Was that foreign aid … or a campaign contribution?

The scholarly literature on aid effectiveness focuses on answering one of two questions: 1) Is aid effective at causing growth? And 2) Is aid effective at reducing poverty? But what about when growth and poverty reduction aren’t the goals? What if the purpose of some aid is to influence a foreign election?

Some clever forensic statistic work is suggestive that bilateral donors use aid (ODA) to influence elections. They give more aid to friendly governments in election years...

An administration that is two standard deviations more politically aligned with the donor can expect to receive $19 million more in ODA flows during an election year relative to a non-election year than the less aligned administration.

And less aid to unfriendly governments in election years...

…an administration one standard deviation below the mean level of donor-alignment receives $8 million less on average during an election year.

It’s also suggestive that the results were most pronounced in highly-contested elections.

A recent example:

In [2006] elections, the U.S.-supported incumbent, the Palestinian Authority (P.A.), faced strong opposition from Hamas. In the weeks preceding the elections the United States Agency for International Development Assistance (USAID) funded several development programs including the distribution of free food and water, a street-cleaning campaign, and computers for community centers. The USAID money was even used to fund a national youth soccer tournament A progress report distributed to USAID and State Department officials was strikingly candid about the purpose of this aid:

“Public outreach is integrated into the design of each project to highlight the role of the P.A. in meeting citizens needs. The plan is to have events running every day of the coming week, beginning 13 January, such that there is a constant stream of announcements and public outreach about positive happenings all over Palestinian areas in the critical week before the elections.”

The whole paper, by Michael Faye of McKinsey and Paul Niehaus of UCSD, is here.

In defense of being mean-spirited: response to a critic

People on Twitter yesterday and today called attention to this thought-provoking critique of yours truly (from Chris Conrad at his blog The Big-Push: Development and Aid Effectiveness)

I did want to take issue with one of Easterly's tweets from yesterday, in which he sardonically impugns USAID's efforts in Afghanistan, suggesting that the most benefit Afghanis have realized from USAID's years of war-time effort is the use of USAID-labeled vegetable oil cans to set up live WIFI nodes in Jalalabad, Afghanistan.

...This is a very unproductive and mean-spirited use of anybody's time.  I honestly have no idea what Easterly expects the response to such a post to be -- this adds nothing to the debate, and perversely co-opts what is otherwise very positive news into an outlet for his nihilistic worldview.

To be intellectually consistent, I have to praise criticism of myself as much as I advocate criticism of aid agencies. So thank you, Chris, for taking the time to give me thoughtful feedback. I read something like this and I re-examine if I am going too far in ridiculing unproductive aid organizations. I will consider whether to dial it down.

At the same time, I still believe in vigorous criticism of aid when it deserves it. In other fields, we recognize a constructive role of even very harsh criticism. Alec Baldwin joked at the Oscars last night that James Cameon had sent his rival director and ex-wife Kathryn Bigelow a good-luck present of "a Toyota." This is a mean-spirited joke at the expense of a corporation that has years of quality service to consumers except for one recent accelerator pedal malfunction. And Toyota deserves every bit of it.

"Aid effectiveness" is a sleep-inducing word that has resulted in endless rounds of summits and declarations ("Accra Agenda for Aid Effectiveness, etc.) and little action. USAID is a politically entrenched bureaucracy that has gotten away with scandalous waste of billions of aid in Afghanistan. A mean-spirited joke at their expense is among the least of the consequences they should suffer.

Afghans and social entrepreneurs improvise when official aid fails

From the blog FabFi (HT to blog Whirled Citizen)

{A} World Bank funded infrastructure project to bring internet connectivity to Afghanistan began more than SEVEN YEARS ago and only made its first international link this June. That project, despite hundreds of millions of dollars in funding, is still far from being complete.

{Meanwhile} the Fabbed Long-Range Wireless Antenna Project, ... as of December 2008 is working on an installation in Jalalabad Afghanistan.

today (Feb 4, 2010)  marks a new peak in the size of Jalalabad's Fabfi network--26 simultaneous live nodes.

