Humanitarian Effectiveness (2)

My previous post on this topic prompted a slight twitter buzz, with Patricia McIlreavy astutely pointing out that the aid ‘oligarchy’ isn’t just the big INGOs, but donors and the UN as well.  Dead right on that one.  They all employ wield effectiveness in an exercise of power.

Effectiveness seems to be part of a powerplay within the oligarchy as well. By way of broad generalization, the question of effectiveness functions as a spotlight, used by people in desk chairs to examine the work of people with mud on their boots.  Sounds good, right?  What about the reverse?  When can Mud-on-Boots cast the same light on the work of Deskchair? More importantly, why doesn’t the functioning of the aid system drive Deskchairs to cast the same scrutiny on the mountain of Deskchair work in the system?

It should. The aid system comprises immense resources and people – energy and ‘action’ – at the level above the field project.  Having just sat through one, how do we assess the effectiveness of a conference on effectiveness? Better yet, what has been the collective effectiveness of years of debates, research, publications, workshops, tools, guidelines and previous conferences on effectiveness?  In other words, why don’t those of us thinking about effectiveness shine the light on our own work?

At great effort and cost, the aid system produces a spectacular amount of material designed to improve the effectiveness of aid. How does that translate into lives saved, or suffering alleviated? Might it even work as an impediment? I remember a medical coordinator in MSF telling me that in the span of six months in South Sudan she received over 600 recommendations from headquarters.  No doubt lots of good advice, but what is the combined impact on stressed out and under-resourced field teams? Trying to regulate or rationalize this onslaught of advice leads to discord at HQ, with staff feeling disenfranchised from the operational mission. Put differently, each and every one of those 600+ recommendations represented the aspiration and drive of somebody at HQ seeking their ‘fix’ of field involvement, their dose of ‘making a difference’.  That’s not speculation. That was my fix too.

[Spoiler alert. This post should end right here. The next bit is a real downer. I blame the start of a cold, wet final weekend to England’s so-called summer.]

Shining the spotlight of effectiveness on this work can be disconcerting. Much of my considerable HQ product seems rather obviously designed to have allowed me to be part of the crisis response based on a blind faith in its actual impact.  This is a faith requiring permanent contortion, to avoid noticing the ten degrees of removal between my efforts in London and saving a life in the field.

It looks like this:

Start with a new / improved [fill in the blank: protocols/tools/reports/guidelines/strategies/etc].

  1. Did overworked field teams even read it?
  2. If they read it, did it change practice?
  3. If it changed practice, was it in a positive direction? Was the new thing better than the old thing? No shortage of examples where idealized efforts at improvement collided with reality on the ground.
  4. If it changed in a positive direction, by how much? In other words, did the impact actually save lives and alleviate suffering more effectively? Remember, much of aid work is pretty damned good from a technical perspective – improvement runs into the law of diminishing returns.
  5. If it had a positive impact, did that outweigh the cost/effort/resources that went into producing the improvement? How many meetings and emails!
  6. If it had a positive impact, did it last? Or: did it calcify into a tick-box exercise? Or: did new teams = old ways?

That, believe it or not, is only the first level of analysis.  If it stopped there, the verdict on effectiveness might often come out OK.  The key here is # 5. Here is what the process does not look like: a couple of smart Deskchairs put their heads together, come up with a new [fill in the blank: protocols/tools/reports/guidelines/strategies/etc], show it to their boss, make a few changes and ship it out to the field.

It looks more like this: a couple of smart Deskchairs put their heads together, come up with a new [fill in the blank: protocols/tools/reports/guidelines/strategies/etc] dealing with X, which then unleashes a frenzy of effort to take the good thing and make it very good.  Within the various branches of the organization, there will be ten, maybe twenty or maybe a hundred who have made a heavy investment in X.  Each will need to comment on the new thing. Many comments will replicate each other, others will contradict. Skirmishes will ensue – “communities” vs. “people” in paragraph 7, roll out in August (rain season!) vs November (too late!!!!), and so many more. Complaints will move up the food chain – Why weren’t we involved sooner? You need our approval! Meetings will be held and hair will turn gray. The thing will launch. Now start at Step 1.

