How would we more plausibly link HIV/AIDS and climate change in six degrees or less? HIV/AIDS is a major health crisis in Malawi. Ranil and Matt used to work in Malawi. Ranil and Matt both share a love for awful b-movies. Kevin Bacon once starred in the awful b-movie "Temors", about worm-like monsters called graboids which attack people from underground. Tremors is of course a rather deep allegory for climate change.
In an unabashed attempt to cash in on two advocacy areas at the same time, UNFPA has just released a report linking climate change to HIV/AIDS. Whenever the global development agenda is dominated by “hot” issues, agencies and think-tanks have a direct incentive to play six-degrees-of-Kevin-Bacon and tie their work in directly with one of those issues. Why? It provides justification for the work, and hopefully diverts resources to their given cause. What was the hot issue of the past eight years? HIV/AIDS. What’s the new hot issue? Climate change!
This isn’t the only reason why advocacy centred around hot topics is a bad idea: when single-button issues dominate the discourse, we’re much more likely to misallocate resources. When we should be talking about improving health and education systems, we end up parceling up these complex problems into impressive soundbites – HIV/AIDS, malaria, and universal primary education.
The problem is that money tends to collect around these simple soundbites instead of rather complex problems. This sets up an optimisation problem across the wrong parameters. Ideally, we should worry about optimally distributing funding across different systems in different countries (or, even better, just across governments), where those systems in turn have to optimise their allocations across problems within their sector.
Instead, as funding gravitates towards hot issues we find ourselves faced with an entirely different optimisation problem, one in which funding is allocated across countries within that sector. For example, the HIV/AIDs industry allocates more money to Malawi than Ethiopia, as Malawi’s HIV burden is higher. This would be a reasonable way of allocating resources only if the global funding for each issue was optimally allocated. But it’s not – it’s decided through desperate PR trench warfare between issues which leaves less popular ones out of the game. Owen Barder accurately describes the situation in his fantastic new post about the dangers of global advocacy:
The development industry seems to be riddled with people whose main job is to divert money to their good cause. The advocates are united by a strong belief in the priority that should be given to their sector (education, water, AIDS etc). They convince themselves that they are speaking for real interests of the poor, which they consider to be unaccountably neglected by everyone else. Within many aid agencies there is a permanent state of low intensity bureaucratic warfare for resources, sucking up the time and attention of staff as they fight to defend and expand funding for the causes they work on. They deliberately stoke up pressure in private alliances with civil society organisations – many of whom they fund – to raise the political stakes through conferences, international declarations, and publications with the aim of committing funders to spend a larger share of aid resources on their issue. Territory is captured and held by way of international commitments in summit communiques. But for the aid budget as a whole these are zero sum games, and everyone would be better off – and many lives would be saved – if it stopped.
An even better way to capture more territory is to merge your hot issue with another hot issue. Thus we have report after report (mostly by NGOs) making quite frankly ridiculous attempts to tie their issue together with the most popular one.
Some may suggest the answer to the resulting allocation problem is just to raise the profile of the less popular interventions. Let me make myself very clear: this is not the answer. A world in which the development agenda is set by publicity campaigns and unbridled advocacy is never going to achieve allocative efficiency. The imbalances are often enormous. In his post, Barder reveals a startling statistic – the relative allocation of funding to HIV/AIDS to fighting pneumonia in Ethiopia and Nigeria suggests we (the global health industry) “value the life of a person with HIV at 8.8 times the value of the life of a child with pneumonia.”
We to move further on re-designing the framework to make it easier for the optimisation problem to be made at the most appropriate (i.e. the country) level. This means general funding for local systems (without earmarks), as well as analytical support, so they can make informed decisions on the ground. I made this case previously in my post about funding health systems instead of health interventions.
We also need to move away from the current development mindset, where the world is full with just a few deep problems that need to be overcome. We need to reject advocates who say: it’s all about primary education, or malaria, or HIV, or agricultural productivity, or elections, etc, or a specific subset.We also need to admonish those who say “we already have the answer.” There is no unanimous answer – our problems are deeply complex and heterogeneous.
I’ll finish with an anecdote: a few years ago, I was hiking around the Viphya plateau in northern Malawi (with Ranil incidentally), as well a middle-aged English couple, who we had given a ride. The couple had just spent several years in Tanzania as volunteer teachers, and had become quite cynical about Western involvement.
“We shouldn’t give any aid,” said the man, “it’s not making any difference.”
His wife nodded in agreement.
“Really?” I said, “Pull out completely?”
“Well”, he said, “except, of course, for education.”
#1 by Ranil Dissanayake on November 20, 2009 - 5:54 am
There’s a typo in the picture caption. Tremors is aw’esome’ not aw’ful’.
easy mistake to make.
on less important issues, you know I agree with everything you write here. Owen Barder agrees. I’m relatively sure Bill Easterly would agree. How do we change it? (sweeping generalisation alert) Most people don’t like complexity, they avoid it. It’s an endemic part of vast swathes of Western popular culture. And the worst thing is, there are only pockets of popular advocates for complexity as a basis for understanding in most disciplines: Ben Goldacre in medicine stands out with Bad Science, for example, and the number of people who know him are far fewer than those who know The Awful Poo Lady (Gillian McKeith).
The other big issue is that the global left (in which I count myself, though as a dissenting voice) LOVES BUNDLING ISSUES. It’s not just about funding. It happens everywhere. Read the comments in the Guardian’s Comment is Free section. It’s full of logic like ‘Of course you’re against fox hunting if you’re pro-secularisation of schooling!’. It happens when they assume because I’m a Republican (note for American readers, this means I’m against the monarchy, not that I’d vote for Palin) that I must also believe that capitalism is on its last legs.
These ISSUES are unrelated. the kind of people who care about one might be more inclined to believe in another cause, but that does not mean the issues should be bundled, because analytically all that does is muddy the waters and give me agita.
#2 by Yi-An on November 23, 2009 - 3:28 am
Love the post – hilarious. To be fair to Kevin Bacon, he does look pretty skeptical of your proposal (I’m assuming of course that you’re the guy on the right, you’ve aged tremendously, and you’ve grown a beard).
I’d love to see greater thinking on your question – how do things change? I guess this is the work that aidinfo and IATI and others are doing, but it feels like there’s so much ranting about what’s wrong and so little talk about progress in fixing it – despite my vague sense that there are lots of efforts in the works. Give me something to hope for and to engage on!