How Low Would An NGO Go For the Sake of Money, Even Spite?

The first time I came to East Africa, in mid-2002, I wondered how I could be part of 'development', part of the efforts to change things for the better (despite knowing that some things that go under the name 'development' make things worse, often by design). The changes may be small, but they would make a big difference to some. Etc.

Like anyone else who had similar wishes, I needed to find out what was going on, what was so bad that it needed changing, how to bring about such change, why this sort of change was not already occurring, or if it was, how to do more of that and less of anything that was inimical to development...

I wanted to meet people involved in development, people from East Africa, people not from East Africa, whatever it took. I went back to Europe to save enough money to return and, at the same time, study for a Master's degree that included development, and perhaps some other areas, so I would have some kind of perspective, maybe even some useful skills.

That may all sound very naive, but in some ways I haven't changed that much. Since I've come back I've been working with individuals, community based organizations (CBO), non-governmental organizations (NGO) and the like, hoping to find that some were doing the right thing so I could learn about where I could fit in. Because, as I spend time trying to find out where I fit in, I have to do something. So I do many things, and I hope that continues.

But what do NGOs and others in the developing world do? Well most people know something about some NGO, what might have once been referred to as 'charity'. They do relief work following emergencies, education of various kinds, healthcare work, poverty reduction work and much else. Nominally, they do all the kinds of things that someone 'with a heart' would wish to do, or wish to know that others do or to support, financially and in other ways.

Well, some people do things because they 'have a heart', but not all do. Some make a living out of their work, some make a very good living, some make a fortune, etc. But one expects NGOs themselves to be run, driven perhaps, by 'a heart', whether it's the heart of a person, several people or some kind of community, perhaps a church.

Many organizations in East Africa doing development work are, to a greater or lesser extent, church-based. Now, we all know from experience that being church-based does not guarantee that the work is always well intentioned. Unless the people driving the organization have good intentions, the work will be of little benefit to people who are in need of, say, education, poverty reduction, healthcare, and the like. As I've said, some 'development' work is harmful, and the ideal of 'making things better', however naive-sounding, was never part of the plan.

Perhaps I'm rambling a bit; that is partly my want, but partly my intention, for the moment. But you do come across organizations who say all the right things, tick all the right boxes and go through all the motions, and all that just to survive as an organization. There is nothing else they can do but survive. They look for calls for proposals, find ones they think they can do or ones they can persuade the donor they can do, and apply. If they get money, they do the job, somehow or other, if not they collapse.

So take an organization I shall call whateverisexcellent.or.tz; they are a church-based organization, they do all of the above and everyone says that they are very good proponents of their church's teachings. They 'help' poor people, sick people, vulnerable and abandoned people, people with disabilities, people who are in some way stigmatized, they care for them and look after them, up to a certain point; they are unlikely to do so for the duration of those people's lives, unless those lives are short (and many are); projects are usually a few years and no more.

But that's something, because they are doing what they say they are doing, donors love them, they give them money and every few years, when a project ends, they can apply for more money and say 'look at these children and old people and orphans and vulnerable children and disabled people and stigmatized people, this is what we have been doing, if you give us more money we will keep doing it and even find some more beneficiaries'.

But when it comes down to it, the organization is just part of a bigger community, which is part of an even bigger congregation, which is part of a whole lot of congregations and overlapping groups. And it happens that whateverisexcellent.or.tz has a neighbour, which whateverisexcellent.or.tz's church was able to help out with some land, so that this neighbour could build another NGO, specializing in some of the above needy groups; let's call the neighbour ladlesoflove.or.tz.

Ladlesoflove.or.tz, as an organization, do very well. So well that the church sees the beautiful buildings and, maybe, they  'covet' them. Whateverisexcellent.or.tz may well tick all the right boxes when it comes to applying for grants and, eventually, reassuring donors that they have spent the money well (and asking for more, of course), but they covet the assets of ladlesoflove.or.tz so much that they ignore the vulnerable, poor, disabled, abandoned, stigmatized beneficiaries of ladlesoflove.or.tz; they threaten to evict their neighbours, to whom they were once so sympathetic.

For me, the question is, if whateverisexcellent.or.tz is so concerned about all needy people, some of whom ladlesoflove.or.tz is benefitting, how could they do something that would compromise every single beneficiary? And just for the sake of some assets (plus a fair amount of spite, jealousy, bloody-mindedness, prejudice or anything else that drives such maneuvers)? Shouldn't their donors say 'hey, why do you take our money but continue to impoverish the poor, stigmatize the stigmatized, abandoned again those who have been abandoned?'