Pictured above is a makeshift reflector constructed from pieces of board, wire, a plastic tub and, ironically enough, a couple of USAID vegetable oil cans that was made today by Hameed, Rahmat and their friend "Mr. Willy".

The War of the Causes in Aid

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

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

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

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

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

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

Owen is equally blunt about the way forward:

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

Chronicle of a death foretold

When the article Madagascar: Textile Industry Unravels came across our desks yesterday, we were saddened but not surprised. That’s because people on the ground have been predicting this outcome (and Aid Watch has been stubbornly blogging about it over and over). Multiple critics have protested ever since the US government, hoping to force President Andry Rajoelina’s questionable government to hold elections, first threatened to remove preferential trading rights for Madagascar. The Malagasy textile industry was a clear success story of the US African Growth and Opportunity Act (AGOA), which removed US quotas and duties from thousands of products from eligible African countries. Madagascar’s exports tripled in the first three years of the program, and the textile sector, which made up 60 percent of Malagasy exports, accounted directly for 50,000 jobs and indirectly at least 100,000 more.

The US pulled the plug on AGOA at the end of December and import duties of up to 34 percent were reintroduced. Now we are starting to see the effects in the formal and informal economy:

• Factories closing and factory jobs lost: “As lead times [expire] on orders placed before the agreement [came to an end], factories are laying off workers and we are seeing an explosion in the numbers of unemployed,” said the director pf the Association of Free Trade Business in Antanarivo.
• Increased competition among street traders now that former factory workers are pushed out to sell goods in overly crowded street markets (and lower wages now for both): “‘I used to be able to earn 20,000 ariary ($9.30) a day,’ said Soloniaina Rasoarimanana, who has been selling clothes from a pavement stall for 10 years. ‘Now, with the political crisis and more competition, I earn around 5,000 ariary ($2.30) a day.’”
• Knock-on effects in neighboring countries (Mauritius, Swaziland, Lesotho, South Africa) which made inputs like zippers to Madagascar’s factories.

Among the effects we are NOT seeing: signs of increased interest in arriving at a power-sharing agreement or instating democratic governance on the part of Rajoelina’s government.

Ineffective sanctions, effective job destruction.  An unaccountable branch of the US government hurts poor people far away who have no voice in US politics. Deeply saddened…we don’t know what more to say.

Some NGOs CAN adjust to Failure: The PlayPumps Story

Back in the 1990s, a billboard advertising executive in South Africa had a very good idea. Spinning on a merry-go-round connected to a water pump, children could generate plentiful, clean water without the time-consuming, hard work of traditional hand pumps. At the primary schools in South Africa where the first of these merry-go-rounds were installed, kids got a place to play, their communities got free drinking water, and girls and women, who bear much of the burden of collecting water for their families, got time to attend school or pursue other activities. Billboards lining the raised water tank brought in advertising revenue to fund the pumps’ maintenance, and spread public health messages about hygiene or safe sex.

In 2000, the idea won the World Bank’s Development Marketplace award. In 2006, Laura Bush announced $16 million in funding from USAID/ PEPFAR and private foundations, with the goal to raise $45 million more to install 4,000 pumps in Africa by 2010. Jay-Z pitched in with concerts and an MTV documentary. PlayPumps announced plans to expand, first to Mozambique, Swaziland and Zambia, and then to Lesotho, Malawi, Ethiopia, Kenya, Tanzania and Uganda. The nonprofit launched a sophisticated social networking campaign, and successfully raised money for “100 Pumps in 100 Days” on World Water Day in 2007 and 2008.

Sadly, somewhere along the way, PlayPumps stopped being a smart homegrown idea and became a donor-pleasing, top-down solution that simply didn’t fit many of the target communities.

The charity WaterAid wrote a position paper on why they did not adopt the PlayPumps technology. For one, they said, PlayPumps are too expensive. At $14,000 each, they cost four times as much as traditional pump systems. The mechanism requires specialized skills to repair and so can’t be fixed with local labor, and spare parts are hard to find and expensive to replace. WaterAid also decried the system’s “reliance on child labour.” A recent critical commentary in the Guardian calculated that children would have to “play” for 27 hours every day to meet PlayPumps’ stated targets of providing 2,500 people per pump with their daily water needs.

