The lethal effects of development advocacy

Aid budgets are limited by the amounts that rich countries are willing to allocate for foreign assistance.  There are limits to the generosity of parliaments, finance ministries and taxpayers.  At the same time, in developing countries there is not enough money to pay for everyone’s basic needs for food, water, shelter, health and education.

Because the total resources available are less than the needs, it is very important how they are used.  If poor decisions are made about the allocation of precious aid resources, the result can be additional suffering and death for millions of people.

This post why I think that attempts from outside to argue for aid to be earmarked for particular causes can lead to unnecessary deaths and suffering.  Aid works, but it could work better, and many sectoral advocates are not helping.


A striking example is the amount of money donors earmark for spending on HIV and AIDS here in Ethiopia.

Government spending on health in Ethiopia comes to about $4 per person per year.  According to OECD/DAC data, foreign aid for health in 2007 added about $5.15 per person to the government’s resources, bringing the total of government and aid resources to about $9 – $10 per person per year. (As an aside: health spending per person per year in the UK is about $2,000 per person per year; in the US it is about $4,500.)

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 we should work 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.

This excessive funding of HIV relative to other health needs is damaging in at least three ways.

First, aid money is not being spent in ways which would yield biggest impact. Take this analysis from the Open Budgets Blog:

Using these estimates, it would cost an additional US$29.7 million to treat all of the 540,000 kids who died from pneumonia/diarrhea in Nigeria and Ethiopia. Were this money to come out of the HIV budget, it would reduce the number of HIV patients that could be provided treatment by about 61,240. So, using these admittedly very rough estimates, our current allocation of resources from the pot of money for disease treatment suggests that we value the life of a person with HIV at 8.8 times the value of the life of a child with pneumonia.

Another way of looking at this is that reallocating resources from HIV to treating pneumonia and diarrhea in Ethiopia and Nigeria alone would have saved nearly half a million additional lives in one year.

Second, the misallocation of aid money sucks scarce resources (administrators, doctors, political attention) from other programmes which would have more impact. As Rakesh notes:

In Tanzania, I have seen any number of health centers which lack water and toilets, where women cannot deliver their babies safely, but which has a new building with 4 air conditioners and 2 Land Cruisers and weekly workshops on AIDS.

I wrote about this problem in 2007 after visiting a clinic in Burkina Faso which had been starved of medical workers by the recruitment drive by the local PEPFAR-funded clinic. And Laurie Garrett wrote in Foreign Affairs about the impact on basic health facilities of funding linked to specific diseases.

Third, the misallocation of aid money creates perverse, possibly lethal, incentives.  Here in Ethiopia the existence of huge amounts of aid money for AIDS chasing too few people with HIV means that there is a kind of welfare state emerging for people with HIV.  It is not perhaps the welfare state we see in many European countries, but it is much better resourced than is available for people without HIV.  As well as free health care, people living with HIV are supported to find work, and their children get free education.  NGOs fall over themselves to get people living with HIV and their families onto their lists.

The result is that some Ethiopians emerge from being told the results of their voluntary HIV tests in tears because they don’t have the disease and so do not qualify for this assistance. The quality of life for them and their families would be better if they did; and their life expectancy could well be higher, given the access to health services that would be unlocked.  There are even rumours here in Addis Ababa that some people are deliberately getting themselves infected, so that they can give their children a better start in life.


I have used the example of HIV because the misallocation is particularly egregious here in Ethiopia (as it is in some other countries in sub-Saharan Africa). But I do not want this to be misunderstood as an attack on AIDS activists, or on funding for HIV in particular.  Some of my best friends – indeed, some members of my family – are AIDS advocates and they are among the most committed and well intentioned development advocates.  If they had been listened to earlier, a great deal of suffering in sub-Saharan Africa and elsewhere could have been avoided; and the path to development would not have been so long and arduous for the countries most affected by AIDS.  These advocates are merely one group among many making the case (and earmarking funds) for their cause.

Look, for example, at this recent paper by ODI on education (funded by the Hewlett Foundation) which complains that while funding for basic education has grown in real terms it has not grown as a share of total aid. The paper is all about how education advocates can do more to “capture” the global stage and compete with health spending. (“Capture” is their word, not mine).  And I am not picking on education either.  There are endless demands from activists to commit more money to agriculture, microfinance, water, maternal mortality and a long list of other important issues.

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, which they consider to be unaccountably neglected by everyone else. Within many aid agencies there is a permanent state of low intensity bureaucratic warfare for resources, sucking up the time and attention of staff as they 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.  Territory is captured and held by way of international commitments in summit communiques.  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.

