On a big wide plain, surrounded by hills, lived the finest herd of goats ever seen. The greatest of them were immensely hairy and roamed around, eating too much and proclaiming themselves to be the hairiest in creation. They kept the best pastures for themselves and spent a lot of time at the top of the hills, from where they could survey their minions. Anything they didn’t want would roll down the hills and on to the plain, and they considered this to be a very good thing.
Their minions were not so hairy and lived all their lives tethered to posts. All day, every day, they grazed the little that grew in the small disk around their posts. And many had to share their disk of grass with others because the posts were so close together. Sometimes, the free goats would even come and steal grass from the tethered goats, although they had plenty of their own and were free to graze anywhere.
The free goats would often discuss the conditions that the tethered goats had to live in. They would ask if the tethered goats shouldn’t have longer ropes, or even shorter ropes. They would ask if the rope should be made of different materials, perhaps cheaper ones. Once, they even tethered some of the goats with bungees, which meant that they would struggle to a little green grass only to be pulled back just as they started to eat it. This caused the tethered goats a lot of suffering but the free goats found it amusing, especially when the tethered goats hit their posts.
Every now and again, a free goat would have the temerity to suggest that all goats should be free, that none should be tethered and that the plains are subject to floods and eventually everyone will suffer, tethered or free. On such occasions, the biggest and hairiest free goat would be summoned, because he was considered to be the wisest. At least, he had the most impressive set of dried dingleberries that rattled as he walked around, a quality much prized among free goats.
This hairy goat would remonstrate with the outspoken goat and point out that great wisdom does not lie in giving the best answers to questions, or even in asking the best questions. Great wisdom lies in recognising who is the wisest and doing exactly as they do. If the wisest has long shaggy hair and a profusion of dingleberries, this is what one must emulate. As for flooding, he pronounced, the rising tide will float all goats.
And he was right, the tide rose and the goats all floated, for a while. The tethered goats were quickly submerged and the free ones ran for the hills. The water kept rising and food supplies dwindled, but the few free goats that were left ate more than ever. The one with the great dingleberries drowned because wet dingleberries don’t float. And the remaining free goats continue to live in isolated groups at the very tops of the highest hills, wondering what to do now that their hairy leader has gone.
Dingleberries are a lot less fashionable now, and even hairiness is no longer much sought after. But the ability to balance on all four feet on a very small patch of ground is considered to be a sign of great wisdom among free goats.
Showing posts with label structural adjustment policies. Show all posts
Showing posts with label structural adjustment policies. Show all posts
Thursday, May 13, 2010
Wednesday, April 8, 2009
IMF: a Sixty Year Old Limping Contradiction
I don't know if it is a coincidence but last year the Americans have finally said they would allow someone other than an American to hold the position of president of the IMF (International Monetary Fund), which they have dominated for 60 years. Will the Europeans also allow a non-European to be Managing Director? At the same time, many developing countries, recipients of IMF loans, have decided that the conditions attached to the loans cause more harm than good. So they have paid back their loans (Thailand, Brazil, Venezuela, Argentina, Indonesia). If this trend continues, the IMF could cease to exist.
Is it possible that the Americans see the IMF as an obsolescent institution? Well, perhaps not. Although the IMF appears to have been limping along for some time, the global financial crisis has prompted the G20 to add half a trillion dollars to its funds. The people who are tasked with dealing with the consequences of financial and banking liberalization are also promoting them, one of the IMF's favourite conditions being financial and banking liberalization.
Contradictions have never been a problem for the IMF or the World Bank. They give loans to countries to assist 'development' at the same time as they oversee the reduction of health, education, social services and infrastructure in the same countries. These are the very areas that are in need of development but if you've got the money, you get to decide on the ‘best’ route to development; even if that route is in the opposite direction to anything that could be described as development.
It's vaguely possible that the IMF, similar institutions and donor countries will one day start listening to their recipients. After all, many recipients have had clearer insights into what they need in order to achieve development that benefits their own people. But given their behaviour to date, it seems unlikely that these unwieldy institutions will change much for the better. One might almost think that they are not designed to benefit their recipients. (Remember the Goldenberg scandal in Kenya? Ok, it’s a bit of an easy target!)
A recent issue of Africa Focus (Africa: Global Economic Crisis 1-3) makes the point that developing countries have long been worried about the subsidies that developed countries paid to its farmers (while stipulating the removal of subsidies in developing countries as a condition of receiving loans). Now they also need to worry about subsidies being paid to financial institutions and the possible subsidies to be paid to manufacturing industries, such as the automotive industry. But those who have the money, again, get to make all the rules. Worse still, they also get to break the rules they later find they don't like.