An aid worker and engineer in Malawi documented some of these problems in a brilliant series of blog posts. His anecdotes and pictures give limited but compelling evidence that PlayPumps in his area are not being used as the inventors intended:

Each time I’ve visited a Playpump, I’ve always found the same scene: a group of women and children struggling to spin it by hand so they can draw water.

He also suggests one reason why PlayPumps might be slow to get that crucial feedback:

[A]s soon as the foreigner with a camera comes out (aka me), kids get excited. And when they get excited, they start playing. Within 5 minutes, the thing looks like a crazy success…. I’ve always figured that as soon as I leave the excitement wears off and the pump reverts back to its normal state: being spun manually by women and kids.

Does the story of PlayPumps carry a broader lesson about the aid world? Suppose the organization had charged ahead with a Twitter campaign to raise millions for THE solution to water problems in Africa, while reality kept diverging from their rosy picture.  Then PlayPumps would represent the triumph of bad but photogenic solutions in a broken aid marketplace.

BUT last fall, the CEO announced instead that their inventory would be turned over to the organization Water for People, where PlayPumps would be just one option out of “a portfolio of technologies from which communities can choose.” This seems like the right outcome. We can ask why it took so long to see the flaws in the PlayPumps model. But in contrast to the official aid world, where the old failed solutions keep getting recycled across 60 years, this is real progress!

Who gets the Last Seat on the Plane? Why Aid Hates Economics

Not long ago, I was returning home from a trip when the airline bumped me from my flight due to overbooking. The airline rep was very sympathetic, but I didn’t want her sympathy, I wanted A Seat On the Plane. She had traded off my wishes against those of other passengers, and I lost. Economists are unpopular because we say there is always SOME resource that is overbooked in aid, and aid is Forced to Choose: who is going to get the Last Seat on the Plane?

Politicians and advocates try to argue their way out of the Scarcity and Tradeoffs, using one or another of these proven strategies:

(1)   There really is no scarcity

This is Sachs’ central argument for more money in aid –you should never be forced to choose who should live and who should die, so you should always ask for more aid money. This has been effective as advocacy, but still doesn’t make aid money an infinite resource – there is still a limit on how much rich people will give. And the scarce resource is not only money – it is also political capital, rich peoples’ attention, or effective and accountable aid workers in the field. So using AIDS as an example, sure you should do some of both treatment and prevention – but how much of each? In the end, they are still competing for limited Seats on the Plane.

(2)   Our project doesn’t use any scarce resources

This argument is usually made by omission. The Millennium Villages don’t advertise that they are dependent on one extremely scarce resource -- Western experts -- perhaps it would then become obvious that they are neither scalable nor sustainable. And of course there is a big tradeoff between the Millennium Villages and better projects you could do with this scarce Western expertise. A better project replaces the scarce foreign expertise very soon with more abundant local expertise and labor – such as training programs to transmit foreign technical skills to locals, who will in turn pass it on to other locals.

(3)   My cause actually is the same as your cause

Advocates of one cause often argue many other causes NEED their cause. If the necessity is absolute, then indeed the tradeoff disappears. If it is less than 100 percent absolute, there is still a tradeoff. Hey, Other Passenger who took my seat: don’t claim that You are so Important that it’s pointless for Me to get on a plane without You! Unless You are the Pilot.

In summary, there really is scarcity and aid really is forced to make intelligent choices. Be sure to give a seat to the pilot.

Set a Big Goal. Give All to Meet It. This is Stupid.

The first two sentences come out of thousands of commencement addresses, not to mention inspirational foreign aid addresses. But they’re bad advice. Social entrepreneurs in foreign aid might learn from private sector entrepreneurs, who don’t stick to fixed goals.

A University of Illinois graduate moved to Silicon Valley with a great goal (perhaps inspired by the Illini commencement address) – develop security software for hot-selling handheld devices like the Palm Pilot. He assumed that enterprises were soon going to be using Palms as primary means of communication and sharing documents, and would need security to protect business secrets. “Any minute now, there’ll be millions of people begging for security on their handheld devices,” he thought. He was wrong – he never found a demand for handheld security software.

