How to Help

There's an interesting editorial by Nicholas Kristof in the New York Times today. Bono was heckled at a conference in Africa recently for demanding more foreign aid. What's the problem? Well, there's a lot of controversy about whether more money is what Africa really needs. Kristof cites the skeptical new book The Bottom Billion (Paul Collier) glowlingly, but then argues that aid really is needed.

Kristof is a master of the vivid story. He says he was recently in Cambodia, where he visited a family with five children now in the care of their grandmother. The mother had recently died of malaria. The problem is that the grandmother had just one malaria net, and so every night she had to decide which two children should be left out, exposed to the risk of disease.

Kristof gives the grandmother another net--an example that's supposed to show that aid is obviously useful. He then offers the reader the url for a group that distributes nets, so he or she can give people nets as well.

The example is actually much more complex than meets the eye, as William Easterly argues in The White Man's Burden. And there's Kristof's blurb on the cover, calling the book "Tremendously important and provocative...an immensely stimulating book."

Easterly has an eye opening comparison. A group called Population Services International sponsored a program in Malawi in which local nurses made money by selling malaria nets, and people had to pay for them (the rich paid much more than the poor). This increased the use of nets from 8% to 55% over several years. By contrast, nets were handed out for free by a program in Zambia, and 40% of people didn't use them.

The example goes to show that, contrary to common sense, simply giving people something life-saving isn't necessarily effective. You need smart people running aid programs, folks who really understand how people think and behave, not just money. Funny that Kristof uses the malaria net example, which seems as simple as could be, but actually isn't!

August 11
If 10 people are given nets and 10 buy them, what number will use them in each group? Easterly's statistics don't really tell you. I probably found him persuasive not just because of his statistics, which are not "apples to apples," but because it's plausible in the first place that people value things more when they have higher prices.


Craig said...

Hi Jean, you are right on about the 'simplicity' of free solutions not being what they seem. Then you have to ask 'what happens the next time when they need to replace the net?' They don't last forever. Who will come around the next time with the free one? That's the dependency that these 'planner' solutions also create. Remember the saying about teaching a person to fish...?

What about those nurses when Africa is in the middle of a 'brain drain' that impacts the number of people who are even available (let alone educated) to attend to the health needs of the poor. Shouldn't they be able to earn a living AND help people too.

Important things to be thinking about. Glad to read it here.

Anonymous said...

I have been investigating microcredit as one approach to this conundrum. Yunus's autobiog, "Banker to the Poor" is well worth reading. I have got several other books about Grameen, but not read tham yet.

Jean Kazez said...

The nurses in the Zambia scenario seemed to have a chance to earn a living...But the nurse shortage in Africa is another interesting issue. Sad but understandable that once trained, many want to come to the west.

I've wanted to read that book about microcredit. People who creatively devote themselves to these problems are my heroes.