The fiscal stimulus package is designed to favour American (and perhaps Western) interests, goods and services. The fact that Americans and Westerners own or have an interest in financial and other institutions, goods and services in developing countries does not mean that those developing countries will benefit from the package. Developing countries are not allowed to protect themselves, developed countries are.
It is almost laughable that one of the conditions the IMF and World Bank like to apply is an increase in democratic accountability and good governance. These institutions have no democratic accountability and their governance has been demonstrated to be flawed over and over again. Almost laughable, but the poorest people in the world suffer from these jokers’ repeated cock-ups.
Those responsible for the way international finance works have screwed up, badly. Yet the same people and institutions are also responsible for addressing these problems and they seem to be applying the same tired and failed solutions. The IMF is supposed to continue to give loans to developing countries with the same conditions that have been so destructive in the past. Even countries who have made some progress in reducing their indebtedness will now go back to where they were, at best.
The first and most practical thing the IMF and other donors can do is to cancel debts. Really cancel them, not just tinker around with the figures. These debts stem from loans that had impossible conditions attached to them. The recipients of these loans usually end up poorer as a result of the loans and, in reality, have paid them back many times over.
It's not developing countries that need to reform, it's institutions like the IMF. If they are to be in a position to assist developing countries, they need to face up to the reality of the mess they have made. They need to be more representative, they need good governance. Or perhaps the IMF has is finished? Perhaps the IMF now realises that is is an experiment that went on sixty years too long.
Is it possible that the Americans see the IMF as an obsolescent institution? Well, perhaps not. Although the IMF appears to have been limping along for some time, the global financial crisis has prompted the G20 to add half a trillion dollars to its funds. The people who are tasked with dealing with the consequences of financial and banking liberalization are also promoting them, one of the IMF's favourite conditions being financial and banking liberalization.
Contradictions have never been a problem for the IMF or the World Bank. They give loans to countries to assist 'development' at the same time as they oversee the reduction of health, education, social services and infrastructure in the same countries. These are the very areas that are in need of development but if you've got the money, you get to decide on the ‘best’ route to development; even if that route is in the opposite direction to anything that could be described as development.
It's vaguely possible that the IMF, similar institutions and donor countries will one day start listening to their recipients. After all, many recipients have had clearer insights into what they need in order to achieve development that benefits their own people. But given their behaviour to date, it seems unlikely that these unwieldy institutions will change much for the better. One might almost think that they are not designed to benefit their recipients. (Remember the Goldenberg scandal in Kenya? Ok, it’s a bit of an easy target!)
A recent issue of Africa Focus (Africa: Global Economic Crisis 1-3) makes the point that developing countries have long been worried about the subsidies that developed countries paid to its farmers (while stipulating the removal of subsidies in developing countries as a condition of receiving loans). Now they also need to worry about subsidies being paid to financial institutions and the possible subsidies to be paid to manufacturing industries, such as the automotive industry. But those who have the money, again, get to make all the rules. Worse still, they also get to break the rules they later find they don't like.
The fiscal stimulus package is designed to favour American (and perhaps Western) interests, goods and services. The fact that Americans and Westerners own or have an interest in financial and other institutions, goods and services in developing countries does not mean that those developing countries will benefit from the package. Developing countries are not allowed to protect themselves, developed countries are.
It is almost laughable that one of the conditions the IMF and World Bank like to apply is an increase in democratic accountability and good governance. These institutions have no democratic accountability and their governance has been demonstrated to be flawed over and over again. Almost laughable, but the poorest people in the world suffer from these jokers’ repeated cock-ups.
Those responsible for the way international finance works have screwed up, badly. Yet the same people and institutions are also responsible for addressing these problems and they seem to be applying the same tired and failed solutions. The IMF is supposed to continue to give loans to developing countries with the same conditions that have been so destructive in the past. Even countries who have made some progress in reducing their indebtedness will now go back to where they were, at best.
The first and most practical thing the IMF and other donors can do is to cancel debts. Really cancel them, not just tinker around with the figures. These debts stem from loans that had impossible conditions attached to them. The recipients of these loans usually end up poorer as a result of the loans and, in reality, have paid them back many times over.
It's not developing countries that need to reform, it's institutions like the IMF. If they are to be in a position to assist developing countries, they need to face up to the reality of the mess they have made. They need to be more representative, they need good governance. Or perhaps the IMF has is finished? Perhaps the IMF now realises that is is an experiment that went on sixty years too long.
