Non-Governmental Imagination

Kenyans: Dog Food Beats Starvation
February 2, 2006, 6:35 am
Filed under: Food, International Aid, Jerks, Uncategorized

Kenya has been suffering through food shortages much to the detriment of their poorest citizens. A woman from New Zealand who owns a dog food company decided to donate 160 tons of dehydrated dog food to feed starving Kenyan children. Naturally, this came off as “culturally insulting” to Kenyan politicians, who do not like to think of their citizens as being equal to dogs in other countries. Lo and behold, hungry Kenyans do not share their government’s disgust:

“Parents of some of the children said leaders opposed to the offer were only after satisfying their personal egos at the expense of starving millions in the country.”

Only people with enough to eat complain about the quality of food. If faced with starvation I’d eat dog food or anything else to stay alive. I think that the woman could have been more sensitive by donating the proceeds from the sale of 42 tons of dog food and gotten much less negative attention. Regardless, I don’t think the Kenyan government can complain about the quality of aid foreigners are bringing in as long as they are frittering away $6 million on 57 Mercedes Benz cars ($105,263.17 each) for governement officials.


Great Article On Why Africa Is Perpetually In Need Of Aid
February 1, 2006, 8:59 am
Filed under: Food, International Aid

The BBC hit the nail on the head today. The article discusses how African countries become mired in situations that require food aid, and that drought is often not a primary cause. While I highly recommend reading the entire article, for you lazies here is the four main causes of famine:

“- Decades of underinvestment in rural areas, which have little political clout.
– Wars and political conflict, leading to refugees and instability.
– HIV/Aids depriving families of their most productive labour.
– Unchecked population growth.”

I couldn’t find much commentary in the blogosphere about this article, but Skeptacles made an excellent point about how the BBC downplays the voices that point to agricultural policies of the global north that perpetuate African poverty. The article is excellent through and through, so check it out.

Can NGOs Be Effective Substitutes For Government Services?
January 15, 2006, 9:51 pm
Filed under: Health, Imagination, International Aid

The New York Times had an interesting article about NGOs in Cambodia that have taken over large swaths of the health system. Apparently, Cambodia has hired a bunch of NGOs to run health districts to provide more efficient health care for its citizens:

“If childbirth is a miracle of nature, then the thriving, honestly run network of clinics and hospitals here is a human marvel, managed not by the government but by one of the nonprofit groups it has hired to run entire public health districts.

The approach is catching on in a growing number of poor countries around the world, from Bangladesh and Afghanistan to Congo and Rwanda, to Bolivia and Guatemala, reaching tens of millions of people.

These contracted services have allowed international donors and concerned governments to cut through dysfunctional bureaucracies – or work around them, and to improve health care and efficiency at modest cost.”

This absolutely fascinates me. Corruption is a huge problem in the global south, and I definitely know how corrupt governments siphon off resources from the intended benficiaries. NGOs can be more efficient by not having to deal with as many layers of intermediaries and bureaucrats taking their cut, but should they be real substitutes?

Cambodia is paying the NGOs as independent contractors. While this seems better for the patients in the short term, doesn’t it just make Cambodia more dependent on aid from the global north in the long term? I’d be interested in hearing about how much interaction the NGOs (such as Health Net International and Save the Children Australia) have with local administrators.

Health Net International has chosen a user fees system to work within the Cambodian Ministry of Health’s health coverage plan:

“The Cambodian Ministry of Health has designed a health coverage plan. The coverage plan describes a minimum package of services and activities (MPA) that should be carried out at health centre level. The MPA consists of basic preventive and curative services such as immunisation, family planning, antenatal care, nutritional support and simple curative treatment for diarrhoea, acute respiratory tract infections and tuberculosis.

The ADB money is a loan to the Ministry of Health to implement the coverage plan. With this loan the effectiveness and efficiency of contracting NGO´s is tested in order to find out which system works best;

Contractors that have complete responsibility for the total health care, contractors that work within the Ministry of Health system and have to strengthen the existing district structure or contractors that depend entirely on the services of the District Health Management Team and the Ministry of Health.

Within this project, HNI has designed and managed a user fees system. This system seems to have the potential to increase utilisation by the poor and decrease their out of pocket expenditures on health care….

The Ministry of Health, with financial support from ADB (Asian Development Bank) will contract in the near future the public health system in Mondulkiri to a private organisation. HNI´s intervention will assist the Provincial health Department to prepare for this change of the public health system. HNI´s partner NOMAD, is planning to turn its organisation into a Cambodian NGO, working with a team of locally based staff. HNI plans to continue the cooperation with NOMAD in the future and support their development.”

From the Save the Children Australia website, it seems like they’re trying two models with varying levels of local collaboration in order to decide which works best:

“No small affair, this project pilots two models for health service provision in Cambodia allowing a comparison of two management styles: contracting out in Memot, where we recruit, manage and train all district health staff and contracting in in Cheung Prey, where we train and manage the district health staff already employed by Cambodia’s Department of Health.”

There is a lot of debate about developing nations privatising public resources (ie water), with the loudest voices doubting the wisdom of moving control to foreign multinational companies. Does that apply to health as well? Does it matter if the contractor is a publicy held company or a nonprofit organization? How much control do local people have over their health now as opposed to before? How has accountability changed?

I am all for finding creative and effective ways to improve health care infrastructure in the global south. This idea is definitely creative, and sounds effective, although I haven’t heard from any Cambodians on the issue.

I am a little cautious about this because the potential for long-term dependency seems high. If Cambodia can snooker NGOs to providing its health care, why should it bother with improving its own system?

Nonetheless, I plan to watch this and try to learn more. If anyone has any opinions on this, I would love to be educated more on the issue, and I plan to invite Health Net, Save the Children, and the NYT author to respond to this post, so we’ll see what they say.