International Development: Has Jeffrey Sachs’ recent calamity masked achievements in Africa?

by Bongs Lainjo

Over the last several weeks, readers have been faced with a deluge of congenial, brutal and compelling reviews on professor Jeffrey Sacks and his millennium village project (MVP). These reports started first with a comprehensive book by Ms Munk followed by subsequent columns in some Canadian and US main stream media:  NY Times by Nocera; The Globe and Mail by Ms Wente; and National Post by Corcoran. The consensus in all these documents was unequivocally loud and clear: Jeffrey Sacks was not the development poster boy that we were all made to believe. These responses send a message to international donors in general and Canada specifically that effective accountability should be the modus operandi of continuous funding of international aid programs.

During the last UN general Assembly meeting in NY and in the maternal and neonatal health (MNH) committee chaired by our PM, Mr Harper, he in no uncertain terms reminded the committee members that it was time for action and not rhetoric. The PM further confirmed Canada’s intention to fulfill its pledge of five billion dollars over a five-year period as made during the 2010 Muskoka G20 meeting. Mr. Harper then outlined with the group Canada’s agenda that includes disbursement of $203 million on nine projects in support of the MNH: health services, vaccination and nutrition.

Whether proactively or re-actively (as a result of the above reviews) the government of Canada (GOC) also said Canada would host a meeting next year with MNH participating implementing partners with a clear objecting of strengthening accountability, effectiveness and achieving intended outcomes. We all need to applaud our government for supporting these initiatives. At the same time Canadian tax payers should continue urging the GOC through their MPs to increase Canada’s support in order to maintain gains and achievements made in poverty mitigation and MNH over the last decade. Canada still lags behind other western donor countries when it comes to funding development programs on a per capita basis. We also need to remind our government to keep ideology on the side and concentrate on helpful initiatives that improve the quality of life in these under-privileged and vulnerable countries. We owe them the assistance and this support needs to be done now. Expanding trade is a good idea; but this can only succeed when people are able feed themselves with access to equitable health care.

I believe Jeffrey Sachs’ problems that led to the demise of the MVP are extensive, diversified and daunting. They range from remote project management, limited knowledge of the project’s environment, culture, traditional values, beneficiary work habits, apprehension and suspicion (what is in it for donor?) by beneficiary, ineffective leadership (in some cases) to accountability to transparency. And in general, the playing field is quite fluid.

There is every reason for one to believe that, the professor’s sentiments notwithstanding, his intentions were genuine, gracious, empathetic and supportive. But as we all now know his best was not good enough. There is adequate and compelling evidence now that his good-will and inability to achieve the planned and intended outcomes – mid and long term – led to the failure of these projects. One overarching question that we all need to ask ourselves as tax payers is: are funding agencies complicit in the demise international development implementation programs like the MVP?

The above negative reports notwithstanding, there is need to appreciate some of the achievements that have been made, both globally and specifically in sub Saharan Africa (SSA). For instance according to a World Bank (WB) report, reduction of the world’s population living in extreme poverty has reduced from 50 per cent in 1980 to 20 per cent in 2013. That’s significant and worth celebrating!

In sub Saharan region, significant achievements have also been made.  The last decade has turned out to be the most successful in terms of improved development indicators. For example, access to impregnated mosquito nets (IMN) or bed nets has and continues to be quite successful. And based on anecdotes and well documented reports, vulnerable communities are well informed about the devastating and potentially fatalistic effects of malaria. This knowledge has strengthened the degree of appreciation of the usefulness of bed nets.

According to the latest UNICEF report, ninety per cent of malaria deaths occur in Africa; and accounts for about seventeen per cent of infant mortality. And significant efforts have paid off. For example, in 2011, The Lancet estimated Uganda’s maternal mortality had dropped from 561/100000 to 74/100000 live births between 1990 and 2011. Maternal and Infant morbidity are two health indicators that are correlated with improved health when compared with malaria morbidity. Higher utilization rates of IMN contribute significantly in the reduction of maternal and infant mortality rates. Malaria remains one of the major risk factors. And here donor assistance in mitigating its effects has been awesome; with examples like The Global Fund, UN, USAID, WB, CIDA, DfID, The Gates Foundation etc.

Current successes have also raised corresponding challenges.

It is true that access (logistics management, universal availability in vulnerable communities etc) initially was a major challenge. This however has been substantially addressed. And one major and successful strategy has been making IMN available in all health facilities (HFs). HF-based distribution networks are quite ubiquitous in all vulnerable communities.

The real and current problem that continues to overwhelm program managers is follow up by recipients. After the initial distribution of these nets, members of these vulnerable groups are expected to come back to HFs periodically for re-supply of the IMN treatment: an event that is supposed to enhance the effectiveness of these bed nets. These revisits have been generally poor and tardiness continues to contribute to the ineffectiveness of these IMN. The bed nets are only as effective as they are consistently used.

With regard to bed net abuse as sometimes alleged, it is true there have been isolated cases of misuse. These however are in no way compared to the level of abuse or misuse of condoms. For instance, there are documented cases of children using condoms as balloons; people using them to patch holes in their bicycle tubes etc. Everything being equal and on a balance of probabilities, there is a strong likelihood that the benefits of using IMN outweigh the risks significantly.

And finally, with regard to Jeffrey Sachs demise, the message on the wall is quite clear: donors need to go back to the drawing board and recalibrate.

 Bongs Lainjo