Surely what is required are both Oxfam’s (with their strong political-economy and campaigning approach) and organisations which do something else, something different? Many NGOs have still not resolved the decades-old debate as to whether small projects vs political campaigns should be their focus (deciding to do both is often an uneasy compromise rather than settled solution). Yes, the BMGF could do with a stronger political-economy focus, though to argue it is completely absent is perhaps to focus more on Gates’ words than on all the various projects and programmes they are supporting.

The point is not that there isn’t a problem. It is that the BMGF is not the only, nor necessarily the most egregious, of such organisations. And any discussion of BMGF must take in this wider perspective – not just of this sector, but of the development architecture as a whole. There is a much better report on philanthropy and development (including a look at the BMGF and similar organisations like the Rockefeller Foundation here). All philanthropic organisations can (and do) have skewing impacts: sometimes for the good, sometimes not; some at the local level, some at the international. It doesn’t make it right, but nor does singling out one institution and suggesting it is the only one that is problematic.

Another major criticism of the BMGF is that it lacks the democratic accountability and scrutiny that democratically-elected governments possess. Well, yes. Because it isn’t a government. Neither is Save the Children; or the Disasters Emergency Committee; or CARE International (or Global Justice). In fact, if that is your point of departure, then your enemy is not the BMGF, but all non-state development action. Moreover, this raises the somewhat ludicrous suggestion that such democratic accountability is essential to avoid dangerous development – what, like structural adjustment, new policy agenda reforms, etc? All generated and pushed by elected governments and the inter-governmental organisations they created. Has the Gates Foundation done more harm – in danger of doing more harm – than official donor organisations and their policies over the past 30 years?

Private development organisations (including NGOs) are not democratically accountable, but look for their accountability in other ways. The report’s suggestion that there is no accountability within the BMGF is not really true, or at least misrepresents the nature of the accountability problem. There is an executive leadership team; there are expert (independent) reviewers; the BMGF has signed up to the International Aid Transparency Initiative; it publishes its reports, it is lectured about, talked about; and its programmes subject to peer-reviewed research and publications. Global Justice’s charge that the Gates Foundation has ‘bought the silence of academics, NGOs and the media’ seemingly rests upon the statement of one academic – hardly evidential proof of conspiracy (they could have found similar – if less overwrought – statements, such as that by Dr Kochi, but that would have conflicted with the idea that these charges are new).

Now, this is not to say that it is a perfect, or perhaps even real and meaningful accountability. The trustee board should certainly be widened. The question is whether the BMGF is worse in these systems than any other non-state actor; or (if not) whether it is just its size which makes it problematic. In my experience, the BMGF is pretty open, more so than many other private development organisations (a category in which I would include all NGOs), less so than some. Yes, the size of the foundation is an issue, given the power such resources bestow upon it. But Global Justice have not criticised the Wellcome Trust – until the establishment of the BMGF, the largest health-focused foundation in the world. And yes, the BMGF is the creation of two people (although as with so many others, Global Justice doesn’t turn too much of its gaze to Melinda and her contribution as part of its narrative), and its trustees limited to Bill and Melinda Gates, and Warren Buffett. But the accountability problem is one that is critical for the entire private development sector, and for organisations – including NGOs – who have done substantial and significant harm despite their best intentions. Is the BMGF less accountable, less open than many or even most NGOs? I’m not sure that it is.

What underpins much of the criticism towards the BMGF is that is part of the trend towards privatisation of development under a particularly muscular form of neoliberalism and corporate globalisation. The size of the organisation (endowed with around $41.3 billion dollars; having made grants totalling a staggering $34.5 billion since 2000, working in over 100 countries) means that its impact on development policies, agendas and approaches is huge. And this influence, Global Justice suggest, is malign. Far from being technocratic and apolitical, the main charge is that it is far too political, too driven by a particular political-economy understanding of development, poverty and precariousness.

I don’t disagree with the analysis of the dangers of philanthrocapitalism, venture philanthropy, or the other variations of this type of institution. But we have to be distinguish between the effectiveness or dangers of the BMGF as a development institution, and its representativeness of a particular type of organisation and approach. And in the case of this particular research, we need to distinguish between the organisation, and the people who established it. Are the sins of Microsoft and the origins of Gates’ wealth sufficient in themselves to condemn the BMGF and the work it is doing? And whilst some would say we need to look at the origins of the wealth of the organisation, I would agree, but ask they do the same for other large foundations, such as the Wellcome Trust, the Rockefeller Foundation, the Kaiser Foundation, and so on.