He could have kept trying to make his original idea work. Entrepreneurs that do stick to fixed goals are very good at least at one thing – wasting investors’ money. An idea for an online grocery startup, Webvan, managed to go through $1 billion before finally pulling the plug.

Illinois Man was different. He shifted to Plan B. Sell his cryptography software. Still no takers. We can skip over Plans C, D, and E, which all failed.

Plan F was a system for securely transferring cash from one Palm Pilot to another. He put a demo on the Internet so people could see how great it would be for Palm Pilots. People liked the web demo and started using it for real transactions, while the demand from Palm users still failed to materialize. eBay users started asking if they could put the web demo in their ads for people to pay them. There was no demand for the product, only for the web demo.

Illinois Man finally realized what might succeed. He forgot about Palm Pilots. Plan G was a system for making secure online payments for sites like eBay. His Plan G company was called PayPal, and his name was Max Levchin. eBay eventually bought PayPal for $1.5 billion. The story is from a new book by John Mullins and Randy Komisar, Getting to Plan B.

This principle translates to social entrepreneurship. Mohammed Yunus was trained as an irrigation economist. If he had stuck to fixed goals they would have involved irrigation. We would never of heard of him or of microcredit (at least until someone else without fixed goals came along).

Why is entrepreneurship so hard? It is always very uncertain what you can do well that the customers will want. Finding that sweet spot is a process of trial and error and gathering feedback. Research cited by Mullins and Komisar shows it takes 58 new product ideas to develop one successful product.

An even better book on this theme of searching for what works rather than sticking to the pre-conceived plan is Bill Duggan’s Strategic Intuition. Duggan uses a nice military analogy. Why was Napoleon such a successful general? Before Napoleon, military strategy was about how to take a fixed position from the enemy. Napoleon realized that the point of a war was to defeat the other army. He said, forget the targets, just keep the army moving relative to the other army until you are in the most advantageous position, then attack.

Of course, this advice about flexible goals might conflict with previous advice about specialization. Yes, you want to get the gains from specialization, but be flexible about what your specialization will produce for the customers. So you might be a health specialist, but which among many interventions that you could do will pay off? James Grant, a former director of UNICEF, knew he wanted to save children’s lives, but he was open to any way to do it. He and his staff stumbled on oral rehydration therapy, which has since saved millions of babies from dying from diarrheal diseases at a cost of about 12 cents per dose.

The economists’ version of this mentality is to keep doing and redoing your cost/benefit analysis. The rational next step is one with the highest ratio of benefits to costs. Many goals are set that ignore cost/benefit analysis altogether (Millennium Development Goals, for example). Other goals might be set with some vague notion of predicted costs and benefits, but these predictions are usually wrong. You have to be willing to adjust as benefits and costs turn out to be different that expected, and often shift to another activity altogether – Plans B,C,D,…Z.

Obviously the official aid world of MDG Plans and Poverty Reduction Strategy Papers does not have a clue about the entrepreneurship needed to solve problems.

Official aid doesn’t know how to operate in a world where most Problems are solved by entrepreneurs who originally intended to solve a DIFFERENT Problem. So it’s up to you private and social entrepreneurs.

Life in the Aid World: Caught Red-Handed, No Consequences

Last week, a report in USA Today brought to light a story of aid funds going badly astray. In case you have not followed the story, it seems that back in 2003, USAID contracted with the UNDP and UNOPS to complete a series of “quick impact” infrastructure projects in Afghanistan, to build badly needed roads, bridges, and community buildings. A US government report on the project, sparked by a tip from an anonymous complainant, found that many of the projects reported as “complete” by the UN were in fact unfinished or had such “life-threatening oversights” that they could not be used. The USA Today reporter filed a Freedom of Information Act Request to access the government report, which he then published along with the article.