And on it goes.  I have been involved in many of these processes. Even the ones avoiding the quicksand of organizational politics involved multiple, duplicative commitments of effort.  More to the point, they involved faith that improvements – objectives phrased more clearly, the addition of a resource annex, newer research included – actually mattered in some way. How could they matter? How could a rephrased set of objectives save lives and alleviate suffering? Faith is beautiful that way.  Proof is not required. A collective investment in the possibility that what we do matters.  The spotlight of effectiveness is unwanted here.  And so is it rarely shined.

The Problem with Effectiveness (1)

My first blog sent from the city of Manchester, arguably the birthplace of modern Capitalism: “there are good reasons why those in the Southern Hemisphere view [the big NGOs] as the ‘mendicant orders of Empire’” (Michael Barnett in The International Humanitarian Order). So an appropriate location for an HCRI-Save conference on humanitarian effectiveness.

What is effectiveness? As with many concepts, the further one dissects it, the more wooly it becomes. So a nice generator of the sort of navel-gazing exercises that I find so stimulating and that consume a lot of humanitarian energy.  That said, the discourse of effectiveness warrants being unpacked from a number of angles, especially within a political economy of aid. On that, two initial reflections.

First, the ‘oligarchy’ of global western humanitarian NGOs uses the language of effectiveness to defend its turf, funding and power.  Argument to donors: give us the money, because we are more effective than them.  Here, ‘them’ refers to emerging NGOs from the global south, who are almost by definition going to come up short in terms of effectiveness. After all, it is the oligarchy’s definition of effectiveness in the first place, and the oligarchy has enormous advantages in terms of resources, experience, infrastructure, etc.

Second, the discourse of effectiveness sidesteps ethical issues.  As somebody pointed out in one of the sessions, what is effective and what is right are two different questions.  Those arguing for the supremacy of effectiveness miss the problematic reality of an aid industry that is often ineffective and unaccountable.  Let’s be clear, aid is a tough business, and we should expect that it often falls short of being effective, no different than welfare programs in our home countries, which have regularly failed in efforts to lift the poor out of ghettos, improve public health or reduce drug abuse (for example).  That is the nature of the work.

But there is a fundamental difference. There is something regrettable about our ineffective efforts to do good in our backyard and for ourselves.  But there is something regrettable and unethical with our ineffective efforts to do good in their backyard, with their lives at stake, and yet where they have neither say over how it unfolds nor recourse when it does not go well.

No Time to Rejoice

Hip hip hooray? The British government has announced it will welcome thousands of Syrian refugees, an abrupt reversal of fortunes for those dreaming of barbed wire boundaries.  So much for the previous day’s logic that the UK’s generous aid / involvement ‘over there’ somehow cancelled out legal and moral obligations right here.  It would be difficult to concoct a more perfect example of abusing the purpose of aid.

There are many who will view this as a victory of politics, a democracy where the voice of the people was heard.  It is certainly a case where the shift in public opinion, not to mention the shame of having even the likes of Nigel Farage (UK’s anti-immigration demagogue) call on the government to do more for the refugees, prompted better policy. But this remains a political failing.

What do Aylan Kurdi and Thomas Eric Duncan have in common?  They are both dead.  And their deaths changed public opinion.  And so their deaths changed prime ministerial / presidential policy.  That is the problem with democracy, its inability to act against the will of the people when the will of the people is too slow to embrace what is right.  David Cameron has long known what is right – legally and morally – in terms of those seeking asylum from Syria, or places like Eritrea, Yemen and Libya.

Both Cameron and Barack Obama knew that their countries needed to launch an urgent response to Ebola long before their catastrophically late (September 2014) interventions.  But they could not act because the increasingly deadly combination of the high stakes of power plus the brutal oppositionalism of domestic politics means that politicians cannot afford to act in accordance with necessity, principles, or even in line with their own moral compass.  When it comes to these sorts of foreign policy issues, it means they must wait for the public because they will not sacrifice political capital to lead the public. So they watched Syrians drown and Sierra Leoneans perish.  We all watched.