If donors don't do that, they are simply accepting that development is just an exercise in identifying some projects that can tick the right boxes, and getting on with the job. So is that all development is? As a person still trying to figure out what development is, I certainly don't accept that it is, effectively, an administrative and PR effort entirely motivated by political and/or commercial interests, with no intentions worthy of a human being as a human being. If development is just another business, and just as unscrupulous as it needs to be, I think many people working in the field will be looking for another way of fulfilling their original intentions.

I'll return to this theme soon and I hope to be clearer about whateverisexcellent.or.tz; are their intentions honorable, or is all the 'we're a church-based organization and we follow the teachings of the bible' just posturing, just a way of keeping the donor funds flowing. Because I've heard many claims about 'following the teachings of the bible' and (sharp intake of breath), some of them sounded quite hollow. But that's just my view.

Kenyan Health Care Suffers From Underfunding and Corruption

Following recent remarks by Kenya's Health Services Minister, Professor Anyang' Nyong'o, to the effect that there major problems with health care provision in the country, there have been a couple of other articles on the same subject.

One of them calls for greater investment in the health sector and suggests that problems in the sector are common knowledge. The article is not very specific and doesn't cite the study it purports to be referring to but it mentions inadequate staffing, drug shortages, lack of equipment and paucity of facilities.

The article claims that conditions are worse in rural than in urban areas, which is debatable, but it says that the rural, slumdwelling poor "simply lack access to quality health services". Indeed, I'd say that in some places people lack access to any health services, quality or otherwise. Staff shortages, the article goes on, leads to the use of shortcuts, longer procedures are avoided and quick fixes are widely used.

Apparently corruption is also a problem in the health sector and "Provisions to public health facilities end up in the hands of crooks, who sell them to private hospitals." The article concludes by calling for more investment, but perhaps any finance or resources involved need to be more carefully monitored as well.

Another article deals specifically with corruption and mismanagement in the sector. Both the Medical Services and the Public Health ministrys are mentioned (there are two on account of the power sharing agreement made following the post-election disputes in 2008). This article also mentions shortages of drugs and poor supervision.

According to the article, the report by the Kenya Anti-Corruption Commission "found absenteeism by medical staff, flawed procurement processes, theft of drugs and other medical supplies, and unnecessary referral of patients to private clinics as major forms of corruption." There is also, apparently, a lack of clarity about fees that patients are charged.

Minister Nyong'o specifically draws attention to the possible contribution that unsafe health services could make to the HIV epidemic and various other blood borne viruses. But the health problems that Kenyans face are numerous. In addition to greater awareness about these there should also be far more spending on safe health care that is accessible to everyone.

Cut Corruption, Don't Cut Aid

I arrived in Nakuru in September of last year expecting to work for an organisation called ICROSS (International Community for Relief of Starvation and Suffering), supposedly to work on a HIV related project. However, in my first week in Nakuru I realised they didn't have any active projects. Officially, they were waiting for funding. But as I was led from one 'site' to another, I realised there was something not quite right about ICROSS. It was hard to put a finger on, but the first thing I found strange was that only a couple of people had ever even met the guy who headed ICROSS, Mike Meegan (also known as Mike Elmore-Meegan, Dr Meegan, Fr Meegan, Br Meegan and probably a few other names not worth repeating). Some had heard of him but most didn't even recognise the name.

Well, it quickly turned out that none of the 'sites', these community based organisations and support groups that I was being taken to see, had any real connection with ICROSS. ICROSS would just collect up organisations and include them in their proposals when they were looking for funding, which was all the time. The only function the organisation seemed to serve was to find funding. Anything worthwhile that was achieved was done by a handful of volunteers, along with some of these organisations that had been 'absorbed' by ICROSS. Of course, ICROSS would always take the credit.

So, to those who are worried about how this work will be affected by the demise of ICROSS Ireland? For a start, it's only ICROSS Ireland that has closed. ICROSS Kenya continues its 'operations'. But even if that were to close, very little would happen on the ground in Nakuru. ICROSS simply didn't do very much here, aside from pay visits when they wanted to show potential funders or publicists around. They would take a few photos, maybe hand out something small that they had acquired from some donor or other, then head back to the Nairobi office (where none of the projects were based).

