The Ambiguity of Aid

Driving through Lusaka, the capital of Zambia, is like a first trip to Las Vegas. Everything is in your face, something to see. Dusty streets, potholes like craters, people hanging off the back of pickup trucks, women wearing babies like backpacks as they hack away at maize, the smell of smoke from burning trash on the side of the road, horns honking, traffic that moves like liquid.

Almost two-thirds of Zambians live below the international poverty line—around 7.5 million people. The average life expectancy is a stunning 46 years. Only 58 percent of the population has access to clean water.

Zambia is a poor country. It is also a cauldron of donor activity. In 2005, the country received $1.7 billion in official development assistance—that’s 17.3 percent of gross national income for a country of 12 million people.

“The question people ask,” says Justin Mubanga, the Director of the Economic Management Department at the Ministry of Finance and National Planning, “is, in the last fifteen years Zambia got so much aid but there was little progress. What caused this?”

Some people say that aid caused this. They say that it has hampered, stifled and retarded Africa’s development. But there are others who say, on the contrary, that aid improves the lives of the poor and makes the sick well.

Gordon

Gordon Brown is standing at his desk in a crisp navy blue blazer and khaki slacks, a phone in one hand, the other tapping his keyboard. Even standing still, he’s humming with energy.

Gordon is the 35-year-old Zambia country representative for Africare, a U.S-based non-governmental organization (NGO). His job is to develop new programs, oversee those that already exist, and form alliances and partnerships.

It’s a long way from Augusta, Georgia, where he grew up. “The first time I walked into a store [in Africa] and nobody knew who I was or cared, I felt like I fit in by not being noticed, you know what I’m saying?”

Africare’s work in Zambia centers on health, food security and agriculture, and emergency response. Their projects, Gordon says, are about meeting peoples’ essential needs. So for example, they are helping to install something called PlayPumps, a merry-go-round of sorts that, when children spin it, pumps clean water into a storage tank that can be accessed by a simple tap on the ground below.

“Market forces alone aren’t enough to solve the problem of poverty in Africa. If we take the Darwinian approach—if you have resources, then you’ll succeed—if we believe that and act on that belief, people will die.”

There are many who think that putting things in such stark terms is just a clever way to drown out the voices of critics.

“[But] it’s okay to be motivated by wanting to do good,” Godron says. “We don’t live in a purely dog eat dog world. We want to believe there’s something greater. We want to be able to respond to need. Not everything we do is about self interest.”

Boyd

Looking at Boyd is like staring into the bottom of a well. His eyes are small and dark, impenetrable. I ask him: What is it like to care for orphans? What is it like to live in a village in the Zambian bush? What is it like to be poor? My words are like arrows shot into the ocean, pointed and tiny against the vast waves.

We pick him up at a small church made of exposed cement blocks where he and other volunteers are being trained in Gender Equity. The words seem sterile and queer in the dust beneath the jacaranda tree, where a little girl stands, hiding in the folds of her mother’s skirt, while some wazungu (white people) try to coax her to speak

Boyd Hamuchemba lives in Shimukuni, a village two hours up the Great North Road from Lusaka. He is a volunteer caregiver with a PEPFAR-funded program called RAPIDS (Reaching HIV/AIDS Affected People with Integrated Development Support). RAPIDS gives him training, a bicycle and a modest medical kit, and Boyd and his wife look after eight orphans, three of whom are his dead brother’s children, and five from the surrounding village. He visits them each week and records each visit in a ledger that is signed by the orphan’s guardian. If they are hungry, he tries to bring them food. If they are sick, he gives them a ride on his bike to the clinic. It was a volunteer caregiver like him who took Boyd to a clinic in February 2008, where he was diagnosed as HIV+.

***

The adult (aged 15-49) HIV prevalence rate in Zambia is 14.3 percent, according to the country’s 2007 Demographic and Health Survey—the seventh highest prevalence rate in the world. Anti-retroviral therapy was introduced in 2004, and 120,000 people now receive treatment in no small part because of the vast sums of money PEPFAR has poured into the country—more than $269.2 million in FY2008 alone. (The entire budget of Zambian Ministry of Health in 2008 was $317.5 million.)

PEPFAR has been criticized for devoting too much money to a single disease and for channeling aid mostly through international NGOs, circumventing the government. One afternoon I asked Dr. Ben Chirwa, Director General of the National HIV/AIDS/STI/TB Council, if Zambia’s battle against the epidemic is too reliant on donor funds.

“AIDS is a global problem,” he said. “It is beyond what any one government can do.”

What about the Washington economist who termed ballooning U.S. funds for AIDS treatment an entitlement that is unsustainable?

Dr. Chirwa just grinned like a pumpkin. “Life is priceless,” he said.

