This is part of my effort to write my way through a number of development-focused books, starting with The White Man’s Burden. Previous chapters: one, two, three, four, five, six, seven, eight, nine, ten
This is it, folks – the final chapter, where Easterly will rain down catch-all solutions to the myriad problems of aid and development. Right?
Of course not! As he notes, “If you think I will now offer a utopian blueprint to fix aid’s complex problems, then I have done a really bad job in the previous chapters at explaining the problems with utopian blueprints.” So… end of chapter, end of book, right? Not quite.
Right away, Easterly recommends ditching the utopian goals and instead contends,
“The aim should be to make individuals better off, not to transform governments or societies… Put the focus back where it belongs: get the poorest people in the world such obvious goods as the vaccines, the antibiotics, the food supplements, the improved seeds, the fertilizer, the roads, the boreholes, the water pipes, the textbooks, and the nurses.”
This sounds great to me! In addition to project-based aid, Easterly also argues that aid agencies could work on higher-level concerns such as,
“…distilling practical knowledge on operating banking systems or stock markets… simplifying business regulations, or making piecemeal reforms that promote a merit-based civil service”
Here’s what I intuit Easterly as arguing: there’s a sizable amount of aid that works – focus on that. This is essentially the opposite of what I expected coming into the book, but I’m glad that this is the argument he lands on; it’s pragmatic, partially technocratic, and narrowly-focused – which is where my intuition generally tells me to go.
What else? First, have the aid agencies put a focus on research — ex ante and ex post intervention, so that knowledge can be shared and “best-for-now practices” (my phrase, not his) can be discovered. Share results – especially failures – and always keep the focus on what can help the poor. As Easterly notes about education interventions in Kenya, “The lesson of all this research is that some equally plausible interventions work and others don’t.” It’s the on-the-ground research that distinguishes interventions that sound good with interventions that do good.
Next up: specialization. This would be a huge shift for most multilateral agencies, and the politicking to get it done would be ridiculous. Which is not to say that it can’t be done – I have all kinds of models scribbled in my notes – just that a degree of caution may be warranted. If the multilateral agencies can’t be revamped, perhaps the way they implement change can be, with a focus on competitive bidding, transparency, and incremental gains. I suspect I’ll have more to say on this in the future, as I continue learning.
Easterly points out two researchers – Dennis Whittle and Mari Kuraishi – who have proposed something similar to what I had in mind: a “marketplace instead of central planning, a kind of eBay meets foreign aid.” Their website – www.globalgiving.com – is well worth a look; I think it needs some revamping but the backbone is in place to do some pretty cool things.
There are a number of other innovative ideas that Easterly touches on: vouchers, conditional cash transfers, and prizes all stuck out to me as plausible interventions that could be pretty neat to see in practice. Conditional cash transfers are big in Mexico (the Progresa program) and have shown success; in Poor Economics, Esther Duflo and Arhibit Banerjee discuss this in some detail. Prizes have more to do with research (finding a successful vaccine for malaria, say) than on-the-ground implementation, but definitely appear to play a role.
All in all, an interesting chapter to capstone an interesting book. A summary post will be up next with some of my final, overarching thoughts.
We’re on home stretch of the book, with Easterly focusing on the success stories of Japan and China (countries never colonized by the West), and the atypical success stories of previously-colonized Singapore and Hong Kong. The thesis of the chapter may best be described in Easterly’s contention that “It is easier to search for solutions to your own problems than to those of others.” While this statement doesn’t scale (I’d actually contend that in a lot of cases, he basically has it backwards – sometimes an outside pair of eyes can provide the solution that insiders are blind to), let’s go with it for now.
Japan’s success can partially be ascribed to their attitude towards the West in the 1860s:
“’Japanese spirit, Western learning.’ The young revolutionaries combined patriotism with pragmatism – they realized the West was ahead, and they wanted to borrow Western methods to catch up, while preserving Japanese institutions, culture, and independence… They invited Westerners to Tokyo, and themselves went on long tours of the West. But this was to create no dependence on the West; the watchword was ‘self-help’”
With strong government institutions, private property rights, and a sufficient tax base, Japan was poised to capture the gains from the private sector’s innovation (known to those us in the West as giant conglomerates like Mitsubishi), and success begat success. Then came World War II and the annihilation of Japan, followed by America’s rebuilding of the decimated country (physically and institutionally). I think it’s fair to say that much of what America did was similar to its Marshall Plan in Europe – the physical and institutional infrastructure existed previously, so Japan simply needed the funding and the time to rebuild.