Political (and financial) dynamics thus twist the financial and proverbial logic, creating a structural preference for pounds of ‘cure’ rather than ounces of ‘prevention’. In other words, for late intervention, after the weight of a crisis has gained sufficient media attention to tip public sympathy.  The well-foreseen, slow-onset 2011 famine in south central Somalia provides a well-documented example. The humanitarian community needed those images of starving children to unblock funding, many fatal months late.  It is not a victory when doing what’s right in the face of (impending) crisis means waiting for the likes of the crumpled little boy on the beach or the feverish Liberian man in a Dallas hospital.

Called Out

Story 1. The Daily Mail’s recent investigation revealed that charity fundraising agents employ aggressive techniques, harassing everyone, even people with dementia in order to score a donation. The DM trumpets a revolting story of how one lovely old woman, 92-year-old Olivia Cooke, was killed by cold calling.

Story 2. All these charities have ‘robust’ measures in place, none of these charities ‘tolerate’ unethical call practices, all these charities have elaborate systems to ensure their telephone fundraising agents comply with the ‘highest standards’ of practice, none of them knew what was going on, all of them are ‘outraged’ and will get to the bottom of this… (see here, for example)

Point 1: Something does not quite add up.

Question 1: Which conclusion is worse? That charities all know exactly how cold-call fundraising campaigns function, and yet make a calculated compromise? That it is largely the charities who dictate a game in which call agencies must deliver the greatest bang for the buck – an equation doomed to sideline ethical concerns? Or that nobody knew the path that was being taken in their names (conveniently, in that case, all we need to do is change paths by hiring a different agency)?

Answer 1: No answer to those questions gets rid of the queasy feeling that more of the public now thinks of us in terms usually reserved for celebrities who get caught cheating on their spouses.

Point 2.  We are all in this together. Trust is the primary precondition for the aid world.

Story 3: The aftermath has been predictable. Now, the industry trots out sincere handwringing, apologies and pledges for investigations/change. Now, announcements to stop using cold call tactics and a new supporter pledge to behave better. Now, the politicians, fundraising industry and aid business have jumped on the bandwagon of salvation.  Tough measures will be taken! Abuse will be stamped out! A new morality will rule the day because it turns out humanitarians – like the politicians and bankers in opposition to whom we routinely define our goodness – need a new morality.

Question 2. The question isn’t whether NGOs should wean themselves from cold calling or establish confidence-building supporter pledges. The question is why supporter promises, a relatively ancient, tried-and-true practice, were not in place long ago. The question is why cold calling is ever used to raise money for humanitarian ends.

Answer 2 (literal version): Decisions were taken not to make a supporter promise.  Decisions were taken to ignore the ethical concerns around cold calling in order to deliver on cash.

Answer 2 (simple version):  We have large headquarters and we have massive needs to fulfill – a globe of human suffering no less –and that costs money.

Answer 2 (complex version): The incentives in a supply-driven aid system emphasize financial bottom lines over operational effectiveness.

Answer 2 (deep version): Across many dimensions of our work, the humanitarian has a vested interest in believing that ends justify means.

Main Point: The Daily Mail – and we should expect as much – almost defines the “shark kills surfer” school of journalism.  Shock sells news.  Little old ladies with Alzheimer’s became the story. So little old ladies become the problem and then drive the solution.  In whipping up the lurid tale of our fallen humanitarian nobility, the media buried the greater imperative. A focus on the extremities of harassment veils the banality of aid’s hard-fought principles being eroded by the business of self-interest.

Story 4:  Where have we heard this saga of disenchantment before? Just about everywhere.

Ebola the lens: What do we see?

[This blog was first posted at the great Humanitarian Practice Network.  The research paper is expected this summer and will be co-written by Caitlin Wake.]

Saying goodbye to MSF’s Head of Mission in Liberia and thanking her for hosting me during my research visit. As I leaned in for the double cheek kiss that we Anglophone aid workers are so fond of displaying – a badge of cool and humanitarian familiarity that breaks with the sterility of the brisk American handshake – she leaned back. Her face was slightly horrified, her expression confused. Even as I leaned in further, confused myself and self-conscious of making a mistake, she pulled another step back. And then it clicked: No Touch Policy.