Here are a few highlights of the report:

• According to a former UNOPS employee, some $10 million of the USAID grant funds was diverted to projects outside of Afghanistan, in Sudan, Haiti, Sri Lanka and, most memorably, Dubai.
• The UNDP withdrew $6.7 million of project funds in 2007, after the project had ended and without USAID’s knowledge. The investigators could not pin down how those funds were spent.
• A bank was built for $375,000 without electricity, plumbing or proper drainage. The report found that the basement had flooded, destroying stacks of money, and the walls were rotting.
• A $250,000 bridge, reported as “completed,” was dangerous and unusable, having been designed too small for the site where it was built.
• An airstrip budgeted at $300,000 actually cost $729,000 to build. After a description of the major engineering flaws in the construction of the airstrip, the report concluded that military planes cannot safely land there and that “erosion rills or ruts will continue to expand until they reach the runway itself, destroying it completely.” In other words, USAID paid $729,000 for a patch of mud.
• There may be more to come: “questions remain unanswered” because several UN officials refused to be interviewed and the UN failed to provide requested documents during the investigation.

USAID is also to blame for choosing such a bad contracting arrangement, and for not having procedures to catch this earlier and seek full compensation. USA Today reported:

Federal prosecutors in New York City were forced to drop criminal and civil cases because the U.N. officials have immunity. USAID has scaled back its dealings with the U.N. and hired a collection agency to seek $7.6 million back, Deputy Administrator James Bever said. The aid agency hasn't heeded its inspector general's request to sever all ties.

"There are certain cases where working with the U.N. is the only option available," Bever said in an e-mail.

At a UN briefing last week, the UNDP spokesman said that “there have already been a number of meetings, including at the highest level of UNDP and USAID, to work through this matter.” He said that he expected that the UNDP would have to pay USAID no more than $1.5 million.

A disastrous aid outcome, exposure in the mass media -- so what were the consequences? A number of meetings, possibly some money back, USAID disregards its own Inspector General’s request to break off ties with the UN (some unspecified “scaling back” except in other unspecified “certain cases”), and yet more meetings “at the highest levels.”

Since the initial reports, there has been no further media coverage or commentary except for an editorial critical of USAID in the Las Vegas Sun on April 17th. The USAID web site accessed on Monday, April 20, 2009 still listed as implementing partners UNDP (who announces it “remains responsive to the changing needs of a nation still in transition from conflict to peace”) and UNOPS (“we help our clients turn ideas into reality.”)

The USA Today story broke the same day that a USAID rep presented at a meeting in Washington called "Open Innovation for Government: Answering President Obama's Call for More Open, Effective Public Service."

A Tale of Two Refrigerators

In 2001 in southern Sudan, it was a time of peace between wars. It was a time ripe for treating diseases that kill thousands of children every year. It was an opportune time for measles vaccination to halt outbreaks of one of the world’s most preventable diseases. The Measles Initiative, founded by the WHO, UNICEF, the CDC and the American Red Cross, was created to address this significant challenge. In the rural county where I ran an NGO, over 1,200 young children died of measles over four months in early 2001. The death toll was devastating to our school children and their families: local villagers did not have the resources to combat the outbreak except to bury the dead.

When we reported the outbreak to the WHO, the officials we corresponded with expressed shock and dismay that our communities had no access to a vaccination program to stop the spread. But the WHO was caught in a Catch-22 of their own devising: they were unwilling to allocate resources and send doctors unless they could be certain the outbreak was measles, but they couldn’t be certain it was measles without a clinical diagnosis by qualified medical personnel.

Our NGO shipped out videotape of the infected children to one of the Measles Initiative partners. A medical doctor and global measles expert said the video was some of the best footage of children with measles he’d ever seen, but unfortunately Sudan wasn’t on the list to have a measles eradication program that year and he couldn’t be certain without seeing the patients. Even with the clear video footage, a senior WHO official still wouldn’t attribute the children’s deaths to measles nor send an investigative team. So, as far as we know, the children who died in eastern Upper Nile state in 2001 were never counted in the WHO’s official measles statistics.

Worse yet, the WHO wouldn’t supply vaccines to inoculate children and stop the outbreak without a refrigerator to store them, and the remote communities where we worked had no refrigerator and no reliable power source. UNICEF, we were told, would provide a fridge if the number of diagnosed deaths from measles was significant. But with no qualified medical personnel to diagnose a “significant” number of deaths in our area, we didn’t qualify.

