The foreign aid scenario under a technical fix approach
Endnote
Tropical Doctor, Vol.30, Oct. 2000.
CLAUDIO SCHUFTAN
schuftan@gmail.com
Technology is inextricably linked to the society in which it is created and used, and will be as socially just or unjust as its milieu. (D. Hammarskjold Seminar Declaration, 1988)
The search for (a) technical silver bullet(s) to solve the problems of ill-health and malnutrition associated with underdevelopment is particularly suited to the development philosophy of many a donor country and this has clearly influenced the still largely predominant Northern-led development model. As a result, the model has ended up paying more attention to the immediate and underlying causes of ill-health, malnutrition and underdevelopment, allowing no room for directing attention to its major basic, structural causes.
From this approach one gets the feeling that if all one needs is to throw more money at the problems, so much the better…
Under such an optic, there prevails the wrong assumption that the underlying causes of ill-health and malnutrition and other social phenomena are largely personal -not structural and institutional. (All the rotten apples should be thrown away, but save the barrel…! And so the barrel remains forever waiting for somebody to toss it into the sea in a bigger ‘Boston Tea Party’). (Zinn)
Such an approach pushes Northern donors, among other, to believe that reliable information using personal data (epidemiological and other) is the key to effective planning and action, regardless of the structural constraints in each local context. Obviously, all results depend on the type of information used, and more importantly, who controls if, how and for what it is used. (Keep in mind that statistics is a good servant, but can be a bad master, and mind that in its infancy statistics was called ‘political arithmeticks’). (Jellife)
Application of quantitative techniques in the health and nutrition business in particular and in the development business in general can lead to an oversimplification of reality and to totally ahistoric analyses, because the coding of information for scientific purposes involves reducing individuality to a few basic characteristics. Therefore, beware! This reductionism of reality can (and does) lead to biased and/or irrational conclusions. (Gianotten and de Wit, 1983)
Using personal data out of their macro context leads the exponents of the ‘efficiency-above-all school’ of development practitioners to very seldom show distributional concerns of the actions they propose and help implement. They complain that political considerations always prevent them from getting as good an investment portfolio as technically feasible. (Ray, 1989) But the reality is that that is the way the real world ticks: ‘political considerations’ are there to stay. Ignoring this, leads us to the kinds of disasters in health/nutrition/development schemes that we have grown too accustomed to accept with remarkably little criticism (Health for all?, Nutrition goals? Agenda 21?)
The 1990s have been characterized by high ‘techno-expectations’; technology is deemed capable of acting as a powerful medium to achieve personal wealth and (!) political change. This assumes that technology rather than politics can become the medium for how society expresses and pursues its values and priorities. (Schrage, 1990)
But unfortunately, as Asiaweek once editorialized, social movements do not spread like technology, in great measure due to the fact that -as opposed to technical innovation- the position of the poor and the underdeveloped rarely impinges on the social consciousness of the rich people who control and have an interest in the spread of technology (health technologies included).
The foreign aid scenario under a technical fix approach
It is my contention that -with the tacit endorsement and help of the aid establishment that pushes technical fixes- recipient governments manage to ‘release ballast’ to meet day to day political pressures for change; by going for those fixes they indirectly ensure their survival. This, at the expense of making serious, long-lasting attempts to eradicate the widespread poverty and people’s disempowerment that are at the base of the people’s ill-health and malnutrition. More comprehensive redistributive plans linger and suffer from chronic lack of government support; inevitable needed reforms are constantly delayed and endless new patch-solutions are tried. But, as long as the government has ‘something’ to show for, it can keep its detractors at bay. (Shepperdson) Willingly or not, donors become instrumental in this process.
As opposed to what many donor agencies want us to believe, together with others I contend that improvements in health in the last 30 years have -for now- largely exhausted the potential for technological breakthroughs to achieve further dramatic health and nutrition improvements in developing countries. (Testa, 1989) I further contend that arguments to the contrary, such as rekindling our hope and faith in interventions packaged in slogans (e.g. The Child Survival Revolution, Adjustment with a Human Face, focus on the Social Dimension of Structural Adjustment), do not fit the evidence.
To me, the proponents of such arguments fall in the same category than those who reduce the development process to the injection of more capital only.
The transferring of aid funds to further technical fixes (including those for health and nutrition) is linked to what some have called the transfer of ‘cold money’, i.e. loans/grants from agency to agency (mostly government), as opposed to the transfer of ‘warm money’, i.e. from people to people, with a human and more equity-oriented touch. The latter modality is more prevalent (but not universal!) in the NGO community that less frequently falls prey to the technical fix creed.
The Northern aid-cum-development apparatus that offers health, nutrition and other development aid conditioned upon cooperation of the dominant elites in the South is -not as a coincidence- designed to foreclose more radical options while maintaining a facade of pluralism. To put it boldly, these days the ideology of Northern-led development and its aid apparatus is to a great extent driven by the interests of globalization in our current unipolar world and is designed, at least in the case of bilateral aid, to expand shares in the global market economy. Such Northern-led development paradigm tends to restructure the world order towards a globalized and centralized capitalist mode of production and certainly does not treat the Third World as an equal partner thus ultimately undermining its own stated principles and the people it purports to help. If you think that health and nutrition aid is different, I invite you to reflect again…
The technical fix approach in foreign aid is part and parcel of the above paradigm, and the extent to which a paradigm pervades our minds is a tribute to the efficiency of its propagation -often beyond common sense. Each compartment of universal knowledge has a ruling paradigm. In the ruling paradigm of Northern-led development, I contend that the real issues are not addressed regarding the pros and cons of the long list of approaches tried so far, i.e. neoliberalism, monetarism, supply-side economics, market economics, health for all, GOBI and all the endless series of etiquettes that keep people who make a living off this discourse busy. We have tried them all and our fundamental problems keep recurring. The present dominant paradigm never gets to the heart of the matter and that is why all these strategies, systems, ‘isms’ and etiquettes have failed. Under the influence of the Northern-led development paradigm, the South lost its own creative self-assurance, began to think the North knew better and embarked on changing its ways of life accordingly. In a sort of ‘Westernizing Avalanche’ the global reach of this Northern paradigm has overshadowed/overruled/belittled/relegated ideology, political empowerment and local grassroots politics in the development process to a secondary level. (Bracho, 1990)
And that is the heart of the matter.
Endnote:
Talking about a clear-cut process of replacement of the Northern-led development paradigm with its frequent technical fix focus is premature at this time. But in development work nothing is black or white (so what I characterized above may be but a fading caricature). In many places, buried in the shades of grey, there are people fighting against the gate keepers of the old paradigm who are, so far, succeeding in keeping the gates shut perhaps with an occasional leak.
Therefore, quite a bit remains to be done before a new equity-oriented, sustainable development paradigm puts the eradication of poverty upfront in the battle against ill-health and malnutrition. We need to put poverty eradication at a higher level of priority than fostering silver bullet technical breakthroughs and giving priority to unfettered, non-distributional economic growth.
Networking of the like-minded is an imperative to overcome maldevelopment, to preempt the negative effects of globalization and to contribute to the launching of a more equitable development paradigm.
Claudio Schuftan
Saigon, Vietnam.