There you have it. One small perversity of the Ebola outbreak. One small particularity in a field of many, and yet also representative of a human crisis where humans are prohibited from touching one another in their blackest moments of need, fear and grief. The sanctioned protocol of bumping elbows – or perhaps fists – just doesn’t allow for the level of human connection that people working in such an unforgiving setting deserve.

A plethora of differences set the humanitarian intervention in West Africa apart from those mounted in response to other major crises, whether in Haiti, Syria or the Central African Republic. Some might find that reason enough to question the wisdom of a research project that aims to draw out lessons for future emergency responses from a black swan of a crisis. I would argue just the opposite – by catching the humanitarian aid system off balance, the Ebola epidemic has thrown the system into high relief, magnifying both strengths and weaknesses that might otherwise have gone unnoticed.

The goal of my research with ODI’s Humanitarian Policy Group (HPG) is to use the international response to the Ebola outbreak in West Africa as a critical lens for scrutinising the ‘humanitarian aid system’ as a whole. We hope to avoid duplicating the multiplicity of other assessments, evaluations and reports by focusing on the big picture, at how the fundamental contours of the aid system result in advantages, as well as shortcomings or gaps. We are interested in the power dynamics which govern the aid system’s architecture, culture and identity, and how these shaped the intervention. Hopefully, this research will contribute to ongoing efforts to improve the system’s response capacity, such as informing HPG’s position towards next year’s World Humanitarian Summit.

For now, though, we must come to terms with the immensity and unprecedented nature of the response, which was not just a colossal humanitarian deployment but also a military and scientific one. To begin with, many viewed this solely as a health emergency, some still do. But when was the last time the aid system confronted a ‘health crisis’ that decapitated local health system systems, shut down schools, postponed elections, gutted economies and shook the stability of nations? Sounds more like a classic complex emergency. Yet beyond MSF and a few specialist NGOs, we consistently hear the same refrain: “We wanted to do something but we didn’t know what to do. We aren’t medical. And we were frightened. Really frightened.” Not the best of starting points for what has become a billion-dollar intervention.

Understanding these dynamics and comprehending how an aid system that was so woefully slow to react has managed to produce such a broad, creative response is part of our task. As is figuring out why some of the mistakes made amount to an almost clichéd repetition of blunders that we have seen over and over again. Do we really need a piece of research to tell us that we are better at identifying lessons learned than implementing them?

The Old Switcheroo

It is difficult to issue a thoughtful mea culpa message and still manage to undermine your credibility. WHO just pulled off that rare double. In short, they posted their message and then replaced it with another, toned-down version. As if the world wouldn’t notice! Sarah Boseley’s blog captures the changes.

The contents should be well-received, in either version. Admitting that it has learned lessons of humility, fragility and (ironically) the need for clear communication – hard to disagree. And it is not the fact of the old switcheroo that bothers me; nor even the innocence in believing that one could slip this by without being caught. No, what I find so depressing is that in all the lessons forced onto the organization by its Ebola response, perhaps the most important has been missed.

I cannot be certain why WHO has toned-down its message, or felt so compelled to do so that it pulled the switcheroo. Somewhere, though, it seems likely that the problem was having rankled some feathers. Some people didn’t like the message, and they weren’t little people. So it had to unrankle them.

And that is the problem. That is precisely what was missing in WHO’s failure to sound the alarm, loudly and early, on this outbreak – the willingness to take the heat for making a call that would have been unpopular with those in power. Humility, fragility, capacity, solidarity… all worthy lessons. But if WHO is to become a force for global epidemic response, it must learn the lesson of rankling feathers. Take a lesson from MSF: It must learn to piss people off.

Building Resilience? Turn Crisis into a School

[This is the second in a series of posts aimed at the World Humanitarian Summit.  Along with the previous post (see it at WhyDev as well!), the idea is to suggest how development and humanitarian organizations can work better together.]

