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The Aid Debate

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Patrick Watt: Health is a right, wherever you are [Nov. 23rd, 2009|10:52 am]
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First of all, it’s really encouraging to see so many people posting entries on this blog – including the Secretary of State for International Development, and his Conservative and Liberal Democrat counterparts.

We need to see more of this kind of debate, not least in the countries that are furthest off track on reaching the fourth Millennium Development Goal, and where child mortality often gets scant political attention.

However, it would be worrying if the debate got stuck in the rut of ‘aid: good or bad?’ Ultimately this misses the point because – as our Child Health Now report makes clear – the fundamental issue is that the interventions that make the biggest difference are currently being neglected.

Unless we rebalance investment in child health, so that family and community care and prevention are given much greater priority, we simply will not meet the health goals, regardless of who is funding them.

Community health workers running health education programmes, skilled birth attendance, immunisation, clean water and safe sanitation, hand-washing with soap, proper nutrition for children and mothers, bed nets to prevent malaria: none of this is especially glamorous, but it’s proven and relatively low-cost.

The current approach to global health is dominated by single-disease initiatives and a narrow approach to strengthening formal health systems. These are urgent issues, but they’re only a part of the picture. We need to start matching our efforts more closely to where the problem really lies. To paraphrase Bill Clinton, ‘it’s the prevention, stupid’.

In this context, DFID’s commitment to spend £6 billion on health up to 2015 is welcome, but we now need a serious debate about how to balance that spending so that it makes the maximum contribution to achieving MDG 4.

Of course aid isn’t going to deliver the health goals, but I agree with Toby Ord that it can spur progress where it’s given in the right way and is complementing national efforts. Equally, there’s lots that the not-for-profit and for-profit private sector can and should do to contribute. The challenge is bigger than any one institution.

In the final analysis, however, health is a right, and where states are failing to realise that right, they need to be held to account and pressed to act. That’s where our campaign comes in. Over the next five years, we’ll be working in countries around the world to get governments to take their responsibility seriously, and act end the scandalous loss of 9 million lives each year.
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A retort to Philip Stevens [Nov. 20th, 2009|04:44 pm]
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Philip,

I agree that one of the main ways in which child deaths can be reduced is to raise the incomes of poor people. It’s clear from East Asia and Latin America, where child mortality rates have fallen sharply in the last twenty years, that rising incomes are an important part of the story.

However, it’s not the whole picture. Malawi is no African economic tiger, but despite its poverty it has almost halved the child mortality rate since 1990. It’s done this largely by using its small health budget well, and investing in low-cost prevention: things like skilled birth attendance and immunisation.

As Malawi shows, you don’t need to wait for high growth rates to kick-in in order to make marked improvements in child survival (and there are plenty of countries that have failed to translate high growth in to lasting gains in human wellbeing).

When it comes to the case for aid, caricature gets in the way of a sensible discussion about what’s needed to improve health outcomes. The answer to bad aid is good aid, not no aid. The aid provided to Zambia through debt relief enabled the government there to scrap user charges for basic health care in rural areas. Utilisation of services has shot up as a result. Four million people on antiretroviral treatment for HIV and AIDS would be dead today were it not for donor aid.

Our recent Child Health Now report makes clear that donor aid has an uneven track record, and that there are too few success stories. But where aid is used as a complementary tool to support national efforts, it can make a positive difference. Let’s not oversell aid – it’s not a magic bullet, and given in the wrong way can create its own problems – but let’s also avoid a scorched earth approach to shortcomings in the aid system.
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Martin Carroll: The key is with the caregivers [Nov. 20th, 2009|02:41 pm]
Ten years on from the historic Millennium Declaration, which promised redoubled efforts to eradicate poverty and improve health, we still face the shocking reality that, in many developing countries, tens of thousands of children die needlessly every day. The latest report by World Vision, Child Health Now, underlines how simple interventions, which address the critical health needs of communities, can play a pivotal role in reducing the toll of preventable deaths.

I am actively involved with Healthcare Information for All by 2015 (HIFA2015), an international network, bringing together over 3000 individuals from 150 countries in pursuit of a common goal: by 2015, every person worldwide will have access to an informed healthcare provider.