The advocates might defend themselves by saying that they are trying to bring more money into development, not to reallocate aid from one cause to another.  But as they know, or ought to know, that is not how development budgets work.  The UK commitment to spend $15 billion on education by 2015 does not advance by one day the path to UK aid reaching 0.7% of GDP.  Either the commitment is meaningless, because that much money would have been spent on education anyway; or it has resulted in a reallocation of aid within a fixed total to education from something else which would otherwise have been a higher priority.

The earmarking of funds within a fixed total takes money from one good cause and puts it into another. If the money moves to a lower priority, the result is additional suffering, more deaths, a longer journey to economic development, and the need to give more aid, for longer, than if choices were driven by locally-determined, well-informed, evidence-based decisions about needs and priorities.

Here in Ethiopia, the Minister for Health is very clear sighted and articulate about the health priorities for his country, and the need to allocate resources to building effective basic health systems.  Within the limited resources it is able to control, the Ethiopian health ministry makes intelligent decisions about priorities, understanding the variations within the country as well as between countries.  They have much more detailed and specific understanding of the issues that affect people here than well-meaning activists in Europe or America.  Furthermore, it is their country and their path to development, not ours.


What do we need to do differently? I set out in a recent  CGD Working Paper the need to address the political economy of aid.

First, we should be much more rigorous and systematic about defining and measuring results from aid so that well-informed choices can be made.  There is a huge and expensive industry of “monitoring and evaluation”, most of the results of which is worth less than a pitcher of spit. We should dismantle it, and use a fraction of the money to fund a smaller, more sharply focused, more rigorous, international, independent collection of real evidence about the cost effectiveness of development interventions.  (Tentative steps in this direction are, of course, being fiercely resisted by the trade union of evaluators.)

Second, we should try to stop earmarking aid; we should make more use of results to demonstrate that aid is effective. The Paris and Accra agendas for aid effectiveness, which have been agreed by all the donor nations, require donors to respect the development priorities of aid recipients.  But there has been almost no change on the ground in this direction.  One step towards doing this is to put in place simple but rigorous ways to measure and attribute results, so that donors can be confident about  (and can explain to taxpayers) how their aid has been used.  If we cannot produce compelling evidence about what aid has achieved, it should be no surprise that ministers and taxpayers want to determine in advance how the money will be spent.

Third, we should stop creating global funds, and merge or close the ones we have got.  The existence of bureaucracies whose raison d’etre is to spend money in a particular sector or in a particular way creates incentives to promote resource misallocation because it protects jobs and institutional budgets.

Fourth, we must massively increase the transparency of past, present and future aid, so that informed decisions can be taken about how resources are allocated (not just between countries and sectors but within them).  Under current arrangements, donors publish details of their aid up to 23 months after it has been spent. Donors need to publish detailed information about their current and planned future activities so that governments, donors and the private sector can identify the gaps where additional resources would have most effect.

Fifth, 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.


You may think that this is all a bit over the top.  Arguments about the architecture of aid may sound rather abstract and rarified, but aid is a scarce, precious resource and it is no exaggeration to say that if we spend it badly, the result is the avoidable deaths of literally millions of people.

29 thoughts on “The lethal effects of development advocacy”

  1. Not over the top at all. Here in Tz I have unhappily witnessed hasty alliances between donors and INGOs to identify good news stories in order defend the relevant NGO and bilateral funding allocations (flying in the face of all evidence, but that’s another story) in the face of recessionary cutbacks. The figures here for HIV and AIDS allocations as a percentage of all aid are also shocking. I recall the figure of 30 percent, which is shockingly high. I hope I’ve mis-remembered….

  2. Excellent post. Keep up the good work. We need more of this kind of thinking. Spending should only be based on sound evidence that it is going to work. Interventions should be tailored to conditions on the ground. Good intentions are no substitute for cold-headed analysis

  3. Owen! thanks so much for this refreshing post
    reminds me of all the “like-minded” donors happily abiding by paris declaration principles and moving to so-called sector budget support in Rwanda… how can one honestly pretend they are supporting strengthening of national budget processes when they provide earmarked sector budget support to eight different sectors??
    but what is true of aid allocations is also true of policy conditionality, isn’t it? my question then is: what role for sector specialists in aid agencies? aren’t they the ones pushing for all this haggling over budget shares, earmarking, and pet policy decisions?
    cheers from Ireland