Over the past years, the ‘new’ grail of resilience has sparked debate within the aid community (see e.g., here, Dialogue 12). Importantly, few disagree on the ambition of strengthening national and local resilience to crisis, and resilience has been named one of four core themes for the World Humanitarian Summit. The central, somewhat distracting argument seems to pertain to its home.

Is it humanitarian work to build resilience? Or is it development work, with humanitarian content? My pedigree places me squarely in the latter camp. In crude jargon, humanitarian work is about immediate harm reduction, not building for the future. But this sort of dogmatism breeds argument, not progress (and ignores the degree to which funding streams for resilience work determine its home).

Perhaps it is more useful to consider How? rather than Who?. In broad terms, the humanitarian community lacks the skills, experience and, frankly, patience to effectuate transformation. And what humanitarians do possess – technical knowledge – is the relatively easily transferred part of crisis response. Where resilience in terms of government response capacity is most lacking, improving the responsiveness of national authorities requires long-term planning, facilitation rather than implementation, and commitment on the scale of years rather than a reporting cycle.

Let’s take this example: How does one help a district ministry of health develop the capability to deal with a cholera outbreak in a remote cluster of villages? Well, here is how not to do it: run a workshop for a week, hand over pristine copies of the cholera guidelines, and then wait to see what happens. My years working with MSF left me all too familiar with the workshop approach, and the subsequent bout of accusations of incompetence or unwillingness when MSF had to step in because the ministry failed to respond.

This workshop approach creates piles of paper, heavy expectations and, too often, little more than a virtual response capacity. The obstacle is not technical understanding of cholera. You can download that here or here. Faced with actual cholera — with the requirement to scale up exponentially in a short time – the government health service or local NGO (just like many INGOs) are often more seriously impaired by the pre-planning (preparedness), scaling up, management of ongoing services, and the lack of access to emergency funding. Building that will take persistent effort over time, not a specialty of humanitarians; will take hands on experience, rarely available during workshops; and a commitment to learn from failure.

Let’s return to that example of cholera response. A well-placed INGO specializing in development could start by working with the ministry to develop recognized contingency plans, such as for the creation of a temporary Emergency Response Management Team, or a plan for identified ministry staff to be allocated to the emergency response and for how remaining ministry staff will cover the gaps caused by shifting resources to cholera. All of this would require agreed TORs, and new job descriptions, contracts, training, etc. for staff. (It may also require striking a deal with its donors, one that will allow contractual flexibility to engage in rapid onset emergency response).

The development team should then play a bridging function to the experienced humanitarian NGO (i.e., INGOs such as MSF, that have experience running cholera treatment projects), facilitating agreements that come into force during an actual outbreak, allowing the national/local to shadow and then take on progressively greater responsibilities over time. In other words, cholera outbreaks rather than cholera protocols become the driver of resilience. The development team ensures proper ministry presence, and removes the burden from the emergency INGO (the Ebola outbreak is an exception to the rule that humanitarians cannot take on responsibilities for training others during the height of crisis).

With the ministry, an agreed plan for rotating of national/local personnel (secondments) into the emergency response of the humanitarians. This should happen systematically, over years, and build capacity in all areas of intervention, from medical doctors to supply officers and registration desk staff. The development team might also have to bridge between the various government departments that must agree (inter alia) to the division of responsibilities and provision of resources. It probably also needs to broker financial support to the ministry, and work to develop the administrative capacity to manage and report on the funding.

Under various names, the aid community has been talking for decades about improved resilience in the form of improved national operational responsiveness. There have been successes. As well, grand plans have fallen flat. In my years with MSF, there were often requests for training, but I don’t ever remember anyone asking us to engage in the sort of transformational work described above. Nor would we have been wise to say yes – wrong people and bad timing. Being used as a school is different from having to organize oneself into one.

Effective strengthening national and local response capacity requires the particular skillset of the development community. So forget the details of the example above – another humanitarian’s misguided imagination of how a development NGO would do it. What is not imagined is the opportunity for development NGOs to get resilience right by catching humanitarians in the act, and taking the national authorities from understudy to lead.