Thursday, April 2, 2009
Is a Woman with Obstetric Fistula Worth Less than an Uncircumcised Man?
The debate about mass male circumcision (MMC) as a solution to the HIV epidemic rages on. The evidence that, in ideal conditions, male circumcision is protective against HIV, is convincing. On the surface, it seems crazy not to implement MMC in Kenya immediately. Many new infections could be prevented and even rates of transmission of other sexually transmitted infections (STI), such as herpes simplex virus, could be cut.
But Kenyans do not live in ideal conditions. If they did, the HIV epidemic there would not be as serious as it is now. The health infrastructure that would be required for MMC does not exist. After independence in the 60s, Kenya's health infrastructure improved. But from the early 80s, global and domestic crises halted this progress.
Then the World Bank and IMF (International Monetary Fund) introduced structural adjustment policies. Countries that got loans from these institutions had to reduce their social services, reduce their public sector employment, privatise as much as possible, remove 'barriers to trade', etc. This process of impoverishment, despite overwhelming evidence of the damage it causes, continues today.
Men in Kenya would be well advised to think twice about being circumcised. The level of adverse affects is 35% for traditional circumcisions, though these have long been known to be hazardous. But the level of adverse affects for clinically performed circumcisions is 18%. I wouldn't even have a tooth extracted in a health service like this. Kenyan health infrastructure is not up to an MMC campaign. It has been systematically run down for thirty years. It will take a long time to build up. Then an MMC campaign may be more feasible.
But there are still problems. Men (all over the world) don't like using condoms. I have met men who will use any excuse to avoid using them and they jump at any 'evidence' that they don't work, such as the maunderings of some Catholic with odd taste in headgear. There is even a myth that condoms don't work for circumcised men. So, if circumcised men use condoms, circumcision may have some effect on HIV and other STI transmission rates.
There is also a phenomenon referred to as 'disinhibition'. People who have been circumcised have been found to behave as if they are protected from HIV and can do without condoms. The same process is thought to occur among people who are on antiretroviral treatment (ART). There is a danger that people who feel disinhibited are likely to have unprotected sex and thus to undermine the effects of all this expensive prevention and treatment.
It is sometimes argued that circumcision is a small and routine operation. Well, in Western countries, maybe it is. But compare it to another small and routine operation, the operation to correct obstetric fistula (OF). Women who have difficulties in labour sometimes suffer from damage to their bladder or rectum. The result is that the baby usually dies and the mother suffers from chronic incontinence.
Lifelong, chronic incontinence is bad enough in itself, but in some societies, where there is no way to reduce the effects of this condition, the person suffering OF is shunned and stigmatised. They can spend their whole life with a preventable condition that could be reversed by a simple, routine operation. OF often occurs in younger girls and it occurs where births are not attended by trained midwives or otherwise qualified people. Lack of education, as well as poor healthcare, is an important factor in maternal health.
An estimated 3000 women suffer OF every year and most don't get treatment. There is currently a backlog of hundreds of thousands. OF is preventable but Kenyan reproductive and maternal healthcare is inadequate, it is unable to prevent this and other maternal health problems. The infant deaths just add to the huge infant mortality rate, which has been growing since the 1980s. Kenyan healthcare is also unable to provide the operation to reverse the damage and allow women to live a normal life.
If the health infrastructure is not up to preventing OF, it is not up to MMC and the follow up care that would be required. And if this simple, routine operation cannot be carried out for those who continue to suffer from OF, what are the chances that the hundreds of thousands of male children born every year can be safely circumcised and cared for? If there is money available for MMC, there must be money available for OF.
But the problem with MMC is that a simple, routine operation for millions of people requires complex health infrastructure. The basic infrastructure needs to be built first. Then, MMC has a chance of working. If the basic infrastructure is there, OF will not even occur or will be as rare as it is in developed countries.
The persistence of OF bears witness to the lack of health infrastructure in Kenya and clearly indicates that MMC or any other grand programme has little chance of success.
But Kenyans do not live in ideal conditions. If they did, the HIV epidemic there would not be as serious as it is now. The health infrastructure that would be required for MMC does not exist. After independence in the 60s, Kenya's health infrastructure improved. But from the early 80s, global and domestic crises halted this progress.
Then the World Bank and IMF (International Monetary Fund) introduced structural adjustment policies. Countries that got loans from these institutions had to reduce their social services, reduce their public sector employment, privatise as much as possible, remove 'barriers to trade', etc. This process of impoverishment, despite overwhelming evidence of the damage it causes, continues today.
