This is in response to David Cameron's June 3 article in the Guardian “Our aid will hit the spot”.
Dear Prime Minister,
I welcome your focus on greater transparency and accountability for overseas aid Most aid resources are spent in countries that do not receive much attention from the UK media or the UK public and so this commitment to be on the front foot is much needed. Helping communities report on whether the aid reached them is a good way of helping mend the broken feedback loop in international development. Asking these communities if the aid was working would be even better.
But my worry about your approach is that it will slant aid towards items for which it is easy to demonstrate delivery. In others words “the things that aid can best deliver and that can make a real long term difference” may not be things that are easily assessed.
Take the example of declines in UK maternal mortality that you cite. Research shows that those declines were attributable to the quality of care from midwives for home birth deliveries. Where deliveries were by physicians in hospitals, often using chloroform and forceps in otherwise uncomplicated births, maternal mortality was much higher. So high maternal mortality was less about knowledge per se but about whose knowledge counted, and that is about power structures within the health system. In the UK these vested interests had to be challenged by the creation of a powerful midwifery service that you mention. It will be troublesome to evaluate UK aid investments designed to, for example, rebalance power structures in health systems in the currency of “lives saved or improved” and may inadvertently direct resources to lower hanging fruit.
Hard headed about aid, yes, but not if it avoids the hard challenges. The biggest spots that aid needs to hit may be the hardest to target.