Making development work for humanitarian response–and vice versa

[This is the first of a series of posts aimed at the World Humanitarian Summit.  More generally, this post and the next one offer ideas on how development and humanitarian organizations can work better together. Many thanks to WhyDev for their encouragement, editorial help and posting of this blog. Check out their excellent site if you don’t know it. – MD]

How many times have we seen this: a complex emergency with a decade or two of heavy humanitarian intervention (maybe some development organisations and peacekeeping forces as well), scores or even hundreds of millions of dollars spent by aid agencies, legions of expats trafficked through–and yet close to zero planned impact on local economic development or resilience? Sound like Eastern DRC? Haiti? South Sudan?

Foreign aid policy and practice have failed to view humanitarian crisis as an opportunity for development. This gap highlights a missed potential to capitalise on the presence of such a well-resourced foreign enterprise as humanitarian intervention.

A house divided

The aid community has improved its performance these past years by learning that, particularly in complex emergencies, contexts cannot be shoehorned into one end or the other of a false continuum, designated as either “humanitarian” or “development”, with one-size-fits-all implications for the aid response. Nonetheless, this divide is deeply ingrained, reinforced by the two-pronged architecture of the aid system, from funding streams to academic departments to organigrams of agencies and governmental ministries.

This divide has given rise to a fair amount of acrimony, and to a blind spot when it comes to opportunity. It is good–but not good enough–to comprehend that humanitarian crisis and developmental needs lie side by side. We must take the next step and see long-term development opportunities as residing within crisis. It’s time for development agencies to seize the presence of the humanitarian machine, by exploiting its potential as a source for financially sustainable (small) businesses. It’s time to make friends with the enemy.

Mind the gap

We understand almost intuitively how humanitarian crisis, whether conflict, flows of refugees or natural disaster, generates destruction, including damage to the local economy. Yet crisis often means that business is booming for the humanitarian endeavour. Viewed through an entrepreneurial lens, humanitarian response, particularly those stereotypical Western-led interventions in long-standing emergencies, resembles a pretty fat cash cow.

In crisis contexts, INGOs possess relatively massive resources, and they often represent the biggest fish in the pond. In line with these resources, humanitarian NGOs also have needs–many of which could be met locally. Why is it, then, that an organisation like MSF/Doctors without Borders works in Goma for decades, and still expends resources on importing and servicing its own vehicles? Or why in Nyala were there so few restaurants where an expat could go out to eat, even at the height of the Darfur response?

With a large, wealthy and needy humanitarian community present for decades, why do we still find development NGOs teaching women to make soap? Okay, that’s an exaggeration. There is nothing wrong with soap. The point is that many income-generating efforts are not successful, in part because of the lack of people willing or able to buy. But the humanitarian industry and the expats it employs are willing and able – so why aren’t development NGOs helping local people meet this demand?

In places like Port-au-Prince and Goma and Nyala, there are, of course, some local businesses and people who take advantage of the presence of foreign NGOs and expats alike, such as landlords, nightclubs and security services. Typically, though, the untapped demand is much larger, particularly for in-house service at NGOs; and, these businesses are either ad-hoc or pre-existing (especially in the early stages of a humanitarian response). Importantly, they are not the result of development agencies capitalising on opportunity, and so do not by design benefit the community, contribute to self-reliance or help establish an entrepreneurial culture.

The major humanitarian NGOs (and the UN) continue to be the managers and providers of an internal set of non-humanitarian services, which is inefficient. Here, one could talk of NGOs that hire and manage staff to clean their offices or residences, rather than having a development NGO work with a local group to create a cleaning service business. Ditto for vehicle maintenance, transport, catering, many aspects of supply and other functions that typically remain in-house to the INGO. And what of demand for highly-skilled counselling or consulting services (why do Westerners get so many of those contracts?), outsourced not necessarily due to a lack of local expertise, but because the local expertise lacks the know-how to package and market itself effectively?

