Aid to Africa

Africa’s stolen medicine

(January 27, 2011) In Geneva on Wednesday, Stephen Harper predicted that the $40-billion United Nations initiative on maternal care will create a “wave of hope” across the developing world. No one doubts that hope is desperately needed. In Canada, a woman’s lifetime risk of dying in pregnancy or childbirth is one in 5,600. In Niger, it’s one in 16.

Yet if recent history is any guide, the maternal health initiative will also create a wave of fraud, theft, waste and organized crime that will rob the very people it was designed to help. Such is the sorry fate of other grandiose initiatives, especially those administered by the UN. Mr. Harper promises that this time will be different. We’ll see.

Earlier this week, one of the world’s most respected public-health donors – the Global Fund to Fight AIDS, Tuberculosis and Malaria – revealed that with some of its grants, as much as two-thirds of the money has been swallowed by corruption. Since its inception in 2002, the Global Fund has given away $10-billion. Only a tiny fraction of this sum has been audited.

But the results are so awful that Sweden has suspended its $85-million annual donation until the fund’s problems are fixed. “For Sweden, the issues of greatest importance are risk management, combatting corruption and ultimately ensuring that the funds managed by the Global Fund really do contribute to improved health,” said a Swedish Foreign Ministry official.

The Global Fund has been hailed by everyone from Bono to Bill Gates as a breakthrough in efforts to fight the world’s worst diseases. But it has a history of stolen funds and failed projects. Last month, the fund announced it had cut off grants to Mali – a major recipient of Canadian aid – after investigators found that $4-million had been stolen.

Canadians have contributed a total of $1.5-billion to the Global Fund, including $540-million last year. Canadians have pledged another $1.1-billion to the maternal health initiative for such projects as distribution of vitamin and mineral supplements and vaccines. Will most of that money be used well? Don’t count on it.

The small, impoverished West African country of Togo is just one example of good intentions gone bad. It has received $10-million worth of anti-malarial drugs from the Global Fund. A third of those drugs were stolen from free government clinics and wound up on the black market, where they were priced out of reach of most Togolese, writes Roger Bates in Foreign Policy Magazine.

“Recipient governments are responsible for managing the funds they receive, and often their local institutions are simply not up to the task,” he comments. He figures that worldwide, as many as 30 million donated malaria treatments are “diverted” every year. Rich international donors have vastly increased the formerly limited drug supply in the developing world – and have also vastly increased the opportunities available to criminal drug gangs.

Corruption and fraud aren’t the only problems with these programs. The biggest problem is that many of them simply don’t work. Research funded by the Bill and Melinda Gates Foundation has uncovered numerous examples, detailed in a scathing Associated Press story this week. When officials studied the effectiveness of a major UN child health strategy, based in 100 countries, they found no difference between the health of children who were included in the strategy and those who weren’t. In one $27-million Unicef-funded program, designed to save children in West Africa, children who weren’t included in the program actually had a better chance of survival than those who were.

The World Health Organization has also chronicled countless examples of futility and waste. It has concluded that much of the medical equipment donated to developing countries is useless. “In some countries, almost 80 per cent of health care equipment comes from international donors or foreign governments, much of it remaining idle,” it said in a recent report.

To its credit, the Global Fund is at least taking baby steps to tackle its own problems. In most of the aid world, accountability is nearly non-existent. Most big development programs sturdily resist looking for corruption, for fear of finding so much of it that donors will be scared off. As aid critic William Easterly asks, “How do you make an impassioned plea for spending more money when we’re wasting so much?”

I’m all for helping the world’s most desperate women and children. Who isn’t? But without a hard head, all the money and compassion in the world are worthless.

Margaret Wente, The Globe and Mail, January 27, 2011

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