Men in Kenya would be well advised to think twice about being circumcised. The level of adverse affects is 35% for traditional circumcisions, though these have long been known to be hazardous. But the level of adverse affects for clinically performed circumcisions is 18%. I wouldn't even have a tooth extracted in a health service like this. Kenyan health infrastructure is not up to an MMC campaign. It has been systematically run down for thirty years. It will take a long time to build up. Then an MMC campaign may be more feasible.
But there are still problems. Men (all over the world) don't like using condoms. I have met men who will use any excuse to avoid using them and they jump at any 'evidence' that they don't work, such as the maunderings of some Catholic with odd taste in headgear. There is even a myth that condoms don't work for circumcised men. So, if circumcised men use condoms, circumcision may have some effect on HIV and other STI transmission rates.
There is also a phenomenon referred to as 'disinhibition'. People who have been circumcised have been found to behave as if they are protected from HIV and can do without condoms. The same process is thought to occur among people who are on antiretroviral treatment (ART). There is a danger that people who feel disinhibited are likely to have unprotected sex and thus to undermine the effects of all this expensive prevention and treatment.
It is sometimes argued that circumcision is a small and routine operation. Well, in Western countries, maybe it is. But compare it to another small and routine operation, the operation to correct obstetric fistula (OF). Women who have difficulties in labour sometimes suffer from damage to their bladder or rectum. The result is that the baby usually dies and the mother suffers from chronic incontinence.
Lifelong, chronic incontinence is bad enough in itself, but in some societies, where there is no way to reduce the effects of this condition, the person suffering OF is shunned and stigmatised. They can spend their whole life with a preventable condition that could be reversed by a simple, routine operation. OF often occurs in younger girls and it occurs where births are not attended by trained midwives or otherwise qualified people. Lack of education, as well as poor healthcare, is an important factor in maternal health.
An estimated 3000 women suffer OF every year and most don't get treatment. There is currently a backlog of hundreds of thousands. OF is preventable but Kenyan reproductive and maternal healthcare is inadequate, it is unable to prevent this and other maternal health problems. The infant deaths just add to the huge infant mortality rate, which has been growing since the 1980s. Kenyan healthcare is also unable to provide the operation to reverse the damage and allow women to live a normal life.
If the health infrastructure is not up to preventing OF, it is not up to MMC and the follow up care that would be required. And if this simple, routine operation cannot be carried out for those who continue to suffer from OF, what are the chances that the hundreds of thousands of male children born every year can be safely circumcised and cared for? If there is money available for MMC, there must be money available for OF.
But the problem with MMC is that a simple, routine operation for millions of people requires complex health infrastructure. The basic infrastructure needs to be built first. Then, MMC has a chance of working. If the basic infrastructure is there, OF will not even occur or will be as rare as it is in developed countries.
The persistence of OF bears witness to the lack of health infrastructure in Kenya and clearly indicates that MMC or any other grand programme has little chance of success.
Saturday, February 14, 2009
Alms for the Rich
Every year, pneumonia kills more under fives than HIV/AIDS, TB and malaria. But huge amounts of money are poured into these three diseases, much of it going towards HIV/AIDS alone. Pharmaceutical companies are speculating on these three diseases, which could make them enormously rich. Well, they are already rich but what they have now will be nothing compared with what they could make if they develop a cure for any of these.
Billions of dollars of aid money goes into disease research but only a fraction of it goes into dealing with treatable and curable conditions, such as acute respiratory infections and diarrhoea. Pharmaceutical companies are not betting on these because there are generic products available for them, products that don’t represent enough of a profit for them.
The number of people who suffer from intestinal parasites of some kind is estimated to be in the billions. This is closely related to malnutrition and nutritional deficiencies, something that may also affect billions of people. But cures for these have been around for a long time. And as no big institutions are interested in speculating in them, they receive very little money.
Don’t we in the development community look like fools, spending most donor money on a few diseases while ignoring the ones we could really have an impact on? There are people on antiretrovirals who are dying because they don’t have enough food or clean water. Are pharmaceutical companies willing to distribute pills without ensuring that there people have access to clean water? That’s how it appears, anyhow.
Some of the biggest sources of donor funding ever, the World Bank’s Global Fund, the President’s Emergency Fund for Aids Relief (PEPFAR) and the Bill and Melinda Gates Foundation, concentrate on more or less the same areas. The work done by each fund overlaps with other well funded concerns. There is very little money left for diseases and social problems that have existed for a long time.