Closing the gap

There needs to be a convergence of policy and practice aimed at the progressive outsourcing of services from within the foreign humanitarian community to local NGOs and businesses. The first step requires a teaming of development NGOs with their humanitarian cousins to delineate the concept. What services already exist? What services and businesses might comprise “easy wins”? What are the no-go areas (where humanitarian NGOs should retain direct control)? In what contexts would outsourcing be most likely to work? How can the development actors reduce the risks of negative impact when the humanitarians go home?

Next, the development agency must negotiate with national and local authorities, humanitarian NGOs and institutional donors to establish coordinated action and goals. NGOs will need to progressively cede control over important components of their activities. Donors may need to nudge them towards compliance, and national governments may be able to encourage change through regulation.

Most importantly, NGOs will have to work in the local community to build the actual businesses and services. This requires working in tandem with humanitarian organisations to ensure that needs are met and the quality of services is sufficient. The point is to create sustainable local capacity–businesses, services, NGOs, etc.–that can fill gaps or replace existing services that are owned or managed by humanitarians themselves.

Even to the extent that the activities proposed here already exist, they remain exceptions, haphazard in their genesis and limited in their impact. They do not reflect policy choices aimed at exploiting large-scale, protracted humanitarian interventions for the benefit of local development. Can we not imagine increasing local businesses’ support and service to the humanitarian community, to the point where it becomes a successful core component of development aid?

This opportunity may prove infeasible in some contexts, or it may be counter-productive to become dependent on cash cows whose presence is temporary. But, there is significant potentially successful development work in transforming existing functions into sound, income-generating local businesses.

The Product of Systems

Who is in charge? Part 1.

The richest 1% of the world will soon have a greater share of the world’s wealth than the other 99%. With that eye-catcher of a stat, Oxfam launched a report and a discussion on extreme global inequality. Great stuff. Do not let the quibbling distract you. This is a street child face down on a busy sidewalk in a pool of excrement. Trust your gut: imbalance on this scale is inherently and dramatically wrong. The only debate should be which is worse – what this says about wealth distribution or what this says about power.

But what if I told you that I just read about a place where the richest few control 99.8% of the wealth? Not 48%, as Oxfam’s report denounces, but the whole enchilada? Ninety-nine point eight percent represents an astounding achievement in disparity. Can you guess where? No, not mega-corrupt states like Angola or Equatorial Guinea. No, not the petrol-rich like Qatar or Bahrain. No, not even Mark Zuckerberg’s family. Give up?

The surprise winner of the award for the most inequitable distribution of wealth and control on the planet is none other than us, the ensemble of humanitarian NGOs. Congrats to the likes of MSF and Save and (of course) Oxfam. Here’s Development Initiative’s excellent financial analysis of the humanitarian system (see p. 55ff): National and local NGOs form an essential part of the humanitarian response, but in 2013 only directly received US$49 million – just 0.2% of the total international humanitarian response. That’s US$49M out of about $2.3 billion hitting NGO coffers worldwide.

You can quibble with that figure – it’s not counting indirect flows to national NGOs – but my advice is to trust your gut. Eat your heart out, Donald Trump.

Who is in charge? Part 2

Bill Gates talks solutions. Bill Gates is right. Bill Gates calling for “germ games”. Bill Gates is all over my Twitter feed.

Gates has published an Op-Ed in the New York Times, an article in the New England Medical Journal and done a lot of media work to proclaim that good old human “ingenuity and innovation” can avoid the next Ebola disaster.

Gates makes sense, of course, calling for the development of vaccines, for better surveillance, for a global logistical and medical epidemic response capacity. Gates’ central point, though, is only half correct, and therein lies the flaw in his cunning plan. Gates claims (NYT piece): The problem isn’t so much that the system didn’t work well enough. The problem is that we hardly have a system at all.

Really? Is it that the system doesn’t exist? Or is it that the non-system of epidemic response is the direct product of another system, a highly inequitable international system of interests and power that does not typically place the public good as its paramount ambition? In other words, the very same international system upon whom Gates calls to act.