We know that many child deaths are preventable if the health worker or caregiver knows what to do or where to seek help. In developing countries, that health worker or caregiver is often a parent and so initiatives such as World Vision's Hearth Programme in Bangladesh are a valuable resource, providing mothers with practical information which they can use to improve the health of their children. Hand-washing with soap can prevent the spread of diarrhoea and save a child's life. When that knowledge is passed on to other members of the community, the power of the 'simple intervention' becomes apparent.

In addition, HIFA2015 welcomes the report's emphasis on the importance of community health workers (CHWs) in addressing this crisis. A recent study by the Institute of Development Studies concluded that, 'CHWs should be recognised both internationally and nationally as a distinct cadre of health professionals, who - by the nature of their position in the community, can access disadvantaged populations well beyond the reach of the health system.' In 2010, for its third Annual Challenge, HIFA2015 will focus on the information and training needs of CHWs. For more information on HIFA2015 and how to become involved in our work, please visit hifa2015.org.



Martin Carroll works for the British Medical Association as Joint Co-Ordinator for the HIFA Challenge Working Group.
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Douglas Alexander: Fighting together for a safer future for the world's children [Nov. 20th, 2009|10:38 am]
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Earlier today, I visited World Vision's UK headquarters to hear first hand from their staff about their latest campaign: 'Child Health Now'.

The work that NGOs do both to raise awareness and press for progress is vital to tackling global poverty and I pay tribute to World Vision for their campaigning and the daily difference their development and humanitarian work is making across the world.

More than 24,000 children in the developing world die each day and every year, more than nine million children do not live to see their fifth birthday. Every single one of those deaths is a stain on the world's conscience because so many of those deaths could have been prevented. Tackling this global tragedy is a key priority for Labour, as we strive to play a leading role in helping the world to meet the United Nations Millennium Development Goals.

Labour has made the long-term commitment of £6 billion up to 2015 to improve health care in the developing world. In the last year alone this funding has delivered almost seven million bednets to protect families from malaria, trained over 60,000 health professionals and vaccinated over three million children against measles. We are helping more than 4.5 million people receive anti-TB drugs and three million more are being treated for HIV/Aids.

Most recently, at September's UN meeting of world leaders it was the UK that helped broker a decision by six developing countries to abolish the user fees which prevent poor people seeking treatment. That agreement could save the lives of millions of newborn children and their mothers simply by allowing them to give birth under medical supervision.

World Vision plays a vital role in driving forward this agenda by campaigning to encourage governments in the global North and South to keep the promises enshrined in the Millennium Development Goals. Working together, we can build a safer future for children across the world.


DFID, the Department for International Development: leading the UK Government's fight against world poverty. Find out more at http://www.dfid.gov.uk.

The road to Copenhagen: the UK Government's ambition for a global deal on climate change. Find out more at actoncopenhagen.gov.uk and about DFID's work at dfid.gov.uk/climate.

Douglas Alexander is Secretary of State for International Development.
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Toby Ord: The myths and misunderstandings of of foreign aid [Nov. 19th, 2009|02:05 pm]
Many of the reasons that governments and individuals decide not to support foreign aid stems from a variety of myths and misunderstandings. These myths are concerned with the nature of giving aid, the way this aid is given to the countries that need it and how it is distributed. Although elements of these ‘myths’ are based on some fact, many do not paint an accurate picture of the state of foreign aid in the contemporary climate.

It is a general misconception that governments and individuals of developed countries already spend a large amount on foreign aid. However, the US actually only spends less than 1per cent of the Federal Budget on foreign aid - this is far less than commonly thought and far less than people would want to spend.

Furthermore, many mistakenly believe that giving aid is useless, as so many of the countries that need this help are steeped in corruption. Obviously corruption in some governments can lead to aid money being diverted from its intended purpose, however this is only in a select number of cases and governments. This is especially true for money that is not given to a foreign government, but is instead directly spent on an aid project. It is vital to remember that aid can definitely still be useful despite the presence of some corruption in a select number of countries.

Many think the problems are so large and on such a global scale that their contributions will not help. It is true that individuals cannot solve the world’s problems on their own. However, every little bit of aid helps and everyone can make a difference in absolute terms.