  4. Owen – this is a great piece, and the topic is critically important. Thank you.

    I think that one aspect of the structure of the World Bank helps moderate this effect, and this is the role and strong influence of Country Directors. They act in a way like a minister of finance (or treasury secretary) in deciding the Bank’s support program. And often they are based in the country, so they have more ability that agency staff back in HQ to understand and take into account evolving country priorities. And the Bank’s funds (and allocations) have to be agreed by the country, including first and foremost their minister of finance. I think all these structural factors are a big help in containing the more harmful tendencies to “follow fashion” of aid spending. I have seen these folks block time and again efforts by sector and issue advocates to shift far too many resources towards the latest issue that has risen in popularity and attention at the global level.
    I’m not sure what the take-away is, but it has something to do with focusing on strengthening this process for allocation of spending at the country level.

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  6. Owen, great post. Just building on your ideas, I wonder how compatible sectoral expenditure targets are with the overall resources that developing countries have at their disposal? The following is a list of the sectoral targets that African countries have signed up to/have as targets. These targets were presumably encouraged by sectoral advisers keen to maintain the importance of their turf. However it is possible that when combined their achievement is unrealistic. If this was the case, the failure to meet these targets would not be a matter of political will but overall resource availability. This would draw into question the wisdom of incompatible and unattainable targets being devised in the first place.

    • Health: 15% government expenditure
    • Education: 20% government expenditure
    • Infrastructure: 11.5% GDP
    • Social protection: 4.4% GDP
    • Water and sanitation: $58 per capita
    • Agriculture: 10% government expenditure

    Owen replies – interesting question, Phil. On the face of it, these percentages don’t look internally inconsistent, though it is strange to think that anyone thinks that there should be international norms of this kind.

  7. Owen, great post. thoughtful and articulate. one question comes to mind: is the process of allocation of resources at a country level inherently less political and more rational than it is at the global level? i guess i’m wondering if we’re still going to end up with advocacy but at a local level rather than a global one. the local telecomms industry is still going to go to the government asking for money and so will defense, transportation, etc.

    while it is clear that we tie the hands of local decision-makers to do sensible, rational allocation, is there evidence that if we untied them it would be more rational? or perhaps more importantly, what steps can we take in untying the aid to promote more evidence-based decisions locally?

    Orin – Nice to hear from you. It is hard to generalise, of course, given the very diverse governments around the world. But let’s not forget that the option we have is not “rational global allocation” but an uncoordinated set of decisions among tens of donors and literally hundreds of global funds and international organisations with nothing in the system to force these independent decisions towards a good overall outcome. There is no question in my mind that the Ethiopian Health Ministry would do a better job of resource allocation than the aid they experience today.

    Local decisions by a government with good local knowledge and – most importantly – accountable to local citizens seems, in general, more likely to make good allocation decisions than unaccountable decisions by international agencies. That cycle of allocation, impact and accountability is essential for any system to operate effectively, and the accountability for global decisions is completely missing. National accountability is far from perfect in many countries, developing and industrialised, but earmarking of aid from outside makes that problem worse, not better.

  8. Owen–

    A good post on an important topic. I’m afraid, however your recommendations are not sufficiently grounded in reality. As you say, aid budgets come from voters and legislative bodies. This constituency is generally more persuaded by human appeals than great evidence. This mix also brings in foreign policy and diplomacy which is another driver for aid budgets. One of the reasons that Ethiopia got such a big HIV allocation was it was a frontline state in the fight against terrorism and was willing to send its soldiers to Somalia. As much as I would like to wish this factor away, we can’t and we better figure out practical ways of dealing with this influence.

    As for people advocating for their cause, I am sympathetic here as well. But you can’t simply ask people to stop it. In some cases, it is driven by a sincere belief that their cause is more important than others, in other cases it is just people responding to incentives. Appeals to solve specific diseases that can be given a face and a name are a hell of a lot easier to raise funds for than for evidence best approaches. I don’t think we will get people to sign up for health system sponsorships the way hundreds of charities get donors to sponsor children.

    Couldn’t agree more about not creating more global funds. I think I was the only person who blogged on the CDG website that we should wind up UNAIDS instead of inventing a new mission for it. We can thank UNAIDS for the overfunding of HIV around the world.

    Heaping scorn on people for advocating for a cause is misguided and will never happen. One idea that I think merits some consideration is a professional certification of charities that establishes rules about the use of evidence and provides guidelines on appropriate fundraising methods. To counteract one set of incentives, you have to create new ones. Major donors would be constrained to fund organizations that only adhere to guidelines on what claims of success can be made from their interventions and how they use data to make those claims. Similarly, those misleading appeals to saving poor africans and sponsorships (which are really a scam) ought to be banned.