In cooperation with Save the Children (US) and funded by USAID, our NGO set up a medical clinic and put qualified African medical staff in place. Training on running a vaccination program was provided and record-keeping started. The communities waited impatiently for the vaccination program as more children died in subsequent outbreaks. There were hundreds more deaths diagnosed from measles each time. Our NGO was repeatedly told it was “near the top” of the waiting list, but years passed with no refrigerator and no vaccines.

Another outbreak of measles started in mid-2008. In desperation, our NGO raised private funds to purchase a refrigerator and fly it into the isolated area where we worked. Within a few months, our new refrigerator was in place and ready to hold the free vaccines that the Measles Initiative promised to qualified organizations. We have found that “free” is a relative term in Africa, however. We quickly learned that a small number of vaccines were available to us at a regional distribution center, a $5000 air charter flight away.

Just last week, a second refrigerator was delivered, this time courtesy of Save the Children (US), nearly seven years after the original request was made. According to locals, thousands of children have died of measles in the mean time, but the major aid agencies still cannot work together to provide truly free vaccines. Seven years later, this community has two empty refrigerators and still no means to keep their children dying from measles. The refrigerator excuse is gone but the vaccines are effectively out of reach.

Even a time between wars is not the best of times for the poor in rural Sudan. As it turned out, it has been a time of bureaucratic “defer and delay” from the UN aid agencies who failed to provide the vaccines needed to save vulnerable children dying from a preventable disease. After seven years, Save the Children (US) is making the most progress, which is disappointingly slow.

It makes me wonder if the 90% drop in measles infection rate between 2000 and 2006 claimed by the WHO is accurate, or if the children who are dying are just too much trouble for them to count.

MADE-UP MALARIA DATA ROUND 2: Gates Foundation responds, WHO graciously offers not to respond

The modest aim of an initiative like Aid Watch is to be one more small voice holding aid agencies and foundations accountable for doing good things for poor people. The aim of more accountability is to induce improved behavior by those guys, so that aid will work better. The Aid Watch blog already has had its first small test on trying to induce accountability. This post took Bill and Melinda Gates to task for claiming in the Financial Times that foreign aid had big victories over malaria in countries like Rwanda and Ethiopia, because the WHO country data they based it on was made up and later contradicted by the WHO itself.

The Gates Foundation did respond to this criticism, to their great credit (not directly, but that’s OK, it was visible enough in a response to the Chronicle of Philanthropy’s coverage of this controversy.)

What was their response to criticism for using invalid country data? Oops, they offered more invalid country data. The Gates Foundation spokesman offered the country data on Rwanda and Ethiopia from this journal article as defense for the Gateses’ claims on those countries' victories over malaria.

What does the cited article actually say? “Districts and health facilities were not randomly selected, but constituted a (stratified) convenience sample, selecting those sites where intervention scale-up had been relatively rapid and successful … Therefore, estimated impacts cannot be extrapolated to the countries nation-wide.”

Still, the Gates Foundation was a tad more responsive than the WHO, whose malaria chief first led astray the Gateses and the New York Times with false reports of victories over malaria based on made up country data, then the WHO issued totally different data in its official 2008 Malaria report a few months later, without ever retracting the New York Times story.

When Aid Watch’s intrepid investigator Laura Freschi approached the WHO for comment, she got the following response from the WHO Project Leader for Information Management & Communications, Epidemic and Pandemic Alert and Response (EPR):

“Hello. I have received your emails and phone call. However, WHO does not participate in blog discussions.

Thank you.”

It may seem obsessive to insist on good data, but bad data costs lives. The sad thing is that there have been SOME victories against malaria, and that solid data on WHAT is working WHERE is vital to guide the campaign against this tragic disease. Would Americans put up with the CDC using made up data to respond to a salmonella outbreak?

I guess Aid Watch is going to have to work a LOT harder to do our part to get a bit more accountability.

Did Bill and Melinda Gates Claim Malaria Victories Based on Phony Numbers?

