Year 25+

I did a thought experiment the other day, imagining I had 100 million dollars to spend on development in Zambia. While there has been much recent criticism of aid from the West to developing countries (some of it well taken- see William Easterly's 'White Man's Burden') there is good data that certain forms of aid do work. Health projects (where outcomes- like deaths and disease rates- are relatively easy to measure) are one area with good data. So as part of my experiment, I tried to conceive of ways to give 100 million dollars directly to health care in Zambia. It's not easy to donate well. For example, giving directly to the Zambian government runs into problems with fungibility, where 100 million dollars donated to health might mean the government spends 100 million dollars less on health, with no net gain. Donating to local community projects has its own problems. The Bamako Initiative, which is a community managed health program piloted in Benin, Guinea and Mali, had success in those countries, allowing local communities to use donations to purchase drugs directly, and empowered to hire their own staff for health clinics. But the success of this type of program hasn't translated to countries like Zambia, where human resource limitations mean no real choice for communities. This lack of 'soft' infrastructure is a major hurdle to donating well in the health sector.