    In any case, keep raising this demands more serious consideration and we are being drowned out by the malaria, AIDS, clean water, family planning, guinea worm, oncho, vaccine, polio, etc. etc. champions.

    Owen replies: thanks Jeff. I agree with your point about the political economy of reform – indeed, my recent CGD Working Paper is all about how to align the political economy with reform of the aid system.

  9. My comments would be the following:
    First of all I don’t believe international dev aid is a zero sum game – there is definitely more money available because of the AIDS epdemic than before. Secondly I am not at all sure that governments always know what is the best way to spend aid money – we tend to forget what political scientists have known all along that any government’s primary objective is to remain in power, so any money they have will be spent to make sure that happens, just look at Zambia. Thirdly, earmarked funding is more earmarked at central level than what it is at district level – at district level health workers usually know how to prioritize and they often defy earmarking – thank God.

    The good news though is that Development Aid is not the solution to development – it is at its best a small contribution to a small group of individuals. Development is basically about open and fair trade, and a global respect of human rights.

    Owen replies: Par – I agree that there are many determinants of development other than aid, and that trade and human rights are important. But aid can help to accelerate development, and it can also help people to live better lives while that development is taking place. It is too precious to waste.

  10. Fantastic blog post as always Owen! I was sitting around the dinner table last night with friends in Dar es Salaam talking about exactly these issues — I’ve forwarded your post to the group. I agree with all your recs (save the heaping scorn bit!), especially on transparency. I’d also like to see development agencies and NGOs publish information on what portion of their budgets goes towards (generous) expat compensation packages, but perhaps that’s the final frontier.

    Best wishes from Dar —


  11. I disagree with you Owen and agree with Carlos. Sadly the counterfactual is that money doesn’t flow at all, not that it suddenly flows in the deeply rational way that we would all of course support.

    To take your example from the UK, 0.7% is far from guaranteed as we all well know, and we do fight on the overall numbers and on 0.7% despite how uncampaignable that is. However, the majority of supporters have to see the human face of what aid can deliver.

    Another important political economy point is that whilst aid from the Global Fund for HIV/AIDS, TB and Malaria may have some serious flaws in terms of aid effectiveness, it is still far better in terms of aid quality than the vast majority of bilateral aid given by those who also support the fund. DFID is always keen to point out that the global fund is not as good as their bilateral aid (which is not a given)- but even if this is true then it is still effectively laundering far worse quality bilateral aid from many others (japan, italy, spain, france, the US….)

    So when you take political economy into account I think the jury is out as to whether global funds actually have a net negative effect on overall aid quality. Those wanting to tackle HIV only have to deal with two behemoths, GFATM and PEPFAR. imagine the nightmare spaghetti of bilateral funds that would be there without them.

    I think blanket dismissal of any new global funds is a mistake too. There are good global funds and there are bad global funds.

    In Education if we had a global fund that could mobilise billions from countries in the next few years, and that combines the great governance arrangements of the global fund with the aid effectiveness of the FTI, giving budget support in a predictable way to support education plans, then that is not necessarily a bad thing.

    In health i think the challenge is to get the global fund a. using country systems and giving budget support as much as possible, over long time frames, and to gradually turn it into a global fund for health, without losing the amazing gains we have seen since its inception (compare with the World Bank, whose track record on health is by their own estimation deeply ineffective).

    I also see what you mean about priorities being set in advance, but I think this is a bit of a red herring. you could reasonably argue that with a few possible exceptions, say for example immediate post conflict countries, almost every government on earth should be spending around a quarter of its budget on education and health.

    Max – you seem less concerned than I am about the human consequences of this donor setting of resource priorities. The Open Budget Project calculation is that about half a million children will die in Ethiopia and Nigeria (alone) as a result of misallocation of aid. This is not an argument among bright young things in a campaign planning meeting: this is somebody’s child dying because we thought it was politically attractive to earmark funds for AIDS instead of something else.

    I agree with you about the need to be politically savvy about building support for more and better aid – indeed, I’ve recently written a whole Working Paper on the subject – but you can’t use politics as a trump card to to say that anything goes because it is politically expedient. There must be a serious risk that the grotesque behaviour of donors, driven by sectoral advocacy, is gradually bringing the whole aid system into disrepute.

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  13. A question and a comment.