Tuesday’s Financial Times printed a Martin Wolf interview with the Gateses from Davos, available as a video on the FT web site. A sample quote from the interview:

We’re trying to make sure that people understand this: aid is effective…So, for instance, malaria incidence is down in countries such as Zambia, Ethiopia, and Rwanda. It’s down in some countries by over 50 percent and some by 60 percent…[if we and other donors] come in and distribute mosquito nets – 60m to date – that is how we have achieved these declines. So we are able to say, “Look, aid is making a huge difference, we are literally saving people’s lives."

Real victories against malaria would be great, but false victories can mislead and distract critical malaria efforts. Alas, Mr. and Mrs. Gates are repeating numbers that have already been discredited. This story of irresponsible claims goes back to a big New York Times headline on February 1, 2008: “Nets and New Drug Make Inroads Against Malaria,” which quoted Dr. Arata Kochi, chief of malaria for the WHO, as reporting 50-60 percent reductions in deaths of children in Zambia, Ethiopia, and Rwanda, and so celebrated the victories of the anti-malaria campaign. Alas, Dr. Kochi had rushed to the press a dubious report. The report was never finalized by WHO, it promptly disappeared, and its specific claims were contradicted by WHO’s own September 2008 World Malaria Report, by which time Dr. Kochi was no longer WHO chief of malaria.

(There was never a retraction in the New York Times, so perhaps Mr. and Mrs. Gates can be forgiven for being confused – although with most of the world’s public health professionals on Mr. and Mrs. Gates’ payroll you would think their briefers would have access to the most accurate information.)

The September 2008 WHO Malaria Report keeps Rwanda as a success story (along with some other new success stories – not mentioned in the New York Times – like Sao Tome & Principe and Zanzibar), but Zambia and Ethiopia are gone: the effects of malaria control in Zambia were “less clear,” and in Ethiopia, “the expected effects” of malaria control are “not yet visible.”

Digging deeper into the WHO Malaria Report, the standards for data on malaria are set so low, it is even more striking how the Kochi numbers – those numbers that fueled a February 2008 New York Times story and a February 2009 Gates claim – failed to meet even these low standards. The WHO says (in a small print footnote): “in most countries of Africa, where 86% cases occur, reliable data on malaria are scarce. In these countries estimates were developed based on local climate conditions, which correlate with malaria risk, and the average rate at which people become ill with the disease in the area.” Another stab at explanation of their malaria numbers was: “From an empirical relationship between measures of malaria transmission risk and case incidence; this procedure was used for countries in the African Region where a convincing estimate from reported cases could not be made.” (Possible translation: we make the numbers up.)

The shakiness of the numbers is visible when you look at them by country in the WHO Malaria Report. For the “success story” of Rwanda, there is an estimate of 3.3 million malaria cases in 2006, with an upper bound of 4.1 million and a lower bound of 2.5 million. But wait – another way to estimate cases, which is the one used to estimate trends, shows 1.4 million cases in 2006 (and this was an increase over the 2001-2003 average). Estimates of child malaria deaths in Rwanda are similarly all over the place – they do show a drop from 2001 to 2006, but the change is dwarfed by the vast imprecision conveyed by the lower and upper bounds.

In another WHO success, Zanzibar (which, to be fair, Mrs. Gates also mentioned as a success by in the interview), there seems to be more consensus on success from a combination campaign featuring indoor spraying of homes, insecticide-treated bed nets, and treatment of malaria patients with advanced drugs. It seems to be easier to make inroads into malaria on small islands. The American Journal of Tropical Medical Hygeine has published two articles suggesting there was success of malaria control in Sao Tome (also an island) and a corridor in South Africa, Mozambique, and Swaziland, apparently using more rigorous data methods.

As far as the country claims by the WHO and Mr. and Mrs. Gates, however, there seems to be mass confusion, and data that ranges from phony to made-up to shaky, about what interventions are responsible for what trends where. The WHO Malaria Report offers this ringing conclusion in its “Key Points” summary on how to control malaria:

In general, however, the links between interventions and trends remain ambiguous, and more careful investigations of the effects of control are needed in most countries.