Many feel that we should change the political systems in the worst affected countries as opposed to sending through large amounts of aid. Working towards a fairer trade policy and also donating enough money to directly improve thousands of people's lives is much better than just working towards a fairer trade policy. Therefore, it is important to remember that we can donate at the same time as taking political action.

It is clear that there are many widespread misunderstandings regarding foreign aid and these need to be addressed in order to ensure that every government and individual is giving the most they can to change the state of some of the world’s poorest countries.

Toby Ord is a British Academy Postdoctoral Fellow at Balliol College at the University of Oxford. He is also involved as a research associate at two of Oxford's exciting new research centres in ethics: the Uehiro Centre for Practical Ethics, and the Future of Humanity Institute.
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World Vision webchat: Should we prioritise aid? [Nov. 19th, 2009|11:45 am]
A report by World Vision this week revealed that 24,000 children under the age of 5 die every single day - and most of those deaths could be prevented. World Vision's recommendations are for greater aid spending (increased from $16bn a year to $42.5bn a year by 2015 and for better prioritisation of resources towards urgent improvements in child nutrition and basic standards in maternal care.


At 12:30pm GMT, Kate Eardley, health policy adviser for World Vision UK and Philip Stevens, Senior Fellow at the International Policy Network, will debate how lives can be saved, the record of international governments in meeting their goal of reducing infant deaths by two thirds by 2015, the role of international aid spending and much more.

Follow the webchat at Independent.co.uk/worldvision
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Andrew Mitchell MP: Achieving value for money in aid [Nov. 18th, 2009|11:14 am]
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Here in Britain we are living in the age of austerity. Times are tough. We are having to tighten our belts. But in the developing world, times are infinitely tougher. Children go to bed hungry every night, and are menaced by the floods, droughts and crop failures caused by climate change.

The scale of maternal, newborn and child mortality is particularly shocking. World Vision are right to focus on this issue. Around 9 million children die before the age of five each year. Four million die within their first 28 days. Three million babies die within one week of birth, including up to two million who die on their first day of life. 500,000 women die each year from complications of pregnancy and childbirth. 68 low and middle income countries account for 97 per cent of all maternal, newborn and child deaths worldwide.

The vast majority of these deaths could be easily avoided. A Conservative government will make it a priority to ensure that mothers can access basic health services and clean water. Child and maternal mortality figures are an excellent barometer of the condition of a nation's healthcare system. Progress in tackling maternal and child mortality will be a crucial measure of the effectiveness of our efforts to improve healthcare systems.

The Conservative Party is committed to reaching, by 2013, the internationally-agreed goal of spending 0.7% of national income as aid. This period of economic hardship is not a time to turn our backs on the poorest in the world, but to reaffirm our commitments to them. But just because the aid budget is growing, it will not be exempt from the line-by-line scrutiny and value for money tests that a Conservative government will impose everywhere and on everything. Our bargain with the taxpayer is this: in return for your contribution of hard-earned money, it is our duty to spend every penny well.

That is why we will replace Labour's complacent system of self-evaluation with proper unflinching scrutiny through an Independent Aid Watchdog. That is why we'll expect more bang for our buck, only handing over cash when we see real evidence of development results. That is why we'll reduce or even abolish funding for multilateral agencies if they fail to deliver.

But we know that development is about much more than just aid. The single most important exit from grinding poverty is economic growth and trade. So we will reemphasise the importance of private sector led growth and wealth creation as the only path to prosperity. We believe that it is through Conservative means that we will achieve the progressive ends of international development.



Andrew Mitchell is MP for Sutton Coldfield and Shadow International Development Secretary
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Eamonn Butler: Throwing good money after bad [Nov. 17th, 2009|06:28 pm]
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Promoting economic development in poorer countries is not a matter of just throwing money at the problem. That is why all the posturing from the G20, the United Nations, and other international bodies, about how much member countries should contribute in aid is wide of the mark. It is urging people to throw money at a barn door in the hope that a few coins will go through the knot-holes and reach their target. More money would reach the target if instead we were urged to throw somewhat less, but learnt how to throw it a lot more accurately.

