Walking Together, Walking Far: How a U.S. and African Medical School Partnership Is Winning the Fight against HIV/AIDS

6. Can Foreign Aid Work?

Can Foreign Aid Work? 77 6 Can Foreign Aid Work? In his PowerPoint presentations to U.S. groups, Bob Einterz likes to show a photo of a truck labeled “Kenya AIDS Control Programme ”—crushed from the top down and abandoned in the weeds. It seemed a perfect metaphor for the recent decades’ efforts to control disease and poverty in Africa. Haroun arap Mengech had seen ambitious foreign-funded health programs founder in Kenya, partly because aid money was misdirected once it landed within the country. As AMPATH began to expand, both in its number of HIV-positive patients treated and in the scope of services provided, its leaders were well aware they were operating in a venue filled with failed aid efforts. Despite the accolades greeting President Bush’s 2003 PEPFAR announcement, foreign aid in Africa and the developing world had a checkered reputation, with some reason. William Easterly, a former World Bank economist who moved on to become a professor at New York University, points out that a whopping $568 billion in 2007 dollars had been delivered as aid to Africa since 1965, yet the per capita economic growth of those recipient African nations has been close to zero. Even after all those billions, 78 walking together, walking far 78 walking together, walking far the continent overall was just as poor as it had been when the influx of aid began. In multiple articles and speeches and in his 2006 book, The White Man’s Burden: How the West’s Efforts to Aid the Rest Have Done So Much Ill and So Little Good, Easterly cites economic studies showing that foreign aid does not help a struggling nation. In fact, Easterly argues, aid actually reduces the prospects for democracy and rule of law and increases the likelihood of corruption . “Large aid flows can result in a reduction in government accountability because governing elites no longer need to ensure the support of their publics and assent of their legislatures when they do not need revenues from the local economy,” he wrote in a 2007 article. Easterly also ridicules the bureaucracy of foreign aid, pointing out that his former employer the World Bank has ten thousand employees and that a struggling country like Tanzania has to issue 2,400 different reports each year to satisfy aid donors. Among the commentators who agree with Easterly is Nicolas van de Walle, a Michigan State University professor. In his 2001 book, African Economies and the Politics of Permanent Crisis, van de Walle argued that by sustaining ineffective policies that otherwise would have been corrected by market forces, aid has blocked the chances for needed changes in dysfunctional African countries. Easterly, van de Walle, and other aid critics focus on this market -distorting effect of foreign development assistance, which they say stifles homegrown political and economic reforms. (Only partly tongue-in-cheek, Easterly claims that Lenin was the twentieth century’s first development economist.) Easterly argues that recent economic development success stories like China, India, and Chile have occurred only after donors and experts got out of the way of indigenous leadership. “The only ‘answer’ to poverty reduction is freedom from being told the answer,” Easterly wrote in “Freeing the Poor,” an article published in the periodical Foreign Policy in 2007. “Free societies and individuals are not guaranteed to be saved. They will make bad choices. But at least they will bear the cost of those mistakes, and learn from them.” Paul Collier, an Oxford professor and like Easterly a former World Bank official, is not as strenuous a critic of foreign aid, but Can Foreign Aid Work? 79 he is convinced that aid is not adequate to the task of lifting the world’s poorest people out of poverty. Aid must be supplemented by action, including military interventions and targeted trade policies, Collier says in his 2007 book, The Bottom Billion: Why the Poorest Countries Are Failing and What Can Be Done about It. “With some important exceptions, aid does not work so well in these environments, at least as it has been provided in the past,” Collier writes. “Change in these societies at the very bottom must come predominately from within; we cannot impose it on them.” HIV/AIDS assistance is singled out for specific criticism by Helen Epstein, a microbiologist and AIDS activist, in her 2007 book, The Invisible Cure: Africa, the West, and the Fight against AIDS. Epstein criticizes...