On one level, Gates forgets what happens to good ideas when their basis for attention and funding is fear and insecurity. What happens when you employ scaremongering to mobilize politicians and Western publics into funding better healthcare systems for the world? My guess: skewed priorities (epidemiological surveillance trumps maternal mortality) and unforeseen consequences, like helping to justify military expansion into global health and humanitarian action. It has not exactly served the lofty goals of international development to have become an integral tool in the global war on terror.

Most importantly, though, Gates seems to be addressing symptoms, not causes. In calling for an international epidemic response system, Gates essentially advocates the same superpower and global institutional approach that helped deliver WHO’s ineffectiveness, Sierra Leone’s woefully inadequate healthcare, or an Ebola response in West Africa that was too late, too slow and too focused on staunching the Westward flow of Ebola rather than healing those who already had it.

Bill Gates outlines a system the world needs to build. Dead right. Now he needs to outline the world that will build it, because he is silent on the need for changes in the way global institutions are conceived, controlled and built in the first place.

“Pound of Cure” Politics

Who hasn’t heard this one: An ounce of prevention is worth a pound of cure. The old adage presents a truism well relevant to the world of international aid. Ebola comes quickly to mind as the latest in a long list of lessons not learned. To wit, at what point – March? May? – would a fairly modest ten million or so have staved off the need for the $1.3B intervention that has been launched to date?

But the proverbial equation generates a false comparison. The “pound of cure” logic dissimulates. That tail of the proverb represents the cost of an intervention at a later stage – the bill for the fix (i.e., action after the problem has materialized). The mistake is to confuse the cost of the fix with the value of the damage. Pound of cure thinking hides ten, twenty or maybe thousands of pounds of loss – 11,000 orphans, schools shuttered, crops unsown or harvests unharvested, businesses bankrupted, national economic growth about-faced. And over 9600 people who are no longer people.

Let’s not be too hard on the proverb. Let’s be hard on ourselves. In the deeply politicized world of international aid and emergency response, the availability of the proverbial ounce of prevention turns out to be part mirage, hence a solid track record of paying for pounds of cure. This study of the 2011 famine in Somalia seems clear enough: Famine early warning systems clearly identified the risk of famine in South Central Somalia in 2010–2011 but timely action to prevent the onset of famine was not taken.

It too often proves more difficult from a political perspective to prevent a problem from arising than to deal later with the consequences of the problem itself. That is because mobilizing preventative action often proves trickier than launching a curative response. Humans seem hardwired to contend with the urgent at the expense of the important. In proverbial terms, that is also because frogs don’t hop out of water brought slowly to boil. And because screeching wheels get the grease before those that merely squeak. Tired yet? How about this? In the aid world, few will pay the early bird to catch the worm.

Enough of the proverbs. Let’s try fairytales. Is it even fair to balance a pound of cure against one sole ounce of prevention? What does the story of the Boy who cried “Wolf!” tell us? If not a boy, then what about the Western NGO? We belong to a business that depends on the production of a veritable smorgasbord of impending disasters; of persistent, strident calls for action (read: squeaky wheels in search of grease). That makes for a fast drip of public alarm, elbow-steered lobbying, and celebrity-endorsed impending doom. Act now! (Or: Send cash!). How many cures – how many actual crises – have actually been averted? Perhaps this is not just a tale of a Boy. Perhaps this is also the work of Chicken Little.

If we flip this around: the emergency aid business is of necessity an industry of alarm. Is there today a cacophony of alarm and media hype that deadens the ear? Have we reached the point where it is actually more efficient and more financially prudent for key donor governments and international institutions to wait and pay for the cure?

And what about the lessons of those fairytales? Cries of “Wolf!” or “The sky is falling” became quite pertinent in the Ebola crisis, where MSF’s early alarm was derided or dismissed in some quarters as yet another NGO fundraising ploy. The NGO cried out that Ebola was real and nobody listened. Real it was. A ton of cure that could have been averted by an ounce of prevention? Seems so. And maybe also a ton of cure that was necessitated by the perception of too many false ounces?


This blog is supposed to spark critical discussion around current issues affecting humanitarian action. And have some fun. (For more, click on the ABOUT button).