There are already a huge number of simple, proven initiatives that can do a vast amount of good without breaking the bank. Getting clean water to people who do not presently have it is probably the most cost-effective way there is of saving lives, improving health, and transforming the lives of the world's poorest people. Simple things like giving people mosquito nets can end the situation where up to a third of a local population is unable to work effectively due to continued bouts of malaria. Simple nutrition supplements give life and self-reliance to more people than any state-sponsored steelworks or construction project. Finding alternatives to people burning dung on their poorly-ventilated fires can prevent infections and lung diseases. So many deaths, and so much continuing illness and disability, are in fact easily – and cheaply – preventable. These are simple things, items of nutrition, healthcare and hygiene that people in rich countries, and particularly the wealthy political classes in rich countries, simply assume exist the world over.

To that extent, World Vision is correct. It is not all about spending money on big projects, but applying some simple solutions that have been known to work. Somehow the Coca-Cola company manages to get its product out to the most far-flung places: so why do government agencies find medicines, supplement, and clean water so hard to distribute? Maybe they should hitch a ride in Coke's cases.

And a little money can seed growing businesses. The Grameen Bank, a microfinance body in Bangladesh lends money to women to buy mobile phones, which they then rent out to users. It gives them independence, and gives the latest communications to the local community. Farmers, for example, can use the phones to find out where to get the best price for their products, so they – and their family, and everyone they trade with – prosper.

It is also about creating the conditions in which that prosperity can expand. Where the government owns all the farmland, for example, there is no point in people working hard to grow crops from which they will get little or no benefit. So the whole nation remains underfed. Where there is no security and bandits can take your crops – or for that matter, the police and politicians can confiscate them – there is likewise no reward for effort. Where routine functions are done by government agencies rather than individuals, they are more likely to serve the interests of the producers than of the general public. If we are to bring growth and eventual prosperity to much of the world, we need also to be urging governments to allow people to hold private property and enforce their right to use it without fear of being robbed; and we need to convince those in power that the whole nation, including they themselves, would be better off if they did not try to control so much but let people live and trade freely as they chose.



Dr Eamonn Butler is director of the Adam Smith Institute, an influential think-tank which for more than twenty years has designed and promoted practical policies to promote choice and competition in the delivery of essential services.
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Rupa Huq: Memo to Western governments - Can do better, much better [Nov. 17th, 2009|05:06 pm]
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Today marks the twentieth anniversary of the UN Convention on Rights of the Child, a landmark declaration. Since then this has been built on with last year’s Manifesto for Children. Yet a disturbing report today from the charity World Vision shows that nearly nine million children won’t see their fifth birthday – that’s 8.8 million or 24,000 deaths. As mum of a five year old it’s a shocker.

All this is largely preventable: vitamin and mineral supplements to beat malnutrition (like Oral Rehydration Salts that cost 10p) and proper postnatal care to prevent post pregnancy complications and infections could turn this around but an agreement made in 2000 by the UN and Western governments to reduce infant mortality by two thirds by 2015 is falling way short of its target.

World Vision is now campaigning for rich countries to increase their commitment to health from the current level of $16 billion a year to $42.5 billion by 2015 to meet the Millennium Development Goals – equivalent to five days of health spending in the USA. Significant progress has been achieved eg in Malawi, of every 1,000 babies born, 125 more children survived to their fifth birthdays in 2008 than they did in 1990. But there’s a long way to go.

Ways in which you can do your bit to increase awareness are listed here. If all this wasn’t so far away it’d be more widely considered scandalous – which it is in the 9th year of the new century.


This post originally appeared on Rupa Huq's blog
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Richard Murphy: How do we beat poverty? [Nov. 17th, 2009|04:29 pm]
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World Vision have sent me a briefing on a new campaign they are launching. I guess a blog has reached critical mass when such things happen.

They say this:

World Vision aims to cut child deaths by two thirds in order to reach the Millennium Development Goals. and note:

· 8.8 million children die each year before the age of five, which equates to 24,000 deaths every day.

· The main causes of these deaths are largely preventable - an estimated two thirds of children could be saved through simple interventions such as low-cost vitamin and mineral supplements to prevent malnutrition and comprehensive postnatal care to prevent post pregnancy complications and infections.