I am not suggesting a conspiracy by big business to make sure that most donor money is spent on them. This is no secret. The money may be called donor money but it is being used as a de facto subsidy for pharmaceutical and other products. Industry lobbyists make sure that national and international laws favour their products and interests, often blocking moves by generic producers to launch far cheaper products.
Those who stand to gain from generous donor funding want all the money to be spent on them. The fact that more and more people are becoming infected with preventable diseases is irrelevant, except when this fact can be used to help squeeze out a bit more donor funding. If donor money ever becomes available in large amounts for presently neglected diseases, you can be sure that there will be companies soaking it up.
If you visit towns and schools in Kenya and Tanzania you will meet people who know more about avoiding HIV than they do about diarrhoea and colds. Some people can get hold of expensive drugs and condoms free of charge, but they can’t feed themselves or their families. There are children here who could tell you more about safe sex than many Western adults.
HIV in Kenya spread among people who had poor health, education, infrastructure and social services. Public spending was reduced in response to structural adjustment policies, starting in the 1980s. These policies are still in effect and many social indicators have been disimproving constantly for the last three decades.
Despite the concentration on HIV, large numbers of people in Kenya work without any security, for very low wages. Men often spend much of their time away from their families. Many people are reduced to exchanging sex for money, food or other commodities. These circumstances can all result in transmission of HIV and other diseases, in addition to their being social problems in themselves.
If donor money is used to chase after a few current obsessions, conditions for people will continue to decline. HIV is only one problem and whether infection rates go up or down, Kenyan people will face more and more problems as the years pass. This is because all but the most fashionable issues have been the recipients of donor funding and the ultimate recipients have been wealthy companies, not poor people.
Billions of dollars of aid money goes into disease research but only a fraction of it goes into dealing with treatable and curable conditions, such as acute respiratory infections and diarrhoea. Pharmaceutical companies are not betting on these because there are generic products available for them, products that don’t represent enough of a profit for them.
The number of people who suffer from intestinal parasites of some kind is estimated to be in the billions. This is closely related to malnutrition and nutritional deficiencies, something that may also affect billions of people. But cures for these have been around for a long time. And as no big institutions are interested in speculating in them, they receive very little money.
Don’t we in the development community look like fools, spending most donor money on a few diseases while ignoring the ones we could really have an impact on? There are people on antiretrovirals who are dying because they don’t have enough food or clean water. Are pharmaceutical companies willing to distribute pills without ensuring that there people have access to clean water? That’s how it appears, anyhow.
Some of the biggest sources of donor funding ever, the World Bank’s Global Fund, the President’s Emergency Fund for Aids Relief (PEPFAR) and the Bill and Melinda Gates Foundation, concentrate on more or less the same areas. The work done by each fund overlaps with other well funded concerns. There is very little money left for diseases and social problems that have existed for a long time.
I am not suggesting a conspiracy by big business to make sure that most donor money is spent on them. This is no secret. The money may be called donor money but it is being used as a de facto subsidy for pharmaceutical and other products. Industry lobbyists make sure that national and international laws favour their products and interests, often blocking moves by generic producers to launch far cheaper products.
Those who stand to gain from generous donor funding want all the money to be spent on them. The fact that more and more people are becoming infected with preventable diseases is irrelevant, except when this fact can be used to help squeeze out a bit more donor funding. If donor money ever becomes available in large amounts for presently neglected diseases, you can be sure that there will be companies soaking it up.
If you visit towns and schools in Kenya and Tanzania you will meet people who know more about avoiding HIV than they do about diarrhoea and colds. Some people can get hold of expensive drugs and condoms free of charge, but they can’t feed themselves or their families. There are children here who could tell you more about safe sex than many Western adults.
HIV in Kenya spread among people who had poor health, education, infrastructure and social services. Public spending was reduced in response to structural adjustment policies, starting in the 1980s. These policies are still in effect and many social indicators have been disimproving constantly for the last three decades.
Despite the concentration on HIV, large numbers of people in Kenya work without any security, for very low wages. Men often spend much of their time away from their families. Many people are reduced to exchanging sex for money, food or other commodities. These circumstances can all result in transmission of HIV and other diseases, in addition to their being social problems in themselves.
If donor money is used to chase after a few current obsessions, conditions for people will continue to decline. HIV is only one problem and whether infection rates go up or down, Kenyan people will face more and more problems as the years pass. This is because all but the most fashionable issues have been the recipients of donor funding and the ultimate recipients have been wealthy companies, not poor people.
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