Sunday, May 17, 2009

The Money Follows the Hype

I was reading a social and economic profile of the area I’m currently visiting, Isiolo, in Eastern Province, Kenya. Close to the end of the profile, it was stated that donor funding is usually followed by government development funding. Therefore, the development priorities of donors strongly influence the priorities of the Kenyan government. Anything not considered a priority receives very little funding from donors, but also from the government.

This leads to the ridiculous situation where far more children, mainly in developing countries, are dying from diarrhoeal diseases than from HIV, TB and malaria combined. Yet only $1.5bn was spent on developing water and sanitation in the years 2004-2006. In the same period, $10.8bn was spent on HIV/Aids. 1.8m children worldwide died of diarrhoea whereas only around 300,000 children died of HIV/Aids.

I want to draw attention to two separate issues here (without wanting to suggest that they are the only two issues!): there is the problem of donors fixating on certain problems and throwing huge amounts of money at interventions that often have little effect; then there is the issue of governments in countries like Kenya failing to target their most serious problems.

I think I can see why donors are so interested in HIV/Aids to the exclusion of almost anything else. They are often led by a powerful media and a powerful public that is also led by a powerful media. Being cool, up to date, with it, sexy, whatever the current term is, these are more important than any real issue. The mere fact that people are sick and dying is irrelevant.

But this doesn’t excuse governments from duplicating the work of donors by adopting the same priorities. Surely they see the many other far more pressing problems that are facing people every day? The fixation on HIV/Aids distorts the way countries allocate funding, it distorts the work that is carried out in the name of development and it distorts the way developing countries allocate their scarce financial resources. There is a distinct lack of autonomy and accountability here; why should an electorate accept the fact that foreign owned institutions with single and narrow interests have far more influence on their lives than their own governments?

HIV/Aids is just one disease of many and one sexually transmitted infection of many. Water and sanitation, in contrast, is vital to life. Diarrhoea is not a disease, it is a symptom, just one symptom of numerous conditions, many of which are caused by a lack of access to clean water and safe sanitation. If wealthy governments and NGOs want to address the most pressing issues they shouldn’t have far to go to find them. But it is not acceptable for them to just react to what is cool in the world of media, hype and political posturing.

Of course HIV/Aids is important, it’s just that people won’t live long enough to be infected or, if infected, they won’t live long enough to die from Aids if they don’t have other things such as adequate nutrition, water and sanitation, basic health and education and many other social services. Fighting HIV/Aids depends on developing countries having the capacity to provide these services first; they are not just optional extras or issues that can be dealt with later.

It’s true that we can’t easily solve the world’s major problems, such as hunger, poverty, lack of social services, disease, inequality, etc. But that doesn’t mean we should do nothing. Some of the money that now goes into dubious HIV prevention programmes could wipe out cholera in many countries, thus massively reducing mortality among children and infants. A fraction of the money that is being wasted on unproven agricultural technology, such as genetically modified organisms, could provide a sustainable solution to food shortages in many countries. The tens of billions that are proposed to fund the provision of one laptop to every child in developing countries could save several thousand children’s lives every day for the foreseeable future.

An estimated 10 million young children die every year from poverty related problems. These are serious problems and they will not go away soon. But there is a lot of money and capacity being wasted on things that are not nearly as urgent. No one would be stupid enough to spend all their money on HIV education for a child that is dying or may die of cholera or something equally easy to prevent or cure. We need to get away from the politics and media hype surrounding HIV/Aids and see that some of the problems people face in developing countries are much more basic and not quite so intractable.



SJOH1013 said...

Hello Simon. I have been wondering if your reading, discussions, travel and study taking you in a direction away from HIV and towards concentrating on more basic problems experienced in [East] Africa?
Given your discussion of the relative importance of the different problems and efficacy of the potential solutions, i was thinking I'd like there to be a web-based tool that you can enter in your interests, experience, skills and influence, which could suggest the ways in which you could improve the most people's lives. Is this a good idea and does it exist, I wonder. C.

Simon said...

In a sense, yes, my view of HIV was always that the basic problems allowed HIV to spread and unless those problems are addressed, HIV prevention efforts will have very little effect.

I'd like such a tool as well and I was looking at the idea of a 'browser', so you could find out why, for example, water and sanitation is relevant and how. It is probably one of the most important ways to improve the most lives in the most ways.

Originally I tried to find every single factor involved in the transmission of HIV, every intervention, all the groups with specific vulnerabilities, etc, and the possibility of matching interventions to needs was of great interest to me.

Alas, I am floundering in data and possibilities without being able to come up with a single one I can concentrate on and write a proposal!