Despite Good Intentions: Why Development Assistance to the Third World Has Failed

Story Five: Warm Bodies

STORY FIVE Warm Bodies Washington, 1984 75 “Yes?” Ben said as he answered the phone. “Hi, Ben, I’m John Becker from ProjectSuccess International in Washington. We’re about to respond to an RFP for a two-and-a-half-year integrated health project in the Philippines. Your name came up in our database, and we’d like to put you forward as the Chief of Party.” Thirty months in the Philippines! Ben had been thinking it would be fun to go overseas again. The expat life is a good one, and few opportunities like this come up anymore for Americans. And to go as COP (Chief of Party) might even be therapeutic—Ben had often felt that a repressed “cop” existed within him—perhaps this would be his last chance to be a boss. Besides, his recent work had become routine. He’s ready, no, anxious for a change. But Ben knows he should play it cool. “Well, can you tell me a little more about it? Like, how long is the assignment, where in the Philippines is it, how big a project is it? Like that.” “Sure. I can send you a copy of the USAID PID. But basically, it will be located in the northern part of Luzon, a town called Baguio about a hundred miles from Manila, and involves working with a very poor rural district to set up health clinics and the like. It would involve setting up an office in the town of Baguio and running the project with about twelve local-hire staff. Plus you’d have two other expats.” “Sounds good. I look forward to receiving the PID.” It was January, and Becker assured Ben that the whole process would be over by summer. If ProjectSuccess won the contract, Ben would have an answer in time to go by September. Ben didn’t waste much time thinking about the scheduling because he knew that the chances of this call developing into a real overseas job were remote. He knew how the system worked. In a memo from USAID’s Washington headquarters to the field offices, the agency administrator indicates that AID must begin implementing the spirit of a new law passed in Congress which states that all U.S. official aid must provide for “basic health needs” to be met in all “relevant projects.” The memo provides guidelines and instructions. A review of the projects in the health sector is therefore requested from the health project officers at all USAID missions. The cable adds that the Alma Ata declaration (an international health protocol dating from 1978) should be used as a benchmark. Do programs focus on the availability of basic drugs at the community level? Do they focus on maternal and child healthcare, particularly preventive care? Are they implementing a nutrition education component and a weight monitoring system for newborns? Is there coordination with local primary schools? Are mothers being encouraged to come to local clinics? What is the governance structure of local clinics? In Manila the USAID mission director sees the cable and requests his chief health project officer to deal with it. The project officer, who has been in the country for twenty-eight months and is, by USAID standards , well seasoned, knows the key players at the Ministry of Health and the Ministry of Planning, her counterparts in the other bilateral aid agencies (they meet monthly to discuss the health sector), and the representatives of the various multilateral agencies, such as UNICEF, the UNDP, and WHO, with whom, increasingly, projects have been shared. At the USAID mission, meetings are held to discuss what the new mandate means. Some staff argue that they are already doing what is required and protest the way Washington imposes new hassles on them. They will, however, soon get to work. An analysis of the current health 76 Story Five project portfolio will be done. Meetings will be held with the Ministry of Health and others. It emerges that there is something new that can be done. One of the poorest areas of the country, an area with no government services, a high level of infant mortality, poor water, a low level of female education, has no significant presence in the health sector on USAID’s part. There is, however, a Dutch-sponsored project in the area, as well as an immunization project under WHO auspices...