Thursday, 21 March 2013

Aid and the social sectors – report on a UNU-WIDER research initiative

By Roger Williamson
Is it true that politicians are “ignorant about trials” (randomized ones, that is – some of them do end up in court) and “weird about evidence”?

If you retire, you can spend more time surfing the web … pretending it’s research. A new on-line favourite of mine is Ben Goldacre – doctor and epidemiologist – scourge of Bad Science.

In an entertaining TED talk, before he gets serious, he provides some examples of how the tabloids deal with evidence – citing reports that housework can prevent breast cancer in women, and the food shop can cause impotence in men. So we see who the Daily Mail thinks should be in charge of the care economy. Coffee both causes and prevents cancer (I never just have one cup – presumably that is now the safest bet….).
But you can also use your retirement to go to places where research is done and communicated. So I left the country and went  to the UNU –WIDER conference at the Swedish SIDA HQ where the research results on Aid and the social sector were communicated.  
Finn Tarp, the Director, set the tone for the day. The questions to be addressed were the important ones – what works, what could work, what is scalable, what is transferable?

The overall project has addressed issues such as growth and employment, governance and  fragility, the social sector, environment and climate, and gender equality. On our day’s agenda were health care, education, water and sanitation, social protection.
Aid has an intrinsic value and an instrumental value for development. The poor consistently refer to health and education as critical channels to escape from poverty. Economic theory strongly associates economic growth with higher and better levels of health and education – i.e. investment in human capital. There is considerable progress to report; since 1990 under 5 mortality has fallen in all world regions.
Miguel Nino-Zarazua gave the facts and figures on aid dependency (higher of course for sub-Saharan Africa than for other regions) with an increasing proportion going to the social sectors.

Arnab Acharya, Jindal Global University, pointed out that health systems are not responsive to the needs of the poor and that it is hard to get significant funds for general strengthening of health systems – too much goes on projects and HIV/AIDS is well funded in comparison with other needs.

Zulfiqar Bhutta (Aga Khan University) stressed that health investments were not always made where the gains were most cost-effective – for example in addressing childhood diarrhoea and measles-related diseases. Tribute was paid at the conference to the community delivery of healthcare by ICDDR in Bangladesh and the lifetime engagement of Richard Cash.
PB Anand (University of Bradford) pointed out that to a visiting Martian it would seem absurd that we are probing the surface of Mars to check for conditions which might support life when 750 million people lack access to improved water, and 2.5 billion lack access to modern sanitation. A constant theme through the day was the importance of national leadership and good governance.

Bob Baulch (RMIT University Vietnam) provided a careful analysis of aid to social sectors with some valuable conclusions, including the findings that multilateral agencies are better at targeting the poorest countries than bilaterals, and that aid for health and population is more progressive than aid to education or other social sectors.
We had a real politician in the room – former government  Minister from Rwanda, Romain Murenzi,  who stressed the importance of what was achieved by the Rwanda Education Strategy Plan in more than doubling the number of children in primary education since the genocide. Yet there is still hesitation by donors to support sector –wide approaches or provide budget support.

It is of course a self-serving occupational hazard that researchers always conclude that more research needs to be done. However, when different methodologies lead to similar results, it is quite possible that the findings are significant and therefore a sound basis for policy.
It is therefore interesting that two of the countries mentioned in this brief report, Rwanda and Bangladesh, were among the top three (along with Nepal) given “star performer” billing in the Global Multidimensional Poverty Index 2013.

I also picked up some reading hints:
  • Anirudh Krishna’s study  One Illness Away  - on what pushes people into poverty or keeps them poor. 
  • Dayna Brown  (Collaborative Learning Project Stanford) emphasizes that it  is “time to listen“ – especially to those who use the aid programmes. Listening is not a new idea, the original human design features one mouth and twice as many ears. 
  • It is still a good question to ask “Where has all the education gone? Part of the answer, of course, is that investment in education is a longer term commitment.
At the conference, there was some excellent, down-to-earth advice:
  • Abby Riddell (UNESCO) summarized a lifetime of experience and frustration in making education aid work (unlike primary school children, education policymakers are slow learners).
  • Elizabeth Kristjansson (University of Ottawa) stressed some clear “do’s and don’ts” from feeding programmes for school age children. Work with the community, give 40-60% of the daily energy requirements. If the feeding programme is through the home, be realistic that some of the nutrition will be shared out among the family. Don’t disrupt breastfeeding, give the food early in the day (apparently it helps with maths).
  • Armando Barrientos (University of Manchester) outlined the contrasting experiences of Latin American and Africa with tax-financed social protection schemes, emphasizing that additional assistance is needed to reach the extremely vulnerable.
  • Iara Leite (from Brazil) presented some hard but realistic lessons on South-South cooperation – a simplistic approach to sharing best practice doesn't work, but a hard look at similar challenges, developing trust and gaining inspiration from southern partners does.
  • Wrapping up the session, UNU-WIDER Chief Economist Tony Addison drew out some conclusions. There is a good story in child survival when diarrhoea as addressed – as my IDS colleague Lyla Mehta so graphically puts it: “shit matters”. (On another occasion I will tell you about the confusion surrounding the man claiming to be head of the WTO who kept talking about toilets to a perplexed trade specialist – his neighbour on a flight.) See:
  • HIV/AIDS is contained or falling. Primary education enrolment is up. Health systems do not respond enough to the needs of the poor. School feeding programmes help. But development overall is still too project focused. More needs to be done on monitoring and evaluation. Is aid efficiency getting adequate attention? It seems the drive has stalled.
Now – of course – the killer question. If all of the above seems pretty obvious, why don’t policymakers do it? Some old habits die hard – the understandable urge to ”show where our money is going” fuels the continued fixation with projects. Higher profile and more glamorous projects tend to get more attention. It’s still a question of Silverstein’s “Millions for Viagra, Pennies for Diseases of the Poor” (Health warning -  do be careful how you Google that one on the work computer).

That’s what ReCom is all about, and I am sure colleagues there will welcome your insights. So, I suggest you settle down with a cup of coffee in each hand and start downloading the RecCom results. The only exemption is if you are a fundamentalist woman who religiously believes every word in the Daily Mail and you therefore have to do the housework and the shopping. (Or perhaps the men should pop down the shops and get the weekend food, causing  impotence on the way home, and solve the population crisis and resource pressures that way). But surely nowadays no-one wants to waste their time or “get cancer” from reading the tabloids – not when you can find out about real evidence and positive health outcomes in the developing world.
More information can be found below: