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Could an anti-malaria campaign be the salvation of the aid world?
By Alex Perry
Does aid work? After half a century of giving billions of dollars to Africa and Asia, donors are finding the answer is often no.
The reasons are well known: ignorance, inefficiency, corruption and the creation of dependence and disincentives to business. There is also rising unease about the way modern aid feels unnervingly like a giant business.
Global aid is worth about $120 billion a year, according to the Organisation for Economic Cooperation and Development, about the same as the annual output of the 20 poorest countries in Africa.
There are striking similarities too between how aid and business work. Originally intended to be small, temporary and specialised, aid agencies today tend to the global and permanent, and their core proposition is not focused assistance but a branded, indiscriminate offer of help. In one country they might be digging wells, in another running a school, in a third distributing medicine, in a fourth advising on microfinance.
Aid workers, like their corporate counterparts, plot long careers stretching from African villages to U.N. agency offices in New York or Geneva that are very generously rewarded. Add up the salary, car, rent and annual expenses for, say, a mid-ranking U.N. manager in Sudan or eastern Congo and you’ll come up with about half a million dollars, or about the same as the U.S. president.
I began following a global campaign to wipe out malaria because I realised it offered the aid world reinvention, perhaps even salvation.
It did that not by shying away from aid’s similarities to business but embracing the idea that aid was as much about economics as it was about health and charity. The campaign had its intellectual foundation in studies done in the 1990s by the World Bank and development economist Jeff Sachs.
Fixing disease wasn’t just about saving lives, the World Bank reported in a ground-breaking report in 1993. It was about saving money too. Afflictions like malaria, tuberculosis and HIV/AIDS had a huge cost in terms of money spent on medicine and treatment, and in days off sick from work and school.
Sachs calculated malaria’s annual total economic loss to Africa at $12 billion. Malaria and diseases like it were keeping Africa poor and aid-dependent. By the same logic, fixing malaria – something Sachs estimated would be a relative bargain at $3 billion a year – would not only save lives but boost livelihoods too and finally move Africa off aid and onto a path to prosperity.
If Sachs supplied the theory, it was Ray Chambers’ job to prove it.
The U.N. Special Envoy for Malaria is a former titan of Wall Street – a pioneer of the leveraged buyout – who made his fortune only to discover in the mid-1980s that money didn’t make him happy. Giving it away delighted him, however, and for the last three decades Chambers has been a pioneer of a different kind, helping inaugurate what grew into a new age of philanthropy featuring mega-donors like Bill Gates and Warren Buffett.
Chambers approaches charity like a business, breaking it down into supply chains, investment decisions, marketing and so on. Fighting malaria appealed to him because of its clear commercial logic. This was as much about “economic cost” as “humanitarian cost,” he said. “Malaria costs Africa $30–$40 billion each year,” he said. “Fixing it is in everyone’s interest.”
Lifeblood: How to Change the World One Dead Mosquito at a Time tells the story of how, over two years, Chambers attempted to do that.
Some of his results were breathtaking. Chambers oversaw the handing out of 365 million bed nets, enough to cover everyone who needed one in the seven most malarious countries on earth (which together accounted for 85-90 percent of the then annual 1 million malaria deaths in the world).
By the end of 2010, malaria incidence was down by two-thirds in Zambia, by 60 percent in Rwanda, by half in Ethiopia and by close to 100 percent on the Tanzanian island of Zanzibar. Though it will be years before the precise figure is known, malarialogists reckon that by 2015, the malaria campaign will have saved 2.5 million lives.
Chambers’s story has lessons not just for the aid world, but for all of us. Like an infinite army of tiny vampires, mosquitoes were sucking the life out of Africa. In days lost to fever and money wasted on medicine that otherwise might have bought a mobile phone or seeds or an education, mosquitoes were taking a giant financial bite out of Africa too, making it dependent on Western charity.
It wasn’t so much that inequality was unjustifiable, though extreme disparity clearly was. It was that inequality was unintelligent. Poverty didn’t just hurt the poor. It hurt everyone. A prosperous, healthy Africa would cost the West less in assistance and benefit the world more as a trading partner. And what seems like a story about blood-borne disease and Africans is actually much more: a tale about Africa’s lifeblood.
Alex Perry is TIME magazine’s Africa bureau chief. His book “Lifeblood: How to Change the World, One Dead Mosquito at a Time” is published by Public Affairs (US), Hurst (UK) and Picador Africa this month.
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