The Donor That Came in From the Cold?

One of the loveliest elements of having so many friends working on international issues is puzzling over the odd bits of the world in which we’re cathected, and tracing the ways in which we became so (an assignment, a particular story, a particular problem, a plane ticket purchased on a whim…). Those, for me, have been the conflagratory slices – Gaza + AfPak + Yemen (1 2 3 4) – for no good reason other than that I find the combination of dire humanitarian need and conflict-based constraints intellectually challenging.

Paul Collier, in opening The Bottom Billion, puts this aptly and succinctly:

“Traditionally, development has been assigned to aid agencies, which are low in almost every government’s pecking order. The U.S. Department of Defense is not going to take advice from that country’s Agency for International Development.”*

Continue reading “The Donor That Came in From the Cold?”

The Donor That Came in From the Cold?

Hearts & Minds: IS, “NGOs” and State Responsibility in Iraq

IS is repairing roads in Iraq.

Other sources have reported forced marriages to IS militants. Forced marriages – a debatable enough term in a place where choice of suitor is often not really left up to female teenagers at all – contrary though it may seem, may also be seen as a form of economic relief. Families in Iraq’s rural areas are large, and feeding a fifteen-year-old girl during times of conflict becomes something of a burden when that responsibility could just as easily be transferred to a husband (a powerful one who has just experienced a windfall, no less!). Continue reading “Hearts & Minds: IS, “NGOs” and State Responsibility in Iraq”

Hearts & Minds: IS, “NGOs” and State Responsibility in Iraq

High Maintenance.

If you’re interested in international development and have not been living under a rock, you’ve probably stumbled across summaries and reviews of Nina Munk’s The Idealist (link to Mike Miesen’s excellent overview as I haven’t yet read it myself). In short, the book highlights the shortcomings of the Millennium Villages Project, conceived of and ceaselessly touted by activist and economist Jefferey Sachs. The project consists of comprehensive funding to the villages over ten (up from an original five) years, with the goal of ultimately providing a system by which holistic aid can eradicate extreme poverty.

As you might suspect, this approach has been flawed. Presidents scoff at the project while purchasing fighter jets; parts arrive, but are not installed; wells are built and run dry. Criticisms of the MVP point to the immense difficulty of building something different in a vacuum of physical and political infrastructure, in an environment that is simply not yet capable of sustaining isolated pockets of prosperity.

This book was published in November, prompting lots of interesting discussion on sustainability and wise investment. But since then, a few articles have highlighted similar struggles in implementation of development projects thousands of miles from sub-Saharan Africa.

After Billions in U.S. Investment, Afghan Roads are Falling Apart,” heralds the Washington Post. And of course they are; this follows an article in the same vein on hospitals by the same author, and the challenges are very similar. Step one: donors invest in basic infrastructure with the hope of promoting a cure-all. Step two: funders are surprised when projects that require maintenance and outside support falter after not receiving those things. Step three: we complain about poor spending and wasted tax dollars, shaking our heads at it all.

For some perspective, Texas and Afghanistan are roughly the same size at just over 250k square miles. The Texas Department of Transportation spent $3,767,263,875 on highway construction and repairs in 2013.  To be fair, those repairs would have been allocated to a more extensive road network (79,645 miles of highway in Texas versus 7,673 miles of paved road in Afghanistan), so let’s cut the amount by a factor of ten. The article notes that international donors have allocated $4 billion since 2001, so we’ll also multiply the Texas amount by 14 for a grand total of $5,274,169,432 – nearly 33% more.

This ignores the fact that many of Afghanistan’s roads are newly constructed, which is more expensive than maintenance, and that they’ve gone without repair all together. Lest you forget, Texas roads are also not targeted by roadside bombs, and we don’t hire security for our construction workers – a substantial portion of costs abroad.

I don’t mean to provide a judgment on the worth of this spending, and this analogy is not intended to be perfect. It is obviously a Colossal Problem that so many of the roads we’ve built over the past decade and a half years are worn away and pockmarked and shredded. But given the challenges of undertaking an infrastructure project of this scope, it seems like $4 billion might be quite the deal. There’s no way these roads were originally planned without the expectation that the Taliban would target them for destruction, and there’s no way anyone reasonably expected one of the least developed countries to manage maintenance on that scale. But I’m a little disheartened by the number of people who seemed to somehow expect the roads and hospitals we plop in Afghanistan to work while simultaneously deriding the MVP and similar short-lived development initiatives in SSA.

My point is that we should not have separate standards for development projects managed by traditional humanitarian donors and those run though defense agencies. If we expect development projects from NGOs to fail or falter when operating in a vacuum, we should expect the same – if not less – of those being implemented in conflict zones and by people who many not necessarily have strong training in development-specific challenges. As we watch the millennium villages backslide when Sachs & co. retreat to other projects, we should not be surprised when IED-induced highway craters go unrepaired as their former stewards withdraw. And if development practitioners have not yet figured out how to maintain infrastructure projects in impoverished places, I don’t see how it’s reasonable to hold the U.S. Army, with its very different mission, to a higher standard on those specific tasks.