The many small organisations that ICROSS claims (incorrectly) to have founded just continue as they did before ICROSS arrived. Some will be better off, some will be a small bit worse off, but most will continue as if nothing had happened. Because nothing has happened to most of them. Some of them will continue to welcome anyone from ICROSS because there is a slight chance of a handout, a few may collapse because they only got together to pick up anything being given out by organisations like ICROSS, but for most, ICROSS will be a faint memory.

As to what happened to all the money ICROSS has raised over the years, these newspaper articles are silent. In addition to the one above, there is another in the Sunday Times, one in the Irish Mail on Sunday and one in the Irish Examiner. These can be added to the collection of articles on the organisation's suspect activities, going back years. For the moment, we can only guess at what the money was used for.

The numerous scientific papers that have Meegan's name on them may seem suspect now, too. But judging from what I've heard, he is unlikely to have had anything to do with the data, at any level. None of the people involved in one of these projects in particular had ever met the man and he never visited the sites where the participants lived, where data was produced and collected. Let's hope that's the case, because many would not wish to rely on data that could be seriously flawed.

But I wouldn't want people to think that no harm has been done, that no one has been depending on all the money donated to ICROSS over the years. After spending a few weeks finding out that ICROSS wasn't doing anything effective in Nakuru, I asked Meegan to make some money available, urgently, as people were sick and in need of help. He and I disagreed on this matter and I finished working with ICROSS before I had even started. Some of the sick people who were in dire need died and many will continue to suffer and die. Meegan likes to boast about how many people he knows have died of Aids here in Kenya. But some of them are dying because aid money is not getting to them.

On a broader scale, also, it matters very much that money intended for poor people, sick people and starving people is not getting to them, regardless of whether it is diverted to repressive regimes, rich foreign contractors, greedy governments or where ever else it may go. If charities, aid organisations, governments, consultancies, commercial organisations or other parties are corrupt, that needs to be remedied. But there are too many people who would like to see aid cut or stopped altogether. Why punish the people who are already suffering because of the conduct of those who are supposed to be accountable, who are from wealthy countries, who are well off themselves? Aid is not the problem, corruption is.

It is extraordinary that Meegan seems to have surrounded himself with so many prominent people. The few people I know who have met him find him utterly unconvincing and I agree with them. But he seems to have been able to fool a lot of people for a long time. Audits and investigations have been carried out over the years and both he and his organisation have been found wanting. Yet ICROSS continued their fundraising and somebody continued, presumably, spending the money. Just not in Nakuru. Hopefully this time will be different.

A Pill for Underdevelopment

An article published on the 24 of December last year claims that a three week drive to test as many people for HIV as possible succeeded in testing one and a half million people. Perhaps my scepticism is misplaced, but I find it hard to believe that over 6600 people were tested every day for three weeks. Still, if it's true that the country has the capacity to test this number of people this quickly, their aim to test 80% of the adult population by the end of 2010 should be fairly easy.

Unfortunately, providing antiretroviral treatment (ART) for everyone found to be in need of it may not be so easy. The Kenyan government has only ever provided a fraction of the money needed to supply ART to everyone who needs it. Most of the money came from donor funds, such as the (US) President's Emergency Fund for Aids Relief (PEPFAR), the Global Fund and the Clinton Foundation. But they are not due to increase their funding in line with the surge in numbers being found to be HIV positive. The Global Fund has even stopped some expected funding due to serious financial irregularities.

The funding gap is thought to be 2.5 billion shillings this year but will rise to many times that in the next few years. Kenya is currently almost out of stocks of some drugs and the Ministry of Health is applying for emergency funding that should tide them over for six months, if the money is forthcoming. The problem will be exacerbated by new World Health Organisation guidelines that recommend the use of more expensive drugs and putting HIV positive people on ART at an earlier stage of disease development.

Meanwhile, the advocates of 'treatment as prevention' are back in the news. They claim that rolling out ART to everyone found to be HIV positive and testing every adult about once a year could prevent nine out of every ten infections. If this is true in practice, testing everyone regularly and treating everyone found to be positive would be even better than very high levels of condom use (levels that have probably never been achieved). Of course, the approach to funding would have to be completely changed as current funding would be nowhere near high enough to cover the costs of 'treatment as prevention'.

Another study claims that the sort of mass screening suggested above could allow HIV to be eradicated in 40 years (in South Africa). My reaction to these articles, and I'm thinking specifically of Kenya, is that if it were possible to test many millions of people every year, it may also be feasible to put millions on treatment. And if it were possible to successfully treat so many people, then transmission rates should drop radically.