But what, if anything, should Japan’s experience tell us about foreign aid specifically? Monetarily, Western foreign aid was sparse – but that’s because it wasn’t needed. Indeed, it’s difficult for me to ascribe any significant lesson from Japan to the developing world today with respect to monetary aid. What was needed included Western expertise from a technological and business management standpoint, which can be seen throughout Japan’s history: the “Western methods” the revolutionaries picked up in the 1860s and Deming’s post-war injection of operations expertise led to the creation of some of the world’s most vibrant and prosperous companies (Sony, Mitsubishi, and Toyota among myriad others). I think this lesson is largely transferable; where possible, Western methods, expertise, and general know-how can serve as innovation catalysts for entrepreneurs and innovators in the developing world – if done in a culturally-sensitive and humble way.
Next up: what’s the deal with Singapore and Hong Kong? They’re both former colonies, yet they’re killing it in the global marketplace. Easterly holds that their success can partially be explained by the fact that,
“they were unoccupied territories that the British colonized with the permission (or coercion) of the nearby local rulers….The British also left the Chinese communities free to pursue their incomprehensible customs and more of less govern themselves…”
To simplify things a bit: the former colonies are successful today because the British didn’t upend everything – mainly because there wasn’t much to upend in the first place. Here too, I think it’s tough to make the argument that significant lessons for today’s environment can be learned from Singapore and Hong Kong, other than a very general “try not to change everything as you try to help – only do what’s absolutely necessary.” Even this is problematic: “absolutely necessary” is an awfully flexible phrase, open to wide interpretation with the benefits of hindsight.
Next up: China. Let’s be honest: China is a weird success story; as Easterly notes,
“It is an unconventional homegrown success, failing to follow any Western blueprint for how to be modern. It combines lack of property rights with free markets, Communist Party dictatorship with feedback on local public services, and municipal state enterprises with private ones.
I am decidedly not an authority on recent Chinese history, so I have a hard time taking a critical eye towards this section; it’s impossible to ascribe China’s success to any one causal explanation, and it’s hard to say if China’s “weirdness” will continue to be a boon for its unheard of growth.
In any event, Easterly’s claim about China – and subsequently India – is that Western intervention was not the proximate cause of their growth; homegrown Searchers were. He holds that the World Bank and IMF are trying to take credit for a success that isn’t theirs. This may or may not be true, but it’s kind of a specious argument; successful development can’t be ascribed to Western help, but all cases of unsuccessful development are at least partially caused by Western ineptitude, Easterly seems to argue.
In short order, Turkey, Botswana, and Chile are heralded as exemplars of homegrown development. I’d rather not touch on Chile (much has been written about Milton Friedman’s “Chicago Boys” and their influence on the country – well worth reading up on), but Botswana warrants some attention. Easterly holds that Botswana is an example of an African country that shows that “if Africans can get good government from their rulers, the abundance of natural resources can be turned into a blessing.” At the same time, Botswana doesn’t typify African countries, so it’s hard to draw a 1:1 conclusion:
“…favorable factors were benign neglect by Britain during the colonial period, the absence of ethnic conflict because of the relative homogeneity of the Tswana people, and clear indigenous property rights based on cattle holdings.”
We can decry colonialism all we want, but we’re stuck with its deleterious effects. Most African countries don’t have the mix of favorable conditions that Botswana does, so the question isn’t “How can we scale Botswana’s success to other African countries,” it’s more like “How can we assist in developing the institutions necessary to allow other African countries to positively draw from Botswana’s experience?” As we’ve seen throughout the book, Easterly would hold that we shouldn’t play a part in that – democracy and free markets are great, but implementing both in a country ready for neither is a recipe for disaster. My intuition says that there should be a third way that is more moderate, but I’m also very new to this, so I’ll hold off on thinking through these possibilities on paper for now.
This chapter explores one of the central questions development thinkers should continuously ask: “What would aid recipients do with funding if they made the decisions?” Easterly uses the Western response to HIV/AIDS in Africa to make two key points related to this question: top-down Planners can often be woefully out of touch with the realities at the bottom, and the Western world’s fascination with AIDS treatment is economically inefficient and antithetical to doing the most good. He questions whether aid recipients would put so much emphasis on treatment at the expense of prevention or other aims.
