Wednesday, March 16, 2011

Could the World Bank be Lying About Conditional Cash Transfers?

Perhaps we should all be kicking ourselves. According to an article in Bloomberg Businessweek, you can reduce HIV infection among young females by giving them some cash every month and paying for their school fees. That's according to the World Bank, anyhow, and they can afford to know such things.

But would that be the same World Bank that has insisted for decades that developing countries, in addition to getting themselves into irreversable debt, need to reduce public service and infrastructure spending, close health and educational facilities, reduce public sector employment levels, including teachers and health personnel and generally place young females, and everyone else, in a position where their health, education, economic and other circumstances suffer?

Denying hundreds of millions, perhaps billions of people, their basic human rights is bad enough. But then handing out a few dollars to some of them and offering to pay the school fees for the same schools that you wanted closed down does not seem like a great way of cleaning up the mess that you have been creating for so many years.

Frankly, I don't believe the results claimed for this exercise. Yes, there are young women and men who sell sex for money, goods, services and other favors. This is intolerable and everything should be done to make sure that it stops. But this phenomenon does not 'drive' (or even 'fuel') high prevalence HIV epidemics like those found in Malawi, Zimbabwe or Tanzania, no matter how much we enjoy the righteous indignation we feel when reading about 'sugar daddies' and the like.

The claim is that several thousand young women were recruited on to the trial and one group received an average of $10 a month and 'payment for school fees' if they attended class. The other group got nothing. And one and a half years later, infection rates were 60% lower among who those received the cash and school fees.

That really would be a remarkable result if it were true, but I think the person producing these results is not being completely frank. But we'll have to wait until the full program results are published. Apparently they are currently being peer reviewed. Although that doesn't seem to prevent the release of their headline figures.

Remarks from the World Bank's Mayra Buvinic sound particularly naive: “It is obvious, but it never occurred to anybody to give girls cash to help prevent transactional sex”. But it has occurred to development theorists to provide girls with education. It is well known that girls who are enabled to attend school have far better health that those who are not; this is not just about HIV.

The expert continues: “They needed money and, you know, since they got money, they didn’t need to interact with older men.” So now that you've made this great discovery about the value of education, perhaps your employers will consider its long running structural adjustment policies; I'm not sure of the current nomenclature, but you know what I mean.

Another expert smugly remarks that cash may be the "ethical policy instrument" of the 21st century. Where the hell do they get these idiots from?

Several others chip in with their stories about some of the terrible things that people in developing countries have to put up with. But these are things that existed before HIV was ever heard of and will continue to result from Western foreign policies, which concentrate on taking what they can get and even causing, or at least exacerbating, many of the problems that these 'experts' seem to think arise spontaneously.

Even if HIV epidemics such as those found in Malawi, Zimbabwe and Tanzania were driven by heterosexual sex, I don't believe you could significantly influence sexual behavior by handing out some money and paying for school fees. But nor do I believe that any severe HIV epidemic could possibly be driven by heterosexual sex, so I don't believe the claims of this article. If I hear otherwise, I'll be sure to blog about it.


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