· Rich countries need to increase their commitment to health from the current level of $16 billion a year to $42.5 billion by 2015 if they are to meet the Millennium Development Goals` outlined in 2000 – this is equivalent to five days of health spending in the USA.

· Progress and change is possible. Even in some of the poorest countries, significant progress has been achieved. For example, the improvements accomplished in Malawi, for every 1,000 babies born, 125 more children survived to their fifth birthdays in 2008 than they did in 1990.

These facts are shocking. I share the concern for them. They motivate a lot of what I do. It’s unacceptable that More than 24,000 children under the age of five die every day.


I’m not sure World Vision – a US charity – has got its analysis right though. They’re right to say:


World Vision believes that simple, proven measures – most of them low cost, such as vitamin and mineral supplements to prevent malnutrition and improved water and sanitation systems to give more people access to a treated water supply - can transform the opportunities of the world’s poorest and most vulnerable children.

The World Bank estimates that a further 2.8 million children could die between now and 2015 unless immediate action is taken, adding further urgency to the challenge of child health.


And this has truth in it:


Many of these problems persist due to political inaction and misdirected effort – they fail to attract much comment, or spark outcry from media, politicians and civil society. In short, the global child health emergency is too often greeted with fatal indifference from those people with the power to address it.

It only has elements of truth in it because they go on to say this:


The epicentre of the child health emergency is sub-Saharan Africa and South Asia, with approximately half of all deaths accounted for by just five countries: India, Nigeria, the Democratic Republic of Congo, Pakistan and Ethiopia. Without a concerted and sustained effort in these countries, there’s little prospect of MDG 4 being met at a global level.

Most high burden countries are poor, and many are poorly governed. All of them are characterised by high levels of health inequality, between rural and urban areas, and between rich and poor. For example, in Nigeria, children from the poorest fifth of the population are three times more likely to die than those from the wealthiest fifth. Reducing the health gap between rich and poor even within the poorest countries would have a dramatic impact on overall mortality rates.


In response to which they say:


The main drivers of change have to come from the developing countries. Experience tells us that significant change is often underpinned by popular demand and informed public debate. However, countries which are poorly governed and ill coordinated with levels of internal corruption need help to make these important changes.


I do not for a minute doubt World Vision’s plan for enhanced nutrition, maternal health and the prevention of easily controlled childhood diseases are all valid. My concern is that this is seen as a process of aid. And it is seen as a process in which developed countries take a lead. and it is seen that, without explanation, health inequalities, which are inextricably linked to wealth inequalities will be solved, as will corruption by the great hand of western largesse.

If only that were true. I applaud all efforts to solve these problems: World Vision’s motives are sound. But they have to ask:

Why is there inequality?
How can it be addressed?
How does the corruption take place?
Who facilitates it?
Where do the proceeds end up?
How can we stop that process?
The answer is, of course, that there is a market mechanism to facilitate these outcomes: the secrecy jurisdiction market.

Secrecy jurisdictions are places that intentionally create regulation for the primary benefit and use of those not resident in their geographical domain. That regulation is designed to undermine the legislation or regulation of another jurisdiction. To facilitate its use secrecy jurisdictions also create a deliberate, legally backed veil of secrecy that ensures that those from outside the jurisdiction making use of its regulation cannot be identified to be doing so.

It is secrecy jurisdictions that allow corruption to happen. They facilitate it, provide the mechanisms to let the funds flow, and provide the secrecy to ensure it is never discovered.

Yes, World Vision are right – this is a developed country problem. We have to close secrecy jurisdictions.

Then with country-by-country reporting we have to help force profits to be declared and tax be paid in these countries. Then they can overcome their own problems.

That is the only real solution.

I am posting this to show solidarity with World Vision – but am asking in return that they face the really big issue of why developed countries help strip the poorest nations on earth of their wealth and return what little goes back to the wealthiest who have no need or entitlement to it.

I hope they will rise to that challenge. Because if they don’t they too are guilty of turning a blind eye – and that won’t do.

This post originally appeared on the Tax Research UK blog.
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