    With regards to: “(Tentative steps in this direction are, of course, being fiercely resisted by the trade union of evaluators),” what specifically are these tentative steps? Which organizations? What types of evaluations? Details please.

    Comment: In both this post and in your working paper, you pay attention the political economy of aid, but not that of countries. I agree that IGOs are inefficiently allocating money, which implies that its possible for a different allocation mechanism to do better. I don’t quite see why country governments are assumed to be better, however. On average, they have been quite bad. I think its analogous to the rural area country diner versus the Applebee’s. Now Applebee’s isn’t great, it’s not even very good, and the diner might have some romantic mystique, but that diner food is much more inconsistent and much more likely to be terrible in multiple ways: country governments are also much more unpredictable and much more likely to be terrible than the generic IGO.

    I don’t recall seeing any mechanism in your white paper for filtering the good from bad local governments, nor do I recall an explanation of why the political economy of a developing country is likely to have better allocation than IGOs.

    Owen replies: Your diner analogy doesn’t work. In your example, both diners are in some way accountable to their customers. A more accurate metaphor would be two restaurants, side by side, one of which depended for repeat business on the quality of its food and the other of which was paid by someone very rich thousands of miles away to do whatever it wanted. Which one would be more likely to serve its customers well?

    On evaluation, I think 3IE is a good initiative. I also think the Poverty Action Lab does good work. The ALINE approach to gathering data from beneficiaries also looks promising.

  14. dear owen

    I love the idea of being a bright young campaigner- sadly I fear I am neither bright nor young any longer!

    I am not for a second seeking to say that misallocated aid costs lives- my only point is that if it wasn’t for the politics there wouldn’t be any aid in the first place. It may well then still be true that it is better to have less aid given better- and many would agree with this. Would the world be a better place without Pepfar, but with US aid to health at previous levels? Maybe. But that doesn’t seem to be your argument unless I am misunderstanding it. Instead you are saying that this aid is being given so badly it is costing lives and should be given much better. I would agree but all I am saying I think this argument is a bit academic as the aid would not be there without the politics.

    I do think there is a strong argument for more clever and constructive campaigning that can tug the heartstrings of northern publics whilst delivering the kind of aid that will make a difference. We have tried to do this at oxfam, and since 2005 have been campaigning for more general and sector budget support given over a minimum of three years, often in the face of a lot of criticism from other ngos and AIDS activists in particular. We pushed really hard for MDG contracts from the EC for example, some of the best aid around in terms of supporting public services. This came out a lot from our experience with debt relief, which we feel needs far more credit as the biggest and most successful example of budget support, something I saw for myself whilst living in Malawi.

    (a rapidly aging policy wonk)

  15. Great post. This is tangential (at best) to your main points, but looking through the comments I was very interested by the numbers Phil put forward. While they aren’t internally inconsistent, I had a suspicion that they were unrealistic.

    Taking a group of 13 low-income African countries (chosen based on data availability, in a limited time frame, on a bad internet connection): weighted average per capita GDP is $1,330, while weighted average per capita gov’t revenue is $183. Thus required per capita expenditures would be as follows:

    Infrastructure: $153
    Health: $27
    Education: $37
    Social Protection: $8
    Watsan: $58
    Total: $283

    Therefore, ignoring other government expenditures (agriculture, parliamentary expenses, diplomatic corps, defense, etc.) there is already a financing gap of $100 (per capita), or 35.7%. This is in line with what donors are financing in many countries, but remember the above targets ignore many areas of government expenditure – thus I don’t think the above targets are realistic for poor African countries.

    Beyond realism, the numbers generated are also quite strange. Using the above targets, the government would be expected to spend more on educatoin than health, more on infrastructure than health and education combined, and twice as much on watsan than on health. Based on my experiences in Africa, this does not seem like a good balance of expenditures.

    Finally, the watsan target seems really strange to me. Taking some generally accepted numbers: a borehole costs around $10,000 to install, provides enough water for 250 people, and lasts for about 15 years. Thus the per capita cost of clean water could be something like $2.67 per year. Allowing that this is a VERY rough estimate, $58pp/year still seems like a lot, especially as compared to other expenditures.

    This comment was mostly just an excuse for me to play with numbers, but I’ll try to draw a conclusion anyways: established expenditure targest are a dangerous concept. (I’m not specifically taking issue with the above targets – just using them as an example. I’m also not meaning to imply anyone has advocated for targets. Just adding to the discussion).

