Ebola Crisis Exposes A Flawed Aid Strategy

By Ashmead Ali, P.Eng.
Pride Guest Writer

Two issues come to mind when I think of the present Ebola crisis – that of a flawed foreign aid strategy by the rich Western nations and internal conflicts in the poor world. Both should be examined in light of crises such as Ebola, which can cause havoc for both the poor and rich worlds.

Many might not even give it a passing thought, least of all the official aid-giving OECD (Organization for Economic Cooperation & Development) rich nations, but I would suggest that there is a direct and high correlation between the amount and use of aid funds and the health-care systems in poor countries.

The current Ebola crisis has brought to the fore the need for these OECD countries to re-examine their aid strategies, to both acknowledge their mistakes and to increase their development aid to poor countries. Over the past five decades of aid giving, aid has been given in up and down cycles, with an average of 0.35 percent of these rich donor countries’ Gross National Incomes instead of the United Nations’ recommended target of 0.7 percent.

The IMF, World Bank, and the aid-giving nations have realized some of their faults in aid giving. The problems with the Structural Adjustment Program are well documented. Also, not so long ago, many aid providers “tied” their aid (for example, if I loan you some money, I must get some benefits plus the interest you will have to repay me). Some still do. In addition, many countries are selective as to the amount of aid given and to whom aid is given as, to them, aid is not necessarily dependent on the needs of poor countries. The poverty and desperation of poor countries can be less important than issues that rich countries consider to be in the rich countries’ interests.

Many poor countries plan their budgets and development programs, including poverty eradication policies, based on promised aid from the rich, donor countries. However, because in many cases and very often, expected aid flows are not forthcoming, countries that are dependent on such aid suffer. The result is that the poor countries’ overall anticipated growth and development are curtailed. In some cases, rich countries changed their aid focus from one region of the world to another, leaving countries in the now neglected region short of desperately-needed funds.

The Ebola crisis in West Africa is taxing a health system that is inadequate to handle even basic health-care needs of its populations. In addition, conflicts have left countries such as Liberia and Sierra Leone with some of the world’s lowest doctor-to-person ratios – as few as one to two for every 100,000 persons; many sub-Saharan  countries have a doctor-to-person ratio of one doctor to more than 30,000 persons.

Were aid funding at a level, over the years, to progressively build a decent health-care infrastructure, the situation, in all likelihood, would not have been as desperate as it has been in the last five months. Belatedly, many countries are now promising and providing financial and other aid to attempt to improve existing, or to build, new facilities to deal with the crisis. Recent aid, in the form of money, supplies, and medical and other humanitarian personnel and services, which has provided much-needed assistance to ease the Ebola problem, shows that had such assistance been given over the years to build and strengthen health care in the affected West African countries, the situation would have been less severe with possibly far fewer deaths.

Increased foreign aid will provide necessary health clinics that the poor can visit in their own villages. These clinics can also provide instructions in, for example, simple hygiene that will go a long way in providing resistance from contracting diseases such as Ebola. With some infrastructure already in place, stepping up existing services to deal with the Ebola crisis, will not be insurmountable and hopeless. Less precious lives, both in West Africa and the US would have been lost.

But aid should not be only about providing assistance. Aid providers should also be held accountable for encouraging professionals from leaving poor countries. There are many reasons why people migrate to other countries, be they personal, country stability, conflicts, lack of economic progress and growth, to seek better conditions, more pay abroad. But rich countries might even try to lure medical doctors from poor countries with incentives such as paid air fare, visa, temporary subsidized rent, and registration with the local medical council. Again, had more aid been provided over the years and internal civil and political problems at a minimum, it is highly possible that many of the problems that encourage these professionals to leave, and that might be the tipping point in their decisions, might very well not be considerations in the first place, thus allowing them to remain in their home countries.

However, less-than-enough aid and having their own professionals are not the only issues that poor countries have to deal with. Many of the aid-giving countries, in addition to not living up to their aid promises, might also destroy valuable and much-needed infrastructure in poor countries. Perhaps a famous and recent example would be Iraq, where infrastructures that are essential and (like water) a human right were destroyed during the invasion and destruction in the first decade of this century. Another not so famous example, was the bombing of a pharmaceutical factory in Sudan by the US government in 1998. The factory, constructed with components from several countries including the US, produced human and veterinary medicine and employed over 300 workers. It is estimated that several thousand Sudanese (and possibly people from other poor countries) suffered or died because of the resulting shortage of drugs produced by the factory. Although there were no solid grounds for the bombing, the US claimed that they retaliated for the 1998 US embassy bombings in Tanzania and Kenya; that the factory was allegedly processing a nerve agent; and for alleged ties to Al-Qaeda. I am not aware of any restitution by the US to compensate for the destruction of the factory.

But notwithstanding the wrongs by some in the developed world, developing countries have to take the initiative to fight poverty on all fronts rather than wait for others to do it for them. To make this happen, developing countries have to start or continue to solve issues of governance, citizen participation, be serious in the work to fight poverty, eliminate civil and political conflicts, and solve their political and international issues (such as mining) amicably. Fewer conflicts will improve their financial resources that will allow for improved infrastructure such as health care. Both developing and developed countries have to acknowledge that they are major stakeholders in a world where the adverse effects of poverty will affect them in a manner with which they will have difficulty dealing. The effects of poverty have a way of beating all of us in the long term, if we do not beat it back.

Let us, hopefully, learn from the Ebola crisis, which is causing destruction in the lives of adults and children and damaging economies in sub-Saharan Africa. Let us not wait for the next “Ebola” to succumb us all. We are already late in providing the necessary foreign aid to poor countries; let us not continue to do so.

Ashmead A. Ali, P.Eng, Vice President, African Connections, Engineers Without Borders; Former Board Member, International Development & Relief Foundation.