Aid: Can It Work?

The conundrum facing the rich countries is that everywhere in the developing world, and particularly in Africa, you see children dying for want of pennies, while it’s equally obvious that aid often doesn’t work very well.

Travel through the third world, and you may see clinics with signs proudly proclaiming that they were built by such-and-such an agency—but no other sign of life. It’s easy to build a clinic, but harder to ensure that doctors and nurses actually report for work in the days that follow—and when the doctor stops showing up, so do patients. Go on to the market, and there you may see the clinic’s stock of medicines for sale (marked “donated by” so-and-so, “not for sale”).

Continue on your way, and you may encounter bridges built with foreign aid over streams—but the construction led to erosion on both banks. So the ends of the bridge are a couple of feet higher than the ground, and vehicles can’t use it. Travelers continue to ford the stream in the dry season, and nobody goes across in the rainy season.

In rural Indonesia, you see a cultural problem that aid can’t easily address: pregnant women and babies going hungry, even having to eat bark from trees, while their husbands are doing fine. It turns out that the custom is for the men and boys to eat their fill first. In Ethiopia, you greet parents cradling hungry babies and explaining that they have no food because their land is parched and their crops are dying. And two hundred feet away is a lake, but there is no tradition of irrigating land with the lake water, and no bucket; and anyway the men explain that carrying water is women’s work. In both cases you can see why many who know about aid say that changing the status and power of women is of prime importance if aid and development are to be effective. But it is far from clear how this can be done.

Discouraged, you move on to southern Africa. You see the very sensible efforts of aid groups to get people to grow sorghum rather than corn, because it is hardier and more nutritious. But local people aren’t used to eating sorghum. So aid workers introduce sorghum by giving it out as a relief food to the poor—and then sorghum becomes stigmatized as the poor man’s food, and no one wants to have anything to do with it.

You visit an AIDS clinic there, and see the efforts to save babies by using cheap medicines like Nevirapine to block mother-to-child transmission of HIV during pregnancy. Then the clinic gives the women infant formula to take home, so that they don’t infect the babies with HIV during breastfeeding. A hundred yards down the road, you see piles of abandoned formula, where the women have dumped it. Any woman feeding her baby formula, rather than nursing directly, is presumed to have tested positive for HIV, and no woman wants that stigma.

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