    While I agree in principle that scarce international aid should be allocated strategically based on need and potential for impact, good ideas like that tend to breakdown in practice – especially in the world of international development. I’d hate to see a useful concept (spending money where it’s most needed, rather than where lobbies dictate it should go) turn into a uniformly applied and largely unscrutinized set of expenditure targets (the big, simple type of idea, that dev’t industry tends to favour), instead of a move towards rigorous process of evidenced based decision making (the hard to implement type of concept that dev’t industry tends to shy from). Just another hurdle to jump in the long process of making aid work I guess…

    Owen – very interesting analysis. I think that does suggest that Phil is right that these targets are simply not consistent with each other.

  16. Bogdan Baginski/Etobicoke

    A message from a guerrilla community worker.

    Thanks God for Owen Barder. I will have to read pretty much everything
    on his web site.

    I have not read the paper but it sort of ties in with my
    interest in economics.

    Taking a global view we might speculate that the world financial system
    has to be re-engineered. Many development economics problems would
    But how to tackle that?
    The stage I am at, in my research:
    1) Arno Peters ( a German professor) and his “equivalence principle”
    2) Bernard Lonergan (Canada’s national treasure) and his work on “circulation analysis”
    3) pretty much don’t waste your time on econometrics and the current output of economics departments

    Who could do that – of course engineers.

    We build the most complex systems in the world: supercomputers, space
    shuttles, power generation grids, bank financial software systems etc. etc.

    We have good brains for numbers, we have creativity and a knack for inventions/new designs, we have the tools to model and test models by
    simulations or all kinds of numerical analysis.

    We have the collaboration tools – look at the success of the Open Software
    projects. Developers from all over the globe are able to create high quality artifacts – without ever meeting face-to-face etc. etc.
    Engineers Without Borders – Canada/Poland

  17. Great post.
    I had the misfortune of going to India with a well known NGO and quickly left them once seeing what their game was. Lovely digs in a New Delhi neighbourhood populated by embassies; generous, by national standards, salaries; nice new land rover etc. My client, who asked me to stay on after I quit the NGO, was focused upon hunger and caste. One type of opponent in their caste conflict was my former and other NGOs who interpreted gender equity as an entitlement, rather an opportunity issue. In other words, by emphasising the mathematics (50% have to be women; a woman must always be on the management team to represent the women’s perspective and so forth) they were promoting the creation a new gender based caste. The reason the NGOs were promoting this interpretation of gender equity and ignoring the larger issue of caste, was that in the UK, caste does not exist whereas the concept of equity as entitlement does – hence the NGOs were responding to the existing interest group in their home country as their basis of support rather than the needs of the host country they were in.
    The difference in resource allocation between HIV/AIDS and malaria also reflects my example of how priorities can be driven by the home country of the NGO rather than then needs of the host country. HIV is a also a donor country issue whereas malaria is not, therefore HIV will receive the lion’s share of donor resources and media attention
    The saddest part of this split is how some NGOs in their drive for self-sustaining funding and volunteer support will deliberately perpetuate existing mythologies for their purpose, rather than honestly educate funding groups and perspective volunteers.

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  21. Hi,
    I’d like to point out a follow-up study of the study discussed by Phil and the other Owen above.
    A recent report published by ODI shows that simultaneously meeting all the six development targets discussed above would require more than 100% of total government expenditure in four of the five case study countries, and 98% in the fifth, and that to meet these targets while retaining current levels of expenditure in other sectors would imply doubling current levels of government expenditure. Often it is claimed that developing country governments lack the political will to allocate resources to some sectors. However, this study suggests that the inadequacy of public expenditure in key sectors is also informed by the inherent impossibility of simultaneously meeting the range of international commitments to which developing counties are signatories.

    The full report can be downloaded here:

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  23. I would argue that this too is a perverse effect of the lack of local feedback loops for donors.

    Advocacy is necessary, as it is part of the genuine political debate on priorities. It is good that this debate happens on the local, national, regional and global level. I guess you would not argue there is too much advocacy and donor push on reproductive health in Ethiopia.

    Like all political debate, advocacy can become extremism. This is doubly so when the advocacy has a strong feedback loop with the donors, and an absent one in the program countries. The advocacy in favour of HIV/AIDS interventions is not balanced by the demand for better health care systems by the population.

    This is why I would advocate (me too, I am an advocate) for keeping global systems professional and nimble. Their mandate should remain catalytic for operations. Indeed, I liked the UNIFEM better the new UN-women.

  24. Pingback: Week Four: Queen, Hagen, and Robinson | Viral Cultures: HIV/AIDS in Global, Academic, and Cultural Contexts

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