Poor development planning and a short-sighted focus on one-off costs is bad behavior for both parties, but it offers much more dangerous consequences when backed with the full faith and credit of the U.S. military. It’s something many professionals in the home field haven’t figured out yet, and so it shouldn’t be surprising that nobody in the Army Corp of Engineers has either. Moving forward, these places need to hire out the very best sustainable development practitioners for consultation on the dirty work.

High Maintenance.

Shots in the Dark

When it comes to a Sophie’s Choice sort of prioritizing, I tend to value national security over minor setbacks in other fields. This is not a popular sentiment in the field of public health, where evangelists are evangelists and the US government is a happy target frequently accused of, god forbid, acting on its own interests. In terms of bulk cost calculations – why spend billions on aircraft carriers when that same money could go to treating malaria? – I also think that Givewell types tend to undervalue hegemonic stability and underestimate, or have perhaps forgotten, the dangerous down stream flailings of a wounded giant. I am One of Those Democrats, and I’m not sorry for it.

But foreign aid, and particularly well-designed health assistance, is in the interest of national security. Unrest results from lack of satisfaction with the state of affairs; extreme dissent emerges in hungry, impoverished, and desperately ill populations where people have the balls to get angry (that is to say, in a less crude manner, societies where women possess limited rights – but that’s another post). And here are a few True Things:
1. Maintaining public health programs abroad is a critical part of the ability of the United States to influence policy abroad in a subtle, effective, and generous way.
2. Vaccination is unparalleled as far as things in our toolbox go. They save money – something entirely uncommon in international aid. This may sound very simple, but it’s extraordinary: a successful vaccination program allows us to prevent lengthy courses of treatment for expensive diseases in difficult-to-access areas.
3. The vaccination “scandals” in the US – such as Andrew Wakefield’s ridiculous shenanigans – have resulted in an inexplicable amount of damage. Accusations of vaccines causing autism in a nation where most people are literate, where 70% graduate from high school after completing a basic biology courses, have been crippling: as an example, one of the most conservative governors in the nation was bullied into not mandating a Gardasil vaccine. The amount of damage associated with something most people don’t understand is amplified as the education of the general population plummets. So when a rumor starts up that US vaccines are intended to render Muslim children infertile in Nigeria? People believe it, and consequently have their children die from preventable diseases.

In attempting to use DNA samples obtained from needles to confirm Osama Bin Laden’s presence in the compound, we did not give the Pakistani children in Abottabad the full 3 courses of the hepatitis B vaccine necessary to ensure functionality. Those kids are not going to have access to the full course – and if they do, why should they trust it?! Why on earth should they, when a legitimate ruse has been constructed against them in which vaccination was hardly considered a fringe benefit? I don’t see what this should have to do with the political sympathies of the children involved, or of their parents; when the United States lies abroad, when we conduct ineffective schemes in places where our word is already compromised, we make enemies. When we do a good thing poorly, we make enemies. Let’s stop doing that right now.

Shots in the Dark

At the intersection of public health and national defense: DoD labs

There’s a new CSIS report out on the effectiveness of overseas labs functioning under the Department of Defense. General findings include more-frequent than expected interaction with regional offices, and an unexpected focus on diseases relevant to the endemic population. This is natural, if you think about it: DoD labs function at the interest of the US military, and members of the service on the ground are (ignoring the effects of malnutrition and resistance) just as susceptible to malaria or cryptosporidiosis or what have you as anyone in the area as a function of birth. The primary goal of these infectious disease units is, consequently, to protect first-world soldiers from third-world diseases.

These labs are important for a few reasons:
– Proximity to location of interest. A permanently funded station abroad to conduct research is an invaluable resource, and allows for longer-term projects.
– Funding is through the defense department rather than general research grants. Though intradepartmental funding is free to shift from year to year, this session of Congress (as with many other sessions of congress) has demonstrated greater reluctance to cut defense budgets than allocated funds for medical research.
– Staffed by military personnel rather than civilian researchers, they stand at the interface of aid and security, and are fit to work with the intricate relationship between the two. More on that sometime later.

This got me thinking:
Health technologies for combat situations in the US are identical in need to those abroad: point-of-care diagnosis is critical in a high-speed situation, no freeze chain may be available, and disposable or reusable technologies may save lives. This represents an alternate path to funding : develop appropriate technologies for and through the US military, cut costs subsequently to re-appropriate technologies for use in resource-poor environments. Implement through existing labs that have established relationships with locals in disease-ridden locations, and with flexible personnel available to monitor program effectiveness.

And put it under “defense funding.”

Why? Because there is no greater source of goodwill than saving lives at the community level. I’m beginning to firmly believe that one of the most firmly IGNORED issues is health in the backwaters(mountains?) of the Middle East. The region lacks instant recognition, the celebrity appeal of sub-saharan Africa, and is of course known for a plethora of other problems. But the concerns, particularly in overall security, are MUCH more high-risk (if less high-profile) with regard to US interests – and where terrorist organizations recruit out of poverty and desperation as a result of illness, where women in childbirth are occasionally not taken to a hospital to be given a caesarian by a man, where operations may be postponed until a family can pay, there can be fewer more substantial security investments.

At the intersection of public health and national defense: DoD labs