Easterly begins with what he calls “The White Man’s Burden Paradox” (modeled off the paradox of evil); he notes that the follow three conditions cannot be all true:
“1) The White Man’s Burden is acting in the interests of the poor in the Rest; 2) The White Man’s Burden is effective at resolving poor people’s problems; and 3) Lots of bad things, whose prevention was affordable, are happening to poor people”
This seems logically inconsistent to me – the word affordable is very open to interpretation, and #1 can hold without meaning that all of the interests of the poor are being acted on – but the general point still feels about right: for areas where the West does focus, #3 still occurs far too often.
As Easterly notes here and elsewhere in the book, Western interventions to improve health are more successful than other Western interventions (for a variety of postulated reasons) – so then why was the response to the African AIDS crisis so poor? It seems that part of the issue was that aid agencies realized the potential scope of the issue but did little to attack it early; the World Bank made a $1 million grant to the World Health Organization to fight AIDS in 1988, a rounding error in its funding.
Another possible reason is that Planners were out of touch at the top “with the tragedy at the bottom;” that they failed to appreciate the scope of the impending crisis because they were too far removed from the countries where it was fomenting. And finally, the lack of response could be due to the “Kitty Genovese Effect” – everyone expected everyone else to do something, but no one did until the crisis was full-blown.
The issue of HIV/AIDS treatment in Africa is next, and Easterly lucidly lays out the contention that “compassion is driving the fight against AIDS in Africa in a direction that may cost more lives than it saves” because money is being spent on treatment of AIDS, not prevention of HIV or other diseases. The specifics of this argument were totally new to me, and it made me question my tacit support for initiatives like the President’s Emergency Plan for AIDS Relief (PEPFAR), President Bush’s $15 billion AIDS relief program passed in 2003.
Let’s start with the top-line figures. According to the book, the rough costs of various health interventions in Africa are:
- HIV/AIDS: $304 per year per patient for highly active antiretroviral therapy (HAART) – $1,500 if all costs are included
- HIV/AIDS Prevention: $1-20 per year of life saved, $20-400 per HIV infection averted
- Tuberculosis: $10 per case
- Drug-Resistant Malaria: $1
- Vaccinations: “pennies per dose”
The takeaway: treatment of HIV/AIDS is about as expensive as it gets. Easterly attributes the zeal for treatment of HIV/AIDS to guilt (for not preventing the crisis when there was an opportunity to do so) and “SIBD Syndrome” (Something Is Being Done) – it’s easy to see someone improving on HAART and difficult to see someone not dying from malaria. To that end, PEPFAR actually restricted funding for prevention of HIV/AIDS to 20% of the total (with one-third of that going to abstinence-only programs) – showing that Western leaders often fund their own goals, not those of the people they are trying to help. It seems fair to believe that this amount of politicking and imposing culture is well above what could be considered unavoidable; abstinence-only hasn’t been shown to be effective anywhere, so it’s a waste of resources to push it on African countries.
This is an issue worthy of a lot more thought (at least for me); as Easterly puts it,
“The big question is whether poor Africans themselves would have chosen to spend scarce funds on prolonging so lives with AIDS treatment, as opposed to saving many lives with other health interventions.”
That’s a really tough question for someone generally optimistic about the effects of aid (done appropriately, anyway). With the funding for HIV/AIDS, it seems like a relatively straightforward answer: no, the poor Africans probably would not have spent those resources on HAART treatment. At the same time, there are myriad complexities that shouldn’t go unnoticed, too; for example, the fact that “studies in Cameroon, Guinea, Tanzania, and Uganda estimated that 30 to 70% of government drugs disappeared before reaching the patient” should give pause to the notion that the Africans themselves will always make the “best” decision.
The basic worry still stands, though; if the Western world is convinced that there is a place for Western aid, then it should grapple daily with the notion that the strictures it attaches to that aid are problematic, inefficient, and dilutive. Foreign aid is a scarce resource that is increasingly threatened by austerity measures in the United States, the United Kingdom, and elsewhere; making inefficient use of it both devalues the act itself (a dollar doesn’t go as far) and leads to poorer outcomes in areas where it is used.
PEPFAR and the World Health Organizations “3 by 5” campaign (to get three-million HIV-positive people on antiretrovirals by 2005) aren’t inherently bad – but they could be so much better. And – crucially – the path towards better is clear! There are – and always will be – myriad examples where the path is much murkier. If the West didn’t have the power to chart a clear path, how will we handle the less-obvious situations?