But I would question the feasibility of testing most sexually active adults in Kenya every year. This is a country where health services are in very short supply and high quality services are only available to the very rich, if at all. Long term care for the chronically ill is in even shorter supply. Is the country really going to raise the money for and implement the vast improvements in health infrastructure that would be required just to make this level of HIV screening possible? And if this happens, will the country also develop its capacity to provide long term care to millions of HIV positive people for several decades to come?

Even if the money is forthcoming, I find it hard to believe that Kenya's levels of health care, education, infrastructure and social services will be raised sufficiently to make anything like these predictions about 'treatment as prevention' become a reality. Maybe it is true that 1.5 million people were tested in three weeks. And maybe the sort of funding required to eradicate HIV will be provided. But I can't help remaining highly sceptical.

My discomfort stems from reflecting on the fact that HIV spread rapidly in Kenya at a time of high and increasing levels of poverty and unemployment. Levels of health and education provision were low and are still decreasing. Health indicators, especially for maternal, child and infant health, were particularly poor and most have been disimproving since the 1980s. Gender inequalities have never been given very high priority and those among whom HIV spread most rapidly, women, commercial sex workers, men who have sex with men and intravenous drug users, are as vulnerable now as they were three decades ago.

If it is true that HIV transmission is related to the conditions in which people live and work, as I would maintain, provision even of astronomical levels of funding to test and treat millions of people will still fail to address these conditions. Therefore, I'm suggesting, HIV could still be a problem for countries like Kenya in 40 or 50 years time. In fact, we have hardly even started to address HIV transmission because we continue to ignore the conditions mentioned. But that's just my take on it.

The Extended Family and Other Myths

Sometimes people write about developing countries as if they are all very similar and they may throw in terms like 'extended family' and 'coping strategies', as if this makes poverty, illness and unemployment less of a burden. They write about 'incongruities', such as drought and famine, but lots of smiling children, playing happily in the dust.

Some people do 'cope', because they have no other option. Many live in large families and they do co-operate, with the sick, young and old being looked after by the able bodied. And of course, children play happily in the dust or mud or whatever.

However, such commentators may not see or may choose to ignore the children and adults lying in bed or the ones who never come out because their disabilities are too great or because they are too stigmatised, for example.

The fact is, people in developing countries have family disagreements, neighbourly jealousies, local spats and far more serious eruptions of discontent and outright violence, just as they do in other countries.

Here in Nakuru, there are differences and perceived differences that make it unlikely that some people will agree to work with some others and that community based organisations with members who see themselves as essentially different from other members can be prone to failure, sometimes quickly, sometimes slowly. Merely setting up a group that consists of members from different groups does not mean people will work happily together.

I don't believe this situation is all that different from wealthier countries. But crucially, many people in developing countries need support, perhaps many different kinds of support, right away and often for a very long period.

There is a severe shortage of most basic resources in developing countries, food, clean water, education, employment, etc. These are some of the things that allow them to be characterised as underdeveloped. When there is a shortage of resources, knowing that your neighbour has plenty when you have none is bound to cause discontent, no matter how friendly you have been in the past.

When people are under extreme pressure, they can do extreme things. Some don't, perhaps most people don't. But community based organisations and various initiatives are often set up when people are already under extreme pressure and they are therefore already precarious.

The majority of people in developing countries have been waiting for much or all of their lives for the most basic of goods. I suspect that that is why now, some people seem to grasp at anything that comes their way, even if it is intended to be shared with others. I think if I were starving, or if my children were, I would do pretty much anything to get food.

This doesn't explain why some of the richest people in the country, politicians, business people, colonials who remained after independence and various other organisations, also grab what they can. Some of them have been stealing vast sums of money and resources intended for people who were in dire need.

It doesn't explain why large multinationals exploit developing countries and see them as vast markets, why international organisations pretend to help developing countries when they are really enriching themselves at the expense of those countries, why huge 'pro-poor' initiatives are really about making rich people richer, selling arms, 'national security' or some other agenda, completely unrelated to development.

It would be nice to think that poverty is really quite a happy, fortunate state, given that the majority of people in the world live in poverty, many in absolute poverty. But it's not true. It's not true that everyone in developing countries live in 'extended families' that make sure no one 'falls through the net'. We just don't see those who fall through the net. It's not true that people 'cope', they either survive or they die, often after a lot of suffering.

Those who see and write about 'extended families' and people 'coping' may just miss or choose to miss those who have fallen through the net, because those who have fallen are no longer visible.