Maybe the Gates Foundation should be funding more rigorous data collection. With all this effort to fight the tragedy of malaria, it’s even more tragic that the malaria warriors can’t even get accurate reports of who is sick and dying when and where.

DRI to Host Conference on Aid Evaluation

On February 6th, NYU's Development Research Institute (DRI) will host What Would the Poor Say: Debates in Aid Evaluation, a one-day conference with the leading thinkers in development economics. The conference will take place at New York University, where participants from universities, NGOs, the independent media and the private sector will add to the dialogue on how to make aid agencies accountable for the most effective solutions to global poverty. A list of speakers and panelists follows, but for a complete schedule of events, go to DRI's website. The conference is free and open to the public, but space is limited and filling up quickly. To reserve a place, RSVP to aidwatch@nyu.edu with your name and affiliation.

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Yaw Nyarko (NYU), Welcome and Introduction

Esther Duflo (MIT), The Evaluation Revolution and the Aid Providers

William Easterly (NYU), The Big Picture on Aid Accountability

Panel 1: Evaluation: Issues in Transparency and Accountability

Andrew Mwenda (The Independent, Uganda), Independent Media in Africa and Foreign Aid

Nancy Birdsall (Center for Global Development), New Methods for Motivating Results in Aid

Dennis Whittle (Global Giving), Accountability in Decentralized vs. Centrally Planned Aid Systems

June Arunga (BSL Ghana Ltd.), Foreign Aid from the African Business Point of View

Lant Pritchett (Harvard), The Political Economy of Evaluation

Panel 2: Issues in Evaluation

Leonard Wantchekon (NYU), Independent Evaluation and the Reaction of Official Aid Agencies

Ross Levine (Brown University), Evaluating the Economics: Finance and the Aid Agencies

Karin Christiansen (Publish What You Fund), Aid Transparency as a Prerequisite

William Duggan (Columbia Business School), Pragmatic Learning from Success and Failure

Everyone Should Be Responsible...(except the aid agencies)

Today, I foist a new blog called Aid Watch on the blogosphere. The objective is to be brutally honest when aid is not helping the poor, but also praising it when it is. Alas, there is far to go. Take World Bank President Robert Zoellick’s oped (A Stimulus Package for the World) in last Friday’s New York Times and another one in today’s Financial Times (It is Time to Herald the Age of Responsibility).

The more you promise, the more you are telling us you don’t expect to be accountable for promises

In the NYT, President Zoellick requests an additional $6 billion from the US in foreign aid, which will “speed up global recovery, help the world’s poor and bolster [America’s] foreign policy influence…facilitate fast and flexible aid delivery…create jobs while building a foundation for productivity and growth…increase demand for American-made equipment...[and] limit the depth and length of the international downturn, prevent the contagion of social unrest and help save a generation from a new poverty trap.”

The more actions you list, the less you are serious about each action

Right after saying “priorities” for actions in poor countries (NYT), President Zoellick manages to touch on agriculture, health, education, nutrition, infrastructure, banking systems, small-and-medium-enterprise development, microcredit, global warming, and private sector development. Mr. Zoellick (FT) also wishes for international action on the Millennium Development Goals, the Doha trade round, the Copenhagen climate change agreement, humanitarian food supplies, energy conservation, and more G20 meetings to agree on fiscal expansion and reopening credit market agreements.

It’s not about aid money to reach objectives, aid money IS the objective

NYT: “The United States could begin by pledging some $6 billion…0.7 percent of its stimulus package.” FT: “How we respond to the crisis…will set the course.” The “first step” is to give more aid.

President Zoellick does mention briefly the critical issue in both the NYT and FT: some “safeguards to ensure that the money is well spent,” which don’t currently exist. In the FT, he makes the inspirational call for an “Age of Responsibility,” but the Responsibility seems to apply only to rich donors, there is nothing about holding the World Bank responsible.

If you are not accountable for promises, if you try to do everything and focus on nothing, and if you obsess about aid money raised rather than results achieved, haven’t you already told us that the money will not be “well spent”?