Clearly, any institution this large, this well-endowed, and run as a private (albeit philanthropic) organisation is problematic. All development is political, and all development actors are political actors. There are huge power issues, issues around accountability, issues around the power of large funders (of any type) to skew priorities and push their own visions. But actually, I think the Foundation should welcome an inquiry into its work, and I think Global Justice may be surprised by what such an inquiry found.

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The precariousness of the franchise state. NGOs & health care in Tanzania

My latest paper – ‘The precariousness of the franchise state: voluntary sector health services and international NGOs in Tanzania, 1960s-1980s’ –  has just been published in Social Science and Medicine.

Here is the link to the article, which  will be free for all until mid-September, 2015, subscription only thereafter).

And here is a brief audio / slide presentation on the paper from the SSM site:


The paper continues my work on the structure, nature and significance of the voluntary sector in Tanzania (and sub-Saharan Africa more widely), and in many ways serves as the second part to the ideas I develop in my 2013 Development and Change article, ‘Common counsel, common policy: healthcare, missions and the rise of the voluntary sector in colonial Tanganyika.’

Much current writing on the voluntary health sector across sub-Saharan Africa sees it as a new creation, linked to the rise of the NGO as powerful development actor from the 1980s especially (indeed, in many texts, the terms ‘NGO’ and ‘voluntary sector’ are used synonymously). Building on this, there is a strong debate within health systems reform literature on the relative merits of private (voluntary) providers vs state-run facilities. In’Common counsel, common policy’, I show how, contrary to this perspective, the formal voluntary sector was the creation of an alliance between the colonial state and Christian missionary organisations in Tanganyika from the 1930s. In other words, it was created, and many of its fundamental characteristics (later ascribed to the impact of INGOs) were already established, by independence, and before the rise of the NGO.

From the 1930s, the colonial state gradually incorporated mission-run services into its own health system, so that by the 1950s we can see health system in Tanzania operating as a public-private partnership model. The state provided (limited) funding for voluntary sector services; and in return, those voluntary providers agreed to subject themselves to greater regulation and direction from the state.

My latest paper, ‘The precariousness of the franchise state’, takes the story into the post-colonial period, and specifically the period in which NGOs emerged as development actors.

I explore, in particular, the trajectory of a maternal and child health programme run by the Bulongwa Lutheran Hospital, in southwest Tanzania. Established in the mid-1970s, the idea was to establish a mobile clinic which would undertake preventive care of infants and children; offer treatment for parasitic infections, malnourishment and other conditions; and provide support for pregnant women and new mothers. It was initially funded by the British NGO, Oxfam. However, when Oxfam made its decision to focus their operations on a smaller number of regions (which did not include that in which Bulongwa was situated), it ended funding. Christian Aid was approached to take up the project, which they agreed to do. But as is the way with NGO grants, this was for a very limited period of time: just two years. And when funding stopped in 1981, the project collapsed through lack of resources. When, a few years later, Christian Aid sought to resuscitate the programme, it was too late: the doctor had left, and there was nothing there to allow for its re-introduction (especially on the short-term time-frame within which funding was allocated).

Bulongwa was not unusual. Across Tanzania in this period voluntary sector hospitals were seriously understaffed; operating theatres left unused where no qualified practitioner was based; equipment too expensive to run, maintain or repair; the heroic efforts of those who struggled to meet community health needs undermined by the incessant requirement to jump through the hoops of form filling, report writing, begging and pleading for the tiny amounts needed to keep them going.

Through this case study, and as with the earlier article, ‘Precariousness’ questions some of the standard critiques of INGOs that have become orthodox accounts of the NGO sector. In particular, it questions the idea that they are complict in the implementation of policies of privatisation and fragmentation under health sector reforms and the new institutional economics that rose to dominance from the late 1980s.

Borrowing from Geof Wood’s useful concept of the franchise state I argue that much of the instability, fragmentation, creation of parallel systems, and problems of accountability identified by the critics of INGO engagement in sub-Saharan Africa, were already in place by the time these organisations arrived on the scene.

However, whilst they may not have created the precariousness that characterised voluntary health services in this period, INGOs did exacerbate some of its worst features. Through their funding methods, the ways decisions affecting the future of much-needed services were made in the distant offices of NGOs rather than within the communities, and the demands INGOs placed upon the voluntary sector ‘partners’, voluntary health sector services were made increasingly vulnerable, unable to plan for the long-term, and at risk of sudden closure. What was lost in this mode of operating were the needs, wishes and voices of those whose lives were most affected, the communities themselves.

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