Promises, promises and donor aid money

It is estimated that the three major communicable diseases, malaria, HIV/AIDS, and TB, kill approximately 16,000 people every day. In recognition of the unacceptably high levels of disease burden the G8 leaders have promised to spend $60 billion to fight these diseases in Africa. However, in reality there is little behind this promise. Of the promised $60 billion it seems that only $15 billion is new money committed by the United States.

Britain’s new Prime Minister, Gordon Brown, when recently addressing world leaders and top businessmen and women at the United Nations in New York, emphasised that one of his first acts as Prime Minister was to renew the push to achieve the millennium development goals (MDGs). After conceding that “we are a million miles away from (reaching the MDG’s)” he called upon developed country governments to deliver on their promises of 0.7% of their GDP’s. Yet 0.7%, apparently a magic number continuously trotted out by the supporters of large aid transfers, will not achieve the MDGs. In part this is because so little effort has been put into measuring progress towards these noble goals.

The reality is that Brown’s promises and those of his G8 colleagues have more to do with image and positioning than substance. Malaria control provides a good case study of good and bad aid spending. Without the necessary reforms to improve the way aid is spent, Africans will continue to suffer from preventable diseases long after the current governments have gone.

The new Harry Potter film opened recently with much fanfare and excitement. If the film producers, Warner Brothers, acted like aid agencies and had Mr Brown at their helm, they would not be interested in how much the film grossed on the first weekend. Rather they would measure only how much it cost to produce the film and the number of cloaks and wands used by the costume department. A disease as serious and as deadly as malaria requires donor agencies to actually start measuring what matters and not what makes politicians look good.

Because malaria is both preventable and curable, it is known to be a good public health “investment” – with a relatively small investment many lives can be saved. As the burden of malaria increased during the 1980s and 90s, the G8 leaders pledged to do something about the disease and lent their support to the Roll Back Malaria (RBM) partnership in 1998, which had just been launched by the World Health Organisation, UNICEF, the World Bank and a host of other leading development agencies. RBM set itself the ambitious target of halving the burden of malaria by 2010 and immediately started to raise the profile of the disease, which kills over 1 million Africans every year.

The RBM Partnership has done an admirable job in ensuring that the world’s leaders take notice of malaria and commit themselves to combating the disease. At every subsequent G8 meeting, the communiqués have contained some reference to malaria and the need to continue to support public health efforts to reduce the burden of the disease. However, it has been less successful in actually reducing malaria cases and deaths. As no real effort was made to measure the baseline number of cases and deaths, its pledge to halve the burden of disease must be regarded with scepticism.

After widespread criticism that the RBM partnership was insular and was not supporting the full range of anti-malaria interventions, which includes spraying small amounts of insecticide inside houses, RBM has begun to evolve. Thanks to a serious will to help malarial countries to control the disease, the RBM partners now are working hard to improve malaria control and implement all the proven strategies.

Measuring success in terms of changes to malaria cases and deaths, however, remains a problem for most donor agencies that prefer to measure success in terms of money spent and commodities procured. A recent donor agency scorecard compiled by Africa Fighting Malaria found that only one agency, the US Agency for International Development, is putting any significant emphasis into monitoring and evaluation. Without proper measurement, how will agencies know whether or not their spending is successfully reducing the burden of disease?

The US has also made impressive progress with transparency. Through the President’s Malaria Initiative, its lead malaria programme, the US is leagues ahead of other donors in explaining how, where and by whom public funds are being spent. In this regard it is vastly more transparent and open than the other major G8 donors. The lesson from the US is clear; more money for disease control is crucial but money alone is not sufficient to control a disease like malaria. Indeed, unless the donors put serious effort into measuring the impact of that spending in terms of malaria cases and deaths, and continuously modify and improve their control tactics, all we will be left with are slightly poorer taxpayers in rich countries.

Authors: Richard Tren and Jasson Urbach are directors of Africa Fighting Malaria. This article may be republished without prior consent but with acknowledgement to the author. The views expressed in the article are the author’s and are not necessarily shared by the members of the Foundation.

FMF Feature Article / 14 August 2007