***

Boyd showed me around his compound—the hut where he stores food, his two goats, a checker board carving in the dirt where his children play games. I ask what he would do without RAPIDS.

“I was already a guardian and parent. But the work has become easier. When given a bike, it lightened my work. I felt very good.”

Aid is keeping Boyd alive. It is also helping him help kids in his village who lost their parents to HIV/AIDS. He would do it anyway, but the help makes his burden light.

Joy

I meet Joy Hutcheon at her office on the second floor of the British High Commission, on Independence Avenue. Joy is country director for the Department for International Development (DFID), the national aid agency of the United Kingdom.

Joy’s interest in development began early. “I can’t remember a time when I haven’t been interested in the different ways people do things in different parts of the globe.” After a visit to India, she applied for a position with the U.K. civil service, marking the Overseas Development Administration (DFID’s predecessor) as her first choice.

“For any country,” she says, ‘the way it is governed is so fundamental. I had the feeling that [in government] I could change something.”

***

The U.K gives about two-thirds of its aid to Zambia directly to the government, more than any other bilateral donor. The idea is to help build the accountability and capability of the state so it can provide for its citizens. Aid to an NGO that buys HIV/AIDS medicine will save lives today, but working with the government to improve its drug distribution system (one of the things DFID is doing) will help all Zambians access essential medicines over the long term.

Chris Pain, who works for the GTZ, the German development agency, as an advisor to the Ministry of Finance, attributes much of Zambia’s strong economic performance over the past four years to budget support, and the way it is helping to slowly strengthen the civil service. “Budget support opens up the whole budget for discussion, so it’s good for enhanced transparency.”

Justin Mubanga at the Ministry of Finance (MOF), who oversees the economic technical cooperation department (the four people in the MOF who manage donors), says that budget support has brought some predictability to the flow of funds, and the division of labor helps “but they still want an audience. They come indirectly to tinker.”

One of the ways donors “tinker” is through the performance assessment framework. Twice a year, they meet with the government to assess its performance on a number of predetermined indicators. If the indicators are not met, funding can be pulled.

Monitoring the government’s performance is necessary because donors must sell aid to policymakers and their constituencies back home, and assure them that funds are not being wasted.

“You can’t have budget support without being worried about corruption,” says Joy.

DFID is trying to help the government create an environment in which finances are well-managed and where corruption is not tolerated. So for example, DFID is helping the MOF install a single Treasury bank account (as opposed to the 300 or so accounts it currently has), to make is easier to track spending. The result is that corruption is more noticeable, Joy says, but there are also voices prepared to speak out and challenge it.

***

When Joy first arrived in Zambia, before anyone knew who she was, she visited a remote village called Kazuni in Southern Province. She shared a mud hut, walked to the river to get water, burned her fingers cooking nshima, laughed around a crackling fire with the women who were hosting her.

One day, a plane passed overhead. The women asked: what is it like to be way up there, in the sky? She felt clumsy as she tried to describe it: imagine you’re in a bus, sitting next to someone, little windows on the side. Are there are toilets, they asked? Yes, there are toilets. There are trays that fold down, and sometimes televisions. The women stared at Joy in wonder. They would probably never set foot on a plane.

“Everyone in Zambia has a village,” Joy said, “and will talk about going to the village. I have heard people I know say things like: this isn’t so bad; it’s like camping. But it’s your life. It’s everything you’ve got and there is no prospect of it changing.”

After three days she returned to Lusaka, over dirt roads, then paved roads, past buildings until she was back in her office, sitting in front of her computer, listening to the hum of the air conditioning.

As she told the story her voice cracked, like a rock breaking the surface of the water. “I really, really have to be sure that what I’m doing matters."

***

Night comes early in Lusaka. In the dark sounds are amplified. The rustle of leaves, dogs barking down an alley, a car engine trying to turn over.

An aid worker from Ireland once told me about a man she met at a health center who was holding his dead daughter in his arms. He needed a ride home; my friend said she could take him. The coffin he had was too small, but he hurried to squeeze the little girl’s body in, worried if he didn’t move fast enough, his ride might leave. The aid worker panicked: she won’t fit in there, let’s find something else. But there wasn’t anything else, so they took a hammer, knocked the end out of the coffin, and drove home with the wooden casket in the back of the pickup truck, the little girl’s legs dangling out the end.

Sometimes it feels like you’re being swallowed up, pulled under by a rip tide. The enormity of need. The limits of what we can do.

Boyd said it was hard to show up at someone’s home, ask them if he could help, and realize that sometimes he couldn’t. I remember him walking across a dirt path to the garden where he grows vegetables for the orphans; Gordon striding across a school yard to see a new water pump; Joy walking down the hall to meet some government officials.

They put one foot in front of the other.

*This is adapted from a piece I wrote in 2009 for the Center for Global Development.